king abdulaziz university faculty of medicine department ... 44. educational development unit nhs...

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King Abdulaziz University

Faculty of Medicine

Department of Family & Community Medicine

CURRICULUM DEVELOPMENT REPORT

Family Medicine Course

2010/2011

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CONTENT OF THE REPORT

1- Process of Development of Family

Medicine Curriculum

2- Students' Study Guide

3- Family Medicine Clerkship Log Book

4- Preceptor Guide

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CCoommmmiitttteeee MMeemmbbeerrss

1. Dr. Ekram Jalali (Co-coordinator, Editor-in-Chief )

2. Dr. Rahila Iftikhar (Assistant to the Editor )

3. Dr. Jawaher Alahmadi

4. Dr. Ali. Fageeh

5. Dr. Mahdi Qadi

6. Dr. Jameel Bashawari

7. Dr. Hashim Fida

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Process of Development of the Curriculum

Step 1: Problem Identification and General Needs Assessment

Step 2: Needs Assessment of Targeted Learners

Step 3: Goals and Objectives

Step 4: Educational Strategies

Step 5: Implementation

Step 6: Evaluation, and Feedback

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The following steps were followed in the development of the curriculum.

STEP 1: PROBLEM IDENTIFICATION

Problem Identification

General Needs Assessment

Current Approach

SWOT analysis

Ideal Approach

International standers

The initial step was the literature review of the current international and national curricula at

undergraduate family medicine clerkship. The literature review was done regarding the major changes in

the teaching and assessment strategies. Then the SWOT analysis was conducted in which the committee

discussed the new opportunities of improvement in the curriculum that meets the international and

national undergraduate requirements.

STEP 2: NEEDS ASSESSMENT OF TARGETED LEARNERS

What?

Why?

Who?

Content?

How?

STEP 2: NEEDS ASSESSMENT: METHODS

Informed discussions

Formal interviews

Focus group discussions

Questionnaires

Direct observation Test

Audit of current performance

Informed discussion was done between the faculty staff for the designing of objectives of the

curriculum. Detailed discussions were done regarding the core topics, mode of instruction and

assessment method.

Formal interview

PRECEPTORS

A meeting was arranged with the preceptor in which curriculum and preceptor guide were

discussed. Their input, suggestions were taken noted. Mutual understanding was made to work as

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partners in teaching and assessment of the students. The points that were discussed in the preceptor

meeting are attached in the appendix.

STUDENTS

Similarly meetings will be arranged with male and female students and their goals and expectations

will be discussed and their feedback will be taken into consideration.

FOCUS GROUP

Faculty staff members worked on the different domains of the curriculum, mainly objective writing,

core topics, assessment, log book and preparation of preceptor guide.

STEP 3: WRITING GOALS AND OBJECTIVES

CURRICULAR GOAL

Is A broad educational outcome

Defined as an end toward which an effort is directed

Provides a global perspective of what students will learn in the curriculum

Communicates the overall purpose of a curriculum

Expressed in non-behavioral terms

CURRICULAR OBJECTIVE

Is used when a specific measurable objective is being discussed

Description of behavior expected after instruction

Tips to writing objectives

( SMART)

1. S=Specific

2. M=Measurable

3. A= Attainable

4. R= Relevant

5. T= Timely

Bloom, Benjamin Taxonomy of Educational Objectives was utilized for writing the objectives.

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Step 4: EDUCATIONAL STRATEGIES

ADVANTAGES TYPE OF

OBJECTIVE

INSTRUCTIONAL

METHOD

Active learning;

Resources

usually available;

Allows

multidiscipline

approach

Cognitive:

problem solving

Group Learning

Low cost; large

number of

learners; structured

presentations

Cognitive:

knowledge

Lectures

Active learning, assess

learner; apply new

knowledge

Affective

Discussion

Active learning;

facilitate

higher cognitive

objectives

Cognitive:

problem solving

PBL

Suitable for crossing

domains (Knowledge,

Skill Attitudes);

efficient;

Psychomotor:

Skills

Role Play

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Step 5: Implementation

Implementation will begin from the next academic year.

Step 6: Evaluation, and Feedback

Feedback from students is a critical tool for improving clinical learning experiences. The evaluation of

the curriculum will be done through students feedback and their change in the objectively evaluated by

comparing students performance with the previous curriculum.

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Major Accomplished Improvement

1. Self study times every Sunday afternoon (1-4 pm). The students will be given specific learning

task. Further he/she will be enquired about the whether the task was completed during that time.

2. Early clinical exposure, starting of third day of rotation

3. Visits to complementary medicine clinic

4. Visits to geriatric setting/nursing home.

5. Total 13 PHC visits each visit 4 hour. If student have 3 clinical encounters per visit he /she 39 per

rotation ( and if 2 then 26 patient per rotation )

6. Total 36 sessions covering 35 topics

7. Number of hours for teaching fundamentals 35 hours

8. Student presentations will cover 16 hours

9. For reinforcement and practical application some topic will be taught in 2 sessions for example,

Evidence based discussion will be given in first week then students will be given assignment

which will be reviewed in week 3.Similarly one tutorial will given about MCH at PHC level and

then student will prepare presentation in week 3 about antenatal care and well child care

10. Other topics will also be done in similar ways to enhance student participation

11. Mid-rotation Exam

12. Mid-rotation feedback about the curriculum.

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References

1. Texas School Of Medicine Office Of Curriculum , Integrating Our Curriculum:

The ABC’s of Writing Learning Objectives Lynn Bickley, MD, 2006

2. Primary Care Medicine: Office Evaluation and Management of the Adult Patient (Primary Care

Medicine ( Goroll ) sixth edition 2009

3. Textbook of Family Medicine Robert E. Rakel MD seventh edition 2007

4. Current Diagnosis & Treatment in Family Medicine Second Edition (LANGE CURRENT Series)

5. Essentials of Family Medicine by Philip D Sloane fifth edition 2008

6. The College of Family Physicians of Canada National Undergraduate Family Medicine and

learning goals and objectives Ian Scott, Cathy MacLean, Risa Freeman (December 2005)

7. Effect of problem –based undergraduate education on lifelong learning

8. Teams without walls RCGP Report and Recommendations

9. Recommendations regarding procedures in Clinical skill

Family Medicine Clerkship Curriculum: Competencies and Resources

Ann O’Brien-Gonzales, PhD; Alexander W. Chessman, MD; Kent J. Sheets, PhD.

(FAM Med 2007; 39(1):43-6.)

10. Family Medicine Curriculum Resource Project (FMCRP) developed a set of resources

To improve medical student education Curriculum Themes Organized by ACGME Competency

Areas (Example: Systems-based Practice).Funded by the Health Resources and Services

Administration (HRSA) from 2000–2005

11. Primary importance: new physician and the future of family medicine

Professional Association of interns and residents of Ontario position paper on the

Sustainability of family Medicine June 2004

12. Wong TY, Cheong SK, Koh GCh, Goh LG. Translating the family medicine vision into

educational programmes in Singapore. Ann Acad Med Singapore. 2008 May;37(5):421-5

13. Undergraduate education in family medicine A/prof. Goh Lee Gan The Singapore

Family physician Jul 2001

14. Experience with portfolio-based learning in family medicine for master of medicine degree.

Lim JL, Chan NF, Cheong PY.Singapore Med J. 1998 Dec;39(12):543-6.

15. Primary health care cycle curriculum for undergraduates’ students COMM421

Department of family and Community Medicine

College of Medicine King Saud University 1429/1430 (2008/2009)

http://www.ncbi.nlm.nih.gov/pubmed/18536831



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16. Teaching and learning primary care by Richard hays

17. Australian general practice network. Australian general practice :submission to higher Education

Review August 2008

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Granek Catarivas M. Isr Med Assoc J. 2001 Dec;3(12):969-72. Review.

21. The challenges of teaching in a general practice setting.Pearce R, Laurence CO, Black LE, Stocks

N. Med J Aust. 2007 Jul 16; 187(2):129-32.

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23. BMC Med Educ. 2005 Aug 22;5:31.Discipline of General Practice The university of Adelaide SA

5005 Australia accessed Feb. 2009

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Weyden MB.Med J Aust. 2007 Jul 16; 187(2):66-7.

26. Soler JK, Carelli F, Lionis C, Yaman H. The wind of change: after the European definition--orienting

undergraduate medical education towards general practice/family medicine. Eur J Gen Pract. 2007;

13(4):248-51.

27. Ross MT, Stenfors-Hayes T. Development of a framework of medical undergraduate

Teaching activities. Med Educ. 2008 Sep; 42(9):915-22.

28. Jones R, Oswald N. A continuous curriculum for general practice? Proposals for

Undergraduate-postgraduate collaboration. Br J Gen Pract. 2001 Feb; 51(463):135-7

29. Bell HS, Kozakowski SM, Winter RO. Competency-based education in family practice. Fam Med.

1997 Nov-Dec; 29(10):701-4. Review.

30. King RV, Murphy-Cullen CL, Krepcho M, Bell HS, Frey RD. Tying it all together? A

competency-based linkage model for family medicine. Fam Med. 2003 Oct;35(9):632-6

31. Davis AK, Stearns JA, Chessman AW, Paulman PM, Steele DJ, Sherwood RA. Family medicine

curriculum resource project: overview. Fam Med. 2007 Jan; 39 (1):24-30.










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32. Stearns JA, Stearns MA, Paulman PM, Chessman AW, Davis AK, Sherwood RA, SheetsKJ,Steele

DJ, Matson CC. Family Medicine Curriculum Resource Project: the future. Fam Med2007

Jan;39(1):53-6

33. Chumley H. The family medicine clerkship core content curriculum. Ann Fam Med.2009 May-

Jun; 7(3):281-2.

34. Nevin J, Paulman PM, Stearns JA. A proposal to address the curriculum for the M-4 medical

student. Fam Med. 2007 Jan;39(1):47-9

35. McWhinney IR.A Textbook of Family Medicine. Oxford, UK:Oxford University press,2009

36. Martens FM, van der Vleuten CP, Grol RP, op 't Root JM, Crebolder HF, Rethans JJ. Educational

objectives and requirements of an undergraduate clerkship in general practice. The outcome of a

consensus procedure. Fam Pract. 1997Apr; 14(2):153-9.

37. Ross MT, Stenfors-Hayes T. Development of a framework of medical undergraduate teaching

activities. Med Educ. 2008 Sep; 42(9):915-22.

38. Chan WP, Hsu CY, Hong CY. Innovative "Case-Based Integrated Teaching" in an undergraduate

medical curriculum: development and teachers' and students' responses. Ann Acad Med

Singapore. 2008 Nov; 37(11):952-6.

39. Stafford F. The significance of de-rolling and debriefing in training medical students using

simulation to train medical students. Med Educ. 2005Nov;39(11):1083-5.

40. Roberts LM, Wiskin C, Roalfe A. Effects of exposure to mental illness in role-play on

undergraduate student attitudes. Fam Med. 2008 Jul-Aug;40(7):477-83.

41. Kelly L, Rourke J. Research electives in rural health care. Can Fam Physician.2002 Sep; 48:1476-

80.

42. Burke MJ, Brodkey AC. Trends in undergraduate medical education: clinical clerkship learning

objectives. Acad Psychiatry. 2006 Mar-Apr; 30(2):158-65.

43. Burke MJ, Bonaminio G, Walling A. Implementing a systematic course/clerkship peer review

process. Acad Med. 2002 Sep; 77(9):930-1. Review.

44. Educational Development Unit NHS Education for Scotland V. Harden The Objective Structured

Clinical Examination (OSCE) Review Project Annotated Bibliography And Structured Contents

Analysis 01/2/02 – 31/5/02

45. Gboyega A Ogunbanjo, Improving the reliability of standardized patient OSCE stations used

during the Family Medicine MBChB6 end-of-block exams at the University of Limpopo

(Medunsa Campus), Pretoria Fam. Med.

46. Chumley HS What does an OSCE checklist measure? Fam Med. 2008 Sep;40(8):589-91


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King Abdulaziz University

Faculty of Medicine

Department of Family & Community

Medicine

Course SPEX

Family Medicine Course 2010/2011

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Index

Welcome & Introduction

2

Learning objectives 3

Description & evaluation of the course

4

Methods of instruction

5

Core topics

6-26

Objective and contents of each topic

27-40

Primary health care center

41-47

Student self learning time (SSLT)

61

Appendix A (principles of family medicine)

Appendix B (knowledge about common

clinical problems)

Appendix C (Red Flags regarding common

problems)

Appendix D ( list of the procedures )

Appendix E (screening recommendations)

Appendix F ( evidence based medicine)

Appendix G Timetable

62

63

64

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Family Medicine Study Guide for the Fifth Year Medical Students

Welcome to the department of family medicine clerkship.

Introduction

The study guide of Family Medicine Clerkship has been developed to assist you in gaining

the most benefit from ambulatory patient encounter. Description of the course, its contents

and the sequences of implementation of different activities, learning objectives of the

course are given. In addition; it includes instructional, and assessment methods.

The clerkship provides hands-on experience combined with in-depth discussion and

interaction with patients under supervision of faculty and preceptors who will help student

to develop basic clinical competencies in the context of encounters with patients.

The goal of family medicine clerkship is to teach fundamental knowledge and to assist you

to develop skills and behaviors necessary to care for people across the spectrum from

healthy to ill patients in ambulatory settings, regardless of their gender, age, and organ

system involved.

