Professional Documents
Culture Documents
Family Medicine
Course
(MED 4068 – 8 Credits)
Year 4 MBBS
(Batch 2007)
3 COURSE PRE-REQUISITES 4
4 AIMS OF COURSE 4
8 COURSE ASSESSMENT 22
9 LEARNING RESOURCES 28
Being the only family medicine course in the undergraduate CUCMS medical program,
the scope of this course is rather wide as it covers important basic concepts and topics
pertaining to care of patients and their families in ambulatory clinical settings.
Family medicine is the clinical and academic discipline whose practitioners aim to make
an early diagnosis, taking into account the physical, psychological and social factors
which may affect the people under his care. Bridging the delivery of healthcare between
the community and hospitals, this course teaches students the details of clinical delivery
of preventive, curative, educative and rehabilitative healthcare to individuals (and family)
from birth to death. Ambulatory care management of common conditions as well as the
skills required to distinguish between serious and non-serious conditions would be
enhanced.
During these eight weeks of Family Medicine Course, you will be seeing the whole
spectrum of local family medicine or primary care services. These include services in both
urban and rural areas, whether government-funded or privately run. CUCMS is proud to
be affiliated with Klinik Kesihatan Bangi, Klinik Kesihatan Dengkil,Klinik Kesihatan
Puchong as well as other private general practices in delivery of this learning experience
to you.
Various teaching-learning methods are utilised which include clinical experiential learning,
clinic assignments, task-based learning, student seminars and clinical skills workshops.
Students are expected, as well as given opportunity to participate in all clinical and other
learning activities to obtain good overall experience of the discipline.
We believe this course will enable you to have basic family medicine knowledge to
function competently as a future junior doctor.
SECTION 2
HOW TO USE THIS GUIDEBOOK?
General information:
This guidebook serves to guide and assist you throughout this course.
Main feature of this guide is the learning objectives expected of you at the end of
this course. These are indeed not a list of facts and information about the topics
listed, but important points to help you plan your learning.
This guide is not to replace the recommended readings or the other learning
opportunities provided during this course.
You are expected to participate and perform the various teaching-learning activities
described, as well as other activities explained by your lecturers.
Make an effort to always record and reflect on your consultations / experiences
throughout this course. Do identify your own questions to better appreciate these
topics.
Do use the internet to get your answers. Otherwise, please present and share your
cases/questions during the debriefing/reflection session each week.
Should you wish, you may even explore these topics deeper from the list of further
reading materials, books, journals and internet websites provided in the Course
Guidebook.
Please do not hesitate to contact the Head of Department / Course Coordinator /
lecturers for any enquiries or assistance.
(Contact numbers are provided in Appendix A)
****************************
****************************
This course needs to be built on the knowledge and skills acquired during your basic
undergraduate pre-clinical training during the following courses:
All Year 1, 2 and 3 courses
Clinical & Health Exposure and Training
Clinical Skills Training/Clinical Correlation
Problem-based learning sessions
You may wish to refresh your memory by looking through your old notes / portfolios on
the above.
SECTION 4
AIMS OF COURSE
The CUCMS’s Family Medicine Course pivots around four areas of learning outcomes, as
the following:
Upon completion of the Year 4 Family Medicine Course, the student should
be able to:
*Note:
List of common illnesses and conditions seen in Family Medicine are listed
under Section 6
At the end of the Family Medicine Course, you are expected to be able to apply and
integrate the basic sciences such as anatomy, pathophysiology, aetiology into formulating
differential diagnosis and proposal of management options of each of these.
Source:
1. Stephenson A. A Textbook of General Practice 2nd Editon, Edward Arnold, 2004.
2. Murtagh J. General Practice, 4th Edition. McGraw Hill, 2007.
3. Practice profile – Assoc Prof Dr Yong Rafidah AR, 1989-2009
Overview:
The Family Medicine Course utilizes various teaching-learning methods to achieve the
aims and objectives indicated for this course. These include:
Students are divided into 6 subgroups with 6 to 7 members. The placement of each group
is as per time table provided during the first week of the course.
Two subgroups will be sent to each teaching centre. The two groups will rotate between
“lecturer percepting clinics” and “service duty clinics” and every group will have at least 6
percepting clinics with the lecturers.
Responsibilities of students:
Students assigned to Lecturer’s Clinic are expected to perform the following tasks:
i) Prepare the assigned room / area for clinic session.
