Family Medicine Diploma Program Complete Guide

SAUDI DIPLOMA IN

FAMILY MEDICINE

(SDFM)

October 2009

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ACKNOWLEDGEMENT

The scientific and working committees are very grateful to His Excellency Minister of

Health for the initiation and support in the development of the Saudi Diploma in Family

Medicine.

Furthermore, we would express our deep thanks to other colleagues who have

contributed with their valuable suggestions and comments.

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SCIENTIFIC COMMITTEE

Chair: Prof. Adnan Albar

1. Dr. Tarek Al-Megbil

2. Dr. Mohammed Al-Ghamdi

3. Prof. Kasim Al-Dawood

4. Dr. Mohammed Al-Doghether

5. Dr. Nourah Al-Nwaiser

6. Dr. Aydah Al-Dugaither

7. Dr. Abdullah Assaggaf

Revision committee

Chair: Dr.Mohammed Al-Doghether

Members:

1. Dr. Abdullah Assaggaf

2. Dr. Mohammed Al-Ghamdi

3. Dr. Basema Al-Khudhair

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CONTENTS INTRODUCTION and RATIONALE ....................................................................................... 5 CURRICULUM STRUCTURE ................................................................................................. 7 GENERAL AIMS ...................................................................................................................... 8 GENERAL OBJECTIVES ......................................................................................................... 9 SPECIFIC AIMS AND OBJECTIVES.................................................................................... 11

FAMILY MEDICINE I and II ............................................................................................. 11 ROTATION IN INTERNAL MEDICINE ........................................................................... 16 ROTATION IN PEDIATRICS ............................................................................................ 22 ROTATION IN SURGERY AND ORTHOPEDICS .......................................................... 27 ROTATION IN OBSTETRICS AND GYNAECOLOGY .................................................. 29

ROTATION IN PSYCHIATRY .......................................................................................... 32 ROTATION IN EMERGENCY MEDICINE ...................................................................... 34 ROTATION IN DERMATOLOGY .................................................................................... 36

ROTATION IN OPHTHALMOLOGY ............................................................................... 38 ROTATION IN EAR NOSE and THROAT (ENT) DISEASES ......................................... 40

SELECTION PROCESS .......................................................................................................... 42 STRUCTURE AND DESIGN ................................................................................................. 42

Family Medicine 1 (Introduction to FM - 8 weeks) ............................................................. 42 Internal medicine rotation (8 weeks) .................................................................................... 43

Pediatric rotation (8 weeks) .................................................................................................. 43 Other Subspecialty Rotations (8 weeks) .............................................................................. 43

Obstetric& Gynecology (4 weeks) ....................................................................................... 44 General surgery & Orthopedic (6 weeks) ............................................................................ 44

Family Medicine 2 (FM clinical rotation - 8 weeks) ........................................................... 45 Emergency rotation (25 on calls) ......................................................................................... 45

Half day release course (HDRC) sessions (50 sessions) ...................................................... 45 Skill sessions (60 sessions) .................................................................................................. 46

EVALUATION ........................................................................................................................ 48

Evaluation of the trainee ...................................................................................................... 48 Evaluation of the program .................................................................................................... 49

REFERENCES ......................................................................................................................... 51 APPENDIX 1 – Most common problems in FM ..................................................................... 53

APPENDIX 2 – Skills list ........................................................................................................ 54

APPENDIX 3 – Log Book ....................................................................................................... 57 Learning activities ................................................................................................................ 58 Skills session - Family Medicine ......................................................................................... 59

Skills session - Surgery and Orthopedics ............................................................................. 61 Skills session - Psychiatry .................................................................................................... 62 Skills session - Emergency Medicine ................................................................................... 63 Skills session - Internal Medicine ........................................................................................ 64 Skills session - Pediatrics ..................................................................................................... 65

Skills session - Obstetrics and Gynecology ......................................................................... 66 Skills session - Ophthalmology ............................................................................................ 67

Skills session - ENT ............................................................................................................. 68 Skills session - Dermatology ................................................................................................ 69 Clinics Diary ........................................................................................................................ 70 Learning portfolio ................................................................................................................ 71

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INTRODUCTION and RATIONALE

We believe that receiving high quality of health care is the fundamental right of every

individual and in the context of family medicine, this can be achieved by structured trainings

for family physicians.

Saudi Arabia has reached a population of 22 million (1). Primary care health services

provided by the Ministry of Health are given through the 1787 health centers distributed all

over the country (2). Around 5 200 doctors out of 34 000 are working in family practice

settings (3) (4). There are around eight family medicine (FM) training centers in the Kingdom

of Saudi Arabia, the first one dating back to 1988 (5).

With the increasing health care expenditure and prevalence of chronic illnesses, community

based care is one of the best solution to provide high quality holistic and comprehensive care,

meeting the needs of the majority of the population (6). On the other hand, it is an obligation

for modern health care that family practice services are given by professionals with specific

training in this area. However, the number of qualified family physicians in Saudi Primary

Health Care (PHC) Centers is far below the expectations and needs (7).

With the widespread implementation of family medicine programs, there is an obvious need

for postgraduate studies in this specialty. Such programs will produce competent family

physicians, leading to the standardization of services and training provided.

The need for a high number of trained family physicians in the Kingdom of Saudi Arabia

made it necessary to create in addition to the existing board programs, other postgraduate

programs such as diploma in family medicine. Most international diploma programs in family

medicine range from 1 to 2 years (8-12) while board programs for family medicine are

suggested to be at least 3 years (13-17). This document provides a one-year full-time diploma

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program, which is believed to provide well trained physicians in a relatively short time, who

will be working at the family practice settings in Saudi Arabia.

This program provides an alternative opportunity for postgraduate training in family medicine

to doctors working in family practice settings who are unable to join long term programs. It

addresses the most important aspects of family medicine to improve and assure the quality of

family practice.

Key elements of the curriculum are professional accountability (e.g. commitment,

responsibility, reliability), evidence based practice, partnership models (e.g. shared decision

making, teamwork, communication), and competence to practice (knowledge, skills,

attitudes). This is an integrated program based on longitudinal teaching model, giving place to

the continuity of care and emphasizes to develop skills throughout the training period. Most

of the total teaching and training activities will be conducted in family practice settings.

Constant contact will be maintained with the family practice setting throughout the week

under the supervision of experienced and qualified faculty.

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CURRICULUM STRUCTURE The total duration of the program will be 54 weeks plus 4 weeks annual leave and 2 weeks exams. The time frame of the diploma program is as

shown in the Table below:

Table: Specialties and durations of rotations.

Weeks 1-6 7-14 15-22 23-26 27-32 33-36 37-42 43-50 51-52 53-54

Duration 6 weeks 8 weeks 8 weeks 4 weeks 6 weeks 4 weeks 6 weeks 8 weeks 2 weeks 2 weeks

Rotations FM 1 Internal

medicine

Pediatrics Psychiatry ENT

Ophthalm

Derma

Obstetrics

Gynecology

General

surgery

Orthopedics

Urology

FM 2

(FM

clinical

rotation)

Emergency I*

Eid

and

Em

ergen

cy leav

es

Typical

week

1 day

FM clinic

+ HDRC

4 days

Theory

1 day

FM clinic

+ HDRC

3 days

6 clinics

medicine

1 day

2 Skills

sessions+

1 day

FM clinic

+ HDRC

3 days

6 clinics

Pediatrics

1 day

2 Skills

sessions+

1 day

FM clinic

+ HDRC

3 days

6 clinics

Psychiatry

1 day

2 Skills

sessions

1 day

FM clinic +

HDRC

4 days

8 clinics per

each

specialty

1 day

FM clinic +

HDRC

3 days

3 clinics

Obstetrics

3 clinics

Gynecology

1 day

2 Skills

sessions+

1 day

FM clinic +

HDRC

3 days

4 clinics

Surgery

2 clinics

Orthopedics

1 day

2 Skills

sessions+

1/2 day

HDRC

3.5 days

7 clinics

Family

medicine

1 day

2 Skills

sessions+

1 day

FM clinic +

HDRC

4 days

A/E

department

E MERGENCY II**

18 total on-calls on week ends

8 adults

6 pediatrics

4 obstertrics

(HDRC= Half day release course) * One of the Eids has to be spent in A/E as part of Emergency I rotation.

** Emergency II rotation is an on-calls on week ends

+ Part of the skill session need to be spent in skill lab

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GENERAL AIMS

This diploma program will provide a knowledgeable, pragmatic and structured teaching in

Family Medicine for physicians. The primary aim of the program is to increase the knowledge

and skills of primary care physicians in the Kingdom of Saudi Arabia. This will be established

by providing evidence based and up to date training and teaching methods such as problem

based learning (PBL) and task-based learning (TBL) through a diploma program. The

participants are expected to become enthusiastic general physicians, who provide high quality,

empathetic, patient-centered, holistic, evidence-based, and resource-conscious medical

services in response to the needs of the population. These services will cover the whole life

spectrum and will be within the context of the person and the community.