In the context of caring for patients, you will learn a logical approach to diagnosis of

symptoms and signs, basic therapeutic approaches to common problems ranging from

emergent to chronic diseases. Understand the role of the family physician in coordination

of patient's care.

Description of the course

The course includes:

Fundamentals of family medicine topics e.g., concepts and principles of

family medicine, preventive care, home care.

Introduction to complementary medicine and geriatric care, common clinical

problems encountered in family practice are also included.

Practical sessions to develop consultation, communication, interviewing, and

management plans skills are basic component of the clerkship.

The objectives of this rotation have been developed as a result of reviewing patient

problems seen most frequently in family practice. They also address medical issues which

are of significant concern to society and family practice.

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ROTATION LEARNNING OBJECTIVES:

A) Principles of Family Medicine and Primary Health Care Learning Objectives

At the end of the rotation, the student will be able to:

1. Describe and apply the principles of family medicine

2. Describe and apply the principles of primary health care

3. Discuss the features unique to the specialty of family medicine

4. Describe the competencies and attributes specific to family physicians

B) Communication Skills learning objectives

at the end of the rotation, the student will be able to:

1. Apply Pendleton's Seven Tasks Model Of Consultation

2. Apply communication skills techniques based on patient’s age, and level of education

3. Write chart notes using subjective, objective, assessment, plan format

4. Write clear and accurate orders for

a. Investigations

b. Prescriptions

c. Referral letter

C) Clinical Skills Learning Objectives


1. Demonstrate knowledge of clinical problems commonly seen in family medicine and their

management ( Appendix A)

2. Demonstrate an ability to assess and manage patients seen within the family medicine setting,

including:

Taking problem oriented history

Perform a focused problem oriented physical exam

Develop an appropriate differential diagnosis

Order investigations in a focused problem oriented manner

Develop and implement an appropriate management plan

3. Recognize “red flags” which might indicate serious medical condition (Appendix B)

4. Demonstrate and explain the indications for procedures commonly performed in family medicine

(Appendix C)

5. Demonstrate and apply knowledge of age and gender specific periodic health examination as

presented in the Guide of the US Preventive Services Task Force. (Appendix D)

6. Develop skills in health promotion, disease prevention, and health education and apply them in

patient care.

7. Apply the patient -centered approach to patient encounters including:

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Identifying the patient’s ideas and concerns regarding his/her illness, the effect

of the disease on patient's functioning and patient's expectations regarding

treatment

Determining the psychosocial context of the patient’s disease

Involve patient in the development of a treatment plan

Demonstrate an understanding of the patient’s life cycle in the context of their

illness

8. Explain and apply basic elements of child preventive services in well baby clinic (WBC) in the

PHC centre

9. Explain and apply elements of antenatal care in the PHC centre

10. Perform geriatric assessment (history and physical examination), including mobility and gait and

balance assessments, mini-mental status examination

11. Describe the main types of complementary and alternative medicine

12. Explain uses of complementary and alternative medicine, and how it can be integrated in

family practice

13. Describe the concepts of evidence based medicine (Appendix E)

D) Community Resource learning objectives


1. Discuss the role the family physician plays in his/her community

2. Demonstrate a basic knowledge of relevant social issues which may impact on a

Patient's health in the community

3. Demonstrate a basic knowledge of health care resources in the community

6. Understand the limitations of health care resources available to the community

E) Professionalism Learning Objectives


1. Demonstrate professional and ethical behavior with the patient, relatives , peers,

And preceptors at all times

2. Demonstrate respect for the confidentiality of patients and their families

3. Recognize his/her limitations and ask for assistance when appropriate

4. Respond to feedback in a constructive and professional manner

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TOPICS

Fundamentals of Family Medicine Topics:

SESSION TITLE

INSTRUCTOR HOURS

1. Concepts and principle of family medicine

2. Concepts and principle of primary health care

3. Consultation and interviewing skills and dealing with

challenging patient encounter ( angry, demanding

patient)

4. Anticipatory care

5. Periodic health exam

6. Learning in family medicine

7. Management in family practice

8. Prescribing in family practice

9. MCH in primary care

10. Counseling (advising, educating and helping patient and

relatives)

11. Introduction to Critical appraisal of medical literature

and EBM

12. Introduction to complementary medicine and concept of

Integrative care

13. Problem oriented medical record

14. The Family In Health And Disease

15. Home Care

16. Telephonic Consultation

17. Interpretation of lab test

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Clinical Topics:

SESSION TITLE INSTRUCTORS HOURS 1. Geriatric care (care of elderly) 2. Evaluation of patient with Type II Diabetes Mellitus 3. Evaluation of patient with Hypertension 4. Evaluation of patient with Dyslipidemia 5. Evaluation of patient with Obesity 6. Evaluation of patient with Asthma 7. Evaluation of patient with Upper respiratory

infections

8. Common skin lessons 9. Evaluation of patient with Back pain 10. Joint pain / Arthritis 11. Anxiety & Depression ( Common Psychiatric

Encounters)

12. Evaluation of patient with Headache 13. Emergencies in family medicine 14. Approach to a patient with Fatigue 15. Approach to a patient with Fever 16. Well Child Care 17. Evaluation of patient with Red Eye 18. Evaluation of patient with abdominal pain

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Instructional Methods and Learning strategies

Different instructional methods will be implemented throughout the clerkship to convey the learning

objectives of the curriculum. Your active role in the learning process active, participation in patient

simulation, assignments, and patients' encounters at the primary health care center can’t be over

emphasized.

Case Scenarios, problem based session regarding the clinical topics listed above in which there

will be patient simulation. Your performance is evaluated by checklist after 15 minutes of role

play. All important points will be discussed by the attending faculty who will act as a facilitator;

this is followed by an interactive power point presentation to reinforce the important point of

presented topic.

Tutorials/seminars (student presentations ) which are intended to help you develop essential

elements of preparing and organizing a successful oral presentation, In addition gives you

opportunity to develop self confidence to speak in public and to fellow students. At the end of

each session there will be staff evaluation and feedback regarding your performance from your

colleagues and the attending faculty member.

Small group sessions at the PHC to discuss some of the cases seen in the clinic to help you

practice different skills in details (consultation, counselling, and develop follow-up management

plan).

Log Book

Assignments

Self Learning

Self learning is a very important component of the family medicine rotation. Self learning is intended to

be a useful instructional tool for further reading and discussion with fellow students at the time dedicated

for the self-study. Students will be given specific task during self learning time and then he/she will report

to the facilitator whether the task was completed or not.

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Tentative Timetable for the Distribution of Instructional Method

by Hours

Instruction method

Number of

session

Total

hours

Core sessions in

fundamentals

18 35

Clinical topics sessions 18 32

A .Case based clinical

sessions

10 20

B. Student presentation

seminars

8 12

Field visits complementary

medicine,/geriatric care

4 16

PHC (direct patient

encounter)

13 52

Student self learning times

(SSLT)

5 15

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Student Assessment

Grade% Evaluation Items

6% Attendance , interest, professionalism 1

6%

5%

------------------------------Assignments

------------------------------ Presentation

2

8% Log Book

3

10% Preceptor Evaluation (Refer to preceptor guide)

4

15% Mid rotation evaluation 5

25% Final exam 6

25% Modified OSCE

67

100% Total

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.

Assignment

There are three assignments (Emergencies in family medicine, evidence based medicine, and maternal

child health)

Mid-rotation Evaluation

Mid-rotation evaluation is scheduled on the first day of the third week of the rotation, it will be delivered

in case based format to assess problem solving competencies rather than simple recall of the information.

It contributes to 15% of the total grade. Mid rotation feedback

Feedback will be taken from the students regarding the curriculum and their learning experience both in

PHC and on campus

Evaluation by the preceptor

Students will be evaluated by the preceptors, at the end of each PHC rotation. It contributes to 10% of the

total grade.

Modified OSCE

We will be introducing modified OSCE as it is one of best tool of assessment of clinical competencies.

There will be structured clinical exam on 5-6 stations. The students will be divided into 3-4 centers. The

exam will be standardized in each center.

Written exam

The exam consists of multiple choice questions. The exam will cover the assigned topics listed as the core

topics in this syllabus, plus assigned readings for case-based sessions. The date of the exam is the last

Wednesday of the rotation

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CORE TOPICS

Family Medicine fundamental Topics by Hour

Topic HOURS

1. Concepts and principle of family medicine 2.5

2. Concepts and principle of primary health care 1.5

3. Consultation and interviewing skills and dealing with challenging patient

encounter ( angry pt, talkative pt)

3

4. Anticipatory care 1.5

5. Periodic health exam 1.5

6. Learning in family medicine 1.5

7. Management in family practice 1.5

8. Prescribing in family practice 1.5

9. MCH in primary care 1.5+1.5=3

10. Counseling (advising, educating and helping patient and relatives) 2.5

11. Introduction to Critical appraisal of medical literature and EBM 3+3=6

12. Introduction to complementary medicine and concept of Integrative care 4

13. Problem oriented medical record 1.5

14. The Family In Health And Disease 1.5

15. Home Care 2.5

16. Telephonic Consultation 1.5

17. Interpretation of laboratory test 1.5

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Clinical Topic by Hours

Topic HOURS

1. Geriatric care 3

2. Evaluation of patient with Diabetes Mellitus 2.5

3. Evaluation of patient with Hypertension 1.5

4. Evaluation of patient with Dyslipidemia 1.5

5. Evaluation of patient with Obesity 1.5

6. Evaluation of patient with Asthma 2.5

7. Evaluation of patient with Upper respiratory infections 1.5

8. Common skin lessons 1.5

9. Evaluation of patient with Back pain 1.5

10. Join pain / Arthritis 1.5

11. Anxiety & Depression ( Common Psychiatric Encounters) 1.5

12. Evaluation of patient with Headache 1.5

13. Emergencies in family medicine 3

14. Approach to a patient with Fatigue 1.5

15. Approach to a patient with Fever 1.5

16. Well Child Care 1.5

17. Evaluation of patient with Red Eye 1.5

18. Evaluation of patient with abdominal pain 1.5

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LECTURE: Geriatrics Student Note: Department: Family and community medicine

Lecturer: Male Section: Dr. Jameel Bashawari

Female Section: Dr Ekram Jalali

At the end of this session student should be able to:

1. Describe normal physiology of aging

2. Explain pharmacologic changes in aging and

relevance to therapeutic decisions

3. Develop a basic understanding of risk factors,

causes, signs, symptoms, differential diagnosis,

initial diagnostic evaluation, and preventive

strategies. Conditions of these Geriatric Syndromes

and Conditions include:

a. Dementia, Depression, Delirium

b. Falls

c. Osteoporosis

d. Hearing and vision impairment

e. Immobility and gait disturbances

f. Sleep Disorders

g. Inappropriate prescribing of medications

4. Identify presenting signs and symptoms elder abuse

and neglect

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LECTURE: Geriatrics Student Note:

5. Apply Preventive Measures including:

a. Primary prevention (for example, exercise,

nutrition, and psychosocial interventions.

b. Secondary Prevention with age appropriate

screening for diseases.

c. Tertiary prevention strategies; for example,

rehabilitation and chemoprophylaxis in the post-

myocardial infarction patient

Contents of the session

1.

Assessment of the Older Adult

1. Geriatric assessment (history and physical

examination), mobility and gait and balance

assessments, mini-mental status examination

2. Discussion of preventive services.

3. Introduction to the normal physiologic,

psychological, social, and environmental changes.

4. Poly-pharmacy in elderly patient

5. Elder abuse and neglect

6. Discussion of syndromes associated with aging:

dementia, delirium, depression ,falls, visual and

hearing impairment, sleep disorders.

EDUCATIONAL METHODS and RESOURCES

Teaching strategies :

1. Lecture

2. Attend multidisciplinary geriatrics nursing home

3. Standardized geriatric simulated case

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LECTURE: Geriatrics Student Note:

4. Direct patient care – in family practice with

preceptor

References & Resources:

http://www.merck.com/mrkshared/mm_geriatrics/ho

me.jsp The Merck Manual of Geriatrics On-line

version

The American Geriatric Society (AGS)

(http://www.americangeriatrics.org/) has multiple

resources including; Geriatrics at Your Fingertips in

both paper and PDA formats, Geriatric Review

(GRS5).

http://www.frycomm.com/ags/teachingslides/

Self-assessment:

MCQ’s

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LECTURE: Skin Disease Student Note:

Department: Family and community medicine

Tutorial : Male Section: Dr. Hashim Fida

Female Section: Dr. Jawaher Al-Ahmadi

The prevalence of skin lesions is around 20% in the

community, but only 25% consult doctors. Family

physicians are well trained to evaluate and treat skin

diseases.

At the end of the tutorial you should be able to:

1-Describe primary and secondary skin lesions

2- Recognize common skin conditions seen in the primary

care setting

3- Evaluate patient with new-onset skin lesion (history-

examination-investigation)

4-Differentiate benign from serious causes of skin lesion

through history and physical examination.

5-Considre the diagnosis of systemic disease in patient

presented with skin lesion through history and physical

examination

6- Illustrate a management plan for different skin lesion

a- infection(viral-bacterial-fungal-parasitic)

b- dermatitis

c- acne

7- Apply the biopsycosocial approach to patient with skin

disease

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LECTURE: Skin Disease Student Note:

Contents of lecture:

1-primary and secondary skin lesion

2-Approach to patient with new onset skin

lesion

3- Red flags for skin lesion

4- Skin infection

5-Dermatities

6-Acne

Methods of delivery

Student prepared seminar

Problem based case scenario

References& readings:

ABC dermatology

Rakel: Textbook of Family Medicine, ed. 7--Chapter 44:

Dermatology

Treatment Options for Atopic Dermatitis. Am Fam

Physician 2007; 75:523-8, 530.

