Learning in family medicine Dr. JAWAHER AL-AHMADI MB. ABFM. SBFM,MSc.

Learning in family Learning in family medicinemedicine

Dr. JAWAHER AL-AHMADIDr. JAWAHER AL-AHMADIMB. ABFM. SBFM,MScMB. ABFM. SBFM,MSc

DEFINATION OF PHCDEFINATION OF PHC

– Essential health careEssential health care– Based on practical, scientifically sound and socialBased on practical, scientifically sound and social

acceptable methods & technologyacceptable methods & technology– Accessible to individuals & families Accessible to individuals & families – It is their first level of contactIt is their first level of contact– Cost that the community & country can affordCost that the community & country can afford– It forms an integral part for both the country’s healthIt forms an integral part for both the country’s health

system & the overall social & economic developmentsystem & the overall social & economic development

ELEMENTS OF PHCELEMENTS OF PHC

PROMPOTIVE :PROMPOTIVE :• Health EducationHealth Education

• Food supply & proper nutritionFood supply & proper nutrition

• Maternal & Child careMaternal & Child care

PREVENTIVE:PREVENTIVE:• ImmunizationImmunization

• Prevention & control of locally endemic diseasesPrevention & control of locally endemic diseases

• Adequate supply of safe water & basic sanitationAdequate supply of safe water & basic sanitation

ELEMENTS OF PHCELEMENTS OF PHC

CURATIVE:CURATIVE:• Treatment of common diseases & injuries Treatment of common diseases & injuries

• Provision of essential drugs.Provision of essential drugs.

ADDITIONAL ELEMENTS:ADDITIONAL ELEMENTS:

• Dental careDental care

• School healthSchool health

• Home health careHome health care

PHC PRINCIPLLESPHC PRINCIPLLES

• Equity in distribution :Equity in distribution : Services to all & more services to the needyServices to all & more services to the needy

• Appropriate Technology:Appropriate Technology:

That the people can use & afford.That the people can use & afford.

• Multisectoral approach:Multisectoral approach: Municipalities, Ministry of agriculture, Municipalities, Ministry of agriculture,

EducationEducation

PHC PRINCIPLLESPHC PRINCIPLLES

• Community participationCommunity participation:: - - Social awareness & community self reliance.Social awareness & community self reliance.

-- The people has the right and duty to participate The people has the right and duty to participate

in the process for the improvement and in the process for the improvement and

maintenance of health.maintenance of health.

• Support from higher levels of careSupport from higher levels of care : : - - Hospitals has to share the social goal of making essential Hospitals has to share the social goal of making essential

health services.health services.

-- Referral Referral

Pandleton seven tasksPandleton seven tasks

To establish & maintain Dr-pt relationshipTo establish & maintain Dr-pt relationship

To define the real reasons for pt attendanceTo define the real reasons for pt attendance

To consider other problemsTo consider other problems

To choose with the pt appropriate action for To choose with the pt appropriate action for each problemeach problem

To achieve a share understandingTo achieve a share understanding

To involve pt in the managementTo involve pt in the management

To use time & resources effectivelyTo use time & resources effectively

PRACTICALPRACTICAL

• PPrior to the consultationrior to the consultation• RRelationshipelationship• AAnxieties nxieties • CCommon languageommon language• TTranslationranslation• IInteractionnteraction• CConverting insight into actiononverting insight into action• AAgreement check, safety nettinggreement check, safety netting• LLeave from consultation, time for eave from consultation, time for

reflectionreflection

Communication skills &Patient Communication skills &Patient interviewing skillsinterviewing skills

A good interview should result in an accurate

&comprehensive history

pitfallspitfalls

Hurried mannerHurried manner

InterruptionInterruption

Lack of eye contactLack of eye contact

Lack of feed backLack of feed back

Dr – Pt RelationshipDr – Pt Relationship

Management option Management option (CRAPRIOP)(CRAPRIOP)

CClarificationslarifications

RReassuranceeassurance

AAdvicedvice

PPrescribingrescribing

RReferraleferral

IInvestigationnvestigation

OObservationsbservations

PPreventionrevention

Course objectivesCourse objectives

11--Define terminologies used in Family Define terminologies used in Family Medicine and primary health care (PHC) Medicine and primary health care (PHC) and explain principles and concepts and explain principles and concepts related to themrelated to them..

22--Acquire and practice skills of establishing Acquire and practice skills of establishing good relationships with patients, families good relationships with patients, families and the served community and as far as and the served community and as far as possible meet their needs and cope with possible meet their needs and cope with their ideas, concerns and expectationstheir ideas, concerns and expectations..

33--Develop appropriate professional knowledge, skills Develop appropriate professional knowledge, skills and attitude pertaining to the management of and attitude pertaining to the management of health problems encountered by the Family health problems encountered by the Family Physician in daily practice, adopting the bio-Physician in daily practice, adopting the bio-psychosocial model and the WHO definition of psychosocial model and the WHO definition of healthhealth..