Please arrive as early as 7.45 am to ensure cleanliness of the room, as well
clinic equipments are assembled
ii) Liaise with peer assigned to registration area for invitation of patients to
Lecturer’s Clinic.
Please take note that every patient invited need to have a verbal consent
vii) Ensure safekeeping of equipments and cleanliness of clinic area at the end of
clinic session
This is one unique experience that you will gain in Family Medicine – the chance to
be part of the healthcare team!
During your attachment to the health clinics during Week 2 to 6, you will be
assigned, on rotation basis to “Service Duties” stations. These stations will
include:
– Assistant Lecturer / Medical Officer’s Service Clinic
– Registration counter (OPD & MCH)
– Pharmacy / Laboratory
– Procedure room / A & E
– Screening counter / X-Ray
– Home visit
– After-hours clinic session (one session compulsory for each student)
The allocation of service duty station will depends on the teaching centres and you
will be briefed on what stations available in each Klinik Kesihatan later.
Students will have the chances to closely observe a family doctor who works in fee-
for-service environment at work. You will have the opportunity to compare and
contrast some areas of family medicine in the private health care system with the
government primary care. Important differences to be looked into include:
There also some interesting areas that could be explored during the GP course
like:
o What make the GP open up a private practice?
o What services are offered by the clinic?
o What are the strengths, weaknesses, opportunities and threats
of a private general practice?
o Why do patients visit private practice instead of government
clinics?
o Is it true that GP has autonomy in life?
o Is it true that GP is a dying profession?
You will also have to carry a small group assignment looking at issues in general
practice. This is done as through your subgroup. You will need to present a proposal
of the project prior to your attachment and the proposal need to be documented in
hard and soft copies of Part A of Section 7 of your logbook. A final presentation of
your group general practice assignment will be done usually at least a week after
completing your attachment. Marks will be given for the group presentation as per
in Section 9 of your logbook.
i. Remember that patients seen in family medicine almost always fall under either
one of these categories of presentation:
- Acute illnesses – either acute minor ailments or major diseases
- Chronic illnesses
- Preventive care (e.g. maternal & child health) and early detection
of illness (e.g. health screening & medical check-ups)
- Rehabilitative care
- Miscellaneous reasons for medical encounter
ii. Try to classify the patients that you come across into one of the above and
make notes under each heading when you are in the clinics. Remember to read
around the presentations later. Try to figure out and understand common
similarities among the presentations, rather than going into depth and trying to
memorize minute details of each conditions that you see.
iii. Remember that you can learn from many various resources and “angles” – not
only learn when you are with the CUCMS lecturers. This is the true concept of
self-directed learning. Examples of questions that can be asked and how you
can learn at various service stations include:
Laboratory:
o What services are available in front-line health care system
such as in the health clinics or private general practices?
o These investigations are normally very common and important
ones – so get to know the indications of the tests, how these
are performed and possible reasons for errors
o Reflect on the cost of each test or investigation and try to
figure out the total price of each patient’s consultation,
including tests and medications. What thoughts you have on
“health economics”
Pharmacy:
o What are the medications / drugs available?
o The medications in family medicine are common drugs. Get to
know their classes, at least. Revise what you have earlier
learnt in Pharmacology Course or elsewhere regarding
medications.
o Try to understand the role of staff at the Pharmacy and training
they have received.
o Observe closely how the staff educate or counsel patients
regarding usage of medications and try to learn from them
o How are drugs kept and recorded?
o What are the problems faced by the Pharmacy staff and how
they overcome them.
Home visit:
o This can be a once-a-lifetime opportunity. Take this
assignment seriously and try to plan your visit with the staff in-
charge. Do make appropriate travel plans at least a day ahead.
Offering to drive the healthcare staff in your own transport
would be most welcome.
o Read the patients’ records, if possible, and try to understand
the reason for home visit.
o Do observe the patient-staff interaction during the visit
o Do try to understand the patient’s environment and how this
influences health of the patient
3 - Interactive lectures
Family medicine may be dealing with common simple conditions, but is known to be
a huge discipline that overwhelms young learners in medicine – basically almost
everything covered in the undergraduate medical school is relevant to family
medicine!
Week 1 of the course is dedicated to orientate and introduce you to the discipline
and most of the information is given through briefings and lectures. Please pay
particular attention to these sessions as your understanding will determine your
success and enjoyment of the course.