According to Wonca, there are six core competencies that every specialist family doctor

should master (18). These competencies are taken into account in preparing the general

competencies as well as specific aims and objectives of this diploma program:

1. Primary care management

2. Person-centered care

3. Specific problem solving skills

4. Comprehensive approach

5. Community orientation

6. Holistic modeling

The core competencies necessary for the family medicine specialist (board training) will be

tailored for the diploma program. It is clear that the core competencies will be the same for

both programs. However, the depth and level of learning objectives will vary.

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GENERAL OBJECTIVES

Learning can be subdivided into knowledge (K), attitudes (A), and skills (S). All these

domains are important and should be considered during the preparation of the program as well

as execution phases. For this reason, each objective in this document is marked according to

the weight of its learning area as K (predominantly knowledge based objective), S

(predominantly skill based objective), and A (predominantly attitude based objective).

At the end of the diploma program, the trainee should;

define and describe the nature of the discipline of family practice including its history,

philosophy and practice (K)

understand the role of the family physician as the gatekeeper of the health care system

and the implications of this role in providing cost-effective primary medical care (K,S)

be able to diagnose and manage common and undifferentiated problems in PHC

including ability to deal with uncertainty (S).

be able to diagnose and manage common emergencies according to PHC setting.(S)

acquire knowledge and skills during the rotations in the defined medical specialties

(K,S)

know and show how to approach a patient using the biopsychosocial model (K,S).

develop primary care-problem solving skills (S).

be able to establish an effective physician-patient relationship (S).

be able to use consultation and referrals in a continuity-of-care model (S).

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know and appropriately utilize community resources for patients (KS).

develop an understanding of the roles of the individual, family, social, cultural and

spiritual context of patients’ lives (KA)

apply acceptable principles and practices related to quality assurance of the health

services at the level of the PHC delivery system (S).

understand the disease patterns of the community and subsequently implement

effective anticipatory care programs (KS).

promote the autonomy of the individual, the family and the community by providing

continuous health education aimed at improving health status at these levels (KA).

Know , value and apply principles of professionalism and medical ethics (K,A).

understand basic critical appraisal and research methods (K)

acquire the self directed learning skills (S)

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SPECIFIC AIMS AND OBJECTIVES

FAMILY MEDICINE I and II

Duration: FM I =6 weeks and FM II= 8 weeks

Aim

Rotation in family medicine will allow trainees to develop a generic concept about family medicine and relevant subjects. Additionally, basic clinical

skills necessary for primary care will be taught during this period. Trainees will learn approaches to problem solving and management in the PHC

setting. The trainees will improve their knowledge and skills in areas such as principles and scope of family medicine, brief introduction to

epidemiology, evidence-based medicine, clinical audit, communication skills, health promotion, patient education, rational drug use, medical ethics,

and clinical skills training.

Competencies Specific objectives

At the end of the family medicine rotation, the trainee should be able to;

(K)nowledge

(S)kill

(A)ttitude

Level of

competence**

1. Can explain the common terms

and definitions related to family

medicine

1.1 define and express the common terms used in primary care K L-I

Family medicine, primary care and minimal care

Access to care

Continuity of care

Comprehensive care

Coordination of care

Contextual care

Problem based learning

Quality in medical care

2. Is competent in history taking and

physical examination at the

primary care setting

2.1 describe and summarize the structure of history taking K L-I

2.2 practice active listening strategies S L-I

2.3 embrace and utilize social and psychological aspects during history

taking

SA

L-I

2.4 accept involving patients in decision making A L-I

2.5 practice complete physical examination S L-I

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3. Can explain the epidemiology of

the common problems

encountered in primary care

3.1 define and infer the following terms:

Incidence

Prevalence

Morbidity

Mortality

K

L-I

3.2 explain disease control measures from an epidemiological perspective K

L-I

3.3 state the prevalence of the common problems in primary care K

L-I

3.4 recognize and hold in accordance with rules on notification and

disclosure of information (occupational trauma, adverse drug reactions,

disease notification, child abuse or neglect)

KA L-I

4. Can manage the common

problems encountered in primary

care

4.1 describe the place of laboratory tests in the management of the common

diseases in primary care

K

L-I

4.2 classify the differential diagnosis of the most common diseases in

primary care (19;20) (See Appendix 1)

K

L-I

4.3 summarize the criteria for referral of the most common diseases

(according to guidelines)

K

L-I

4.4 apply the biopsychosocial approach KS L-I

4.5 express the principles for rational drug use K L-I

5. Can perform common procedures

necessary for primary care

practice

5.1 perform the most common procedures needed in family practice

(Appendix 2)

S L-I

6. Can follow local and international

guidelines on ethical issues

6.1 describe the principles for rational drug use K L-I

6.2 manipulate situations of conflict between the patient’s right of autonomy

and the physician’s legal protection

SA

L-I

6.3 believe in patient confidentiality A L-I

6.4 treat patients with respect in teaching situations A L-I

6.5 establish and hold a balance between the roles as the patient’s advocate,

an administrator of health service resources and a clinical researcher

AS L-I

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7. Can establish an effective

communication in clinical

practice

7.1 apply the rules of good communication K L-I

7.2 manage poor compliance AS L-I

7.3 communicate with all patients regardless of social group S L-I

7.4 describe how psychosocial and cultural factors influence communication S

L-I

7.5 maintain a mutual trusting relationship with the patient during the

treatment course

KS L-I

7.6 conduct telephone consultations AS L-I

7.7 break bad news S L-I

8. Can apply patient education

strategies in primary care

8.1 accept that educational interventions are essential in family practice A

L-I

8.2 accept the responsibility of the physician to facilitate patient education SA

L-I

8.3 recognize that patient education must take cultural differences into

account

A

L-I

8.4 explain and apply the principles of patient education KS L-I

8.5 recognize the barriers to patient learning K L-I

8.6 identify patient's educational needs KS L-I

8.7 discuss and apply the basic methods to motivate patients K L-I

9. Can carry out preventive

consultation and health promotion

9.1 recognize that lifestyle counselling is an integral part daily practice A

L-I

9.2 recognize the general principles of nutrition K L-I

9.3 execute periodic health examinations and screenings KS L-I

9.4 guide and advise about the risks of alcohol and smoking KS L-I

9.5 guide and advise in relation to exercise KS L-I

9.6 guide and advise for injury prevention KS L-I

9.7 describe factors related with lifestyle changes K L-I

9.8 measure cardiac risk and provide guidance accordingly KS L-I

10. Can work collaboratively within

the general practice

10.1 believe in mutual respect in relation to patients, staff and colleagues A

L-I

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10.2 effectively utilize the practice’s human resources KS L-I

10.3 value team work A L-I

11. Can use the computer at work 11.1 access and utilize relevant websites S L-I

11.2 operate the common softwares during clinical practice S L-I

11.3 use the computer as a learning resource KS L-I

11.4 keep and maintain medical records using the computer as well as

paper based file systems

KS L-I

12. Can participate in the general

management of the practice

12.1 describe the physician’s responsibilities in respect to staff support,

especially the importance of a well-functioning work environment

K

L-I

12.2 provide relevant feedback to colleagues and practice staff KS L-I

13. Can work effectively with the

specialists and hospital system

13.1 describe the activities of the hospital system K L-I

13.2 willing to take part in collaborations between the practice and the

hospital system

A

L-I

13.3 describe the key features of good collaboration K L-I

13.4 prepare a detailed problem-oriented consultation/referral and inform

the patient about the relevant procedures and precautions

KS

L-I

13.5 interpret information from hospital discharge letters and outpatient

notes and plan the further patient management

KS L-I

14. Can perform vaccinations and

prophylaxis

14.1 describe the national vaccination program K L-I

14.2 advise and guide about the prophylactic vaccination program KS L-I

14.3 vaccinate S L-I

14.4 employ immunization and prophylaxis for foreign travels K L-I

15. Can apply the principles for

professional development

15.1 use different methods to reveal gaps in own knowledge or abilities

(e.g. audit, self-evaluation, critical incident reporting)

KS

L-I

15.2 register own training activities (e.g. portfolio) A L-I

15.3 share and exchange the experiences A L-I

16. Can retrieve and evaluate

knowledge and integrate it into

16.1 collect and assess new knowledge using an evidence based approach K

L-I

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current practice 16.2 state the literature resources for family medicine K L-I

16.3 understand basic research and statistical methods used in medical

articles

K

L-I

16.4 apply knowledge in own practice in consideration of its relevance and

validity

KS L-I

Suggested reading material

1. Fraser RC. Clinical Method: A General Practice Approach. Butterworth-Heinemann.

2. McWhinney IR. A Textbook of Family Medicine. Oxford University Press.

3. Al-Gelban KS. Family Medicine A Practical Approach. Jarir Publishing.

4. Pendleton D. The new consultation: Developing doctor-patient communication. Oxford University Press.

Journals and Websites:

1. American Family Physician

www.aafp.org

2. British Journal of General Practice

www.rcgp.org.uk/journal/bjgp.aspx

3. Saudi Medical Journal

www.smj.org.sa

4. Journal of Saudi Society of Community and Family Medicine

http://www.ssfcm.org/ssfcm_en/

5. Evidence Based Medicine Journal

http://ebm.bmj.com/

http://www.aafp.org/

http://www.rcgp.org.uk/journal/bjgp.aspx

http://www.smj.org.sa/

http://www.ssfcm.org/ssfcm_en/

http://ebm.bmj.com/

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ROTATION IN INTERNAL MEDICINE

Duration: 8 weeks

Aim

The aim of internal medicine rotation is to equip the trainees with the necessary knowledge, skills and attitudes necessary to cope with the

comprehensive acute and chronic medical problems encountered in PHC.