Topical Therapy for Acne. Am Family Physician

2000;61:357-66

Self-assessment

Describe (plaque-pustule-scale)

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LECTURE: EBM


Tutorial : Male Section: Dr.Jameel Bashawari


EBM is a recent valid approach to clinical decision

making instead of relying on reasoning and clinical

experience alone.

Student Note:


1-Define EBM

2-Explain the rationale for EBM

3-Discusse the concepts and steps of EBM

4-Classify and grade evidence (from most to least reliable)

5-Applay EBM in family medicine when possible

6-Recgunize the limitation to EBM

7-Develop the skills of

a-formulating clinical questions

b-searching for appropriate literature

c-critically appraising therapeutic study according to users

guides to medical literature series.


Definition of EBM

The origin and evolution of EBM

Concepts and Steps of EBM

Levels of evidence

32 | P a g e

LECTURE: EBM Family medicine approach to EBM

1. validity of result

2. Critical appraisal for therapeutic study

3. Importance of the result

4. Applicability of the result

EBM is a relatively new approach emerged from different

disciplines such as epidemiology and biostatistics aiming to

improve patient care

The key feature that distinguishes EBM from other

approaches is the use of valid replicable methods to answer

clinical questions.


users guides to medical literature series(How to use an

article about therapy or prevention)

http://www.tripdatabase.com

http://www.bmj.com

http://www.attract.com

http://www.clinicalevidance.com

Assessment & evaluation method:

Define EBM

List the steps of EBM

Assignment for EBM

The students will be divided into 6 groups and each

group (6-8)should prepare a presentation and report

33 | P a g e

LECTURE: Evaluation of patient with Diabetes Mellitus


Tutorial : Male Section: Dr.Hashim Fida

Female Section: Dr. Ekram

Student Note:


1. List the risk factors for diabetes.

2. List the diagnostic criteria of diabetes.

3. Demonstrate the ability to perform an appropriate

physical exam in the context of diabetes and diabetes

complications.

4. Discuss the non-pharmacological approach to

diabetes management.

5. Discuss the mechanism of action of oral

hypoglycemic medications and their use.

6. Discuss insulin use and its mechanism of action.

7. Discuss primary cardiovascular prevention for

diabetics.

8. Explain the importance of monitoring for

complications of diabetes.

9. Discuss a multidisciplinary approach to the

management of diabetes mellitus type 2.

10. Perform and interpret glucometer testing.

11. Perform and interpret monofilament testing.


1. Diagnostic criteria

2. Clinical presentation, and course of type II DM

34 | P a g e

LECTURE: Evaluation of patient with Diabetes Mellitus 3. Discussion of macrovascular and microvascular

complications

4. Cardiovascular risk assessment by history and

Clinical examination

5. Laboratory investigations (first visit, subsequent

visits)

6. management

a. of weight, nutrition, and physical activity

b. Oral hypoglycemic agents, aspirin

c. of associated hypertension, lipid disorders

d. smoking cessation

e. immunization

7. Monitoring:

a. Home glucose monitoring

b. Hemoglobin A1c

c. Adverse effects of drug therapy

8. Patient education

9. Screening recommendation for DM

10. Discussion of the role of primary care physician in

coordination of care among (dietician,

ophthalmologist,…etc)

11. Indications for referral and admission

EBM is a relatively new approach emerged from different

disciplines such as epidemiology and biostatistics aiming to

improve patient care.

The key feature that distinguishes EBM from other

approaches is the use of valid replicable methods to answer

clinical questions.



References:

1. RAKEL Essential Family Medicine,

Fundamentals& Case Studies, Third edition

2. Primary Care Medicine Allan H. Goroll, Albert

G. Mulley, Jr.

Latest edition of the following publications:

1. American Diabetic Association. Clinical practice

35 | P a g e

LECTURE: Evaluation of patient with Diabetes Mellitus

recommendations

2. American Diabetic Association Expert

Committee. Diagnosis and classification of

diabetes mellitus.

3. Joint National Committee on Prevention,

Detection, Evaluation, and Treatment of High

Blood Pressure. The Seventh Report

Independent learning from the Internet

Web Sites

American Diabetes Association

http://www.diabetes.org/homepage.jsp

National Diabetes Information Clearinghouse

NIDKK

Physicians' Committee for Responsible Medicine

Nutrition Education-Diabetes Unit

PACE

Patient Centered Assessment Counseling for Exercise

and Nutrition

http://www.aafp.org/


Problem-Based Cases

Participation in the session

End of rotation MCQs

http://www.diabetes.org/homepage.jsp

http://diabetes.niddk.nih.gov/

http://www.pcrm.org/resch/edresources/nutr_curr/

http://www.pcrm.org/resch/edresources/nutr_curr/

http://www.paceproject.org/



http://www.aafp.org/x17367.xml


36 | P a g e

LECTURE: Counseling

Student Note:


Tutorial : Male Section: Dr.Ekram

Female Section: Dr. Hashim Fida

At the end of the lecture you should be able to:

Know the Definition of counseling

Discuss Counseling in PHC

Advantages and disadvantages

Application of counseling in clinical practice

Describe stages of counseling


Definition

Helping the person to help himself.

Counseling is a process of assisting people to

overcome obstacles in their personal growth and in

their interpersonal relationships. growth and offer

effective guidance to patients.

Counseling in PHC Advantages

1.to identify emotional problem early to prevent more

serious disturbances develop

2.deacrease the need for psychotropic medication

3.deacrease consultation rate

Disadvantages

1.time

2.special training and interest

37 | P a g e

LECTURE: Counseling Student Note:

Application of counseling in clinical practice

Chronic risk patient

Dying patient

Bereaved (ventilation + acceptance)

Parent with very ill handicapped

Disable patient

Personal

Counseling setting

Patient exploration to understanding and define the goals

and facilitating action changes

1;exploration

2;uunderstanding the problem and defining goals

3;faciliting action

The basic assumption is that each individual goes

through 3 life stages in physical, psychological, social,

and spiritual development. The stages are dependent,

independent, and interdependent

.Dependent stage

This stage begins after birth. The individual relies on the

primary caregivers to provide nourishment and to nurture

for physical and biological growth; therefore, the family

environment and the sociocultural setting play a crucial

role in shaping emotional, psychological, social, cultural,

and spiritual perspectives.

Independent stage

Later on in life, the individual learns to be independent.

Apart from physical independence, this stage involves

the development of identity, self-esteem and confidence,

and a belief and value system from which free decisions

and life choices are made.

38 | P a g e

LECTURE: Counseling Student Note:

Continue Lecture :

1


Lecture note

Rakel ;essential family medicine

CD-ROM

You have the opportunity to read the lectures of CD-ROM

In the following site (or at the department library??)

http://www.pitt.edu/~super1/

http://www.bmj.com/collections/epidem/

http://wwwmedicalstudent.com

http://www.acepidemiology.org

Self-assessment


Student Notes:



http://wwwmedicalstudent.com/

http://www.acepidemiology./

http://images.google.com.sa/imgres?imgurl=http://www.kinderreaders.com/images/CD.jpg&imgrefurl=http://www.kinderreaders.com/put_your_files_on_a_cd_page.htm&h=720&w=617&sz=72&hl=ar&start=7&um=1&tbnid=OXC-jdVqEytAvM:&tbnh=140&tbnw=120&prev=/images?q=Cd+computer&svnum=10&um=1&hl=ar

39 | P a g e

LECTURE: Problem Oriented Medical Record Student Note:


Tutorial : Male Section: Dr.Jameel Bashawari


Problem oriented medical record (POMR) achieves its

maximum potential in family medicine. It is essential for

providing continues care for chronic or complex cases.


1-List the purpose of POMR

2-Descripe the component of POMR

3-Use POMR to present patient data.

4- Use POMR to prioritize patient’s problems

5-Write case summaries using SOAP format

6- Describe the methods used to store medical records

7- Outline the electronic record system


1-Purpose of medical record

2-Criteria for good medical record

3-Component of POMR

4-Electronic medical record

.

POMR are fundamental to good patient care.

It provides a comprehensive mechanism for integrating and

managing patient data

References& readings

Rakel: Textbook of Family Medicine, 7th ed

40 | P a g e

LECTURE: Problem Oriented Medical Record Student Note:

http://www.centerforhit.org


Self-assessment

Describe SOAP format

41 | P a g e

LECTURE: HEADACHE

Student Note:


Tutorial : Male Section: Dr.Mahdhi


Headache is among the 12 most common presenting

complaints in family practice. It forms a diagnostic

challenge for family physician, who must distinguish

between the rare headache that represents life –

threatening diseases and the harmless majority.


1-Outlin epidemiology of headache

2-Describe risk factors for headache

3--Evaluate patient with new-onset headache (history-


4-Outline a prioritized differential diagnosis for the

complaint of headache based on history and exam

4- Recognize "red flag" indicators for acute investigation and

management.

5-List and defend the use of imaging studies and ancillary

laboratory exams

6- Illustrate a management plan for different headache

patients (migraine –tension-cluster)

7- Explain the role of lifestyle measures in managing

headache

7- Apply the biopsycosocial approach to patient with

headache

42 | P a g e

LECTURE: HEADACHE

Student Note:


1-Diagnosis of headache

2-Risk factors for headache

3-Beingn and serious causes for headache

4-Approach to a patient with new-onset headache

5-Types of headache (migraine –tension-cluster)

5-Prevetive measures

Methods of delivery

Student prepared seminar


Headache is a common clinical challenge encountered by

family physician.

A comprehensive history and physical examination are the

essential steps in the management.


-ABC of headache

- Evaluation of Acute Headaches in Adults. Am Fam

Physician 2001; 63:685-92.

- Tension-Type Headache. Am Fam Physician 2002;66:797-

804,805

http://www.aafp.org/afp/20010215/685.htm

Self-assessment

Describe the red flags for headache?

http://www.aafp.org/afp/20010215/685.htm

43 | P a g e

LECTURE: Learning in Family Medicine

Student Note:


Lecturer: Male Section: Dr. Jameel Bashawri

Female section :Dr.Jawaher Alhmadi


1. Discuss common clinical problems seen in family

medicine.

2. Identify the role of the family physician in the

management of these common problems.

3. Utilize current advances in the diagnosis and

treatment of common problems using, whenever

possible, an evidence-based approach.

4. Institute appropriate evidence-based medicine

prevention strategies into your practice.

5. Use appropriate test preparation techniques

In approaching the exam.

Tell me and I forget

Show me and I remember

Involve me and I understand

44 | P a g e

LECTURE: Learning in Family Medicine

Student Note:


CD-ROM



http://www.ejournal.afpm.org.my

Self-assessment

Q: Choose a learning method and discuss how it helps to

produce deep learning.


- Student's portfolio


45 | P a g e

LECTURE: Evaluation of Patient with Abdominal Pain

Student Note:


Lecturer: Male Section Dr.Mahdi Qadi

Female Section Dr. Rahila Iftikhar

Abdominal pain is a common presentation in the outpatient

setting and is challenging to diagnose. It can represent a

spectrum of conditions from benign and self-limited disease

to surgical emergencies. Evaluating abdominal pain requires

an approach that relies on the likelihood of disease, patient

history, physical examination, laboratory tests, and imaging

studies.


Take appropriate history of patient with abdominal

pain

Make differential diagnosis /Know important causes

of abdominal pain

Differentiate between medical and surgical causes of

abdominal pain

Perform physical examination of a patient with

abdominal pain

Discuss the indication the basic laboratory

investigation for patient with abdominal pain

Be familiar with indication and advantages of the

basic imaging( x ray/ultrasound/CT SCAN) for

evaluation of patient with abdominal pain

Discuss the red flags of abdominal pain

List the indication for referral

Apply biopsychosocial approach to patient with

abdominal pain


History of a patient with abdominal pain

Physical examination ( skill)

Differential diagnosis/ Major causes of

abdominal pain

Approach to patient with the following

conditions

Renal colic

46 | P a g e

LECTURE: Evaluation of Patient with Abdominal Pain Student Note:

Gastroesophageal reflux/dyspepsia

Irritable bowel syndrome

Dysmenorrheal

Common laboratory investigation in

abdominal pain

Role of imaging in evaluation of abdominal

pain

Red flags for abdominal pain

Indication for referral

Although most abdominal pain is benign, but a fewer

percentage of patient in outpatient setting have a severe or

life-threatening cause or require surgery. Therefore, a

thorough and logical approach to the diagnosis of abdominal

pain is necessary.


Essential Family Medicine Fundamentals and case studies

Rakel third edition

www.afp.org Evaluation of Acute Abdominal Pain in

Adults April 1, 2008

SARAH L. CARTWRIGHT, MD, and MARK P.

KNUDSON, MD, MSPH, Wake Forest University School of

Medicine, Winston-Salem, North Carolina

Self-assessment


MCQ’s

Clinical scenario description

http://www.afp.org/

47 | P a g e

LECTURE: Evaluation of Patient with Asthma

Student Note:


Lecturer : Male Section Dr.Hashim Fida


Despite increased scientific knowledge about asthma and

improved therapeutic options, the disease continues to cause

significant morbidity and mortality. Recently the guidelines

are updated on asthma medications, prevention of disease

progression, and patient self-management


Define asthma

Know how to diagnose asthma

Classification according to the NICE guidelines

Evaluate patient with newly diagnosed asthma

(Appropriate history and Physical examination of

patient with asthma)

List the laboratory investigations usually done to

make the diagnosis ( PEFR, pulmonary function test)

Know the role of chest X ray in patient with asthma

Discuss the management of patient with asthma

Know Non pharmacological management (Elicit

environmental factors contributing to the disease

process.)

