Introduction FM2 [2014]

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Information about Introduction FM2 [2014]

Published on February 18, 2014

Author: FayzaRayes



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Introduction & Orientation FM II 2014 Fayza Rayes MBBCh. Msc. MRCGP Consultant Family Physician Joint Program of Family & Community Medicine, Jeddah

Objectives: 1. Allocation of responsibilities 2. Agreement on the method of training 3. Get the maximum benefit from this rotation

Contents (4 hours): 1. The curriculum for FMII rotation 2. Educational activity timetable 3. How to maximize your benefit from PHC clinic training 4. Evaluation and final exam 5. Simulated clinic assignment (workshop)

Family Medicine II Rotation 24th February – 30th April 2014 Morning Break Sunday Clinic Clinic Monday Educational Activity HDRC Tuesday Educational Activity SDL Wednesday Clinic Clinic Thursday Clinic Logbook Discussion Every candidate need to set with his/her supervisor in the program every week to discuss his /her portfolio and any other personal or educational issues

Educational Activities   Logbook Sessions Clinical problems:  Chronic diseases: DM / Hypertension / Asthma  10 Other common clinical problems        Physical examination workshop Data interpretation 2 workshop Consultation skills : 3 sessions MEQs : 2 sessions EBM : 2 sessions Session arranged by trainees: 2 sessions Information Technology: 1 session

Common Clinical Problems

Educational Activity FM II 2014

How can you detrmine your specific, relevant and important learning needs ? The more time you invest in planning of learning, the more likely it is that you will focus your learning effectively. You will then spend the precious time you have learning about things that are relevant

Determination of your learning needs from your own experiences in patient care 1. “Blind spots” 2. Clinically generated unknowns 3. Competence standards (see the curriculum) 4. Diary of knowledge gaps and difficulties arising in practice 5. Knowledgeable patients 6. Mistakes 7. Patients' complaints and feedback 8. PUNs (patient unmet needs) and DENs (doctor's educational needs) 9. Reflection on practical experience 1. Family Medicine Rotation Facebook group 2. Special for R3 FM Rotation (JPFCM2) 3. References for the educational activities 4. Communication tool between us 5. ……

How can you maximize your benefit from PHC clinic training ?

> 10 Ways to maximize your benefit from PHC clinic training 1. Discover your learning needs 2. Write 3-5 challenging questions everyday and direct your reading to these questions 3. Write interesting pt’s scenario for future discussion (in your logbook) 4. Discuss interesting patients with your seniors

> 10 Ways to maximize your benefit from PHC clinic training 5. Study your pt’s results of investigations (e.g. ECG, blood test, X-Ray) 6. Practice proper physical examination (and evaluate your performance using SHCS forms) 7. Practice health education with every patient (and evaluate your performance) 8. Practice health promotion with every patient (and evaluate your performance)

> 10 Ways to maximize your benefit from PHC clinic training 9. Make photos for interesting signs 10. …….???? 11. ……..????

Examples of Smartphone App and Health care • • • • • • • • • • • • • • • Learning (E books/ you tube) Teaching (graphs / images) Problem solving (Guidelines) Clinical decision support Prescribing drug reference E prescribing Health care team communication tool CME (interactive courses) Diagnostic procedures Home monitoring (24 hours BP) Critical care patient monitoring (ECG) Physical therapy Behavioral Health Care Reporting of infectious diseases Compliance (drug reminder) 10. Use of Smartphone to improve consultation skills      Patient’s record Follow up Self help groups Health promotion Health education  … ???

Video Tape Your Consultation 1. You need written permission from the patient 2. You need to pay attention to the sound quality 3. Video at least three consecutive consultation to discover your pattern of consultation 4. Review the videos with your supervisor and discover your learning need 5. Work in your learning need and repeat the experience to monitor your progress

>10 Ways to maximize your benefit from PHC clinic training 11. ……..? 12. ……..? 13. ……..?

Meet your supervisor: Arrange the exact time with your academic supervisor Meeting Agenda:  Review your portfolio  Discussion of interesting experience in your current training  Discussing educational needs & personal development plan  Solving any current issue in your training & psychosocial support  ……….????

Address their educational needs Identify their strength and weakness Provide motivation Explore options with their trainee Act as challenger Encourage reflection

Portfolio Contents In your clinical training you need to do  3 CBD.  3 Mini CEX and  3 DOPS and document this in your portfolio

Logbook Clinical cases you have seen in your clinic Example of learning needs ?? FM II Logbook 3 cases/clinic

SDL & Portfolio Discussion ???