44--Acquire the essential knowledge, skills and Acquire the essential knowledge, skills and attitudes regarding the provision of continuing, attitudes regarding the provision of continuing, comprehensive care to individuals and family, comprehensive care to individuals and family, including anticipatory, common, chronic, and including anticipatory, common, chronic, and emergent problems care and demonstrate emergent problems care and demonstrate appropriate problem solving and referral decisionsappropriate problem solving and referral decisions..

55--Conduct holistic consultations with patients in a Conduct holistic consultations with patients in a primary care setting, and show abilities of primary care setting, and show abilities of establishing patient’s reason for consulting, the establishing patient’s reason for consulting, the nature of the problem, how it affects his lifestyle and nature of the problem, how it affects his lifestyle and family and to determine the management options family and to determine the management options availableavailable..

66--Get acquainted to the different sections of a PHC Get acquainted to the different sections of a PHC Center and other practices work dynamics and Center and other practices work dynamics and functions including the well baby clinic, pharmacy, functions including the well baby clinic, pharmacy, Lab…..etcLab…..etc..

77--Attain the skills and attitudes for self directed life-long Attain the skills and attitudes for self directed life-long learning, critical evaluation and self assessmentlearning, critical evaluation and self assessment..

Simulated clinicSimulated clinic

• SubjectiveSubjective

• ObjectiveObjective

• AssessmentAssessment

• Plan Plan

LIST OF CASE SCENARIOSLIST OF CASE SCENARIOS

• 1.1. Breaking Bad News. Example: Malignancy, Breaking Bad News. Example: Malignancy, bad prognostic bad prognostic

• congenital anomalies, serious hereditary congenital anomalies, serious hereditary diseases…etc.diseases…etc.

• 2.2. Health Education Skills. Example: Patients Health Education Skills. Example: Patients use of peak use of peak

• flow meters, inhalers, glucometers, growth flow meters, inhalers, glucometers, growth charts….etc.charts….etc.

• 3.3. Health Appraisal. (Verifying & Projecting the Health Appraisal. (Verifying & Projecting the potential health risks of an individual). Examples: potential health risks of an individual). Examples: Newly diagnosed hypertensive or diabetics, close Newly diagnosed hypertensive or diabetics, close relative of patients with colon cancer….etc.relative of patients with colon cancer….etc.

• 4.4. Health Promotion. Example: Smoking Cessation, Health Promotion. Example: Smoking Cessation, Physical exercise.Physical exercise.

• 5.5. Dealing With Specific Request. Examples patient Dealing With Specific Request. Examples patient coming insisting on specific referral, refills, MRI, CT coming insisting on specific referral, refills, MRI, CT Scans,...etc.Scans,...etc.

• 6.6. Dealing With Difficult Patients. Example: Angry Dealing With Difficult Patients. Example: Angry Patient. The Shopper, talkative patients, multiple Patient. The Shopper, talkative patients, multiple complainer...etc.complainer...etc.

• 7.7. Counseling A Patient With A Newly Discovered Counseling A Patient With A Newly Discovered Chronic Chronic

• Disease. Example: Diabetes, Hypertension, Bronchial Disease. Example: Diabetes, Hypertension, Bronchial asthma, ….etc.asthma, ….etc.

• 8.8. Giving Dietary Advise. Example: In cases of Giving Dietary Advise. Example: In cases of antenatals, Hypertension, Obesity, Diabetes, antenatals, Hypertension, Obesity, Diabetes, Dyspepsia…..etc.Dyspepsia…..etc.

Adult Learning

•Self-Directed Learning

•Critical Reflection

•Experiential Learning

•Learning to Learn

Self-Directed Learning

•Self-directed learning focuses on the process by which adults take control of their own learning,

• In particular how they set their own learning goals, locate appropriate resources, decide on which learning methods to use and evaluate their progress.

Critical Reflection

• As an idea critical reflection focuses on three interrelated

processes;• (1) the process by which adults question and then

replace or reframe an assumption that up to that point has been uncritically accepted as representing commonsense wisdom,

• (2) the process through which adults take alternative perspective on previously taken for granted ideas, actions, forms of reasoning and ideologies,

• (3) the process by which adults come to recognize the hegemonic aspects of dominant cultural values and to understand how self-evident renderings of the 'natural' state of the world actually bolster the power and self-interest of unrepresentative minorities.

Experiential Learning

•Adult education was, therefore, “a continuing process of evaluating experiences”

Learning to Learn

•The ability of adults to learn how to learn to become skilled at learning in a range of different situations and through a range of different styles

Emergent Trends

•Cross Cultural Adult Learning

•Practical Theorizing

•Distance Learning