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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)
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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
18. Countries. Khalid BA.
Ann Saudi Med. 2008 Mar-Apr; 28(2):83-8.
19. Clinical teaching capacity in New Zealand general practice.Pullon S, Lum R.
N Z Med J. 2008 Jan 25; 121(1268):U2895
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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.
22. Evaluation of a task-based community oriented teaching model in family medicine for
undergraduate medical students in Iraq.Al-Dabbagh SA, Al-Taee WG
23. BMC Med Educ. 2005 Aug 22;5:31.Discipline of General Practice The university of Adelaide SA
5005 Australia accessed Feb. 2009
24. General practitioners for the next millennium: suggestions for medical curriculum reform.
Siddiky A.Br J Gen Pract. 2004 Aug; 54(505):638-40; discussion 641.
25. Expanding primary care-based medical education: a renaissance of general practice? Van Der
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
At the end of the rotation, the student will be able to:
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
At the end of the rotation, the student will be able to:
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
At the end of the rotation, the student will be able to:
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
Department: Family and community medicine
Tutorial : Male Section: Dr.Jameel Bashawari
Female Section: Dr. Jawaher Al-Ahmadi
EBM is a recent valid approach to clinical decision
making instead of relying on reasoning and clinical
experience alone.
Student Note:
At the end of the tutorial you should be able to:
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.
Contents of lecture:
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.
References& readings:
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
Department: Family and community medicine
Tutorial : Male Section: Dr.Hashim Fida
Female Section: Dr. Ekram
Student Note:
At the end of the tutorial you should be able to:
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.
Contents of lecture:
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& readings:
References& readings:
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/
Assessment & evaluation method:
Problem-Based Cases
Participation in the session
End of rotation MCQs
36 | P a g e
LECTURE: Counseling
Student Note:
Department: Family and community medicine
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
Contents of lecture:
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
References& readings:
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
Assessment & evaluation method:
Student Notes:
39 | P a g e
LECTURE: Problem Oriented Medical Record Student Note:
Department: Family and community medicine
Tutorial : Male Section: Dr.Jameel Bashawari
Female Section: Dr. Jawaher Al-Ahmadi
Problem oriented medical record (POMR) achieves its
maximum potential in family medicine. It is essential for
providing continues care for chronic or complex cases.
At the end of the tutorial you should be able to:
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
Contents of lecture:
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
http://www.aafp.org/x3843.xml
Self-assessment
Describe SOAP format
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LECTURE: HEADACHE
Student Note:
Department: Family and community medicine
Tutorial : Male Section: Dr.Mahdhi
Female Section: Dr. Jawaher Al-Ahmadi
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.
At the end of the tutorial you should be able to:
1-Outlin epidemiology of headache
2-Describe risk factors for headache
3--Evaluate patient with new-onset headache (history-
examination-investigation)
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:
Contents of lecture:
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
Problem based case scenario
Headache is a common clinical challenge encountered by
family physician.
A comprehensive history and physical examination are the
essential steps in the management.
References& readings:
-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?
43 | P a g e
LECTURE: Learning in Family Medicine
Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr. Jameel Bashawri
Female section :Dr.Jawaher Alhmadi
At the end of the lecture you should be able to:
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:
References& readings:
CD-ROM
You have the opportunity to read the lectures of CD-ROM
In the following site (or at the department library??)
http://www.ejournal.afpm.org.my
Self-assessment
Q: Choose a learning method and discuss how it helps to
produce deep learning.
Assessment & evaluation method:
- Student's portfolio
45 | P a g e
LECTURE: Evaluation of Patient with Abdominal Pain
Student Note:
Department: Family and community medicine
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.
At the end of the lecture you should be able to:
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
Contents of lecture:
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.
References& readings:
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
Assessment & evaluation method:
MCQ’s
Clinical scenario description
47 | P a g e
LECTURE: Evaluation of Patient with Asthma
Student Note:
Department: Family and community medicine
Lecturer : Male Section Dr.Hashim Fida
Female Section Dr. Rahila Iftikhar
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
At the end of the lecture you should be able to:
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:
Contents of lecture:
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
Assessment & evaluation method:
MCQ
Case-Based Discussion
50 | P a g e
LECTURE: Interpretation of Laboratory Test
Student Note:
Department: Family and community medicine
Lecturer: Male Section Dr.Mahdi Qadi
Female Section Dr. Rahila Iftikhar
At the end of the lecture you should be able to:
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
Contents of lecture:
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:
References& readings:
Essential Family Medicine Fundamentals and case
studies Rakel third edition chapter 13 page 148
Self-assessment
Assessment & evaluation method:
MCQs
Case based Discussion
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LECTURE: The Family in Health & Disease Student Note:
Department: Family and community medicine
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
At the end of the lecture you should be able to:
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
Contents of lecture:
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
References& readings:
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
Assessment & evaluation method:
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.