FM 2 Rotation - SDL Documentation Candidate Name:………………………………………………… Supervisor:…………………………………….. Date 1 2 3 4 5 6 7 8 9 Summary of the activity Supervisor signature

Rules & Regulations Family Medicine Rotation Welcome to Family Medicine Rotation. In this rotation you are going to have 1. 4 clinical sessions every week. Totally 40 clinics in 10 weeks 2. 1 Logbook discussion with your trainers at the health center every week 3. 3 Educational activities in the program (Monday morning and full Tuesday). Totally 30 theoretical sessions in this rotations (10 weeks) 4. 1 Self-Directed Learning session every week. Totally 10 Self-Directed Learning (in 10 weeks) 5. You need to meet your academic supervisor once a week. If your supervisor is on leave or commitment outside the program, you can communicate with him/her through e mail or mobile. Or you can ask him/her to refer you to another supervisor to report to him/her your progress every week , and you need to document this in your portfolio 6. In your clinical training you need to do 4 CBD. 4 Mini CEX and 4 DOPS and document this in your portfolio Rules & Regulations: 1. Delay more than 15 minutes from any session will be considered as absence 2. Any delay or absence with acceptable excuse will be counted as (2 excuses =1 absence) 3. SDL should be reported to your supervisor every week, any misreporting will be consider as absence and will affect your portfolio evaluation (40% of the final evaluation) 4. If you are absence more that 25% of the time according to SCHS regulation you will not be allowed to sit for the end of rotation exam and you will repeat the rotation next year

Facebook Group Family Medicine Rotations Jeddah

Family Medicine Rotation Jeddah Facebook Group

End of Rotation Assessment 1. Portfolio ………………..….……. 40% (including attendance of meeting supervisor sessions) 1. Continues assessment from the PHC center trainers….……..............…….…. 2. Written Exam ………..……..…. 3. OSCE ………..…………….………. 30% 15% 15%

Written Exam  30 MCQs  3 Data  3 MEQ & CRQ


Simulated Clinic Assignment Every candidate will prepare one simulated clinic as part of self-directed learning activity

General Advantages of Simulated Patients & Role-Play  Drama is an attractive way of learning  Application of theory into practice  Encourage interaction  Encourage spontaneity and problem solving  Teaching attitude & skills  Increase self-confidence  Learning by doing- Increase retention up to 90%

Simulated Patient Advantages :  Rehearsal  Flexibility  Standardization (in exam)  Customization  Specific issues and difficult situation  Availability  Time efficiency  Feedback  Facilitation, instruction and evaluation

Developing Simulated Patient  Presenting situation  Profile of patient  Emotional tone  History of present illness  Additional information (Smoking. Drug ..)  Past medical history  Psychosocial history (ICE & hidden agenda)  Physical examination  Equipment needed

Example of an OSCE station CONTRACEPTION Instruction for patient  You are a 30 year old nurse attending with your husband . You have been building up courage to come and see the doctor and have decided to open with "I'd like to go on pill". You have 6 children. Your husband is hesitant about the pill as he thinks contraceptive pill can cause infertility  You smoke 10 cigarettes a day and have regular periods and no past medical or gynaecological problems.

MARKING SCHEDULE A HISTORY (10 marks) Sexual /Contraceptive / Relationship / Medical/ Family/ Gynaecological Rubella / Smears / Smoking EXPLORING (10marks) Patient's ideas and concerns EXAMINATION (10MARKS) BP / Breasts / Pelvic / Weight/Height / Rubella EXPLANATION (10 marks) Other Methods of Contraception How pill works / Advantages and disadvantages of pill Clarify false beliefs about the pill How to take the pill / What to do if you forget When it will not work e.g. antibiotics and D & V, first 2 weeks How pill works and disadvantages of pill Starting on 1st day Leaflet to build up information Advice about smoking Smear test When to seek medical help? / Any questions? OTHER (10 MARKS) Communication with two party (wife & husband) Clear use of language understandable to a 30 years old nurse. Supportive attitude about seeking contraceptive advice. Appropriate use of time. Overall result: Clear pass Pass Borderline Fail B C

Steps in preparation of simulated clinic 1. It is preferable to chose patient’s scenario from your real practice 2. Clinical problem + Behavioral problem 3. Write a draft and modify it with your supervisor 4. Apply it as a role-play to insure its practicality 5. E-mail it to me as soon as it become ready



Marking Schedule CANDIDATE SHOULD COVER THE FOLLWING A B C 1- INFORMATION GATHERING 2- DOCTOR/PATIENT INTERACTIONS 4- MANAGEMENT 5- EFFECTIVE USED OF CONSULTAT A = Complete answer B = Partial Answer C = Not answered to mostly inappropriate answer. Final Grade: ---------- % Examiner comments if any: ……………………………………….