Know the step wise management of asthma

according to guidelines

Pharmacological (must know when to start steroid

inhaler)

Counsel the patient about inhaler use

Patient education

Apply biophysical approach to patient with asthma

Discuss the indication of referral

48 | P a g e

LECTURE: Evaluation of Patient with Asthma Student Note:


Evaluate patient with newly diagnosed

asthma/ previously diagnosed

(Appropriate history and Physical

examination of patient with asthma)

Definition and classification of asthma

List the laboratory investigations

usually done to make the diagnosis

( PEFR, Pulmonary function test)

The role of X-ray in patient with

asthma

Discuss the management of patient

with asthma

( NICE guidelines)

Non pharmacological management

The step wise pharmacological

management of asthma according to

guidelines

Counseling the patient about inhaler

use

Patient education about using charts in

self management

Biophysical approach to patient with

asthma

Discuss the indication of referral

References& readings: The New Asthma Guidelines Yawn B

May 1 2009 Vol. 79 No. 9 American family physician

www.aafp.org

Essential Family Medicine Fundamentals & Case Studies

Rakel Third Edition: Chapter 55

Practical general practice Alex Khot


49 | P a g e

LECTURE: Evaluation of Patient with Asthma Student Note:

Andrew Polmear Fifth edition chapter 6

Self-assessment


MCQ

Case-Based Discussion

50 | P a g e

LECTURE: Interpretation of Laboratory Test

Student Note:


Lecturer: Male Section Dr.Mahdi Qadi



List the indication and interpretation of following laboratory

test

Complete blood count

2 point glucose

Urine analysis

Liver function test

Renal function profile

Bone function profile


The tutorial will include different cases and

with laboratory results and following

interpretation will be discussed

Complete blood count

2 point glucose

Urine analysis

Liver function test

Renal function profile

Bone function profile

51 | P a g e

LECTURE: Interpretation of Laboratory Test Student Note:


Essential Family Medicine Fundamentals and case

studies Rakel third edition chapter 13 page 148

Self-assessment


MCQs

Case based Discussion

52 | P a g e

LECTURE: The Family in Health & Disease Student Note:


Lecturer: Male Section Dr.Jameel Bashawari

Female Section ( Dr. Rahila Iftikhar)

The importance of the family to family physician is inherent

in the paradigm of family medicine It recognizes the strong

connection between health and disease, and personality, way

of life, physical environment and human relationship


Know the universal importance of family and role of

family physician in taking care of the family

Know the General rules of family care

Recognize the four levels of involvement of

physicians in family care

Be familiar with the recent changes in family

structure and function of family

Delineate the important influence of the family on

health and disease

Understand the family life cycle and developmental

task (stage –critical family developmental task

through the family life cycle)

Know how families are affected by the trauma

(conflict, divorce, bereavement, poverty,

unemployment, migration

Know the significance of family conference


Discussion regarding the Importance of

family to family physician

Discuss the involvement of family physician

with families

General principles regarding family care

Recent changes in structure and function of

the families.

53 | P a g e

The important influence of the family on

health and disease

Discussion regarding the family life cycle and

developmental task (stage –critical family

developmental task through the family life

cycle)

The effect of trauma on families (conflict,

divorce, bereavement, poverty,

unemployment, migration)

The significance of family conference

Look out for vulnerable families and give them extra

support

Look out for vulnerable family members, the “hidden

patient”

Look out for patient who are family scapegoat or

presenting symptoms of a family problem

Always “Think Family” in consultation with the

patient


Text book of family Medicine Ian R.McWhinney

Thomas Freeman page 217 - 240

Essential Family Medicine Fundamentals and case studies

Rakel third edition

Self-assessment


Care for at least two members of one family during the

rotation OR

Work with several members of the same family on the

care of one patient.

54 | P a g e

LECTURE: Approach to a Patient with Fever

Student Note:


Lecturer: Male Section: Dr. Hashim Fida

Female Section: Dr. Ekram


Know the approach to fever

Know the pathphsiology and etiology of fever

Know the proper history and examination of febrile

patient

Know the appropriate methods of investigation in

patient complaining of fever

Know type of fever

Know the causes of fever


Introduction to fever and URTI

Approach to any patient complaining of

fever

How to take history and examination

Discuss type of fever

How to measure temperature

What investigation you will order

Complication of fever

Treatment of fever

Scenario and role play


Lecture note


55 | P a g e

LECTURE: Approach to a Patient with Fever Student Note:

CD-ROM







Self-assessment







56 | P a g e

LECTURE: Periodic Medical Examination Student Note:


Lecturer: Male Section: Dr Mahdi

Female Section: Dr Ekram


1- Understand the concept of clinical preventive

services and the periodic medical examination.

2- Identify the elements of the periodic medical

examination.

3- Know how it could be applied

4- Mention examples of valid maneuvers to be done at

different ages


1- Definitions , importance, concepts and

elements of clinical preventive services and

the periodic medical examination

2- Methods of delivering the periodic medical

examination.

3- Examples of maneuvers to be done at

different ages

- Degree of evidence of the maneuvers

- Advantages and disadvantages related to the

periodic medical examination and it's the

maneuvers

- Importance of updating our knowledge in

the periodic medical examination.


- Gorrol. Primary care medicine. The chapter

of Health maintenance and the role of

screening.

57 | P a g e

LECTURE: Periodic Medical Examination Student Note:

- Rackel. Textbook book of family medicine.

- Uspstf:

http://www.ahrq.gov/clinic/uspstfix.htm

- Ctfphc: http://www.ctfphc.org/

Self-assessment

- What are the major components of the

periodic medical examination?

- Give two examples of valid maneuvers to be

done for each of the components of the

periodic medical examinations for the

different age groups?.


Short assay or MCQs

http://www.ahrq.gov/clinic/uspstfix.htm

http://www.ctfphc.org/

58 | P a g e

LECTURE: Upper Respiratory Tract Infections (URTI)

Student Note:



Female Section: Dr.Rahila Iftikhar


1- Recognize importance , types, complications and

prevention of URTI

2- Differentiate between viral and bacterial URTI.

3- Recognize serious and important diseases which may

present as or mimic URTI.

4- Distinguish the serious types of URTI


1. Pharyngitis, tonsillitis, common cold,

influenza, croup, epiglotitis and acute

bronchitis.

2. Scoring system for differentiation between

bacterial and viral infections.

3. Work up and differential diagnosis for a

case of URTI. Examples of serious and

important diseases which may present as

or mimic URTI.

59 | P a g e

LECTURE: Upper Respiratory Tract Infections (URTI) Student Note:

The red flags in cases presenting with URTI manifestations.

When there is need to do chest x ray and to give antibiotic in

acute bronchitis


1-Gorrol.Primary care medicine. The chapters of

pharyngitis and common cold.

2- Rakel. Essentials family medicine

3- Current text book of family medicine

- American Academy of Family Physicians.

http://www.aafp.org/online/en/home.html

- http://www.wrongdiagnosis.com/

Self-assessment

- Mention five examples of serious and

important diseases which may present as or

mimic URTI.

- How to recognize serious swine flu case. - Assessment & evaluation method:

- Short assay or mcqs

http://www.aafp.org/online/en/home.html

http://www.wrongdiagnosis.com/

60 | P a g e

LECTURE: MCH care at the PHC level

Student Note:


Lecturer: Male Section: Dr. Waleed Mailat


At the end of this session student should be able to:

1. Identify elements of primary health care and their

application practice in various PHC centers settings

2. Determine magnitude and shape of delivery of

maternal and child services in PHC level.

3. List objectives and functions of MCH care programs

in PHC level.

4. Identify resources and training needs for the

implementation of these programs in the PHC level.

5. Identify techniques and methods of monitoring and

evaluation of MCH programs in the PHC level.

Contents of the session:

1. Group discussion on levels of health care

delivery.

2. Elements of Primary health care.

3. Magnitude and relation of MCH care in PHC

elements application.

4. Type of MCH care programs.

5. Objectives and application methods of MCH

care programs in PHC level.

6. Resources and training needs for application

of MCH programs.

7. Evaluation of MCH care programs in PHC

level.


MCH section in the PHC book of Saudi Arabia

61 | P a g e

LECTURE: MCH care at the PHC level Student Note:

http://www.who.int/publications/almaata_declaration

_en.pdf

http://www.who.int/bulletin/primary_health_care_ser

ies/en/index.html

http://saudiprimarycare.com/pdf/Arabic_book.zip

Extra material will be supplied by the instructor.

Self-assessment


The student will be evaluated through his/her

participation in the session by the class and by the

teacher.

Final rotation exam will include MCQs about this case and

similar cases

http://www.who.int/publications/almaata_declaration_en.pdf

http://www.who.int/publications/almaata_declaration_en.pdf

http://www.who.int/bulletin/primary_health_care_series/en/index.html

http://www.who.int/bulletin/primary_health_care_series/en/index.html

http://saudiprimarycare.com/pdf/Arabic_book.zip

62 | P a g e

LECTURE: Practical session I: Case Scenario on Antenatal –Care

Student Note:


Lecturer: Male Section: ( Dr. Waleed Mailat)

Female Section: Dr.Rahila Iftikhar

At the end of the case scenario student should be able to:

1. Identify elements of antenatal care in the PHC centre

2. Determine risk factors during pregnancy

3. Identify techniques and methods of history taking and

points in examination of pregnant lady in the ANC

clinic.

4. Identify investigations to be requested during ANC on

the PHC level.

5. Discuss points to be covered in health education of

pregnant in ANC clinic.

6. Prepare materials for health education of pregnant in

ANC.

Content of the session:

A student presentation answering questions raised

after reading a case scenario of a risky pregnancy.

History and examination points will be prepared

by the students and discussed with the class.

Needed investigations will be reviewed with the

class. Practical training on health education points

will be conducted for the class during the

presentation through role play by the presenting

group

63 | P a g e

LECTURE: Practical session I: Case Scenario on Antenatal –Care

Student Note:


Antenatal care section in the PHC book of Saudi Arabia

Web sites: www.safemotherhood.com

Extra material will be supplied by the instructor

Self-assessment


The student will be evaluated through his/her

participation in the session by the class and by the

teacher.

Final rotation exam will include MCQs about this case

and similar cases.

64 | P a g e

LECTURE: Practical session II: Case scenario on well baby clinic Student Note:


Lecturer: Male Section: ( Dr. Waleed Mailat)

Female Section: Dr.Ekram

At the end of the case scenario student should be able to:

1. Identify objectives and basic elements of child services

in well baby clinic (WBC) in the PHC centre

2. Determine basic principles and techniques used to

accomplish different tasks covered during the WBC visit

3. Identify real life problems in the application of these

services and possible solutions at the PHC level.

4. Discuss points to be covered in health education of

mothers getting their children to WBC clinic.

5. Prepare materials for health education of mothers in

WBC clinic.

Contents of the session:

A student presentation answering questions

raised after reading a case scenario of a child

attending to the WBC clinic. History and

examination points will be prepared by the

students and discussed with the class.

Practical training on problems encountered

and health education points will be conducted

for the class during the presentation through

role play by the presenting group.

65 | P a g e

LECTURE: Practical session II: Case scenario on well baby clinic Student Note:


1. Well baby care section in the PHC book of Saudi Arabia

.

a. http://www.who.int/childgrowth/en/

b. http://www.cdc.gov/nccdphp/dnpao/growthcharts

/training/index.htm

c. http://www.rcpch.ac.uk/Research/Growth_Charts

_Education_Training_Resources

Extra material will be supplied by the instructor.

Self-assessment

The student will be evaluated through his/her participation in

the session by the class and by the teacher. MCQs will be

included in the final exam.

http://www.who.int/childgrowth/en/

http://www.cdc.gov/nccdphp/dnpao/growthcharts/training/index.htm

http://www.cdc.gov/nccdphp/dnpao/growthcharts/training/index.htm

http://www.rcpch.ac.uk/Research/Growth_Charts_Education_Training_Resources

http://www.rcpch.ac.uk/Research/Growth_Charts_Education_Training_Resources

66 | P a g e

LECTURE: Hypertension Student Note:


Tutorial : Male Section: Dr.Ali Fakeeh


Hypertension is one of the most common chronic health

problems in the world. It is form a challenge to family

physician (high prevalence, asymptomatic and high

complication rate


1-Define hypertension according to JNC-VII

2-Classify hypertension according to JNC-VII

3-- Discuss the risk factors for hypertension.

4 Describe the USPSTF recommendations for screening for

hypertension

5- Apply preventive measures in hypertension(primary-

secondary -tertiary)

6-Differntiate between primary and secondary hypertension

by (history-examination-investigation)

7-Evaluate a newly diagnosed hypertensive patient(history-


8 -Measure blood pressure correctly

9-Explain the role of lifestyle measures in managing

hypertension

10- Describe the end organ complications of untreated

hypertension

11-Illustrate a management plan for different hypertensive

67 | P a g e

LECTURE: Hypertension Student Note:

patients in the context of the patient's life and environment.

