1. Introduction & OrientationFM II2014Fayza Rayes MBBCh. Msc. MRCGP Consultant Family Physician Joint Program of Family & Community Medicine, Jeddahwww.fayzarayes.com

2. Objectives: 1.Allocation of responsibilities2.Agreement on the method of training3.Get the maximum benefit from this rotation 3. Contents (4 hours): 1.The curriculum for FMII rotation2.Educational activity timetable3.How to maximize your benefit from PHC clinic training4.Evaluation and final exam5.Simulated clinic assignment (workshop) 4. Family Medicine II Rotation 24th February 30th April 2014 MorningBreakSundayClinicClinicMondayEducational ActivityHDRCTuesdayEducational ActivitySDLWednesdayClinicClinicThursdayClinicLogbook DiscussionEvery 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 5. 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 6. Common Clinical Problems 7. Educational Activity FM II 2014 8. 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 9. 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 10. www.fayzarayes.com 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. 11. How can you maximize your benefit from PHC clinic training? 12. > 10 Ways to maximize your benefit from PHC clinic training 1. Discover your learning needs 2. Write 3-5 challenging questionseveryday and direct your reading to these questions 3. Write interesting pts scenario for future discussion (in your logbook) 4. Discuss interesting patients with your seniors 13. > 10 Ways to maximize your benefit from PHC clinic training 5. Study your pts 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 everypatient (and evaluate your performance) 8. Practice health promotion with every patient (and evaluate your performance) 14. > 10 Ways to maximize your benefit from PHC clinic training 9. Make photos for interesting signs10. .???? 11. ..???? 15. 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 Patients record Follow up Self help groups Health promotion Health education??? 16. Video Tape Your Consultation 1. You need written permission from the patient2. You need to pay attention to the sound quality 3. Video at least three consecutive consultationto discover your pattern of consultation 4. Review the videos with your supervisor anddiscover your learning need 5. Work in your learning need and repeat theexperience to monitor your progress 17. >10 Ways to maximize your benefit from PHC clinic training 11. ..?12. ..? 13. ..? 18. Meet your supervisor: Arrange the exact time with your academic supervisorMeeting Agenda: Review yourportfolio Discussion of interesting experience in your currenttraining Discussing educational needs & personal development plan Solving any current issue in your training & psychosocial support .???? 19. Address their educational needsIdentify their strength and weaknessProvide motivationExplore options with their traineeAct as challengerEncourage reflection 20. Portfolio Contents In your clinical training you need to do 3 CBD. 3 Mini CEX and 3 DOPSand document this in your portfolio 21. LogbookClinical cases you have seen in your clinicExample of learning needs ??FM II Logbook 3 cases/clinic 22. SDL & Portfolio Discussion??? 23. FM 2 Rotation - SDL Documentation Candidate Name: Supervisor:.. Date1 2 3 45 6 7 8 9Summary of the activitySupervisor signature 24. 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 portfolioRules & 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 25. Facebook GroupFamily Medicine Rotations Jeddahhttps://www.facebook.com/groups/794017410624305/ 26. Family Medicine Rotation Jeddah Facebook Group 27. End of Rotation Assessment 1. Portfolio ....40%(including attendance of meeting supervisor sessions) 1. Continues assessment from the PHC centertrainers................. 2. Written Exam ..... 3. OSCE ....30% 15% 15% 28. Written Exam 30 MCQs 3 Data 3 MEQ & CRQ 29. Break 30. Simulated Clinic Assignment Every candidate will prepare one simulated clinic as part of self-directed learning activity 31. 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% 32. Simulated Patient Advantages : Rehearsal Flexibility Standardization (in exam) Customization Specific issues and difficult situation Availability Time efficiency Feedback Facilitation, instruction and evaluation 33. 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 34. Example of an OSCE station CONTRACEPTIONInstruction for patient You are a 30 year old nurse attending with yourhusband . 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. 35. MARKING SCHEDULEAHISTORY (10 marks)Sexual /Contraceptive / Relationship / Medical/ Family/ Gynaecological Rubella / Smears / SmokingEXPLORING (10marks) Patient's ideas and concernsEXAMINATION (10MARKS)BP / Breasts / Pelvic / Weight/Height / RubellaEXPLANATION (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 passPassBorderlineFailBC 36. Steps in preparation of simulated clinic 1. It is preferable to chose patients scenariofrom your real practice2. Clinical problem + Behavioral problem 3. Write a draft and modify it with yoursupervisor4. Apply it as a role-play to insure its practicality 5. E-mail it to me as soon as it become ready 37. Patient Brief Record Case Title: NAME: AGE:SEX: OCCUPATION: SUMMARY OF MEDICAL RECORD: 38. Patient Scenario AGE:SEX: MaleOPENING STATEMENT:SAY VOLUNTARILY (Without Asking) SAY WHEN DOCTOR ASKS YOU: BEHAVIOUR DURING THE CONSULTATION: TASKS TO TEST 1. 2. 3. 39. Marking Schedule CANDIDATE SHOULD COVER THE FOLLWING A BC1- INFORMATION GATHERING2- DOCTOR/PATIENT INTERACTIONS4- MANAGEMENT 5- EFFECTIVE USED OF CONSULTATA = Complete answerB = Partial AnswerC = Not answered to mostly inappropriate answer.Final Grade: ---------- %Examiner comments if any: . 