Simulated Clinic Assignment  Every candidate will do one simulated clinic in the coming 7 weeks  21 simulated clinics will be come in the end of rotation exam

Simulated Clinic Assignment Benefits:  Active learning of the consultation skills  The best way to pass the exam is to think like the examiner  You will learn one simulated clinic in depth  You will learn 20 other simulated clinics from your colleagues

Simulated Clinic Assignment Simulated Clinic 1. DM 2. Hypertension 3. Asthma 4. Obese patient for counseling 5. child for vaccination 6. Patient with anxiety 7. Patient with joint injury 8. Patient with osteoarthritis 9. Patient with Back pain Trainees

10. DM 11. Patient with acute abdomen 12. Pt with chronic abdominal pain 13. infant with failure to thrive 14. Child with behavioral problem 15. Patient with dyspepsia 16. Patient with dyspnoea 17. Patient with high cholesterol and IHD 18. Patient with PV bleeding 19. Elderly with osteoporosis 20. Hypertension

Simulated Clinic Workshop 1. Discussion and writing (20 min) 2. Demonstration (10 min) 3. Feedback & comments

Simulated Clinic Discussion & writing 28-old teacher with migraine and stress at work requesting sick leave Work as 3 groups independently Every group will discuss and writ the following: 1. Patient Brief Record 2. Patient Scenario 3. Marking Schedule

Simulated Clinic Exam

Workshop Simulated Clinic Exam Patient Physician Evaluator Supervisor 1.    FMII will be distributed to 3 groups Blue group 7 candidates Yellow group 7 candidates Red group 7 candidates 2. There is going to be 7 stations . 15-20 minutes in each station (10 minutes for role-play and 5-10 minutes for feedback) 3. Every 3 stations every group will shaft their role (the evaluator group will be the patient and the patent will be the physician and the physician will be the evaluator) 4. The one who play the patient role will use his checklist

The Role of the Evaluator 1. He/she will use the checklist for evaluation 2. He/she will give comment on the simulated doctor performance and decide about the mark (%)

The Role of the Supervisor 1. Comment on the forms (scenario and the checklist) 2. Comment on the simulated patient performance 3. Comment on the simulated doctor performance 4. Comment on the simulated evaluator performance * Every 3 stations the supervisor will move to another stations but opposite to the candidate movement direction

Preparation of Educational Activity Sessions Tomorrow

Common Clinical Problems

Family Medicine Rotation Jeddah Facebook Group

Preparation of Educational Activity Sessions Workshop

List of Sessions in FMII Rotation 1. Osteoporosis 9. Ischemic Heart Disease 2. Dyspnea 10. Common behavioral problems in 3. Anxiety children 4. Obesity 11. Growth & development 5. Back Pain 12. Joint pain & Injuries 6. Vaginal Bleeding 13. Abdominal/ Pelvic Pain 7. Vaginal Discharge 14. Data interpretation workshop 8. Hyperlipidemia 15. Physical Examination workshop

Workshop objectives: 1. To find out together our educational gaps 2. To be selective in your reading 3. To prepare in depth about the topic 4. To move from theories to practice applications (from just knowledge to attitude and skills) Using the result of the learning needs questionnaire & reflecting on our previous clinical experience

Q. How can you find out your educational gaps (specific learning needs) Review Reflect

How can you find out your educational gaps (specific learning needs) Review:  Reviewing the curriculum and picking up your educational gaps (core contents & core skills …)  Reviewing quick reference guideline and picking up all unfamiliar recommendations in the guideline


How deep do we need to know ? Joint Injection is it A. very important to know ?! B. nice to know ?! C. no need to know ?!

Learning Needs: knee injection skill Steps in learning new skill: 1. 2. 3. 4. 5. 6. Reading Watching (real patient or video) Training in the skill lap Performing the skill under supervision Performing the skill independently Teaching others (Mastering the skill)

Learning Needs OA Management Options

Every Body Responsibility 1. To read short review about the topic before the session:  Symptoms , signs & DD  Risk factors and prevention  Evidence based stepped-care management 2. Try to find out answers for the challenging Qs 3. To share with the group any new interesting Qs or pt’s scenarios 4. Participate effectively during the session 5. Add the new learning needs in his/her action plan

Example: Learning needs in OA

How can you find out your educational gaps (specific learning needs) Reflect:  What is the deference between undergraduate (KSA) and postgraduate ?!  What is the deference between practicing GP and consultant family physician ?!