12-Discusse indications for referral

13- Consider the role of other disciplines, e.g., pharmacy,

nursing, social work, and allied health, in the treatment of

hypertension

14- Differentiate between hypertensive emergency and

hypertensive emergency.


1-Diagnosis of hypertension

2-Risk factors for hypertension

3-Primary and secondary hypertension

4-Approach to a newly diagnosed hypertension

5-Prevetive measure

Methods of delivery


The most important component of hypertension management

is accurate measurement of blood pressure.

All patient with hypertension should be educated about the

benefits of lifestyle modification

http://www.nhlbihin.net/jnc7/jnc7pda.htm

http://www.aafp.org/afp/20030101/67.pdf

Self-assessment

List 5 risk factors for hypertension

http://www.nhlbihin.net/jnc7/jnc7pda.htm

http://www.aafp.org/afp/20030101/67.pdf

68 | P a g e

LECTURE: Introduction to CAM and Concepts of Integrative Care Student Note:


Tutorial : Male Section:


At the end of this session you should be able to:

1. Define what is Complementary and Alternative

medicine

2. List and discuss the most common types of CAM

3. Gain knowledge about conditions for which patients

most commonly seek out complementary approaches

4. Gain knowledge about applications of principles of

evidence-based medicine to the study of CAM

5. Develop ability to inquire into patients’ use of

complementary therapies in a non threatening,

non judgmental manner

6. Develop ability to gather relevant information (when

available) regarding safety, efficacy, and cost of a

complementary therapies intervention and to communicate

this information clearly to the patient

7. Develop ability to integrate the use of conventional and

unconventional options in clinical practice

69 | P a g e



1. Introduction to Complementary and

Alternative Medicine “CAM”

2. Definition of CAM and Allopathic

Medicine

3. Present Perspective of CAM and

Allopathic Medicine

4. Potential Problems with Traditional

Medicine and Potential Pitfalls with CAM

5. Quality of Evidence and Scientific

Methods in CAM

6. Safety Issues of CAM

7. Model Guidelines for the Use of

Complementary and Alternative Therapies in

Medical Practice

8. Guidelines when evaluating the delivery or

co-management of CAM

Medical Legal and safety Issues of CAM


- Text book of Family Medicine by: McWhinney

- RAKEL Essential Family Medicine

CD-ROM

70 | P a g e




www.naturaldatabase.com

www.consumerlab.com

nccam.nih.gov

www.usp.org

Self-assessment

Q 1. Define CAM and list common types used by

patients.

Q 2. Discuss safety issues of CAM use in family

medicine practice.


1. MCQ

2. Problem solving method

http://www.naturaldatabase.com/

http://www.consumerlab.com/

http://www.usp.org/


71 | P a g e

LECTURE: Back Pain

Student Note:



Female Section:


1. Outline an approach to the office evaluation of a

patient presenting with an initial episode of back

pain.

2. Describe physical findings on examination of a

patient with low back pain which suggest nerve

root or spinal cord compression as its etiology.

3. Describe patient factors which may hinder clinical

improvement of low back pain symptoms.

4. Determine whether psychosocial distress is

amplifying the pain

5. List and interpret critical clinical and laboratory

findings which are key in the processes of

exclusion, differentiation, and diagnosis

6. List the indications and limitations of the

following in determining the etiology of back pain;

plain x-rays, CT scan, MRI.

7. Describe a management plan for treatment of a

patient with low back pain.

8. Select patients in need of specialized care

72 | P a g e

LECTURE: Back Pain Student Note:


1. Approach to patient presenting with back pain.

2. Physical examination of patient with low back

pain.

3. Psychosocial aspects in patient with back pain.

4. Differential diagnosis of back pain.

5. Indications and limitations of laboratory and

radiological investigations for diagnosing back

pain.

6. Management plan for treatment of a patient

with low back pain.

7. Counseling patient with back pain.

8. When to refer?

Check for any neurologic deficit, abnormal bladder,

bowel, or sexual function, an inciting event exists, pain

location, radiation, and effect of rest or leg motion




CD-ROM


73 | P a g e

LECTURE: Back Pain Student Note:



www.aafp.org

Self-assessment

Q: Discuss red flags that indicate the presence of an

emergency situation in a patient with low back pain.


- MCQ

- Case scenario clinical exam


74 | P a g e

LECTURE: Joint Pain / Arthritis

Student Note:




1. Outline an approach to the office evaluation of a

patient presenting with joint pain.

2. Describe physical findings on examination of a

patient with joint pain.

3. Differentiate between inflammatory and non-

inflammatory arthritis.

4. Determine whether the arthritis is migratory or not,

if fever is present or absent, symmetric or not.

5. Describe articular and extra-articular

manifestations and complications.

6. List and interpret critical clinical and laboratory

findings which are key in the processes of

exclusion, differentiation, and diagnosis.

7. Conduct an effective initial plan of management

for a patient with joint pain.

8. Outline the principles of multidisciplinary

management of arthritis.

9. Outline a management plan for patients with

inflammatory and non-inflammatory arthritis

including drug therapy, physiotherapy,

occupational therapy, and treatment of joint

75 | P a g e

LECTURE: Joint Pain / Arthritis Student Note:

deformities.

10. Select patients in need of specialized care and/or

referral.

11. Conduct counseling and education of patients


1. Approach to patient presenting with joint

pain.

2. Physical examination of a patient with

joint pain.

3. Differential diagnosis of joint pain.

4. Indications and limitations of laboratory

and radiological investigations for

diagnosing joint pain / arthritis.

5. principles of multidisciplinary management

of arthritis.

6. Management plan for a patient with joint

pain including drug therapy, physiotherapy,

occupational therapy, and treatment of joint

deformities.

7. Counseling and education of patients with

joint pain / arthritis.

8. Special care and/or referral.

Differentiate between inflammatory and non-

inflammatory arthritis (pain worse with immobility,

lasts>1 hour, or relieved by rest and worse with

motion)


76 | P a g e

LECTURE: Joint Pain / Arthritis Student Note:



CD-ROM



www.aafp.org

Self-assessment

Q.1: Describe typical clinical presenting signs and

symptoms of osteoarthritis.

Q.2: Discuss the goals of therapy in this condition.

Q.3: Describe the non-pharmacologic and pharmacologic

management of this disease.


- MCQ

Case scenario clinical exam



77 | P a g e

LECTURE: Emergencies in primary health care(PHC)



Female Section:

Student Note:



5- Appreciate the importance of emergencies in

primary health care.

6- Recognize important considerations, roles related

to emergencies in primary health care.

7- List the types of emergencies seen in PHC.

8- Recognize serious and important emergencies in

PHC.

9- Identify cautions and precautions in certain

emergencies.

10- Recognize certain important life saving

emergency skills.

11- Describe the management of certain important

emergencies in PHC.

12- Indicate what PHC doctor should know and do

regarding emergencies.

13- List examples of cases where pitfalls can happen.

14- Appreciate the importance of continuous training

in emergency medicine for the PHC doctors

78 | P a g e




Female Section:

Student Note:


Importance and responsibilities

1. Roles and important considerations

2. Decision making in emergency medicine

3. List of serious and important emergencies with

cautions and precautions related to them.

4. Primary and secondary survey plus certain life

saving skills.

5. Hypertensive urgency and emergencies, Airway

foreign body obstruction, acute confusional state

and post partum hemorrhage.

6. What should PHC doctor know and do regarding

emergencies.

7. Examples where pitfalls can happen

8. Real life stories about pitfalls and mistakes.

9. Advices to be ready.

- Index of suspicion

- Life saving skills

- Cautions and precautions.

- Safe referral and deposal.

- Your role as a general practitioner in emergencies.


- Current emergency diagnosis and treatment.

- Almazrou. Principles and practice of primary

79 | P a g e




Female Section:

Student Note:

health care.(The chapter of managing

emergency).

- Moulds, Martin., Bouchiers-Hayes.

Emergencies in general practice.

- Emergency medicine secrets.

- Prehospital emergency care secrets.

- Handout

Cochrane Prehospital and Emergency Health

Field Website. http://www.cochranepehf.org/news.php

Canadian association of emergency physician(especially

the medical student section). http://www.caep.ca/

Self-assessment

- Mention one important caution or precaution

about 10 important emergencies could be seen

in PHC.

- Write short notes about hypertensive urgency

and emergencies.


- Assignment: Summarizing 2 articles about

decision making in emergency medicine.

- Short notes and mcqs

http://www.cochranepehf.org/news.php

http://www.caep.ca/

80 | P a g e

LECTURE: Obesity Student Note:


Lecturer: Male Section: Dr.Hasim Fida

Female Section

Obesity is a risk factor for a number of disorders e.g., type

2 diabetes, polycystic ovary syndrome, hypertension, and

cardiovascular disease .Mortality increases exponentially

with increasing body weight. There is considerable

evidence that lifestyle modification can reduce the

morbidity and mortality.


1. Definition of obesity

2. Prevalence of obesity

3. Medical Causes of obesity

4. Classification of obesity

5. Approach to the patient with obesity (history

,physical examination)

6. BMI calculation

7. Complication

8. Management of obese patient

Non pharmacological Life style modification

(behavioral and dietary issues)

Pharmacological

9. Indication for referral

Surgical treatment

10. Biopsychosocial approach to patient with

obesity

Educate all patients about the hazards of obesity and

81 | P a g e

LECTURE: Obesity Student Note:

health benefit of modest weight loss and help them set a

realistic goal for weight reduction.


Lecture note


CD-ROM






Self-assessment







82 | P a g e

LECTURE: Anticipatory care Student Note:


Lecturer: Male Section: Dr.Ali Fakeeh

Female Section


- To define the anticipatory care

- To classify anticipatory care

- To know the concept of health promotion

- To know prevention (concept principle and levels)

- To know disease prevention

- To identify and practice the role of family

physician.

- To understand that the optimal setting for

anticipatory care is in general and family practice.

- To know the deterrent activities of promotivc and

preventive care


- Definition of anticipatory care

- Health promotion activities.

- classification of anticipatory

- Prevention of disease

- Types of different promotivc activities

- Role of family physician in anticipatory care

- Priorities for improvement of health care

New roles in prevention

83 | P a g e

LECTURE: Anticipatory care Student Note:


- Robert e. rakel, essential family medicine

fundamental 8 case studies third edition

- Anne Stephenson: text book of general praetice,2nd

edition

- Gorol et al. Primary care medicine: The office

management of the adult patient. Publisher:

Lippincott Williams and Williams.

CD-ROM







Self-assessment







84 | P a g e

LECTURE: Prescribing in family practice

Student Note:



Female Section


- To identify elements of ideal prescription

- To know the criteria of essential drugs used in

family and primary health care practices

- To be familial with common mistakes committed

by physician while writing drugs and how to

prevent them

- To know the commonly used abbreviations in

family practice in prescribing

- To identify the important clinical notes before and

during prescribing drugs.eg (reaction , interaction

,sensitivity affordable ,generic name ,dose,

formula


- Elements of ideal prescriptions

- Criteria of essential drugs

- Common mistakes committed by patients while

using drugs and how to prevent them

- Commonly used abbreviations

- Clinical notes before writing any prescriptions

- Clinical notes during writing prescriptions

- Why patient does not comply

85 | P a g e

LECTURE: Prescribing in family practice

Student Note:



fundamental &case studies

- third edition


edition



Lippincott Williams and Williams.

CD-ROM







Self-assessment







86 | P a g e

LECTURE: Evaluation of patient with Fatigue

Student Note:



Female Section

At the end of the lecture you should be able to

- Define fatigue and know the alternative names

- Identify epidemiology of the problem

- list the differential diagnosis of the condition in

PHC office

- To know minor and major criteria of acute and

chronic fatigue

- To interview patient with fatigue

- To examine properly pt with fatigue

- To know how to manage comprehensively. his

condition

- How to investigate condition

- To know when to refer the case


- Definition of fatigue and alternative names

- Differential diagnosis of fatigue

- Minor and major criteria of acute and chronic

fatigue

- Interviewing patient with fatigue

- Managing properly patient with fatigue

- When to refer pt with fatigue

87 | P a g e

LECTURE: Evaluation of patient with Fatigue Student Note:

- References& readings:




edition



Lippincott Williams and Williams

CD-ROM


I





Self-assessment







88 | P a g e

LECTURE: Evaluation of patient with anxiety and depression

Student Note:



Female Section


- Define anxiety and depression

- Know the prevalence of condition in general

population

- To be able to classify anxiety and depressive state

according to DSM IV

- To be familial with significant risk factors of the

condition

- List the common differential diagnosis

- Take good comprehensive clinical history

including exploring hidden agenda

- To know indicators for impending suicide in

patient with anxiety-depression state

- Manage condition including giving advices,

prescribing to know the indicators for referral


- Definition and epidemiology of anxiety-depression

state

- Risk factors for anxiety-depression state

- Differentiation between major-minor depression

- Classifications of the condition

- How to diagnose the condition according to DSM

IV criteria

- How to treat properly including drug prescribing

and giving advices and psycho therapy

Know the indicator for referral

89 | P a g e

LECTURE: Evaluation of patient with anxiety and depression Student Note:





edition



Lippincott Williams and Williams 2010

Lecture note


CD-ROM


I





Self-assessment







90 | P a g e

Minutes of the meeting with preceptor Date: 28-2-2010 Place: Joint program for Family & community Medicine

Prof .Adnan started the meeting by welcoming the preceptors and thanking them for their

contribution toward 5th year teaching on family medicine, then he give a small talk about the

new methods of teaching (SPICIE CURRICLUM) .

latter Dr. Ekram presented the new curriculum and the preceptor's manual to the audience.