At the end of the internal medicine rotation, the trainee should be able

to;

(K)nowledge

(S)kill

(A)ttitude

Level of

competence**


targeted during the internal medicine

rotation

17.1 perform the following procedures learned during the internal

medicine rotation (Appendix 2)

S L-I and L-II

18. Can manage patients with oedema 18.1 examine and differentiate between different forms of oedema KS

L-I

18.2 perform primary investigation, diagnosis, treatment, and referral

of the common reasons for oedema in primary care:

Heart failure

KS

L-II

Liver disease L-II

Kidney dysfunction L-II

Allergy L-I

19. Can manage patients with

musculoskeletal symptoms

19.1 diagnose, treat and refer patients with the following common

conditions:

Osteoarthrosis

KS

L-I

Rheumatoid arthritis L-I

Gout arthritis L-I

Septic arthritis L-II

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19.2 explain neurological symptoms associated with musculoskeletal

illness

K L-I

19.3 explain how psychological and physical strain affects the

musculoskeletal system

K L-I

20. Can manage patients with chest pain 20.1 diagnose, treat and refer patients with the following common

conditions:

Musculoskeletal pain

KS

L-I

Peptic ulcer L-I

Acute coronary syndrome (Ischemic heart disease), L-II

Pneumothorax, L-III

Pulmonary embolism, L-III

Pulmonary tumors L-III

21. Can manage patients with abdominal

pain


conditions:

Dyspepsia

KS

L-I

Gallbladder disease L-II

Hepatitis L-II

Renal colic L-I

Gastroenteritis L-I

Irritable Bowel Disease L-III

22. Can manage patients with dyspnoea 22.1 diagnose, treat and refer patients with the following conditions:

Chronic obstructive pulmonary disease (COPD)

KS

L-I

Heart failure L-II

Ischaemic heart disease L-III

Asthma L-I

Anaemia L-I

Psychological causes L-I

Pulmonary embolism L-III

Foreign body aspiration L-III

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23. Can manage patients with coughing 23.1 diagnose, treat and refer patients with the following common

conditions:

Upper respiratory tract infection

KS

L-I

Lower respiratory tract infection L-I

Tuberculosis L-II

COPD L-I

Asthma L-I


Cardiac causes L-II

24. Can manage patients with fever 24.1 Diagnose, treat and refer patients with the following common

conditions:

Infectious disease

KS

L-I

Systemic disease L-II

Malignant disease L-I

25. Can manage patients with dysuria 25.1 Diagnose, treat and refer patients with the following common

conditions:

UTI

KS

L-I

Prostatizm L-II

Urinary stones L-I

STD’s L-I

26. Can manage patients presenting with

headache

26.1 Diagnose, treat and refer patients with the following common

conditions:

Migraine/cluster headache

KS

L-II

Tension headache L-I

Vascular problems L-III

Eye problems L-II

Malignant problems L-III

Hypertension L-I

Sinusitis L-I

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27. Can manage patients with chronic

illness


conditions:

Diabetes mellitus

KS

L-I

Hypertension L-I

Asthma L-I

Musculoskeletal problems L-I

Hyperlipidemia L-I

27.1 willing to participate in long-term management and rehabilitation

of chronic medical problems

A

L-I

27.2 support the individual and the family through consultation,

evaluation, treatment, and rehabilitation

AS L-I


neurological symptoms


conditions:

Stroke and its sequelae

KS

L-II

Cerebral palsy L-III

Seizures L-II

29. Can manage patients who present with

dizziness

30.1 diagnose, treat and refer patients with the following conditions:

Vestibular neuronitis

KS

L-II

Vertigo L-I

Cardiovascular causes L-I

Metabolic causes L-II

Menière’s disease L-III



fatigue


conditions:

Anaemia

KS

L-I

Thyroid diseases

Heart disease

L-I

L-I

Renal insufficiency L-II

Chronic fatigue syndrome L-I

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Fibromyalgia L-II


31. Can manage patients presenting with

weight change


conditions:

Thyroid diseases

KS

L-I

Anorexia L-I

Diabetes mellitus L-I

Cancer L-III

Malabsorption L-I

Obesity L-I

32.2 calculate Body Mass Index (BMI) KS L-I


altered bowel habits


conditions:

KS

Irritable bowel syndrome L-I

Malabsorption L-II

Infectious causes L-I

Myxoedema/thyrotoxicosis L-I

Constipation L-I

Food intolerance L-I

33. Can manage patients with arrhythmias 34.1 diagnose, treat and refer patients with the following conditions:

Atrial fibrillation

KS

L-II

Ventricular extrasystoles L-II

Bradicardia L-II

Paroxysmal atrial tachycardia L-II

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1. Rakel RE. Textbook of Family Practice. Saunders.

2. Kumar P. Clinical Medicine: A Textbook for Medical Students and Doctors. Elsevier.

3. Boon NA. Davidson's Principles and Practice of Medicine. Churchill Livingstone.

4. South-Paul J. Current Diagnosis & Treatment in Family Medicine. McGraw-Hill Medical.


1. British Medical Journal

www.bmj.co.uk

2. Saudi Annals of Medicine www.saudiannals.net

3. New England Journal of Medicine

http://content.nejm.org/

4. American Journal of Family Medicine

www.aafp.org

5. Modern Medicine

www.journalofmodernmedicine.com/

http://www.bmj.co.uk/

http://www.saudiannals.net/

http://content.nejm.org/


http://www.journalofmodernmedicine.com/

22 / 71

ROTATION IN PEDIATRICS

Duration: 8 weeks

Aim

Pediatric problems represent a large proportion of family practice visits. The family physician should be competent in the initial assessment and

management of the common pediatric problems with emphasis on problems that are more prevalent at the PHC level.


At the end of the pediatrics rotation, the trainee should be able to; (K)nowledge

(S)kill

(A)ttitude

Level of

competence**


targeted during the pediatrics rotation

35.1 perform the following procedures learned during the pediatrics

rotation (Appendix 2)

S L-I


musculoskeletal symptoms


conditions:

Congenital hip dislocation

KS

L-I

Rhematic fever L-II

Henoch schönlein purpura L-II

Infective arthritis L-III

36. Can manage patients with abdominal

pain


conditions:

Psychological causes

KS

L-I

Gostroesophageal reflux disease (GERD) L-II

Hepatitis L-I

Gastroenteritis L-I

Bowel obstruction L-III

37. Can manage patients with dehydration 38.1 diagnose patients with dehydration

38.2 interpret relevant laboratory results

KS

KS

L-I

L-I

38.3 identify the causes of dehydration K L-I

38.4 describe and grade dehydration KS L-I

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38.5 calculate fluid replacement needs KS L-I

38.6 describe and practice the proper methods for re-hydration

treatment

KS

L-I

38.7 describe the criteria for referral K L-I

38. Can manage patients with dyspnoea 39.1 diagnose, treat and refer patients with the following common

conditions:

Croup

KS

L-I


Asthma L-I

Metabolic disturbances L-II

Anaemia L-I

Psychological causes L-II


39. Can manage patients with coughing 40.1 diagnose, treat and refer patients with the following common

conditions:

Upper respiratory tract infection

KS

L-I


Tuberculosis L-II

Asthma L-I


40. Can manage patients with fever 41.1 diagnose, treat and refer patients with the following common

conditions:

URTI

KS

L-I

LRTI L-I

Meningitis L-III

Mumps L-I

Measles L-I

Chickenpox L-I

Rubella L-I

Gastroenteritis L-I

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UTI L-I

Hepatitis L-I

41.2 Choose appropriate antibiotics for infectious diseases KS L-I

41. Can manage patients with chronic

illness


conditions:

Diabetes mellitus

KS

L-II

Anemia L-II

Asthma L-I

Obesity L-I

Common genetic disorders L-I

42.2 willing to participate in long-term management and

rehabilitation of chronic medical problems

A L-I

43 Can manage patients with

lymphadenopathy


conditions:

Infectious disease

KS

L-I

Lymphoma L-III

Leukaemia L-III

44 Can manage patients with

neurological symptoms


conditions:

Cerebral palsy

KS

L-II

Febrile convulsions L-I

Epilepsy L-II

Other common causes of seizures L-II

Meningitis L-III

45 Can manage patients who present

with fatigue


conditions:

Anaemia

KS

L-I

Heart disease L-II

Drugs L-II

Psychological causes L-II

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46 Can manage patients presenting with

weight change


conditions:

Diabetes mellitus

KS

L-II

Malabsorption L-II

Obesity L-I

46.2 calculate Body Mass Index (BMI) KS L-I

46.3 use growth charts KS L-I

46.4 describe and explain normal weight gain and development KS L-I

47 Can manage patients who present

with altered bowel habits


conditions:

Malabsorption

KS

L-II

Infectious causes L-I

Constipation L-I

Food intolerance L-II

48 Can participate in the collaborative

management of the threatened child

48.1 identify and support children who are emotionally, socially or

physically threatened

KA

L-I

48.2 describe when and where to refer K L-I

49 Can manage patients with jaundice 49.1 diagnose, treat and refer patients with the following common

conditions:

Physiological jaundice

KS

L-I

Pathological jaundice L-II


1. Kliegman RM. Nelson Textbook of Pediatrics. Saunders.

2. Berkowitz CD. Pediatrics: a primary care approach. Saunders.

3. Polanay L. Community Pediatrics. Churchill Livingstone.


26 / 71

Journals and Websites: 1. Journal of Pediatrics

http://journals.elsevierhealth.com/periodicals/ympd

2. Annals of Saudi Medicine

www.saudiannals.net

3. American Family Physician

www.aafp.org

http://journals.elsevierhealth.com/periodicals/ympd

http://www.saudiannals.net/


27 / 71

ROTATION IN SURGERY , UROLOGY AND ORTHOPEDICS

Duration: 6 weeks (4 weeks Surgery + 2 weeks Orthopedics)

Aim

The comprehensive care delivered by family physicians spans the preoperative and post-operative timeframes. The rotation in surgery and orthopedics

should help the trainee to acquire knowledge, skills and attitude that will enable them to provide the essential services and to make clinical decisions

related to common surgical and orthopedic problems encountered in the PHC setting.


At the end of the rotation program the trainee should be able to; (K)nowledge

(S)kill

(A)ttitude

Level of

competence**

50 Can perform common procedures

targeted during the surgery and

orthopedics rotations

50.1 perform the following procedures learned during the surgery

and orthopedics rotations (Appendix 2)

S L-I and L-II

51 Can assess, diagnose and treat patients

with rectal bleeding


conditions:

Hemorrhoids

KS

L-II

Anal fissure L-II

Malignancies L-III

52 Can assess, diagnose and treat patients

with upper GI bleeding


conditions:

Peptic ulcer disease

KS

L-I

Malignancies L-III

53 Can manage patients with acute

abdomen


surgical conditions:

Appendicitis

KS

L-III

Cholescystitis L-III

Intestinal obstruction L-III

Pancreatitis L-III

28 / 71

Renal colic L-I

54 Can manage patients who consult for

breast-related conditions



Breast discharge

KS

L-II

Breast mass L-II

Breast cancer L-III

Inflammatory breast disorders L-I

55 Can manage patients with abdominal

mass



Hernia

KS

L-III

Malignancies L-III

Organomegaly L-III

55.2 show sensitivity to the patient’s and family’s concerns and

anxieties regarding the potential need for surgical intervention

A

L-I

55.3 recognize the importance of family physician and surgeon

collaboration

A L-I

56 Can manage patients with fractures and

dislocations


orthopedic conditions:

Upper and lower limb fractures

Dislocations

KS L-II



2. Collier JAB. Oxford Handbook of Clinical Specialties. Oxford Medical Publications.

3. Doherty GM. Current Surgical Diagnosis & Treatment. McGraw-Hill Medical.

4. Apley AG. A System of Orthopedics and Fractures. Appleton-Century-Crofts.


1. Annals of Surgery

www.annalsofsurgery.com

2. Orthopedics Information

www.worldortho.com

http://www.annalsofsurgery.com/

http://www.worldortho.com/

29 / 71

ROTATION IN OBSTETRICS AND GYNAECOLOGY

Duration: 4 weeks

Aim

The obstetrics/gynecology practice occupies a central position in the care of the whole family. A significant proportion of problems dealt with in

family practice are related to the discipline of obstetrics and gynecology. The family physician should be competent in initial assessment and interim

management of all these cases and in the overall management of common obstetrical and gynecological problems.


At the end of the gynecology and obstetrics rotation, the trainee should

be able to;

(K)nowledge

(S)kill

(A)ttitude

Level of

competence

**

57 Can explain the common terms and

definitions related to gynecology and

obstetrics

57.1 define and express the common terms used in gynecology and

obstetrics

Menarche

Climacterium

Menopause

Menorrhagy

Amenorrhea

Oligomenorhea

Polimenorrhea

Dysmenorrhea

Dysfunctional uterine bleeding

Abnormal uterine bleeding

Miscarriage

Abortion

K L-I

58 Is competent in history taking and

physical examination of the

gynecology and obstetrics patient

58.1 take history from an obstetrics/gynecology patient KS L-I

58.2 Perform the relevant gynecologic and obstetric examinations

(Appendix 2)

KS

L-I, L-II

59 Can perform common procedures

targeted during the gynecology and

59.1 perform the following procedures learned during the gynecology

and obstetrics rotations (Appendix 2)

S L-I, L-II

30 / 71

obstetrics rotations

60 Can manage common gynecologic

problems

60.1 describe the normal menstrual cycle/bleeding patterns K L-I

60.2 give advice with respect for the norms and values of the

individual and the community

A

L-I

60.3 give guidance on relevant hygiene KS L-I


gynecologic conditions:

Abnormal menstruation

KS

L-II

Abnormal uterine bleeding L-II

Premenstrual syndrome L-I

Menopause L-I

Dysmenorrhea L-I

PID L-II

Vaginal discharge L-I

STDs L-I

61 Can manage common obstetric

problems

61.1 give advice with respect for the norms and values of the

individual and the community

A

L-I

61.2 provide preconceptional counselling (epilepsy, hypertension,

diabetes mellitus, asthma, other chronic medical illness, genetic

malformations)

KS L-I

61.3 advise and counsel about the significance of lifestyle for the

pregnancy and the foetus

KS

L-I

61.4 collaborate with relevant partners A L-I

61.5 understand the physiology of breast feeding and support breast

feeding

KA

L-I


obstetric conditions:

normal pregnancy (antenatal care, postnatal care, puerperium,

breastfeeding problems)

KS

L-I

high risk pregnancy L-III

31 / 71

62 Can advise about contraceptive

methods

62.1 describe different types of contraceptive methods

Hormonal

IUD

Surgical procedures

Barrier methods

Traditional methods

K

L-I

62.2 support the patient to choose the correct method A L-I

62.3 explain the side effects of contraceptive methods K L-I

62.4 explain the indications and use of emergency contraception K L-I


1. Cunningham FG. Williams Obstetrics Crafts, McGraw-Hill Professional.


3. DeCherney AH. CURRENT Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Medical.

4. Monga A. Gynaecology by Ten Teachers. A Hodder Arnold Publication.

5. McPherson A. Women's Problems in General Practice. Oxford Medical Publications.

Journals and Websites: 1. Journal of Obstetrics and Gynecology

http://www.ccspublishing.com/j_obg.htm

http://www.ccspublishing.com/j_obg.htm

32 / 71

ROTATION IN PSYCHIATRY

Duration: 4 weeks

Aim

The rotation in psychiatry should help the family physicians to acquire knowledge, skills and attitude that will enable them to provide the essential

services and to make clinical decisions related to common psychiatric problems encountered in the PHC setting as well as to refer when necessary.


At the end of the psychiatry rotation, the trainee should be able to; (K)nowledge

(S)kill

(A)ttitude

Cmpetency

levels**

63. Can explain the common terms and

definitions related to psychiatry

63.1 define and express the common terms used in psychiatry

Anxiety

Psychosis

Phobia/Panic

Obsession/compulsion

Hallucination/Illusion/Delusion

Dysthymia

Hyperactivity

K L-I

64. Is competent in history taking and

physical examination of the

psychiatric patient

64.1 take history from a psychiatric patient KS L-I

64.2 perform mental status examination S L-I

64.3 perform the mini mental test S L-I


psychiatric problems


conditions:

Affective disorders (major depression, dysthymia, mania)

anxiety disorders (generalized anxiety disorder, panic disorder,

phobias, posttraumatic stress disorder, obsessive compulsive dis.)

disorders of thought (e.g. schizophrenia)

Attention deficit hyperactivity disorder

KS L-I

33 / 71



2. Markus AC. Psychological Problems in General Practice. Oxford Medical Publications.

3. Goldberg D. Psychiatry in Medical Practice. Routledge.

4. American Psychiatric Association. DSM. Diagnostic and statistical manual of mental disorders: primary care version. American Psychiatric

Association.


