1. FM II RotationIntroduction & Orientation Fayza Rayes MBBCh. Msc. MRCGPConsultant Family Physician Joint Program of Family & Community Medicine, Jeddahwww.fayzarayes.com

2. AIM:Getting the maximum benefits from FM II rotationOBJECTIVES:1. Agreement on the objectives , contents and methods of the educational activity sessions2. Agreement on the contents and methods of the final evaluation of FM II3. Allocation of responsibilities 3. CONTENTS: Preparation of educational activities Allocation of Responsibilities PHC Clinic Training Simulated Clinic Assignment SDL & Portfolio 4. Educational Activities Medical Education (Learning Skills) Clinical Nutrition Clinical problems: Chronic diseases: DM / Hypertension / Asthma 13 other common clinical problems Physical examination workshop Data interpretation workshop MEQs : 2 sessions EBM : 2 sessions Consultation skills : 2 sessions Ethics & professionalism : one session Practice Organization : one session 5. 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 thenspend the precious time you have learning about things that are relevant 6. Preparation of EducationalActivity Sessions1st Step:Determination of your learning needs 7. Determination of your learning needs from your own experiences in patient care1. Blind spots2. Clinically generated unknowns3. Diary of knowledge gaps and difficulties arising in practice4. Knowledgeable patients5. Mistakes6. Patients complaints and feedback7. PUNs (patient unmet needs) and DENs (doctors educational needs)8. Competence standards (see the curriculum)9. Reflection on practical experience 8. Find out your educational gaps (specific learning needs)Competence standards: Review curriculum Review quick reference 9. How can you find out your educational gaps(specific learning needs)Review: Review the curriculum and pick up your educational gaps (core contents & core skills ) Review quick reference guideline and pick up all unfamiliar recommendations in the guideline 10. Example: Learning needs in OA FAMILY MEDICINE CUURICULUM 11. Learning Needs OA Management Options 12. Find out your educational gaps (specific learning needs)Reflection 13. 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 ?! 14. 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 ??!! 15. Example of Educational NeedsReflecting on my clinical experienceQ1. 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. choices of pain management medications? 16. Preparation of EducationalActivity Sessions2nd StepLearning needs ObjectivesObjectives 17. How to prepare for the session ?2nd Step :Transfer the Qs in to objectivesExample: Q1. How can you advise elderly obese to do exercise?Objectives:1. Communication with elderly pt2. Special consideration in management elderly pt with OA3. Special physical exercises for elderly pt 18. How to prepare for the session ?3rd Step : Categorize your objectivesHow deep do we need to know ?1. Very important to know2. Nice to know3. No need to know 19. How to prepare for the session ?4th Step :Transfer the objectives in toScenarios Pt with multiple pathology A typical presentation / very early stage of thedisease Pt at extreme of age Pt with communication problem Working with limited recourse 20. FAMILY MEDICINE CUURICULUMCommunication skills Curriculum The Principles of Communication skills 8. Patient with Somatization Uses and applications of Consultation9. The Dependent and Demanding patientModels 10. The Dramatic or Manipulative patient Barriers to communication11. The Long Suffering, Masochistic Body Language patient Telling Bad News 12. The Orderly and Controlled patient Telling family members 13. The Manic, Restless patient Communication in difficult encounters14. The Guarded Paranoid patient1. The Silent or Reticent patient15. The Superior patient2. The Rambling or Talkative patient 16. Breaking bad news3. The Vague patient 17. Caring for the dying patient4. The Angry patient 18. Conflicted Roles5. The Depressed or Sad patient19. Solving Conflicts6. The Denial patient20. Communication with different agegroups and sexes7. The Anxious patient 21. How to prepare for the session ?Example of scenarios for discussionScenario: Sada is an 80-year-old obese lady with severe OA, looking depressed how are you going counsel her?Objectives: Communication with elderly depressed pt Options of physical exercise and physiotherapy for elderly pt Role of FP in management of severe OA 22. How to prepare for the session ?5th Step : chose the appropriate methodsMethods: Motivating learners Interactions Audio-Visuals Exercises Scenarios Simulations Feedback Memory tools Sessions that dont bore you out of your minds! 