On the second part of the meeting (1.5 hrs) the floor was opened for discussion and the following points

were raised:

1-All preceptors were positive toward the new curriculum and they said it was very comprehensive but

they need to study it carefully before their final comment. So Dr. Ekram agree to send the curriculum to

them by E-mail for review .

2-Dr. Faiza comment on the short time allocated for the course and suggest that the course need at least 6

weeks.

3-Dr. Areej suggested that the oral exam to be OSCE exam and each time one center will be responsible

for organization.

4-Dr. Qurashi emphasized on the important of taking on consideration students opinion about the new

curriculum and that the self learning hours need to be very clear to the student with special assignment

bound to them.

5-Dr. Manal suggested that the certain clinics (WBC,ANC) need a chick list of the activity that the

student need to know or to do.

Finally Prof. Adnan thanked all the preceptors for their participation on the meeting.

91 | P a g e

APPENDIX A

KNOWLEDGE REGARDING THE COMMON MEDICAL PROBLEMS

1. Prevalence

2. Risk factors

3. Patho -physiology

4. Clinical presentation

5. Diagnosis/ Diagnostic criteria for example for DM ,HTN and Asthma

6. Complications

7. Investigations

8. Management

a. Non-pharmacological

i. Patient education/counseling

b. Pharmacological

9. Prevention /Screening

10. Indications for referrals

92 | P a g e

APPENDIX B

Red Flags

ASTHMA Red Flags

1. Subjective report of severe difficulty breathing

2. Failure to respond fully and promptly to inhaled β2-agonist therapy

followed promptly by full doses of prednisone

3. Use of accessory muscles of respiration (sternocleidomastoid retraction)

4. FEV1 of less than 1.0 L/sec; peak flow reduced by more than 50% and

declining

5. Underlying cardiac condition

6. Inadequate home situation or a history of poor compliance

7. Failure to respond to treatment, particularly if frequent severe

exacerbations necessitate the use of systemic steroids

8. History of recent asthma attack and ER visits

9. History of ICU admission

10. Fever or existing chest infection

Hypertension Red Flags

1. Malignant hypertension (DBP >130 mm Hg, (retinal hemorrhages,

papilledema, mental status changes, heart failure)

2. Refractory hypertension of unknown etiology

3. Suspected secondary cause of hypertension

4. Worsening renal failure in the setting of adequate control

Obesity Red Flags

1. BMI of 35 or more

2. One or more severe co morbidities that are expected to have a meaningful

clinical improvement with weight reduction (for example, severe mobility

problems, arthritis, type 2 diabetes)

3. Evidence of completion of a structured weight management programme

that covered diet, physical activity, and psychological and drug

interventions but did not result in significant and sustained improvement

in co morbidities

4. Binge eating disorder, dysfunctional eating behavior, history of

intervention for substance misuse, psychological dysfunction, and

depression

Surgical consultation should be considered when the patient is so

morbidly obese and so refractory to medical therapy that the risks

associated with the surgery are less than those of remaining morbidly

obese

93 | P a g e

Abdominal

pain

Red Flags

1. Any evidence suggestive of peritoneal irritation(cholicystitis, appendicitis )

2. Obstruction

3. Acute vascular compromise

4. Ectopic pregnancy

5. Suspected cancer( stomach, pancreas ,liver or colon)

6. Sometimes, further observations made in the hospital can save the patient

a surgical procedure, but no patient with the possibility of a condition that

might require urgent surgery should be sent home from the office.

7. Elderly patients are especially prone to subtle presentations.

8. The patient with unexplained pain that has defied outpatient diagnostic

attempts may benefit from further assessment in the hospital

Common Skin

Problems

Red Flags

1- Failure of ulcers to heal despite good management and a compliant patient

indicates the need for surgical consultation. Fever or other signs of

bacteremia

2- Suspected precancer or cancer( basal cell carcinoma, squamous cell

carcinoma and melanoma)

Diabetes Red Flag

1. Acute hospitalization for intravenous (IV) administration of fluids is

necessary for diabetic patients with protracted nausea and vomiting who

are becoming dehydrated and hyperglycemic. (Diabetic ketoacidosis)

2. Cellulitis of the foot requires IV antibiotic therapy,

3. Pyelonephritis.

4. Elderly diabetic patients with pneumonia or urinary tract infections

benefit from brief hospitalizations.

5. Diabetic retinopathy

6. Marked fluctuations in blood sugar with frequent episodes of

hypoglycemia and hyperglycemia.

7. Nephropathy

8. Ischemic Heart disease

9. Transient ischemic attack/stroke

Red eye Red Flag

1. Problems associated with eye pain, visual disturbance, or corneal

abnormality require immediate referral

2. Keratitis

94 | P a g e

3. Uveitis

4. Corneal lesions/abrasions

5. Acute glaucoma

Anxiety and

depression

Red flag

1. Disabling major depression

2. Bipolar illness, psychosis

3. Patients who fail to respond after 1 to 2 months of appropriate

antidepressant treatment should have a psychiatric consultation.

4. High suicide risk, lack of reliable social supports (if the depression is

severe), history of previously poor response to treatment, or symptoms

that are so severe that the patient requires constant observation or nursing

care

Joint pain Red Flag

1. The diagnosis of polyarticular arthritis may remain uncertain.

2. Consider referral to rheumatology to confirm or establish diagnosis

(differential diagnosis may be difficult, and early treatment is essential).

All patients with RA should be followed by a rheumatologist

3. Septic arthritis

4. Vasculitis

5. Extraarticular disease, involvement of the eyes, lungs, heart, kidneys, or

nervous system is found, hospitalization and consultation should be

promptly considered.

6. Persons with severe constitutional symptoms (e.g., disabling fatigue, fever,

weight loss)

Back pain Red Flag

1. Patients with rapidly progressive neurologic deficits

2. Urgent admission and referral are indicated if symptoms suggestive of

cauda equina syndrome or cord compression develop (e.g., new bilateral

neurologic deficits, urinary retention, sphincter incontinence, saddle

anesthesia, upper motor neuron symptoms and signs, truncal sensory loss).

3. Acute vertebral collapse because spinal stability may be compromised by

the fracture.

4. A suspicion of osteomyelitis or epidural abscess is an indication for

immediate hospitalization and infectious disease consultation

5. In Patients with epidural abscess, treatment must be initiated early to be

effective

Headache Red Flag

1. Progressive headache.

2. Headache that is worse in the morning.

3. Vomiting.

95 | P a g e

4. Inequality of pupils.

5. Papilledema.

6. Onset of severe headache after age 50.

7. Confusion, personality change.

8. Headache that prevent sleep.

9. Headache associated with straining or coughing.

10. A change in usual headache pattern.

11. Other neurological signs or symptoms.

12. Isolated severe headache.

13. Presence of symptoms or signs of vascular disease

a. (e.g. angina, claudication, valvular disease.....).

14. Headache of recent onset (< 6 months)

a. Headache not responding to appropriate management

Fever Red Flag

1. Patients who appear toxic, frail, or immunocompromised should be

admitted promptly and infectious disease consultation obtained.

2. Weight loss and debilitation, early hospitalization should also be

considered.

3. Fever remains elevated above 101°F for weeks and ambulatory diagnostic

efforts have been unsuccessful, It is often beneficial to bring the patient

into the hospital for closer evaluation, documentation of fever, and

infectious disease consultation

Upper

respiratory

tract infection

Red Flags

1. High fever

2. prolonged fever and illness.

3. Toxicity and looking ill.

4. Mental state changes

5. Breathlessness

6. Prominent Headache

7. Features of Kawasaki disease

8. Drooling of saliva

9. Stridor

10. Neck stiffness

11. Coming from areas endemic with malaria or other infections

12. Presence of epidemics of hemorrhagic viral diseases or influenza.

13. Jaundice and possibility of hepatitis

96 | P a g e

APPENDIX C

PROCEDURAL SKILLS

1. Taking vital signs 2. First aid 3. Infant measurement (HC, HT, Wt) 4. Growth chart plotting & reading 5. Psychomotor assessment (DENVER DEVELOPMENT CHART) 6. Glucometer testing 7. Injections – subcutaneous, intradermal, intramuscular, and intravenous 8. Urine dipstick 9. Pelvic and rectal exams 10. Peripheral neuropathy testing (filament) 11. Peak flow meter, inhalers 12. Wound dressing

(Note: The degree of expertise that a student will be able to demonstrate for any one of these procedures depends on the learning context; the procedures are listed simply as a guide to the type and range of procedural skills appropriate for learning in a family practice setting.) .In addition to the PHC setting students will have one half day session in clinical skill lab where they will be guided about the procedures.

97 | P a g e

APPENDIX D

Screening Recommendations

Update of existing recommendations as well as new recommendations issued by USPSTF, could be

accessed at http://www.ahrq.gov/clinic/prevnew.htm.

THESE ARE FEW IMPORTANT RECOMMENDATIONS AS ACCESS IN March 2010.

Kindly Refer to the above link for additional detail.

Breast Cancer, Mammography:

Family physicians should discuss with each woman the potential benefits and harms of breast

cancer screening tests and develop a plan for early detection of breast cancer that minimizes

potential harms. These discussions should include the evidence regarding each screening test, the

risk of breast cancer, and individual patient preferences. The recommendations below are based

on current best evidence as summarized by the United States Preventive Services Task Force

(USPSTF) and can help to guide physicians and patients. These recommendations are intended

to apply to women who are not at increased risk of developing breast cancer and only apply to

routine screening procedures.

The AAFP recommends that the decision to conduct screening mammography before age 50

should be individualized and take into account patient context including her risks as well as her

values regarding specific benefits and harms. (January 2010)

(Grade C Recommendation)

(Grade Definition: http://www.ahrq.gov/clinical/uspstf/gradespost.htm#crec)

Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm#clinical

The AAFP recommends biennial (every two years) screening mammography for women between

ages 50 and 74. (January 2010)

(Grade B recommendation)



Breast Cancer, Mammography

The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of

screening mammography in women aged 75 years and older. (January 2010)

(Grade I recommendation)



Aspirin for the Prevention of Cardiovascular Disease The AAFP recommends the use of aspirin for men age 45 to 79 years when the potential

benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an

increase in gastrointestinal hemorrhage.

(Grade: A recommendation)

(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)

http://www.ahrq.gov/clinic/prevnew.htm

98 | P a g e

(Clinical Considerations:

http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical)

Aspirin for the Prevention of Cardiovascular Disease :

The AAFP recommends the use of aspirin for women age 55 to 79 years when the

potential benefit of a reduction in ischemic strokes outweighs the potential harm of an

increase in gastrointestinal hemorrhage. (Grade: A recommendation)

(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)

Clinical Considerations:

http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical

Cervical Cancer: New Technologies The AAFP concludes that there is insufficient evidence to recommend for or against

routine use of new technologies to screen for cervical cancer.

(Grade: I recommendation)

(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)

(Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical)

Cervical Cancer, HPV Testing:

The AAFP concludes that there is insufficient evidence to recommend for or against

routine use of human papillomavirus (HPV) testing as a primary screening test for

cervical cancer.

(Grade: I recommendation)



Cervical Cancer, Pap Smear:

The AAFP strongly recommends that a Pap smear be completed at least every 3 years to

screen for cervical cancer for women who have ever had sex and have a cervix.

(Grade: A recommendation)



Colorectal Cancer:

Adults The AAFP recommends screening for colorectal cancer using fecal occult blood testing,

sigmoidoscopy, or colonoscopy, in adults, beginning at age 50 years and continuing until age 75

years. The risk and benefits of these screening methods vary. (Grade: A recommendation)

(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec) (Go to Rationale and

Clinical Consideration : http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm)

99 | P a g e

APPENDIX E

Oxford Centre for Evidence-based Medicine Levels of Evidence (March

2009)

(for definitions of terms used see glossary at

http://www.cebm.net/?o=1116)

Level of Recommendation

A consistent level 1 studies

B consistent level 2 or 3 studies or extrapolations from level 1 studies

C level 4 studies or extrapolations

from level 2 or 3 studies

D level 5 evidence or troublingly inconsistent or inconclusive studies of any level

http://www.cebm.net/?o=1116

100 | P a g e

Level Therapy/Prevention,

Etiology/Harm

Diagnosis Differential diagnosis/symptom

prevalence study

1a SR (with homogeneity*)

of RCTs

SR (with homogeneity*) of Level

1 diagnostic studies; CDR† with

1b studies from different clinical

centers

SR (with homogeneity*) of

prospective cohort studies

1b Individual RCT (with

narrow Confidence

Interval‡)

Validating** cohort study with

good††† reference standards; or

CDR† tested within one clinical

centre

Prospective cohort study with

good follow-up****

1c All or none§ Absolute SpPins and SnNouts†† All or none case-series


of cohort studies

SR (with homogeneity*) of Level

>2 diagnostic studies

SR (with homogeneity*) of 2b

and better studies

2b Individual cohort study

(including low quality

RCT; e.g., <80% follow-

up)

Exploratory** cohort study with

good††† reference standards;

CDR† after derivation, or

validated only on split-sample§§§

or databases

Retrospective cohort study, or

poor follow-up

2c "Outcomes" Research;

Ecological studies

Ecological studies


of case-control studies

SR (with homogeneity*) of 3b and

better studies

SR (with homogeneity*) of 3b

and better studies

3b Individual Case-Control

Study

Non-consecutive study; or without

consistently applied reference

standards

Non-consecutive cohort study, or

very limited population

4 Case-series (and poor

quality cohort and case-

control studies§§)

Case-control study, poor or non-

independent reference standard

Case-series or superseded

reference standards

5 Expert opinion without

explicit critical appraisal,

or based on physiology,

bench research or "first

principles"

Expert opinion without explicit

critical appraisal, or based on

physiology, bench research or

"first principles"

Expert opinion without explicit

critical appraisal, or based on

physiology, bench research or

"first principles"

Produced by Bob Phillips, Chris Ball, Dave Sackett, Doug Badenoch, Sharon Straus, Brian Haynes,

Martin Dawes since November 1998. Updated by Jeremy Howick March 2009.