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LECTURE: Approach to a Patient with Fever
Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr. Hashim Fida
Female Section: Dr. Ekram
At the end of the lecture you should be able to:
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
Contents of lecture:
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
References& readings:
Lecture note
Rakel ;essential family medicine
55 | P a g e
LECTURE: Approach to a Patient with Fever Student Note:
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
Assessment & evaluation method:
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LECTURE: Periodic Medical Examination Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr Mahdi
Female Section: Dr Ekram
At the end of the lecture you should be able to:
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
Contents of lecture:
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.
References& readings:
- 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?.
Assessment & evaluation method:
Short assay or MCQs
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LECTURE: Upper Respiratory Tract Infections (URTI)
Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr Mahdi
Female Section: Dr.Rahila Iftikhar
At the end of the lecture you should be able to:
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
Contents of lecture:
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
References& readings:
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
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LECTURE: MCH care at the PHC level
Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr. Waleed Mailat
Female Section: Dr. Jawaher Al-Ahmadi
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.
References & Resources:
MCH section in the PHC book of Saudi Arabia
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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
Assessment & evaluation method:
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
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LECTURE: Practical session I: Case Scenario on Antenatal –Care
Student Note:
Department: Family and community medicine
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:
References & Resources:
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
Assessment & evaluation method:
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.
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LECTURE: Practical session II: Case scenario on well baby clinic Student Note:
Department: Family and community medicine
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:
References & Resources:
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.
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LECTURE: Hypertension Student Note:
Department: Family and community medicine
Tutorial : Male Section: Dr.Ali Fakeeh
Female Section: Dr. Jawaher Al-Ahmadi
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
At the end of the tutorial you should be able to:
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-
examination-investigation)
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
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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.
Contents of lecture:
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
Problem based case scenario
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
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LECTURE: Introduction to CAM and Concepts of Integrative Care Student Note:
Department: Family and community medicine
Tutorial : Male Section:
Female Section: Dr. Jawaher Al-Ahmadi
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
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LECTURE: Introduction to CAM and Concepts of Integrative Care Student Note:
Contents of lecture:
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
References& readings:
- Text book of Family Medicine by: McWhinney
- RAKEL Essential Family Medicine
CD-ROM
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LECTURE: Introduction to CAM and Concepts of Integrative Care Student Note:
You have the opportunity to read the lectures of CD-ROM
In the following site (or at the department library??)
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.
Assessment & evaluation method:
1. MCQ
2. Problem solving method
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LECTURE: Back Pain
Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr. Jameel Bashawri
Female Section:
At the end of the lecture you should be able to:
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
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LECTURE: Back Pain Student Note:
Contents of lecture:
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
References& readings:
- Text book of Family Medicine by: McWhinney
- RAKEL Essential Family Medicine
CD-ROM
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LECTURE: Back Pain Student Note:
You have the opportunity to read the lectures of CD-ROM
In the following site (or at the department library??)
www.aafp.org
Self-assessment
Q: Discuss red flags that indicate the presence of an
emergency situation in a patient with low back pain.
Assessment & evaluation method:
- MCQ
- Case scenario clinical exam
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LECTURE: Joint Pain / Arthritis
Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr. Jameel Bashawri
At the end of the lecture you should be able to:
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
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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
Contents of lecture:
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)
References& readings:
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LECTURE: Joint Pain / Arthritis Student Note:
- Text book of Family Medicine by: McWhinney
- 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??)
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.
Assessment & evaluation method:
- MCQ
Case scenario clinical exam
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LECTURE: Emergencies in primary health care(PHC)
Department: Family and community medicine
Lecturer: Male Section: Dr Mahdi
Female Section:
Student Note:
At the end of the lecture you should be able to:
At the end of the lecture you should be able to:
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
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LECTURE: Emergencies in primary health care(PHC)
Department: Family and community medicine
Lecturer: Male Section: Dr Mahdi
Female Section:
Student Note:
Contents of lecture:
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.
References& readings:
- Current emergency diagnosis and treatment.
- Almazrou. Principles and practice of primary
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LECTURE: Emergencies in primary health care(PHC)
Department: Family and community medicine
Lecturer: Male Section: Dr Mahdi
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.
Assessment & evaluation method:
- Assignment: Summarizing 2 articles about
decision making in emergency medicine.
- Short notes and mcqs
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LECTURE: Obesity Student Note:
Department: Family and community medicine
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.
Contents of lecture:
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
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LECTURE: Obesity Student Note:
health benefit of modest weight loss and help them set a
realistic goal for weight reduction.