23. How to prepare for the session ?6th 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) 24. Example of Lesson Plan1.Introduction should include local data from KSA2.4 groups discussing 4 case scenarios (every groupwill discuss the 4 cases)3.Every group will present one case4.Discussion with the other group for any comments ineach case5.Comments from the presenter (special tips asPowerPoint presentation)6.Role-play if there is any communication issue7.Video demonstration and comment from the presenter8.Data interpretation questions9.Discovering new learning needs10. Final message and conclusion 25. Allocation of Responsibilities 1. The role of the presenter 2. The role of the supervisor 3. Every body responsibility 26. The role of the presenterIn collaboration with his/her supervisor:1. Collect challenging questions and learning needs fromhis colleagues2. Transfer questions in to case scenarios3. Search for answers of these challenging questions4. Select high quality references and send it to his/hercolleagues5. Prepare highly selective, short PowerPoint presentationwith special tips and valuable comments (No need topresent any well known knowledge)6. Decide the session plan7. Run the session , control the discussion & manage histime 27. The role of the presenterBefore the session (at least one week) Send all interesting (stimulating) questions toyour colleagues Send the stimulating scenarios Send the link for selective interesting referenceso Guidelineso Video demonstrationo MCQso Data interpretation (X-ray/ Blood result / ECG / photos)o .. Send your lesson plan 28. The role of the supervisorGuide the presenter to:1. Make the Qs and the scenarios more challenging2. Make the answers more practical3. Chose more selective material4. Presentation rehearsalDuring the session:1. Watching most of the time2. PRN comments3. Discovering new learning needs4. Giving feedback 29. Every Body Responsibility1. To read short review about the topic before the session: Symptoms , signs & DD Risk factors and prevention Evidence based stepped-care management2. Try to find out answers for the challenging Qs3. To share with the group any new interesting Qs or pts scenarios4. Participate effectively during the session5. Add the new learning needs in his/her action plan 30. PHC Clinic Training How can you maximize yourbenefit from PHC clinic training ? 31. > 10 Ways to maximize yourbenefit from PHC clinic training1. Discover your learning needs2. Write 3-5 challenging questions everyday and direct your reading to these questions3. Write interesting pts scenario for future discussion (in your logbook session)4. Discuss interesting patients with your seniors 32. Determination of your learning needs fromyour own experiences in patient care Clinically generated unknowns Diary of knowledge gaps and difficulties arising inpractice Knowledgeable patients Mistakes Patients complaints and feedback PUNs (patient unmet needs) and DENs (doctorseducational needs) 33. > 10 Ways to maximize yourbenefit from PHC clinic training5. 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 every patient (and evaluate your performance)8. Practice health promotion with every patient (and evaluate your performance) 34. > 10 Ways to maximize your benefit from PHC clinic training9. Make photos for interesting signs and share it with your colleagues 35. Examples of Smartphone App and Health careLearning (E books/ you tube)Teaching (graphs / images)10. Use ofProblem solving (Guidelines) SmartphoneClinical decision supportPrescribing drug referenceto improveE prescribingconsultationHealth care team communication toolCME (interactive courses)skillsDiagnostic proceduresHome monitoring (24 hours BP) Patients recordCritical care patient monitoring (ECG) Follow upPhysical therapy Self help groupsBehavioral Health Care Health promotionReporting of infectious diseases Health educationCompliance (drug reminder) ??? 