Teaching and learning about community orientation in family medicine/general practice

Dr. Yonah YapheDepartment of Family Medicine

Rabin Medical Centre andSackler Faculty of Medicine,

Tel Aviv University, Israel

Objectives At the end of this

presentation the learner will:

Know the definition of community and community orientation

Know how the community effects medicine and vice versa

Value a community orientation in teaching and learning family medicine

Community A collection of

people with common social characteristics and generally geographical proximity

The physical surroundings in which we are usually located

Why is this important? Context is everything Engel’s bio-psycho-

social model Systems theory –

interaction between higher and lower levels

Advances in health through social progress

How is this done Epidemiology –

the big picture Social medicine

and public health – social engineering

Community orientation by the family doctor

What do we expect from our graduates in family medicine?

Clinical knowledge Clinical skills,

communication skills, management skills

Holistic approach to the care of a wide range of problems in the context in which our patients live

Ho do we teach this? Practical

experience Direct

supervision Classroom

learning Projects Reflection

How do we assess this? Formative and

summative assessment

Written and oral knowledge tests

Demonstration of competence in OSCE’s

Direct and indirect observation of performance (video, medical records)

Final examination for specialization in family medicine in Israel

After 2 years - 150 MCQ’s - knowledge

After 4 years – 4 hour oral exam Two hours of clinical

topics including standardized questions

One hour family presentation

One hour community presentation

Community presentation Age-sex distribution of

practice Chronic disease register Physical layout of clinic Structure of health care team Relations with community

services Prevention and health

promotion activities Future plans for practice

Examples of outputs Age-sex distribution

(graph) Chronic diseases (list) Practice organization

and staffing (diagram) Medical records

(charts) Sample questions to

candidates (tables)(Thanks to Dr. Vered Ezra

for her clinic data.)

Age distribution (n=600)

0

10

20

30

40

50

15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Ages

%

National Clinic

Age distribution How does your data differ from

national data? What are the implications for

practice of an older or younger population?

Country of birth (n=600)

ISRAEL52%

ETHIOPIA32%

EUR-USA1%

USSR7%

ASIA-N.AFRICA8%

Ethnic mix How does the ethnic mix of your

practice affect morbidity? What do you and your staff need to

know about your population?

Chronic Disease Prevalence

0

5

10

15

20

%

Chronic disease prevalence Questions to the candidate:

Compare with national data What does this mean? Why are there more or less

cases?

Changes in HBA1C Q1-Q3 2005

0%

10%

20%

30%

40%

50%

<7 7 to 9>9

HBA1C level

Q1

Q3

Quality improvement Describe a health problem in your

community and the means that you used (or plan to use) to address it.

Conclusions Community orientation can

be integrated into the training of future family practitioners.

The are innovative ways to teach and assess the acquisition the knowledge, skills and attitudes that make up this element of general practice.

In this course we will explore and experience this further with the aim of expanding this further in our own contexts.