1. Archives of General Psychiatry

http://archpsyc.ama-assn.org/

2. American Psychiatric Association

www.psych.org

http://archpsyc.ama-assn.org/

http://www.psych.org/

34 / 71

ROTATION IN EMERGENCY MEDICINE

Duration: Emergency I (one of the Eids ) + Emergency II ( 18 on-call duties (8 adults, 6 pediatrics, and 4 obstetrics))

Aim

During practice, family physicians may be exposed to a variety of medical emergencies. Therefore, they should be competent in the initial assessment

and interim management of emergencies in all age groups and in the overall management of common emergencies. They should also be familiar with

the contribution of hospital emergency services in order to make appropriate referrals.


At the end of the emergency medicine rotation, the trainee should be

able to;

(K)nowledge

(S)kill

(A)ttitude

Level of

competence**

66. Can manage the common emergency

problems


emergency conditions:

Cardiovascular emergencies

o acute coronary syndrome

o acute heart failure

K

L-III

Respiratory insufficiency

o status asthmaticus,

o pneumothorax

L-III

Neurological emergencies

o convulsions

o stroke

L-III

Hematological emergencies

o Acute blood loss

o Sickle cell crisis

L-III

Anaphylaxis L-III

35 / 71

Reduced level of consciousness L-III

Acute metabolic state (e.g. diabetic ketoacidosis,

hyperkalemia, hypokalemia)

L-III

Trauma management

o Burns

o Fractures

o Lacerations

o Cut wounds

L-II

66.2 classify and manage emergency cases according to the triage

rules

K

L-I

66.3 initiate acute treatment (e.g. oxygen, intravenous fluids,

Trendelenburg position)

S

L-II

66.4 work efficiently with other members of the health care team A L-III

67. Can perform common emergency

procedures necessary for family

practice

67.1 perform the following procedures learned during the emergency

medicine rotation (Appendix 2)

S L-I and L-II


1. Lawrence N. Handbook of Emergencies in General Practice. Oxford University Press.

2. Stone CK. Current Emergency Diagnosis and Treatment. McGraw-Hill Medical.

3. Moulds AJ. Emergencies in General Practice. Petroc Press.


1. Journal of Emergency Medicine

http://www.sciencedirect.com/science/journal/07364679

http://www.sciencedirect.com/science/journal/07364679

36 / 71

ROTATION IN DERMATOLOGY

Duration: 2 weeks

Aim

A significant proportion of problems dealt with in PHC practice is related to the specialty of dermatology. The family physician should be competent in

the initial assessment and interim management of these cases and in the overall management of common dermatologic problems. The trainee should

also be familiar with the contribution of specialists in dermatology, in order to make appropriate referrals.


At the end of the rotation in dermatology, the trainee should be able to; (K)nowledge

(S)kill

(A)ttitude

Level of

competence**

68. Can explain the common terms and

definitions related to dermatology

68.1 define and express the common terms used in dermatology

Erythema

Nodule

Pustule

Echymosis

Macule

Papule

Vesicle

Bullae

K L-I

69. Can manage the common problems

related with skin


dermatologic conditions:

impetigo

KS

L-I

Warts L-I

herpes simplex and herpes zoster L-I

pityriasis rosea L-I

Urticaria L-I

Dermatophytosis L-I

atopic dermatitis L-I

37 / 71

acne vulgaris L-I

Rosacea L-I

Scabies L-I

Lice L-I

Leishmaniasis L-II

70. Can manage patients with skin

manifestations due to systemic

disease

70.1 investigate and initiate treatment or refer the following common

conditions which may cause skin symptoms:

infectious diseases (e.g. viral/septic)

allergy

autoimmune manifestations, anaemia

jaundice

porphyria

K L-II

70.2 distinguish between benign/temporary skin manifestations and

symptoms that require investigation and treatment

KA L-I


necessary for dermatology

71.1 perform the following procedures learned during the

dermatology rotation (Appendix 2)

S L-I, L-II



2. Graham–Brown R. Lecture Notes on Dermatology. Blackwell Publishers.

3. Rycroft RJG. A color handbook of dermatology. Thieme Medical Publishers.

4. Buxton PK. ABC of Dermatology. BMJ Books. Blackwell Publishing.

http://resources.bmj.com/bmj/topics/abcs


1. The Journal of Dermatology

http://www.dermatol.or.jp/Journal/JD/index-e.html

2. Pictures and images in dermatology

www.dermis.net


http://www.dermatol.or.jp/Journal/JD/index-e.html

http://www.dermis.net/

38 / 71

ROTATION IN OPHTHALMOLOGY

Duration: 2 weeks

Aim

Eye diseases represent an important proportion of problems dealt with in family practice. The family physician should be competent in initial

assessment and interim management of these cases and in the overall management of common ophthalmologic problems. The trainee should be

familiar with the contribution of specialists in ophthalmology, in order to make appropriate and timely referrals.


At the end of the ophthalmology rotation, the trainee should be able to; (K)nowledge

(S)kill

(A)ttitude

Level of

competence**

72. Can explain the common terms

and definitions related to

ophthalmology

72.1 define the common terms used in ophthalmology:

Myopia

Hypermetropia

Astigmatism

Strabismus

Nystagmus

Scotoma

Amblyopia

Chemosis

Exopthalmos

Ectropion

Entropion

Miosis

Mydriasis

Nanopthalmos

Photophobia

Ptosis

Tropia

K L-I


problems related with the eye

73.1 diagnose, treat and refer patients with the following common eye

conditions:

Strabismus

KS

L-II

Amblyopia L-II

Dry eyes L-I

Glaucoma L-III

Hordeolum/chalazion L-II

Dacryocystitis L-II

39 / 71

Nasolacrimal duct obstruction L-II

Retinal diseases (e.g. diabetic retinopathy, hypertensive

retinopathy)

L-II

Refraction errors (myopia, hypermetropia, astigmatism,

presbyopia)

L-II

Visual acuity problems (e.g. cataract, uveitis) L-II

Red eye (e.g. infections, inflammations, foreign body, corneal

abrasion)

L-I

First aid and referral for eye trauma L-I

73.2 describe how a number of systemic diseases can present with eye

symptoms

K L-I

73.3 appreciate the effects of impairment of visual function in daily

activities

A L-I


necessary for family practice

74.1 perform the following procedures learned during the ophthalmology

rotation (Appendix 2)

S L-I



2. Khaw P. ABC of Eyes. BMJ Books. Blackwell Publishing



1. British Journal of Opthalmology

www.bjopthalmology.com

2. American Academy of Opthalmology

www.aao.org


http://www.bjopthalmology.com/

http://www.aao.org/

40 / 71

ROTATION IN EAR NOSE and THROAT (ENT) DISEASES

Duration: 2 weeks

Aim

A significant proportion of problems dealt with in family practice is related to the specialty of ENT. The family physician should be competent in

initial assessment and interim management of these cases and in the overall management of common ENT problems. The trainee should be familiar

with the contribution of specialists in ENT in order to make appropriate referral.


At the end of the ENT rotation program, the trainee should be able to; (K)knowledge

(S)kill

(A)ttitude

Level of

competence

**

75. Can manage the common problems

related with ENT

75.1 diagnose, treat and refer patients with the following common ENT

conditions:

tonsillitis

KS

L-I

mouth ulcers L-I

nasal bleeding L-II

rhinitis L-I

nasal polyp L-III

sinusitis L-I

otitis media L-I

otitis externa L-I

hearing loss L-III

tinnitus L-III

hoarseness L-II

adenoid hypertrophy

vertigo

L-III

L-II

75.2 recognises systemic diseases that may present with oral cavity

signs/symptoms

K L1


related with ENT

76.1 perform the following procedures learned during the ENT rotation

(Appendix 2):

S L-I, L-II

41 / 71



2. Collier J. Oxford Handbook of Clinical Specialties. Oxford University Press.

3. Ludman H. ABC of Otolaryngology. BMJ Books. Blackwell Publishing.


Journals and Websites: 1. ENT Journal

www.entjournal.com

**Competency Levels: L-I (Mastery Level): trainee can do it

independently

Knowledge or skills those are essential to the independent and timely management of illness and

disorders.

L-II (Proficiency Level, Shared Care):

trainee can do it under direct

supervision

This level of knowledge or skill may lacking in-depth knowledge/skill, physician may review

reference texts, consult other specialists, or refer to other physicians without posing a risk to

patients' health or well-being.

L-III (Familiarity Level): trainee

cannot do it, only observer.

This level of knowledge facilitates comprehensive and thorough diagnosis and/or management

of complex clinical problems encountered, but more detailed knowledge seldom benefits

patients' health or well-being. Referral to other specialists is generally required for the diagnosis

and/or management of these conditions.