101 | P a g e

Appendix F

Tentative Timetable for the Family medicine course (5 weeks)

Week 5

(8) hours

Week 4

12 hours

Week 3

12 hours

Week 2

12 hour

Week 1

8 hours

Chronic Disease

Clinic DM (3)

Health (2)Education

ANC

((3

WBC

)3)

Triage

(1hr)

Counseling

(2)

Chronic Disease

Clinic HTN

(3)

Medical

Records

(1)

Dietitians

(1)

Emergency

(2)

Chronic Disease

Clinic Asthma

(3)

Pharmacy

Essential

Drugs (1)

GC (5) GC (6) GC (6) GC (5) GC (5)

52 hrs TOTAL

Tentative Educational Activities at PHC Center

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Appendix G

Tentative Timetable for the Family medicine course (5 weeks)

2:30-4:00

pm 1:00-2:30 pm 10.30-12 Noon am 8:00-10:30 week (1)

Consultation & communication skills in family medicine

Family medicine

Concepts and

principles

Concepts and

principles of

primary health

care

Saturday

SELF LEARNING Counseling In

Family Medicine Approach to

patient with Fever Sunday

Problem Oriented

Medical Record

Family in health and disease

PHC Monday

Evidence Based Medicine PHC Tuesday

Anticipatory

care Management in

family practice Skills Lab Wednesday

Tentative schedule for the Family medicine course (week 1)

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1:00-2:30 pm 10:30-12 noon 8-10:30 am Week (2)

Learning in

family medicine Prescribing PHC Saturday

SELF LEARNING Evaluation of Type

II Diabetes Evaluation of patient

with headache Sunday

Geriatric care

PHC Monday

MCH at PHC level

Interpretation of

lab test PHC Tuesday

Evaluation of

patient with

Anxiety and

depression

Periodic health

exam complementary medicine field visit Wednesday


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2.30-4pm 1-2.30 pm 10.30 -12:00

noon 8-10.30 am Week (3)

Hypertension Dyslipidemia Feedback Mid Rotation

Evaluation Saturday

SELF LEARNING PHC Sunday

Approach to patient with Fatigue

Evaluation of patient

with Obesity

PHC Monday

Common Skin Disease Evaluation of patient

with Red Eye

PHC Tuesday


with Back pain


with Joint pain

Geriatric s Field Visit Wednesday


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2:30-4:pm 1:00-2:30pm 10.30-12 noon 8:00-10:30am Week (4)

Hypertension Dyslipidemia PHC Saturday

SELF LEARNING Evaluation of

patient with abdominal

pain

Evaluation of patient with asthma

Sunday

Approach to

patient with Fatigue

Evaluation of patient with Obesity

PHC Monday

Common Skin

Disease Evaluation of patient

with Red Eye PHC Tuesday

Evaluation of

patient with Back pain

Evaluation of patient with Joint pain

Home Care Field Visit Wednesday


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1-4pm 8:00-12:00

Days

Home Health Care

Telephone

Consultation

PHC Saturday

Self Learning PHC Sunday

Feedback & Revision Monday

Modified OSCE

Tuesday

Final written Exam Wednesday

Tentative schedule for the Family medicine course (week5)

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Total

Hours

Fifth

Week hours

Fourth Week hours

Third

Week hours

Second Week hours

First Week hours

Activity

35 6 10.5 18.5 Fundamentals topics

32 10 12 8.5 1.5 Clinical topics

52 8 12 12 12 8 PHC

16 4 Home care

4 Geriatric care

4 complementary

medicine

4 Skills lab

Field visit

22 3+7 3 3 3 3 Self study

157 TOTAL

Instructional Method by Number of Hours /Week

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KING ABDULAZIZ UNIVERSITY

FACULTY OF MEDICINE

DEPARTMENT OF FAMILY & COMMUNITY MEDICINE

Family Medicine Clerkship

Log Book

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INDEX

CONTENTS: Page No.

Introduction … 3

Attachment Centers … 4

Common problems … 5

Psychiatric, behavioral & emotional problems … 9

Acute and Emergent problems … 10

Anticipatory Care … 11

Health education counseling … 13

Laboratory … 14

The pharmacy … 15

Dressing room … 16

Emergency room … 17

The practical skills and competencies … 18

General comments & Observations … 26

Students Attachment Evaluation Format … 30

Appendices … 31

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INTRODUCTION: Welcome to Family Medicine Clerkship.

This Log book together with the Study guide are helpful orientation tools for

you , and euthanatize what has been done and for us to comprehend what you

have achieved and best evaluate you. The log book accounts for 8% of the overall assessment. In addition, you will be questioned about rational of

management of the cases as part of the end of rotation assessment.

Pay careful attention to instructions provided by faculty member, preceptors.

Punctuality, attendance, active participation and positive attitude are essential for a successful rotation.

Don’t hesitate to nicely ask and seek the help of anybody at the center.

Be friendly and humble with everyone and enjoy this very fruitful rotation.

Good Luck

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Student Name: ___________________________

I.D. Number: ____________________________

Attachment Centers:

1. ___________________________

2. ___________________________

3. ___________________________

Academic Supervisor(s):

1. ____________________________

2. ____________________________

Trainers:

1. ___________________________

2. ___________________________

3. ___________________________

4. ___________________________

5. ___________________________

6. ___________________________

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LOG OF EXPERIENCES

Experience: Common Problems

(e.g. Infections, minor trauma, skin & eye disorders, URTI,

UTI, diabetes, hypertension, asthma…..etc.)

No.

Description of the case, the consultation process, procedures,

assessment and plan including education, follow up, referral

…..etc.(+ Learning notes).

Data, Place &

Authentication

1.

Date:

Place:

Attended with

Name:

Signature

2.

Date:

Place:

Attended with

Name:

Signature

No. Description of the case, the consultation process, procedures, Data, Place &

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Authentication

3. Date:

Place:

Attended with

Name:

Signature

4. Date:

Place:

Attended with

Name:

Signature

5.

Date:

Place:

Attended with

Name:

Signature

No. Description of the case, the consultation process, procedures,



Data, Place &

Authentication

6. Date:

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Place:

Attended with

Name:

Signature

7. Date:

Place:

Attended with

Name:

Signature

8. Date:

Place:

Attended with

Name:

Signature




Data, Place &

Authentication

9. Date:

Place:

Attended with

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Name:

Signature

10. Date:

Place:

Attended with

Name:

Signature

11. Date:

Place:

Attended with

Name:

Signature

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LOG OF EXPERIENCES

Experience: Psychiatric, behavioral and Emotional problems

(e.g. Stress reactions, grief reactions, anxiety, depression, addiction,

family conflicts & abuse (children, mothers, elderly….etc.)

No.

Description of the case, the consultation process, procedures,



Data, Place &

Authentication

1.

Date:

Place:

Attended with

Name:

Signature

2.

Date:

Place:

Attended with

Name:

Signature

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LOG OF EXPERIENCES

Experience: Acute and Emergent Problems

(e.g. chest pain, acute abdomen, shock, trauma,….etc.)

No.

Description of the case and what has been done; History,

examination, investigation, procedures…etc.(+Learning notes).

Data, Place &

Authentication

1.

Date:

Place:

Attended with

Name:

Signature

2.

Date:

Place:

Attended with

Name:

Signature

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LOG OF EXPERIENCES

Experience: Anticipatory Care (Promotive and Preventive Care)

(Antenatal / Postnatal care, child screening, immunization, Premarital counseling, preplacement

counseling, Periodic health counseling….etc.)


education, follow up..etc.(+ Learning notes)

Data, Place &

Authentication

1.

Date:

Place:

Attended with

Name:

Signature

2.

Date:

Place:

Attended with

Name:

Signature


education, follow up..etc.(+ Learning notes)

Data, Place &

Authentication

3. Date:

Place:

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Attended with

Name:

Signature

4. Date:

Place:

Attended with

Name:

Signature

5. Date:

Place:

Attended with

Name:

Signature

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LOG OF EXPERIENCES

Experience: Health education counseling

(e.g. use of inhalers, smoking cessation, dieting advice,

Exercise, family spacing,….etc.)

No.

Describe the encounter and patients details, what was done to

him and how and who else was involved.(+Learning notes)

Data, Place &

Authentication

1.

Date:

Place:

Attended with

Name:

Signature

2.

Date:

Place:

Attended with

Name:

Signature

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LOG OF EXPERIENCES

Experience: the mini attachments: Laboratory

The attachement

A brief description of the things learned, cases or procedures

observed.

1) The first laboratory

attachment:

Place:

Date:

Attended with:

Name:

Signature:

2) The second laboratory

attachment:

Place:

Date:

Attended with:

Name:

Signature:

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LOG OF EXPERIENCES

Experience: the mini attachments: the Pharmacy

The attachement


observed.(+Learning notes)

1) The first pharmacy

attachment:

Place:

Date:

Attended with:

Name:

Signature:

2) The second pharmacy

attachment:

Place:

Date:

Attended with:

Name:

Signature:

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LOG OF EXPERIENCES

Experience: The mini attachments: Dressing Room.

The attachement



1) The first dressing

room attachment:

Place:

Date:

Attended with:

Name:

Signature:

2) The second dressing

room attachment:

Place:

Date:

Attended with:

Name:

Signature:

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LOG OF EXPERIENCES

Experience: The mini attachments: Emergency Room.

The attachement



1) The first emergency

room attachment:

Place:

Date:

Attended with:

Name:

Signature:

2) The second emergency

room attachment:

Place:

Date:

Attended with:

Name:

Signature:

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LOG OF EXPERIENCES

The Practical Skills and competencies:

(A list of the disease based competencies skills done or seen:

See the appendix. A minimum of 50% of the listed skills

And competencies have to be done during the 5 weeks rotation).

Authentication Place Date The skill or competency No.

Name:

Sig.

1.

Name:

Sig.

2.

Name:

Sig.

3.

Name:

Sig.

4.

Name:

Sig.

5.

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LOG OF EXPERIENCES






Name:

Sig.

6.

Name:

Sig.

7.

Name:

Sig.

8.

Name:

Sig.

9.

Name:

Sig.

10.

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LOG OF EXPERIENCES






Name:

Sig.

11.

Name:

Sig.

12.

Name:

Sig.

13.

Name:

Sig.

14.

Name:

Sig.

15.

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LOG OF EXPERIENCES






Name:

Sig.

16.

Name:

Sig.

17.

Name:

Sig.

18.

Name:

Sig.

19.

Name:

Sig.

20.

LOG OF EXPERIENCES


129 | P a g e





Name:

Sig.

21.

Name:

Sig.

22.

Name:

Sig.

23.

Name:

Sig.

24.

Name:

Sig.

25.

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LOG OF EXPERIENCES






Name:

Sig.

26.

Name:

Sig.

27.

Name:

Sig.

28.

Name:

Sig.

29.

Name:

Sig.

30.

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LOG OF EXPERIENCES






Name:

Sig.

31.

Name:

Sig.

32.

Name:

Sig.

33.

Name:

Sig.

34.

Name:

Sig.

35.

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LOG OF EXPERIENCES






Name:

Sig.

36.

Name:

Sig.

37.

Name:

Sig.

38.

Name:

Sig.

39.

Name:

Sig.

40.

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LOG OF EXPERIENCES

Experience: Complementary medicine session

The attachement



Place:

Date:

Attended with:

Name:

Signature:

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LOG OF EXPERIENCES

Experience: The home care visit

The attachement



Place:

Date:

Attended with:

Name:

Signature:

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LOG OF EXPERIENCES

Experience: Geriatric visit

The attachement



Place:

Date:

Attended with:

Name:

Signature:

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LOG OF EXPERIENCES

Experience: Community health resources

(Write down the health resources in the

Community which are helpful for the center

role in health care " + Learning notes ")

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LOG OF EXPERIENCES

Other activities and experiences:

(On the next pages document the case scenarios, presentations, lectures, other out center extra-

reach activities, or any other beneficial experiences you come across during the attachment).

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LOG OF EXPERIENCES

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LOG OF EXPERIENCES

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LOG OF EXPERIENCES

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Appendix I

LIST OF COMPREHENDED AND PRACTICED COMPETENCIES:

1. How to breaking bad news or dealing with a demanding or angry patient.

2. How to write a proper referral letter.

3. Using the Problem Oriented Medical Record “POMR” in documentation of medical data for

patients.

4. Plotting charts for anthropometric measurements (weight, height, head circumference….etc).

5. Listing developmental milestones systematically including normal psychosocial developments of a

child.