40. Simulated Clinic Assignment Every candidate will do one simulated clinic in the coming 7 weeks21 simulated clinics will be come in the end of rotation exam 41. Simulated Clinic Assignment Benefits: Active learning of the consultation skills The best way to pass the exam is to think like theexaminer You will learn one simulated clinic in depth You will learn 20 other simulated clinics from yourcolleagues 42. Simulated Clinic Assignment Simulated Clinic 1. DM 2. Hypertension3. 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 painTrainees 43. 10. DM11. 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 44. Simulated Clinic Workshop 1. Discussion and writing (20 min) 2. Demonstration (10 min) 3. Feedback & comments 45. Simulated Clinic Discussion & writing 28-old teacher with migraine and stress at work requesting sick leave Work as 3 groups independentlyEvery group will discuss and writ the following: 1. Patient Brief Record 2. Patient Scenario 3. Marking Schedule 46. Simulated Clinic Exam 47. WorkshopSimulated Clinic ExamPatient Physician Evaluator Supervisor1. FMII will be distributed to 3 groups Blue group 7 candidates Yellow group 7 candidates Red group 7 candidates2. 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 48. The Role of the Evaluator 1. He/she will use the checklist for evaluation 2. He/she will give comment on the simulateddoctor performance and decide about the mark (%) 49. The Role of the Supervisor 1. Comment on the forms (scenario and thechecklist)2. Comment on the simulated patientperformance3. Comment on the simulated doctorperformance4. Comment on the simulated evaluatorperformance* Every 3 stations the supervisor will move to anotherstations but opposite to the candidate movement direction 50. Preparation of Educational Activity SessionsTomorrow 51. Common Clinical Problems 52. Family Medicine Rotation Jeddah Facebook Group 53. Preparation of Educational Activity SessionsWorkshop 54. List of Sessions in FMII Rotation 1. Osteoporosis9. Ischemic Heart Disease2. Dyspnea10. Common behavioral problems in3. Anxietychildren4. Obesity11. Growth & development5. Back Pain12. Joint pain & Injuries6. Vaginal Bleeding13. Abdominal/ Pelvic Pain7.Vaginal Discharge14. Data interpretation workshop8.Hyperlipidemia15. Physical Examination workshop 55. Workshop objectives: 1.To find out together our educational gaps2.To be selective in your reading3.To prepare in depth about the topic4.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 56. Q. How can you find out your educational gaps (specific learning needs)Review Reflect 57. How can you find out your educational gaps (specific learning needs)Review: Reviewing the curriculum and picking up youreducational gaps (core contents & core skills ) Reviewing quick reference guideline and pickingup all unfamiliar recommendations in the guideline 58. Example: Learning needs in OA SAUDI BOARD OF FAMILY MEDICINE CUURICULUM 59. 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 ?! 60. Learning Needs: knee injectionskill 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) 61. Learning NeedsOA Management Options 62. Every Body Responsibility 1. To read short review about the topic before thesession: Symptoms , signs & DD Risk factors and prevention Evidence based stepped-care management2. Try to find out answers for the challenging Qs 3. To share with the group any new interesting Qsor pts scenarios 4. Participate effectively during the session 5. Add the new learning needs in his/her action plan 63. Example: Learning needs in OA 64. How can you find out your educational gaps (specific learning needs)Reflect: What is the deferencebetween undergraduate (KSA) and postgraduate ?! What is the deferencebetween practicing GP and consultant family physician ?! 65. How can you find out your educational gaps (specific learning needs)Reflecting on your clinical experience Not feeling 100% satisfaction with myperformance ??!! Difficult patient / difficult decision / mystiques ??!! New information / new skill ??!! 66. 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. . 67. How can you bridge your educational gapsActive Learning: 68. 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! 69. 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 70. 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 71. 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 72. 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 73. 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 youdo not have enough time or recourses You may encourage trainees to achieve some objectives by active learning (reading before the session) 74. 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 75. Before the session (at least one week) Send all interesting (stimulating) questions toyour colleagues Send the stimulating scenarios Send the link for o o o o oselective interesting referencesGuidelines Video demonstration MCQs Data interpretation (X-ray/ Blood result / ECG / photos) .. Send your lesson plan 76. 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 77. 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 rehearsalDuring the session: 1. Watching most of the time 2. PRN comments 3. Discovering new learning needs 4. Giving feedback 78. Example of Data interpretation Qs 79. OA bilateral knee OA of the Knee jointknee replacement : Front view & Side view A normal health y knee 80. QuestionUse Case Scenarios An 81-year-old man presented toyour 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?? 81. AnswerX-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 recommendedVideo demonstration of knee injection 82. Every Body Responsibility 1. To read short review about the topic before thesession: Symptoms , signs & DD Risk factors and prevention Evidence based stepped-care management2. Try to find out answers for the challenging Qs 3. To share with the group any new interesting Qsor pts scenarios 4. Participate effectively during the session 5. Add the new learning needs in his/her action plan