Modified from: Society of Academic Emergency Medicine, www.saem.org/SAEMDNN/LinkClick.aspx?link=model.doc&tabid=57&mid=1020


http://www.entjournal.com/

42 / 71

SELECTION PROCESS

Selection criteria will be applied according to the criteria set by the Saudi Commission for

Health Specialties as follow:

50% for Saudi licensing examination SLE

10% for GPA

40% for interview with local committee. Interview should include areas such as :

Value and orientation to PHC/FM

Value and orientation to the family medicine residency training program

Interpersonal (positive attitude)

Self management

Way of thinking and management

Professional value and growth

STRUCTURE AND DESIGN

Family Medicine 1 (Introduction to FM - 6 weeks)

Typical week:

4 days theory

1 PHC (FM Family Medicine ) clinics

1 HDRC

Contents: 6 clinics PHC.

5 sessions half day release course.

24 full days of theory classes.

Topics to be covered are:

1. Introduction of the program: objectives, learning needs, design, curriculum,

requirements, evaluation, learning contract.

2. Concepts and principles of Family Medicine.

3. Primary health care system in Saudi Arabia.

4. Epidemiology and statistics in family practice

5. Evidence based medicine

6. Consultations & Communication: Principles and practice

7. Health promotion and education

8. Morbidity patterns and approach to most common health problems in family

practice

43 / 71

9. Rational drug prescription

10. Women’s health/reproductive health

11. Child health care

12. Adolescent health care

13. Mental health and mental disorders

14. Professional development

15. Practice management and team work

16. Continuous Quality Improvement (CQI)

17. Medical Ethics and professionalism and patient safety

End rotation evaluation: Total marks 100 as follow:

Portfolio/Log book = 30

Theoretical assessment (MCQ + Oral ) = 40

Attendance= 30

Internal medicine rotation (8 weeks)

Typical week:

6 General medicine clinics

1 PHC clinic

1 HDRC

2 Skill sessions

End rotation evaluation:

Total marks 100 as follow:


Supervisor evaluation (based on the competency list) = 30

Attendance= 30

Pediatric rotation (8 weeks)

Typical week:

5 General pediatric clinics

1 neonatal clinics (If available)

1 PHC clinic

1 HDRC

2 Skill sessions





Attendance= 30

Other Subspecialty Rotations (6 weeks)

Typical week:

6 subspecialty clinics

1 PHC clinic

1 HDRC

44 / 71

2 Skill sessions related to the subspecialty


Total marks 100 as follows:



Attendance= 30

Psychiatry (4 weeks)

Typical week:

6 psychiatry clinics

1 PHC clinic

1 HDRC

2 Skill sessions


Total marks 100 as follows:



Attendance= 30

Obstetric& Gynecology (4 weeks)

Typical week:

3 obstetric clinics

3 gynecological clinics

1 PHC clinic

1 HDRC






Attendance= 30

General surgery, Urology & Orthopedic (6 weeks)

Typical week:

6 specialty clinics

1 PHC clinic

1 HDRC






Attendance= 30

45 / 71

Family Medicine 2 (FM clinical rotation - 8 weeks)

Typical week:

7 PHC clinics

1 HDRC

2 Skill sessions





Attendance= 30

Emergency rotation I

Typical week:

4 emergency shifts of 6-8 hours in recognized hospital

2 Skill sessions related to Emergency medicine

Total of 8 on calls

o 4 on calls adult medicine

o 4 on calls pediatrics





Attendance= 30

Emergency rotation II

Typical week:

Longitudinal, throughout the program at the weekends

Total of 18 on calls through out the year

o 8 on calls adult

o 6 on calls pediatric

o 4 on calls labor and delivery





Attendance= 30

Half day release course (HDRC) sessions (50 sessions)

Typical week:

Once per week throughout the program.



46 / 71

Pass mark will be 70%

o Attendance: At least 40% out of 50%

o Presentation: At least 30% out of 50%.

Skill sessions (60 sessions)

Skill sessions will be longitudinally organized under each rotation. There will be 2 skills

sessions every week. The skills aimed are given in Appendix 2.

Training process:

The tools for training include:

Case discussion (trainee' sees patient first, then presents history, physical and

suggested management)

Chart review (similar to case review, but written record of patient's visit is used

instead of trainee's verbal report)

Direct observation (can be accomplished by a video camera, through a one-way glass,

or by preceptor sitting in the consultation room with the trainee and observing the

clinical encounter)

Standardized patient encounters / role play

Didactic presentation in rotations and HDRC

Field notes

Trainee logs

Direct Observation: Direct observation can be accomplished by a video camera, through a one-way glass, or with

the preceptor sitting in the consultation room with the trainee.

Trainees are to be directly observed at least 3 times a week during the Family Practice block

time, and at least twice a month during the longitudinal clinic sessions.

General Principles:

o If it is possible; Videotaping is the preferred technology for direct observation. It would

be a very valuable tool for the trainee in the process of self-evaluation.

o Patient consent must be obtained for videotaping of clinical encounters .

o It is helpful for both the trainee and preceptor to agree on some specific objectives for the

viewing session. This does not preclude dealing with issues which arise from the

interview, but can help to focus the leaning experience.

In general, one should consider the following in the training and evaluation of trainees:

1. trainee evaluation should be thought of as a continuum throughout a specific rotation,

culminating in a final written record

2. trainee and supervisor should formally establish goals at the beginning of the rotation and

come to a mutual understanding of responsibilities and expectations.

3. Halfway through the rotation, trainee and supervisor should meet and there should be a

47 / 71

mid-rotation evaluation, with comments recorded by the supervisor on the appropriate

evaluation form

4. Periodic meetings between trainee and supervisor help to keep objectives in mind

5. At the completion of the rotation, supervisor and trainee should formally meet and discuss

the final evaluation. The appropriate evaluation form must be completed, discussed with

the trainee and signed by both.

48 / 71

EVALUATION

Evaluation of the trainee

Evaluation of the trainee will be based on the evaluation after each rotation (in order to pass

that rotation) and appear in the final examination. The final evaluation will include the

portfolio assessment.

Formative evaluation The purpose of formative evaluation is to facilitate learning by providing methods

for ongoing monitoring and feedback regarding a trainee's performance. In order to give

feedback to the trainee and enable formative evaluations, the trainee and his/her assigned

family practice/speciality trainer should meet once every two weeks. During these meetings

they are expected to review the portfolio and develop a plan to improve in deficient areas.

The process should assist trainees in assessing their strengths and learning needs. This then

directs appropriate modification of clinical experiences in order to more effectively meet

individual learning needs. The responsibility for formative evaluation rests primarily with the

trainee in consultation with the preceptor/ supervisor.

End of rotation Evaluation

At the completion of a clinical rotation, each trainee (resident) receives an evaluation that

offers an objective assessment of their level of achievement. The trainee must achieve a level

of competence appropriate to their level of training in order to pass.

The primary supervisor(s) on each rotation will provide a final evaluation. The evaluation is

to based on the supervisor's perception as to whether the trainee has successfully met program

objectives and specific learning outcomes for that specific rotation.

Medical staff (e.g. head nurse) who have brief encounter (e.g. One evening in Emergency

department,) are asked to offer opinions on the skills, attitudes, knowledge and behavior

demonstrated during that time. This information is taken into consideration when completing

the overall evaluation for the trainee.

Tools that can be used in assessment:

Multiple tools would be better and more valid than individual tool. These tools include:

o Portfolio ; The trainee should regularly maintain the portfolio and use it for the

following:

o To store and organize Work Based Assessments documents as they occur

o To record clinical experience (log book)

o To reflect upon clinical experience and plan learning (reflective diary)

o To record meetings with educational supervisor (appraisal documents)

o To prepare for the annual assessment (revalidation)

49 / 71

o To record formal and informal learning episodes (CPD document)

o To store audit/research/teaching activities

o To record any critical incidents, complaints, guidelines (clinical governance)

o Any other information that supports the trainee's Good Medical Practice e.g.

letters from patients, feedback

o DOPS (direct observation of practical skills); Competence in practical skills (PS)

listed in Appendix 2 is assessed using a modified version of the DOPS rating

scale

o Mini-Clinical Evaluation Exercise(Mini CEX)

o Multisource Feedback ( 360° Feedback )

o Mid-term OSCE with feedback

Final (Summative) Evaluation

Prerequisite to be eligible to set for final exam:

1. To pass all rotations: At least 70% out of 100%.

2. To pass HDRC: At least 70% out of 100%.

Attendance: At least 40% out of 50%

Presentation: At least 30% out of 50%. (the presenting trainee will

be evaluated by the audience during the HDRC using an evaluation

form)

3. Completed portfolio

Final exam :

o Theoretical (Written) : MCQ + Applied knowledge (data + Pictures) 50%

o Clinical : in form of simulated clinical scenarios 50%

Passing mark: out of a total score of 100, 65 is the passing grade

and 50 is the minimum grade to pass the theoretical examination

and clinical examination.