36. Video Tape Your ConsultationA. If you video tape the pt. you need written permission from the patientB. You need to pay attention to the sound qualityC. Video at least three consecutive consultation to discover your pattern of consultationD. Review the videos with your supervisor and discover your learning needE. Work in your learning need and repeat the experience to monitor your progress 37. >10 Ways to maximize yourbenefit from PHC clinic training10. Know more aboutPHC Team11. Practiceorganization 38. Simulated Clinic Assignment Every candidate will do one simulated clinic in the coming 7 weeks 39. 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% 40. 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 41. Example of an OSCE station CONTRACEPTION Instruction for patient You are a 30 year old nurse attending with yourhusband . You have been building up courage tocome and see the doctor and have decided to openwith "Id like to go on pill". You have 6 children.Your husband is hesitant about the pill as he thinkscontraceptive pill can cause infertility You smoke 10 cigarettes a day and have regularperiods and no past medical or gynaecologicalproblems. 42. MARKING SCHEDULEAB CHISTORY (10 marks)Sexual /Contraceptive / Relationship / Medical/ Family/ GynaecologicalRubella / Smears / SmokingEXPLORING (10marks)Patients ideas and concernsEXAMINATION (10MARKS)BP / Breasts / Pelvic / Weight/Height / RubellaEXPLANATION (10 marks)Other Methods of ContraceptionHow pill works / Advantages and disadvantages of pillClarify false beliefs about the pillHow to take the pill / What to do if you forgetWhen it will not work e.g. antibiotics and D & V, first 2 weeksHow pill works and disadvantages of pillStarting on 1st dayLeaflet to build up informationAdvice about smokingSmear testWhen 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 BorderlineFail 43. Steps in preparation of simulated clinic1. It is preferable to chose patients scenario from your real practice2. Clinical problem + Behavioral problem3. Write a draft and modify it with your supervisor4. Apply it as a role-play to insure its practicality5. E-mail it to me as soon as it become ready 44. Patient Brief RecordCase Title:NAME:AGE:SEX:OCCUPATION:SUMMARY OF MEDICAL RECORD: 45. Patient ScenarioAGE:SEX: MaleOPENING STATEMENT:SAY VOLUNTARILY (Without Asking)SAY WHEN DOCTOR ASKS YOU: BEHAVIOUR DURING THE CONSULTATION:TASKS TO TEST1.2.3. 46. Marking ScheduleCANDIDATE SHOULD COVER THE FOLLWING A B C1- INFORMATION GATHERING2- DOCTOR/PATIENT INTERACTIONS4- MANAGEMENT5- EFFECTIVE USED OF CONSULTATA = Complete answer B = Partial Answer C = Not answered to mostly inappropriate answer.Final Grade: ---------- %Examiner comments if any: . 47. Simulated Clinic AssignmentBenefits: 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 48. WorkshopSimulated Clinic Exam 1. FMII will be distributed to 3 groups Blue group 7 candidatesPatientYellow group 7 candidatesPhysicianRed group 7 candidatesEvaluatorSupervisor 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 49. The Role of the Evaluator 1. He/she will use the checklist forPatientPhysicianevaluationEvaluatorSupervisor 2. He/she will give comment on thesimulated doctor performance anddecide about the mark (%) 3. With the agreement with thesupervisor he/she will decide thefinal mark 50. The Role of the Supervisor1. Comment on the forms (scenario and thechecklist)2. Comment on the simulated patient performance3. Comment on the simulated doctor performance4. Comment on the simulated evaluatorperformance * Every 3 stations the supervisor will move to anotherstations but opposite to the candidate movement direction 51. SDL & PortfolioIn 12 weeks: 3 CBD 6 Mini SEX 6 DOPS Simulated clinic assignment 52. Meet your supervisor:Afternoon session once a weekChoose the day with the agreement of your supervisorMeeting Agenda: Review your portfolio Mini-CEX or CBD discussion (filling one of each every week) Preparing your simulated clinic assignment Discussing educational needs & development plan Solving any current issue in your training & psycho-social support .???? 53. Mini CEX Identify CBD their DOPS strengthandweakness AddressExplore theiroptionseducationalwith theirneeds trainee Provide Act asmotivation challengerEncouragereflection 54. Tools tomonitortrainingandprogressing 55. Tools tomonitortrainingandprogressing 56. Tools tomonitortrainingandprogressing 57. End of Rotation Assessment1. Portfolio .... 40%2. Continues assessment ... 20%3. Written Exam .... 20%4. Simulated Clinic Exam .20%