AETCOM in Surgery

AETCOM in Surgical Practice: A Complete Guide for MBBS Students & Faculty

What is AETCOM & why does it matters in Surgery?

AETCOM (Attitude, Ethics, and Communication) represents a crucial paradigm shift in medical education under the Competency-Based Medical Education (CBME) curriculum. Unlike older training models focused primarily on clinical knowledge, AETCOM emphasizes the human element of medicine, focusing on effective patient interaction, ethical decision-making, and communication in healthcare settings.

For MBBS students and faculty in medical colleges, AETCOM is not merely an academic requirement; it is a vital, life-saving competency, particularly in surgical practice. A surgeon proficient in AETCOM can reduce patient anxiety, ensure proper informed consent, and build the trust necessary to improve surgical outcomes.

Why AETCOM is Crucial in  Healthcare Context

Various large nations have unique socio-economic landscape presents specific challenges that make AETCOM mastery essential:

  • Language barriers exist across many regional languages and hundreds of dialects.
  • Cultural sensitivities surround gender, religion, and traditional beliefs.
  • Decision-making is often family-centered rather than focused solely on individual patient autonomy.
  • Economic disparities heavily influence treatment decisions.
  • Limited resources require careful ethical resource allocation.

 

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The Three Pillars of AETCOM: Attitude, Ethics, and Communication

Mastery of AETCOM requires developing skills across these three core pillars, specifically tailored for the surgical environment:

  1. ATTITUDE (Empathy & Professionalism)

Attitude involves developing cultural sensitivity for diverse population and treating every patient with dignity, regardless of their socio-economic status.

Practical Tips for Students:

  • During ward rounds: Always introduce yourself, make eye contact, and ask permission before examining a patient.
  • In OPD: Show genuine interest in the patient’s full story, not just the medical diagnosis.
  • Cultural awareness: Understand local customs, such as respecting dietary restrictions or removing shoes before entering certain patients’ rooms.

Role Modeling for Faculty: Faculty must demonstrate respectful patient interaction during bedside teaching and include psychosocial aspects, not just medical facts, in case discussions.

  1. ETHICS (Moral Decision-Making)

Surgical practice relies on core principles like Autonomy (respecting the patient’s right to decide), Beneficence (acting in the patient’s best interest), Non-maleficence (“Do no harm”), and Justice (fair allocation of resources and care).

Common Ethical Dilemmas in resource limited nations:

  • Resource limitations, such as determining who receives the only available ICU bed.
  • Family members disagreeing with the patient’s decision.
  • Cultural conflicts, where religious beliefs clash with medical recommendations.
  • Gender issues, such as a male surgeon treating female patients in conservative settings.

Students can utilize the INDIAN Approach as a framework for ethical decision-making: 

Identify the ethical issue
Navigate cultural sensitivities
Discuss with seniors/ethics committee
Involve patient and family appropriately
Act with transparency and documentation
Nurture ongoing communication

  1. COMMUNICATION (Effective Patient Interaction)

Surgical communication is unique due to high-stakes decisions, technical complexity requiring simple explanations, and the emotional intensity involved, often compounded by time constraints in emergencies.

Practical AETCOM Implementation Strategies

For MBBS Students: Daily Practice

  1. Morning Ward Rounds: Shift from the traditional approach (doctors discussing cases while the patient lies silently) to the AETCOM approach by including the patient in the discussion.
  • Greet the patient in the local language (e.g., “Namaste/Good Morning”).
  • Explain your role: “I am Dr.(your name), intern in Surgery Department”.
  • Ask permission before examination: “Can I examine you?”.
  1. Pre-operative Communication Checklist (The CONSENT Process): This structured approach helps ensure clear, ethical communication, especially when obtaining informed consent:
  • C – Connect culturally and linguistically: Use appropriate greetings and ask: “What do you understand about your condition?”.
  • N – Navigate the procedure explanation: Use simple, local language terms (e.g., “Operation” instead of “surgical procedure”).
  • S – Share risks and benefits honestly: Include understandable terms for common complications and discuss cost implications upfront.
  • E – Engage in shared decision-making: Respect family consultation time and document which family members are present.
  • T – Time for questions: Encourage questions in any language they are comfortable with
 
    1. Breaking News About Complications: When communicating difficult post-operative news, use the SPICES Model :
    • S – Setting: Ensure a private, comfortable space with family present.
    • P – Perception: Ask, “What do you think about how the surgery went?”.
    • I – Information: Give news in stages and check understanding.
    • C – Cultural Sensitivity: Acknowledge family dynamics and decision-making processes.
    • E – Empathy: State, ” I can understand how difficult this must be”.

    S – Support: Explain the immediate next steps and available resources

  • Integration and Assessment for Faculty

    Faculty are crucial in modeling AETCOM behavior and integrating it into training.

    Integrating AETCOM into Teaching

    • Morning Briefing: Start each day with an AETCOM focus point.
    • Case Presentations: Include AETCOM aspects alongside traditional medical facts (e.g., noting that a 45-year-old laborer with a hernia faces economic constraints).

    Assessment Tools

    AETCOM competencies must be formally assessed using integrated methods.

    1. DOPS (Direct Observation of Procedural Skills) with AETCOM: Assessment weightage should include:
      • Technical skill: 60% weightage
      • Communication: 20% weightage
      • Professionalism: 20% weightage Faculty should specifically check if the student introduced themselves, obtained consent in understandable language, and respected cultural sensitivities.
    2. AETCOM-Integrated OSCE Stations: These stations assess criteria such as language appropriateness (25%), completeness of information (25%), cultural sensitivity (25%), and patient engagement (25%).

    Leveraging Technology

    Digital tools can support AETCOM implementation:

    • WhatsApp-Based Learning: Faculty can share daily AETCOM tips, and students can engage in peer learning.
    • Mobile Apps: Utilize tools like Google Translate for multilingual interactions or ethics consultation apps for quick access to ethical guidelines.

Navigating Complex AETCOM Scenarios

Students and faculty frequently encounter real-world ethical challenges in surgical practice.

Scenario Example

AETCOM Approach Required

Practical Solution

The Economic Dilemma: A patient needs elective surgery but cannot afford it.

Attitude: Show empathy without judgment. Ethics: Advocate for timely care within resource limits. Communication: Clearly explain options and risks.

Connect with a hospital social worker and explore government schemes like Ayushman Bharat.

Cultural Sensitivity Challenge: Family prefers a male surgeon’s expertise over a female surgeon’s availability for gynecological surgery on an unmarried female.

Attitude: Respect cultural concerns while prioritizing medical needs. Ethics: Balance sensitivity with medical best practices.

Facilitate family discussion, potentially involving appropriate cultural mediators.

Breaking Bad News: Post-operative biopsy reveals malignancy, but the family requested, “don’t tell the patient”.

Ethics & Communication: Focus on shared decision-making, involving the oncology team and counselors, and ensuring continuous emotional and medical support.

Use the SPICES Model for staged information delivery (see above).

Conclusion: AETCOM as the Foundation of Surgical Excellence

Integrating AETCOM competencies is not an added burden; it is the foundation of excellent surgical care. In India’s complex environment, surgeons who master AETCOM build trust, reduce complications through improved patient compliance, and create healing relationships that extend beyond the operating room.

The journey to AETCOM mastery requires continuous reflection and practice. Remember, every patient interaction is an AETCOM learning opportunity. To start, faculty and students should focus on learning basic phrases in their hospital’s local languages and observing experienced colleagues who model excellent patient communication. Small steps, like spending an extra minute explaining a procedure, lead to transformative practice.