Trainees who cannot pass the final exam will be allowed to enter the same examination on the

following year according to the Saudi Commission for Health Specialties rules/regulations.

Evaluation of the program

Program evaluation has been described as the effort to determine whether program objectives

have been reached and the gathering of information to assess the efficiency of a program.(21)

50 / 71

It has also been suggested that program evaluation emphasizes both educational processes and

outcomes (Demirel, 2002)

Each training activity will be evaluated by the learners using appropriate instruments.

Trainee performance levels, oral and written trainee and trainer feedback will be assessed, and

reports of educational committees will be evaluated.

Feedback will be given to the trainers. At the end of the teaching year the trainers will prepare

a report to improve the program.

Levels of Kirkpatrick model of training program evaluation would be adopted. Kirkpatrick

has described four levels of program outcomes to be assessed (Kirkpatrick 1998). The first

level is learners’ and instructors’ reactions and contentment with the program. The second

level is to assess the increase in learners’ knowledge and skill, and the third level evaluates

whether learners apply their new knowledge and skills through appropriate behavioral

changes in their subsequent work/roles. The fourth level is to evaluate the impact of the

program on the institution and society in which the program was implemented. It has been

suggested that program evaluation should start with assessments of the first evaluation level

and then, within practically achievable limits, continue with the second through fourth levels

(Nickols, 2003);

51 / 71

REFERENCES

(1) Saudia Online. Saudi Arabia, The Country in Brief. Saudia Online 2007 [cited 2007

Feb 22];Available from: URL: http://www.saudia-

online.com/saudi_arabia.htm#people

(2) Ministry of Health. Health Statistical Year Book. Saudi Arabia: MoH; 2002.

(3) Khoja TA, Farid SM. Saudi Arabia Family Health Survey. Riyadh: MoH; 2000.

(4) Ministry of Health. Saudi Arabia Total Health Resources. Ministry of Health 2006

[cited 2006 Aug 23];Available from: URL:

http://www.moh.gov.sa/ch02_pdf/total_health_resources_in_moh.pdf

(5) Abdurrahman K.A., Al-Dakheel A. Family Medicine Residency Program in Kingdom

of Saudi Arabia: Residents Opinion. Pakistan Journal of Medical Sciences

2006;22(3):250-7.

(6) Stange KC, Miller WL, McWhinney I. Developing the knowledge base of family

practice. Fam Med 2001 Apr;33(4):286-97.

(7) Jarallah J, Khoja T, Mirdad S. Continuing medical education and primary health care

physicians in Saudi Arabia: perception of needs and problems faced. Saudi Med J

1998;19:720-7.

(8) Monash University Department of General Practice. Graduate Diploma in Family

Medicine. Monash University 2007Available from: URL:

http://www.med.monash.edu.au/general-practice/teaching/files/family-med.pdf

(9) CUHK School of Public Health Faculty of Medicine. Diploma in Family Medicine

2006-07. Chinese University of Hong Kong 2007Available from: URL:

http://www.csu.med.cuhk.edu.hk/%7Edfm/course/dfm/intro.htm

(10) University of Cape Town School of Public Health and Family Medicine. Higher

Diploma in Family Medicine and Master of family Medicine. University of Cape

Town 2007Available from: URL: http://www.fammed.uct.ac.za/

(11) National University of Singapore. Graduate Diploma (Family Medicine) Programme.

National University of Singapore 2007Available from: URL:

http://www.nus.edu.sg/nusbulletin/0405/med/325.htm

(12) Postgraduate Institute of Medicne of Sri Lanka. Regulations and Guidelines for

Diploma in Family Medicine MD Family Medicine. Sri Lanka: University of

Colombo; 2005.

(13) Council of Europe. Primary Care Training in Europe. 1998.

(14) Thomas H, Field S, Hibble A, Swanwick T. RCGP Training Curriculum. Royal

college of General Practitioners; 2005.

http://www.saudia-online.com/saudi_arabia.htm#people

http://www.saudia-online.com/saudi_arabia.htm#people

http://www.moh.gov.sa/ch02_pdf/total_health_resources_in_moh.pdf

http://www.med.monash.edu.au/general-practice/teaching/files/family-med.pdf

http://www.csu.med.cuhk.edu.hk/~dfm/course/dfm/intro.htm

http://www.fammed.uct.ac.za/

http://www.nus.edu.sg/nusbulletin/0405/med/325.htm

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(15) The Danish College of General Practitioners. Specialist training in general practice:

statement of aims. Danish College of GP; 2004.

(16) TAHYK. Family Medicine Board Training Program. Turkish Association of Family

Physicians; 2006.

(17) AAFP. Recommended Curriculum Guidelines for Family Practice Residents.

American Academy of Family Physicians; 2007.

(18) Wonca-Europe. The European definition of GP/FM. Global Family Doctor

2002Available from: URL: www.globalfamilydoctor.com/publications/Euro_Def.pdf

(19) Al-Gelban KS. Family Medicine A Practical Approach. Riyadh: Jarir Publishing;

2007.

(20) O'Brien-Gonzales A, Chessman AW, Sheets KJ. Family Medicine Clerkship

Curriculum: Competencies and Resources. Fam Med 2007;39(1):43-6.

(21) B Musal, C Taskiran, Y Gursel, S Ozan, S Timbil, S Velipasaoglu . An Example of

Program Evaluation Project in Undergraduate Medical Education . Education for

Health, Volume 21, Issue 1, 2008 .Available from: http://www.educationforhealth.net/

. Retrieved date: 2 September 2009

(22) UBC, Department of Family Practice, Postgraduate program. Faculty of Medicine.

http://www.familymed.ubc.ca/residency/Resident_Resources/Education/Evaluation/Fo

rmative___Summative_Evaluations.htm (accessed Aug 2009)

(23) Kirkpatrick, D.L.. Evaluating Training Programs: The Four Levels. San Francisco,

CA: Berrett-Koehler. 1998

(24) NICKOLS, F. (2003). Evaluating Training: There is no “cookbook” approach.

http://home.att.net/~nickols/articles.htm. Retrieved date: 2 September 2009

http://www.globalfamilydoctor.com/publications/Euro_Def.pdf

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APPENDIX 1 – Most common / important problems in FM

The 33 most common problems encountered in family medicine

# Complaint/Diagnosis

1. Abdominal pain

2. Allergic rhinitis

3. Anemia

4. Antenatal/postnatal care

5. Back pain

6. Bronchial asthma/COPD

7. Brucellosis

8. Irritable Bowel Syndrome IBS

9. Chest pain

10. Depression/anxiety

11. Diabetes mellitus

12. Dizziness and vertigo

13. Dyslipidemia

14. Dyspepsia

15. Dysuria and STD

16. Ear pain

17. Fatigue

18. Fever

19. Headache

20. Hypertension

21. Jaundice and hepatitis

22. Malaria

23. Menstrual disorders

24. Obesity/Nutrition

25. Painful joints

26. Periodic health assessment

27. feeding and growth problems

28. Rectal bleeding

29. Red eye

30. Skin problems

31. Sore throat

32. Tuberculosis

33. Vaginal symptoms

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APPENDIX 2 – CORE PROCEDURAL SKILLS

Graduates of the diploma program should be able to;

Skills Rotation/setting Level of

competence

Context

1. Access and utilize relevant websites FM

L-I OPD

2. Apply casts and splints SO, EM

L-I Skill Lab

3. Apply common methods of injections FM, IM, EM, Ped.,

SO

L-I Skill Lab

4. Apply different vaccines and sera. FM, Ped.

L-I Skill Lab

5. Apply gastric lavage FM, IM, Ped. SO.

L-II Skill Lab

6. Apply Glasgow coma scaling and

Trauma scoring

EM L-I OPD

7. Apply skin sutures SO

L-I Skill Lab

8. Apply wound dressing SO

L-I OPD

9. Assess strabismus in children O, FM, Ped.

L-I OPD

10. Communicate effectively to patients FM, IM, Ped, SO,

OG, D, ENT, EM

L-I OPD

11. Conduct antenatal and postnatal care

(ANC, PNC),

OG, FM L-I OPD

12. Conduct CPR (Adult and Pediatric) EM, Ped., IM

L-I Skill Lab

13. Conduct proper mental & psychiatric

examination.

Psy, FM L-I OPD

14. Conduct screening FM

L-I OPD

15. Conduct telephone consultations

FM

L-I OPD

16. Control nasal bleeding by pressure

and chemical cautery

ENT L-II OPD

17. Critically reading scientific papers FM

L-I OPD

18. Demonstrate the proper use of

inhalers and nebulizers and spacers

FM, IM, Ped L-I OPD

19. Demonstrate the use of

peakflowmeter appropriately

FM, IM, Ped L-I OPD

20. Draw family tree FM

L-I OPD

21. Examination of the CNS FM, IM, Ped L-I OPD

22. Examine children in different ages

and doing routine check up in WBC

FM, Ped. L-I OPD

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23. Family planning counseling FM, OG

L-I OPD

24. General Examination including

female breast examination

FM, IM, Ped, SO,

OG, D, O, ENT

L-I OPD

25. General eye examination O, FM

L-I OPD

26. Initiate vascular access and Give IV

fluids & different solutions

EM, Ped.,

IM, SO

L-I Skill Lab

27. Give local anesthesia. SO

L-I OPD

28. Immobilize fractures FM, SO, EM

L-I Skill Lab

29. Incise and drain abscess SO

L-I OPD

30. Insert and remove IUD OG, FM

L-II Skill Lab

31. Insert NGT FM, IM, Ped. OG,

SO.