References& readings:
Lecture note
Rakel ;essential family medicine
CD-ROM
You have the opportunity to read the lectures of CD-ROM
http://www.pitt.edu/~super1/
http://www.bmj.com/collections/epidem/
http://wwwmedicalstudent.com
http://www.acepidemiology.org
Self-assessment
Assessment & evaluation method:
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LECTURE: Anticipatory care Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr.Ali Fakeeh
Female Section
At the end of the lecture you should be able to:
- 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
Contents of lecture:
- 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
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LECTURE: Anticipatory care Student Note:
References& readings:
- 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
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
Assessment & evaluation method:
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LECTURE: Prescribing in family practice
Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr.Ali Fakeeh
Female Section
At the end of the lecture you should be able to:
- 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
Contents of lecture:
- 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
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LECTURE: Prescribing in family practice
Student Note:
References& readings:
- Robert e. rakel, essential family medicine
fundamental &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
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
Assessment & evaluation method:
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LECTURE: Evaluation of patient with Fatigue
Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr.Ali Fakeeh
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
Contents of lecture:
- 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
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LECTURE: Evaluation of patient with Fatigue Student Note:
- References& readings:
- 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
You have the opportunity to read the lectures of CD-ROM
I
http://www.pitt.edu/~super1/
http://www.bmj.com/collections/epidem/
http://wwwmedicalstudent.com
http://www.acepidemiology.org
Self-assessment
Assessment & evaluation method:
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LECTURE: Evaluation of patient with anxiety and depression
Student Note:
Department: Family and community medicine
Lecturer: Male Section: Dr.Ali Fakeeh
Female Section
At the end of the lecture you should be able to:
- 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
Contents of lecture:
- 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
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LECTURE: Evaluation of patient with anxiety and depression Student Note:
References& readings:
- 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 2010
Lecture note
Rakel ;essential family medicine
CD-ROM
You have the opportunity to read the lectures of CD-ROM
I
http://www.pitt.edu/~super1/
http://www.bmj.com/collections/epidem/
http://wwwmedicalstudent.com
http://www.acepidemiology.org
Self-assessment
Assessment & evaluation method:
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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.
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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
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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
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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
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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.
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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
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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.
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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)
(Grade Definition: http://www.ahrq.gov/clinical/uspstf/gradespost.htm#crec)
Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm#clinical
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)
(Grade Definition: http://www.ahrq.gov/clinical/uspstf/gradespost.htm#crec)
Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm#clinical
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)
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(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)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
(Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical)
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)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
(Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical)
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)
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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
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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
2a SR (with homogeneity*)
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
3a SR (with homogeneity*)
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.
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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
Tentative schedule for the Family medicine course (week 2)
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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
Evaluation of patient
with Back pain
Evaluation of patient
with Joint pain
Geriatric s Field Visit Wednesday
Tentative schedule for the Family medicine course (week 3)
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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
Tentative schedule for the Family medicine course (week 4)
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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
111 | P a g e
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 &
113 | P a g e
assessment and plan including education, follow up, referral
…..etc.(+ Learning notes).
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,
assessment and plan including education, follow up, referral
…..etc.(+ Learning notes).
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
No. Description of the case, the consultation process, procedures,
assessment and plan including education, follow up, referral
…..etc.(+ Learning notes).
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,
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
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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.)
No. Description of the case, the consultation process, procedures,
education, follow up..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,
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
A brief description of the things learned, cases or procedures
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
A brief description of the things learned, cases or procedures
observed.(+Learning notes)
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
A brief description of the things learned, cases or procedures
observed.(+Learning notes)
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
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.
6.
Name:
Sig.
7.
Name:
Sig.
8.
Name:
Sig.
9.
Name:
Sig.
10.
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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.
11.
Name:
Sig.
12.
Name:
Sig.
13.
Name:
Sig.
14.
Name:
Sig.
15.
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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.
16.
Name:
Sig.
17.
Name:
Sig.
18.
Name:
Sig.
19.
Name:
Sig.
20.
LOG OF EXPERIENCES
The Practical Skills and competencies:
129 | P a g e
(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.
21.
Name:
Sig.
22.
Name:
Sig.
23.
Name:
Sig.
24.
Name:
Sig.
25.
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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.
26.
Name:
Sig.
27.
Name:
Sig.
28.
Name:
Sig.
29.
Name:
Sig.
30.
131 | P a g e
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.
31.
Name:
Sig.
32.
Name:
Sig.
33.
Name:
Sig.
34.
Name:
Sig.
35.
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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.
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
A brief description of the things learned, cases or procedures
observed.(+Learning notes)
Place:
Date:
Attended with:
Name:
Signature:
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LOG OF EXPERIENCES
Experience: The home care visit
The attachement
A brief description of the things learned, cases or procedures
observed.(+Learning notes)
Place:
Date:
Attended with:
Name:
Signature:
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LOG OF EXPERIENCES
Experience: Geriatric visit
The attachement
A brief description of the things learned, cases or procedures
observed.(+Learning notes)
Place:
Date:
Attended with:
Name:
Signature:
136 | P a g e
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 ")
137 | P a g e
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
140 | P a g e
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.
142 | P a g e
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)
At the end of the rotation, the student will be able to:
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
At the end of the rotation, the student will be able to:
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.
146 | P a g e
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
At the end of the rotation, the student will be able to:
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
At the end of the rotation, the student will be able to:
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
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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