How can you find out your educational gaps (specific learning needs) Reflecting on your clinical experience  Not feeling 100% satisfaction with my performance ??!!  Difficult patient / difficult decision / mystiques ??!!  New information / new skill ??!!

Educational Needs Reflecting on my clinical experience Q1. How can I advise an elderly obese to do exercise? Q2. What is my role as FP for early diagnosis intervention ? Q3. The effectiveness of local treatment?! Q4. When do I advise pt to go for surgery? The short term and long term prognosis of artificial joints? The update in OA surgery? Q5.The prevalence of this problem in KSA? Any relevant local study in this issue? Q6.Managment Pt. with PU and OA ? Q7. Management of elderly pt with severe OA who can not go for surgery? Q8. High-heel shows and OA? Q9. EB Management of OA? Q10. ….

How can you bridge your educational gaps Active Learning:

Bridging the Learning Gap Bridging the Learning Gap  Motivating learners  Interactions  Audio-Visuals  Exercises  Scenarios  Simulations  Feedback  Memory tools  Practice with spaced-repetition  Sessions that don't bore you out of your minds!

How to Prepare for the Session ? 1. How to prepare for the session ? 2. The role of the presenter 3. The role of the supervisor 4. Every body responsibility

How to prepare for the session ? 1st Step :Transfer the Qs in to objectives Example: Q1. How can you advise elderly obese to do exercise? Objectives: 1. Communication with elderly pt 2. Special consideration in management elderly pt with OA 3. Special physical exercises for elderly pt

How to prepare for the session ? 2nd Step : Categorize your objectives How deep do we need to know ? 1. Very important to know 2. Nice to know 3. No need to know

How to prepare for the session ? 3rd Step :Transfer the objectives in to Scenario Scenario: Sada is an 80-y-old obese lady with OA, how are you going counsel her? 4th Step : chose the appropriate methods Method: Case discussion ± Video demonstration ± Role-play

How to prepare for the session ? 5th Step :collect all objectives and methods and arrange them in your lesson plan  You may need to merge 2 objectives together  You may need to postponed some objectives if you do not have enough time or recourses  You may encourage trainees to achieve some objectives by active learning (reading before the session)

Example of Lesson Plan 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Introduction should include local data from KSA 4 groups discussing 4 case scenarios (every group will discuss the 4 cases) Every group will present one case Discussion with the other group for any comments in each case Comments from the presenter (special tips as PowerPoint presentation) Role-play if there is any communication issue Video demonstration and comment from the presenter Data interpretation questions Discovering new learning needs Final message and conclusion

Before the session (at least one week)  Send all interesting (stimulating) questions to your colleagues  Send the stimulating scenarios  Send the link for o o o o o selective interesting references Guidelines Video demonstration MCQs Data interpretation (X-ray/ Blood result / ECG / photos) …..  Send your lesson plan

The role of the presenter In collaboration with his/her supervisor: 1. Collect challenging questions and learning needs from his colleagues 2. Transfer questions in to case scenarios 3. Search for answers of these challenging questions 4. Select high quality references and send it to his/her colleagues 5. Prepare highly selective, short PowerPoint presentation with special tips and valuable comments (No need to present any well known knowledge) 6. Decide the session plan 7. Run the session , control the discussion & manage his time

The role of the supervisor Guide the presenter to: 1. Make the Qs and the scenarios more challenging 2. Make the answers more practical 3. Chose more selective material 4. Presentation rehearsal During the session: 1. Watching most of the time 2. PRN comments 3. Discovering new learning needs 4. Giving feedback

Example of Data interpretation Qs

OA bilateral knee OA of the Knee joint knee replacement : Front view & Side view A normal health y knee

Question Use Case Scenarios  An 81-year-old man presented to your clinic with a 1-year history of pain in his right knee. He stated that the pain had become more severe over the previous 2 months but denied any acute trauma or injury. The physical examination revealed that the knee had limited range of motion. The accompanying anteroposterior x-ray view of the patient's right knee was obtained.  What is your interpretation  What is your management ? ?

Answer X-ray shows  Severe degenerative changes  Joint-space narrowing most marked in the medial compartment  Subchondral sclerosis  Osteophyte formation. Diagnosis: degenerative joint disease. Treatment  Conservative measures  pain medications & NSAI  Injection therapy for patients who want to delay surgery or for whom surgery is not recommended Video demonstration of knee injection

Every Body Responsibility 1. To read short review about the topic before the session:  Symptoms , signs & DD  Risk factors and prevention  Evidence based stepped-care management 2. Try to find out answers for the challenging Qs 3. To share with the group any new interesting Qs or pt’s scenarios 4. Participate effectively during the session 5. Add the new learning needs in his/her action plan

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