L-II Skill Lab

32. Interpret x-rays FM, IM, Ped, SO,

ENT

L-I OPD

33. Manage burns (degree 1 and 2 ) FM, EM

L-I OPD

34. Manage sprains and strains FM, SO

L-I OPD

35. blood pressure measurement Ped., EM, IM

L-I Skill Lab

36. Perform and interpret Weber & Rinne

test properly

ENT L-I OPD

37. Perform cervical smear OG, FM

L-I Skill Lab

38. Perform direct ophthalmoscopy O, FM

L-I OPD

39. Perform Leopold maneuvers OG, FM

L-I OPD

40. Perform otoscopy / rhinoscopy

properly

ENT, FM L-I OPD

41. Perform proper bone & joints exam. SO

L-I OPD

42. Perform the Heimlich maneuver EM,

L-I OPD

43. Perform vaginal Exam and vaginal

swab

OG, FM

L-I Skill Lab

44. Physical examination for congenital

hip dislocation

Ped., SO L-I OPD

45. Rational prescription FM

L-I OPD

46. Record and interpret ECG FM, IM

L-I OPD

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47. Reduce common dislocations SO, EM

L-II OPD

48. Remove different foreign bodies EM

L-II OPD

49. Remove ear wax ENT, FM

L-I OPD

50. Take throat swab and culture

specimen

FM, IM, Ped. OG,

SO. ENT, Opth.

L-I OPD

51. Transport the traumatic patient safely. EM, SO

L-I Skill Lab

52. Treat skin warts D, FM

L-I OPD

53. Write proper referral letters FM

L-I OPD

D = Dermatology

EM = Emergency Medicine

ENT = Ear Nose and Throat

FM = Family Medicine

IM = Internal Medicine

Skill Lab = Skills laboratory

O = Ophthalmology

OG = Obstetrics and Gynecology

OPD = Outpatient department

Ped. = Pediatrics

SO = Surgery and Orthopedics

WBC = Well baby clinic

57 / 71

APPENDIX 3 – Log Book

Contents of LOG-Book:

1. Learning activities

2. Skills session - Family Medicine

3. Skills session - Surgery and Orthopedics

4. Skills session - Psychiatry

5. Skills session - Emergency Medicine

6. Skills session - Internal Medicine

7. Skills session - Pediatrics

8. Skills session - Obstetrics and Gynecology

9. Skills session - Ophthalmology

10. Skills session - ENT

11. Skills session - Dermatology

12. Clinics diary

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Learning activities

To be filled by the trainee and signed by the supervisor. This form should be given to the

family practice trainer every two weeks. Extra sheets may be used if necessary.

Date Title Type of activity Supervisor (signature) (Please indicate the

date and duration of

activity)

(Please give the name of the activity i.e.

“Evidence Based Medicine”)

(e.g. seminar, case presentation,

conference attendance, journal

club etc.)

(signature of the supervisor)

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Skills session - Family Medicine

Name of the Rotation: Family Medicine

Starting date:……………… Ending date:……………… Number of outpatients seen:……

This form should be filled by the trainee, signed by the supervisor of the rotation and handed over to the

family practice trainer at the end of each rotation.

Title Frequency done

Access and utilize relevant websites

Apply common methods of injections

Apply different vaccines and sera.

Assess strabismus in children

Communicate effectively to patients

Conduct antenatal and postnatal care (ANC, PNC),

Conduct proper mental & psychiatric examination.

Conduct screening

Conduct telephone consultations

Critically reading scientific papers

Demonstrate the proper use of glucometer.

Demonstrate the proper use of inhalers and nebulizers

Demonstrate the proper use of spacers

Demonstrate the use of peakflowmeter appropriately

Draw family tree

Examination of the CNS (including minimental examination)

Examine children in different ages and carrying out routine check up

in well baby clinic

Family planning counseling

General Examination including female breast exam

General eye examination

Give IV fluids & different solutions

Immobilize fractures

Keep and utilize medical records efficiently

Manage burns

Manage sprains and strains

Perform bandage of sprained joint

Perform

Perform direct ophthalmoscopy

Perform Leopold maneuvers

Perform otoscopy / rhinoscopy properly

Perform the Heimlich maneuver

Perform visual field examination,

Rational prescription

Record and interpret ECG

Remove ear wax & ear FB

Take throat swab

Test urine by using sticks

60 / 71

Treat skin warts

Use pin hole disc

Use the snellen chart

Write proper referral letters

(Extra skills which you have applied during rotation kindly add to the bottom of this form)

Signature of the Supervisor Signature of the department chair

61 / 71

Skills session - Surgery and Orthopedics

Name of the Rotation: Surgery and Orthopedics





Apply casts and splints

Apply gastric lavage

Apply skin sutures

Apply wound dressing

General Examination

Initiate vascular access and Give IV fluids & different solutions

Give local anesthesia.


Incise and drain abscess

Insert NGT

Interpret x-rays related to surgery and orthopedics

Manage sprains and strains


Perform breast exam

Perform proper bone & joints exam.

Physical examination for congenital hip dislocation

Read & interpret X-rays related to GIT

Reduce common dislocations

Remove different foreign bodies

Take culture specimen

Transport the traumatic patient safely.



62 / 71

Skills session - Psychiatry

Name of the Rotation: Emergency Medicine





Psychiatric exam

Family interview

Psychiatric counseling

Applying diagnostic/screening tests



63 / 71

Skills session - Emergency Medicine

Name of the Rotation: Emergency Medicine





Apply casts and splints

Apply common methods of injections

Apply Glasgow coma scaling and Trauma scoring


Conduct basic CPR

Give IV fluids & different solutions & injections


Manage burns


Perform the Heimlich maneuver

Reduce common dislocations

Transport the traumatic patient safely.



64 / 71

Skills session - Internal Medicine

Name of the Rotation: Internal Medicine





Apply different methods of injections

Apply gastric lavage


Conduct CPR

Demonstrate the proper use of inhalers and nebulizers and

spacers

Demonstrate the use of peakflowmeter appropriately

Examination of the CNS (including minimental examination)

General Examination


Insert NGT


Read and interpret chest X-rays

Record and interpret ECG

Spirometer usage





65 / 71

Skills session - Pediatrics

Name of the Rotation: Pediatrics





Apply different methods of injections

Apply different vaccines and sera.


Conduct pediatric CPR

Demonstrate the proper use of inhalers and nebulizers and use of

spacers

Demonstrate the use of peakflow meter appropriately

Examination of the CNS

Examine children in different ages and carrying out routine check up

in well baby clinic

General Examination


Pediatric blood pressure measurement

Physical examination for congenital hip dislocation


Read and interpret chest X-rays

Spirometer usage


Take throat swab




66 / 71

Skills session - Obstetrics and Gynecology

Name of the Rotation: Obstetrics and Gynecology





Assess fetal growth by ultrasonography


Conduct antenatal and postnatal care (ANC, PNC),

Family planning counseling

General Examination

Insert and remove IUD

Perform cervical smear

Perform Leopold maneuvers

Perform vaginal Exam

Perform vaginal swab





67 / 71

Skills session - Ophthalmology

Name of the Rotation: Ophthalmology





Assess strabismus in children

General eye examination

Perform direct ophthalmoscopy

Perform visual field examination,

Use pin hole disc

Use the snellen chart



68 / 71

Skills session - ENT

Name of the Rotation: ENT





Control nasal bleeding by pressure

Perform and interpret Weber & Rinne test properly

Perform otoscopy / rhinoscopy properly

Remove ear wax


Take throat swab



69 / 71

Skills session - Dermatology

Name of the Rotation: Dermatology






General Examination

Treat skin warts



70 / 71

Clinics Diary

(Cases seen by the trainee and discussed with the trainer)


evaluation and feedback division at the postgraduate training center every two weeks. Extra sheets may

be used if necessary.

Date Rotation Age& sex Diagnosis Management

Name & signature of Supervisor:---------------------------------------------

71 / 71

Learning contract

Main area Learning needs Time Resources Status

e.g. Cardiovascular

diseases

- BP goals

- ..

December 2007 - JNC7 report

- ..

Family Medicine Diploma Program Complete Guide

Documents

internal medicine rotation

pediatric rotation

mohammed alghamdi

family medicine sdfm

mohammed aldoghether

emergency medicine

basema alkhudhair

tarek almegbil