Introduction FM2

FM II Rotation

Introduction & Orientation

Fayza Rayes
MBBCh. Msc. MRCGP
Consultant Family Physician
Joint Program of Family & Community Medicine, Jeddah
www.fayzarayes.com

AIM:
Getting the maximum benefits from FM II rotation

OBJECTIVES:
1. Agreement on the objectives , contents and
methods of the educational activity sessions

2. Agreement on the contents and methods of the final
evaluation of FM II

3. Allocation of responsibilities

CONTENTS:
 Preparation of educational activities
 Allocation of Responsibilities
 PHC Clinic Training
 Simulated Clinic Assignment
 SDL & Portfolio

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

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

Preparation of Educational
Activity Sessions

1st Step:

Determination of your learning needs

Determination of your learning needs from
your own experiences in patient care
1. “Blind spots”
2. Clinically generated unknowns
3. Diary of knowledge gaps and difficulties arising in
practice
4. Knowledgeable patients
5. Mistakes
6. Patients' complaints and feedback
7. PUNs (patient unmet needs) and DENs (doctor's
educational needs)
8. Competence standards (see the curriculum)
9. Reflection on practical experience

Find out your educational gaps
(specific learning needs)

Competence standards:
 Review curriculum
 Review quick reference

How can you find out your educational gaps

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

Example: Learning needs in OA
FAMILY MEDICINE CUURICULUM

Learning Needs

OA Management Options

Find out your educational gaps

Reflection


Reflect:
 What is the deference
between undergraduate
(KSA) and postgraduate ?!

 What is the deference
between practicing GP
and consultant family
physician ?!


Reflecting on your clinical experience

 Not feeling 100% satisfaction with my
performance ??!!

 Difficult patient / difficult decision / mystiques ??!!

 New information / new skill ??!!

Example of 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. choices of pain management medications?

Preparation of Educational
Activity Sessions

2nd Step

Learning needs Objectives

Objectives

How to prepare for the session ?

2nd 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


3rd 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


4th Step :Transfer the objectives in to
Scenarios

 Pt with multiple pathology
 A typical presentation / very early stage of the
disease
 Pt at extreme of age
 Pt with communication problem
 Working with limited recourse
 …

FAMILY MEDICINE CUURICULUM

Communication skills Curriculum
 The Principles of Communication skills 8. Patient with Somatization
 Uses and applications of Consultation 9. The Dependent and Demanding patient
Models 10. The Dramatic or Manipulative patient
 Barriers to communication 11. 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 encounters 14. The Guarded Paranoid patient
1. The Silent or Reticent patient 15. The Superior patient
2. The Rambling or Talkative patient 16. Breaking bad news
3. The Vague patient 17. Caring for the dying patient
4. The Angry patient 18. Conflicted Roles
5. The Depressed or Sad patient 19. Solving Conflicts
6. The Denial patient 20. Communication with different age
groups and sexes
7. The Anxious patient


Example of scenarios for discussion
Scenario: 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


5th Step : chose the appropriate methods
Methods:
 Motivating learners
 Interactions
 Audio-Visuals
 Exercises
 Scenarios
 Simulations
 Feedback
 Memory tools
 Sessions that don't bore you out of your minds!


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)

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

Allocation of Responsibilities

1. The role of the presenter

2. The role of the supervisor

3. Every body responsibility

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

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

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

PHC Clinic Training

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 session)
4. Discuss interesting patients with your
seniors

Determination of your learning needs from
your own experiences in patient care

 Clinically generated unknowns
 Diary of knowledge gaps and difficulties arising in
practice
 Knowledgeable patients
 Mistakes
 Patients' complaints and feedback
 PUNs (patient unmet needs) and DENs (doctor's
educational needs)


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)


9. Make photos for interesting signs
and share it with your colleagues

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

Video Tape Your Consultation
A. If you video tape the pt. you need written
permission from the patient
B. You need to pay attention to the sound quality

C. Video at least three consecutive consultation
to discover your pattern of consultation
D. Review the videos with your supervisor and
discover your learning need
E. Work in your learning need and repeat the
experience to monitor your progress

>10 Ways to maximize your

10. Know more about
PHC Team

11. Practice
organization

Simulated Clinic Assignment

 Every candidate will do one simulated clinic in the coming 7 weeks

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%

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 B C

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

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

Patient Brief Record
Case Title:

NAME:

AGE:

SEX:

OCCUPATION:

SUMMARY OF MEDICAL RECORD:

Patient Scenario
AGE: SEX: Male

OPENING STATEMENT:

SAY VOLUNTARILY (Without Asking)

SAY WHEN DOCTOR ASKS YOU:

BEHAVIOUR DURING THE CONSULTATION:

TASKS TO TEST”
1.
2.
3.

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
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

Workshop
Simulated Clinic Exam
1. FMII will be distributed to 3 groups
 Blue group 7 candidates
Patient  Yellow group 7 candidates
Physician  Red group 7 candidates
Evaluator
Supervisor 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
Patient
Physician
evaluation
Evaluator
Supervisor 2. He/she will give comment on the
simulated doctor performance and
decide about the mark (%)

3. With the agreement with the
supervisor he/she will decide the
final 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

SDL & Portfolio

In 12 weeks:
 3 CBD
 6 Mini SEX
 6 DOPS
 Simulated clinic assignment

Meet your supervisor:
Afternoon session once a week

Choose the day with the agreement of your supervisor

Meeting 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
 ……….????

Mini CEX
Identify
CBD their
DOPS strength
and
weakness
Address Explore
their options
educational with their
needs trainee

Provide Act as
motivation challenger

Encourage
reflection

Tools to
monitor
training
and
progressing

End of Rotation Assessment

1. Portfolio …………………….…..…. 40%

2. Continues assessment …..……. 20%

3. Written Exam ………..……….…. 20%

4. Simulated Clinic Exam ………….20%

Introduction FM2

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