6. Giving advice for a balanced diet for a child or a pregnant women or an adult.

7. Examining and managing a child with diarrhea, URTI, UTI or any other acute problem.

8. Giving antenatal and post natal care consultation.

9. Exercise education for a pregnant woman or obese patient, or a diabetic or a hypertensive patient.

10. Prescribing for a pregnant lady or a child, or an elderly.

11. Psychosocial preparation of a pregnant lady for delivery.

12. Giving birth spacing advice.

13. Fundosopic examination.

14. Otoscopic examination.

15. Measuring blood pressure using sphygmomanometer

16. Interviewing and managing a case of URTI.

16. Interviewing and counseling a diabetic patient.

17. Interviewing and counseling a hypertensive patient.

18. Interviewing and counseling an acute asthma patient, including drug instruction demonstrating the

usage of inhalers, spacers, desk haler….etc. and measuring lung functioning using the peak flow

meter and educating patient on in usage of peak flow meter.

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19. Giving psychotherapy, consulting and prescribing for a depressed or an anxious patient.

20. Giving counseling for smoking cessation.

21. Interviewing and counseling a patient with headache.

22. Interviewing and counseling a case of irritable bowel syndrome.

23. Interviewing and counseling a patient with back pain including examination and exercise

education.

24. Dealing with a red eye.

25. How you perform ABC’s of First Aids.

26. How you establish an effective CPR?

27. Giving I/M injection.

28. Giving I.V injection.

29. How you dress a wound?

30. How to interpret urinalysis results?

31. How to interpret CBC?

32. How to interpret a lipid profile?

33. How to interpret a renal profile?

34. How to interpret a liver profile?

35. How to use a glucometer?

36. How to use and interpret a dipstick for a diabetic?

37. How you interpret CXR, KUB, plain x-ray abdomen and x-ray?

38. Health educating a group of patients & relatives.

39. Reading an article critically and designing for project, survey and paper publishing.

40. Family medicine based outreach activity.

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KING ABDULAZIZ UNIVERSITY

FACULTY OF MEDICINE

DEPARTMENT OF FAMILY & COMMUNITY MEDICINE

Family Medicine Clerkship

Preceptor Guide

2010-2011

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Introduction:

Department of Family medicine in the College of Medicine at the King Abdulaziz

University would like to express its gratitude and appreciation for your cooperation and

participation in the clinical training of the fifth year students in the clerkship of Family

Medicine at your Primary health care center.

We believe that offering the student an opportunity to train in a real clinic environment

will go a long way in strengthening their perception and realization of the professional

duties of a practicing family physician. In addition; it will provides hands-on experience

about the scope of patients encounters in the community. The Family medicine rotation is

comprised of five-week clinical clerkship, currently scheduled during the fifth year of

medical education. The clerkship is intended to introduce students to the profession of

family medicine, family physicians responsibilities and approach to the ongoing health

care of individuals and families, integrating social, psychological, economic, cultural and

biological issues.

As an instructor in the clerkship, we would like to provide you with the specific objectives

of the clerkship.

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ROTATION LEARNNING OBJECTIVES:

A) Principles of Family Medicine and Primary Health Care Learning Objectives (Appendix A)


5. Describe and apply the principles of family medicine

6. Describe and apply the principles of primary health care

7. Discuss the features unique to the specialty of family medicine

8. Describe the competencies and attributes specific to family physicians

B) Communication Skills learning objectives

at the end of the rotation, the student will be able to:

5. Apply Pendleton's Seven Tasks Model Of Consultation

6. Apply communication skills techniques based on patient’s age, and level of education

7. Write chart notes using subjective, objective, assessment, plan format

8. Write clear and accurate orders for

a. Investigations

b. Prescriptions

c. Referral letter

C) Clinical Skills Learning Objectives


14. Demonstrate knowledge of clinical problems commonly seen in family medicine and their

management ( Appendix A)

15. Demonstrate an ability to assess and manage patients seen within the family medicine setting,

including:

Take an accurate and appropriate history

Perform a focused and accurate physical exam

Develop an appropriate differential diagnosis

Order investigations in a focused problem oriented manner

Develop and implement an appropriate management plan

16. Recognize “red flags” which might indicate serious medical condition (Appendix B)

17. Demonstrate and explain the indications for procedures commonly performed in family medicine

(Appendix C)

18. Demonstrate and apply knowledge of age and gender specific periodic health examination as

presented in the Guide of the US Preventive Services Task Force. (Appendix D)

19. Develop skills in health promotion, disease prevention, and health education and apply them in

patient care.

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20. Apply the patient -centered approach to patient encounters including:

Identifying the patient’s ideas and concerns regarding his/her illness, the effect

of the disease on patient's functioning and patient's expectations regarding

treatment

Determining the psychosocial context of the patient’s disease

Involve patient in the development of a treatment plan

Demonstrate an understanding of the patient’s life cycle in the context of their

illness

21. Explain and apply basic elements of child preventive services in well baby clinic (WBC) in the

PHC centre

22. Explain and apply elements of antenatal care in the PHC centre

23. Perform geriatric assessment (history and physical examination), including mobility and gait and

balance assessments, mini-mental status examination

24. Describe the main types of complementary and alternative medicine

25. Explain uses of complementary and alternative medicine, and how it can be integrated in

family practice

26. Describe the concepts of evidence based medicine (Appendix E )

D) Community Resource learning objectives


1. Discuss the role the family physician plays in his/her community

2. Demonstrate a basic knowledge of relevant social issues which may impact on a

Patient's health in the community

3. Demonstrate a basic knowledge of health care resources in the community

6. Understand the limitations of health care resources available to the community

E) Professionalism Learning Objectives


5. Demonstrate professional and ethical behavior with the patient, relatives , peers,

And preceptors at all times

6. Demonstrate respect for the confidentiality of patients and their families

7. Recognize his/her limitations and ask for assistance when appropriate

8. Respond to feedback in a constructive and professional manner

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PRECEPTOR INVOLVEMENTIN FAMILY MEDICINE ROTATION

↓

↓

↓ ↓

↓

5 week Family medicine rotation

Assign students to preceptors on the first day of rotation, Student

orientation to PHC

Task about working of different components of PHC pharmacy, laboratory radiology etc

(Not more than 1 hour/day)

Student will have patient encounters (history, physical examination,

differential diagnosis, management of patient with common problems) 20

min/patient

The Preceptor will review student’s performance

By the end of the second week

Preceptor will evaluate students beginning of 5

th week

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Student Expectations

The students will be coming to the primary health care centers on 3 rd day of their rotation,

during the first week of the clerkship, the student and the preceptor in charge should

discuss the student’s goals for the rotation, and what the student has to accomplish in the

context of the preceptor’s practice in order to pass the clerkship. We encourage you to get

your patients’ permission for students to participate in their care.

We feel that all physicians and health care workers are the teachers of medical students

and can better equip the medical students today to be excellent physicians in the future.

These students will be teachers to each of us as well.

The medical content of this rotation is defined by the fact students spend the majority of

their rotation seeing patients with you in your primary care clinic where most patients have

their first contact with the medical system.

.

During the clinical experience in family practice, you will instruct the students and help

them to achieve the following

Demonstrate and apply communication and consultation skill with the patient

Approach to common medical problems. (chronic illness)

Refine skills in conducting PROBLEM ORIENTED histories and physical

examinations on patients in the outpatient settings.

Compose appropriate clinical progress notes in the SOAP format for the chart

Develop prioritized differential diagnoses and treatment plans for the patients seen.

Age-appropriate preventive medical care medicine, health maintenance and follow-

up.

Demonstrate and recognize appropriate professional behavior.

Know his or her limitations in a given field of knowledge.

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Participate/oriented in the different activities

How to coordinate the care of the patient within and outside the PHC

GENERAL INFORMATION ABOUT THE FAMILY MEDICINE

PRECEPTORSHIP

Length and Activities of the Preceptor ship

The rotation is Five weeks in length. The last 3 days of the rotation students will be

involved exam.

Scheduling Process

Students will be spending some time in the following areas of PHC

Dressing room

Laboratory

Pharmacy

Antenatal clinic

Well baby clinic

Screening clinic

Majority of the time should be devoted to patient encounters

Physician’s Office Orientation

An orientation to the office of the preceptor should be provided by the preceptor or

designated staff person the first morning of the rotation. It should include:

- PHC location and layout

- the office staff

- Patient care documentation

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- Issues of confidentiality

- Mutual goals and expectations

- Numerical Patient Target Goals

- Student should discuss their goals and expectations for the course

Introduction to Patients

Past experience shows that most patients do not object to the properly introduced medical

student. The student should be introduced as a “medical student.” Students have name tags

with medical student beneath their name so there should be no confusion as to their level

of training. When a patient objects to the presence of a medical student and no other

clinical opportunities are available at that time, have the student read or work on course

objectives.

STUDENT DOCUMENTATION

Students are encouraged to write in SOAP format. All written orders and chart entries

made by the student must be countersigned by a supervising physician.

SUPERVISION AND TEACHING:

Meet with the student the first day of the rotation

.

Provide an office-oriented, ambulatory patient-care experience with emphasis on

diagnosing common problems, delivering preventive health care, and providing

continuity of care.

Assess the student’s level of skill and experience. Attempt to match the student’s level

of patient-care responsibility to the level of student’s patient-care skill.

Review the next day’s schedule to identify patients of educational benefit. Students can

focus reading activities around those patients. It is not the responsibility of the

preceptor to teach the student about every medical problem seen. Students should be

expected to read and research topics and bring information back to preceptors for

discussion.

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Provide on-site supervision of the student at all times and ensure that the student is

never involved in the actual or apparent practice of medicine without this on-site

direction.

Supervision by multiple preceptors

The majority of student time in this rotation should be spent with one (or possibly two, if

pre-arranged) preceptors. If there are partners in the same primary care, a student may

spend a day with one of them. However, the approved preceptor for that rotation should be

the primary teacher. Under no circumstances should a student rotate for a day or two at a

time with multiple partners.

Contact course coordinate promptly if there are concerns about student performance or

other issues of concern.

REQUIRED READING

Topics assigned to Family Medicine Preceptor ship students during the FM rotation.

Students will be responsible for discussing the material in these cases with their

preceptors. These topics are

Also covered in clinical sessions at campus.

The Clinical Topics

1) Diabetes Mellitus

2) Hypertension

3) Dyslipidemia

4) Obesity

5) Asthma

6) Upper respiratory infections

7) Common skin lesions

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8) Back pain/osteoporosis

9) Joint pain/arthritis

10) Abdominal pain

11) Anxiety And Depression (common psychiatric encounters)

12) Headache

13) Emergencies in family medicine

14) Fatigue

15) Fever (general approach)

16) Well Child Care

17) Antenatal Care

18) Red Eye

19) Geriatric care

20) Anticipatory care

Further readings based on clinic experiences or clinical questions are strongly encouraged Students in the Family Practice Clerkship must attend all assigned clinical sessions, which

includes at least 15 half days in the ambulatory setting. Absences from assigned

outpatient sessions must be pre-arranged with and approved by the course coordinator.

The logbook will verify student attendance in the clinical setting.

During the clerkship, instruction is provided on skills appropriate to family practice. By

the end of the clerkship, the student should have observed or performed at least 50% listed

in the clerkship logbook. These skills must also be verified by the supervising physician.

These will also be reviewed at mid-clerkship and end of posting exam.

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The student maintains a logbook of patients and problems seen in the clinical setting. The

student is encouraged to enter all diagnoses and procedures into the logbook, whether

those encounters are required or not. This way the student will have a complete record of

his/her experience.

Family medicine clerkship specifies the number of encounters of different diagnoses that a

student must have to achieve the objectives of the clerkship. These are mentioned in the

log book. If a student does not meet the minimum (based on log-book documentation),

paper cases will suffice for fulfilling the requirement.

At mid-clerkship, student logbook will be reviewed to insure that they are keeping up and

are being exposed to the clinical encounters.

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Evaluation of Students

You will be responsible for rating the student’s clinical performance at the end of the clerkship.

This evaluation will be sent to you via email and completed in a web-based application called E-

Value. In an attempt to provide more consistency in evaluating student clinical performance, we

have added specific criteria to each question in the data collection and assessment portion of which

will be included in the web-based evaluation form.

The course coordinator will be contacting you during the 4th

or 5th week of the clerkship for a brief

update on the student’s performance.

Evaluation of Preceptors At the end of each clerkship, students have the opportunity to provide comments regarding their

experiences with their community preceptors.

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Preceptor evaluation form

Domain/ Assessment Poor

(0) Average

(0.50) Good

(1)

Interpersonal

skill

Description of

The expected behavior

1 Establishes rapport with

patients

2 Demonstrates respect for

patients

3 Works well with all

members of the healthcare

team

(team work)

Clinical skills

4 History taking

Reports clinical data by

obtaining and

communicating the clinical

facts in an organized

manner

5 Physical examination

6 Differential diagnosis

7 Problem solving(Interprets

clinical data by prioritizing

problem list and selecting

clinical findings and test

results to support the most

likely diagnoses)

8 Management plan (Devises

an appropriate and

comprehensive

management strategy.)

Professional

Attributes

.

9 Attendance

(Punctuality)

.

10 Follows through on

commitments and tasks

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How long (e.g. days/ weeks) have you worked with this student? ________

Please include your written comments

Student’s Strengths:

Areas for Improvement:

Was this evaluation discussed with the student? ____Yes ____No

Preceptor’s Name _______________________________________

Preceptor’s Signature: _____________________________________________

Date: ______________

Thank you for submitting this form and helping us in the evaluation of the students

king abdulaziz university faculty of medicine department ... 44. educational development unit nhs...

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