The key difference between PBL and TBL is that the focus for learning is not scenario
presented on paper, but real tasks or work undertaken by doctor in clinical practice -
that will confront the new graduate in medical profession.
2. The group leader – in collaboration with all group members - will prepare a roster
for sub-groups to lead TBL sessions, as well as area of topic to focus on.
3. Please prepare at least one-week before session by identifying the “trigger” i.e.
patient presentation / problem to discuss. This needs to be from real patient seen
during clinic attachments – only summary of main problem, history and physical
examination is needed.
Note:
The trigger can be chosen from the following groups of common/important reasons for
consultations in family medicine: (refer Section 6 of Course Guidebook)
i. patients for care of acute illness (5-6 topics – symptom-based)
example: “An elderly with low back pain”; “Child with sore throat” etc
ii. patients for care of chronic illness (3-4 topics)
example: “Teenager with severe pimples” etc
iii. patient on rehabilitation care/follow-up
iv. patient who attended well-child clinic
v. patient for antenatal care
vi. patient for adult preventive health
vii. patient for family planning
viii. patient for post-natal care
(any 3 to 4 topics from items iii to viii)
4. Once the trigger / topic is agreed, members of the sub-group need to discuss
among themselves and identify learning issues to be pursued (and later shared
with the rest of other sub-groups). It is expected that each sub-group member to
be assigned at least two learning issues or tasks to handle.
Example:
Trigger: “Managing a child with sore throat”
7. Once approved, do proceed to prepare for the TBL session. Use Power Point
to aid your discussion / presentation.
Developed by Assoc Prof Dr Yong Rafidah, Head, Family Medicine Department, January 2009
These are mainly group presentations of the General Practice Experience as well as
Task-based Learning sessions.
Marks will be given for the seminars/ TBL/ group assignments presentation in your
logbook Section 9.
Ample opportunities for training, practice and assessment are provided throughout
this course to facilitate achievement of the above objective. Training is provided
through multiple resources (books, internet), as well as dedicated procedural skill
workshops during the course. Details of the sessions are as scheduled in the
Course Time-table.
Items to be filled in the log book relate to procedural skills that are common in family
medicine. These are nothing new – students might have observed or performed
personally in previous courses. (Please refer to Logbook - Section 4 - for details)
However, students are reminded to always seek permission from the patient
and supervising staff before performing any procedures on patients.
Investigative procedures:
Vital signs measurement - temperature & pulse
Blood pressure measurement (adults and children)
Body Mass Index calculation (to include weight and height measurement;
interpretation and recommendations)
Weight and height measurement in children (to include interpretation and
recommendations)
Waist circumference
Glucometer
Venepuncture (adults only)
Pap smear
Urine dipstick
Urine pregnancy test
Peak flow meter measurement
ECG recording
Apart from the above, there are at least a dozen more frequently performed
procedures done in family medicine, such as foreign body removal, suturing of
minor skin injuries, incision and drainage of abscesses, management of other
sporting injuries (e.g. dislocations), first aid and resuscitation and others. Students
are highly encouraged to observe and assist in all these procedures whenever
possible, even though assessment of competency not indicated.
Students will meet at least once in two weeks with either academic supervisor/
mentor, Course Coordinator or Head of Family Medicine.
What is “reflection”?
“Reflection is a learning process of examining current or past practices, behaviours, or
thoughts in order to make conscious choices about future actions.” (Barnett, 2006)
For Family Medicine Course, reflective learning exercises are embedded throughout daily
activities and logbook. This competency is a component of assessment in this course
(refer objectives of course).
1. FORMATIVE ASSESSMENT
(Cognitive & Psychomotor )
A) Mid-Course Assessment
B) Personal Supervisor/GP Teacher Assessment
C) Peer assessment
A. CONTINUOUS ASSESSMENT
( Psychomotor predominant – 30%)
Continuous assessment (CA) for this course is based on the eight sections of Learning
Objectives indicated (see Section 4), with more weight-age on affective and psychomotor
components. CA contributes to 30% of the Course assessment.
These are group assignments for task-based learning sessions and student
seminar / presentation
Refer Section 9 of Logbook for details
Students will have to submit the perception by the end of the course. The
hardcopy has to be hand-written in Section 7 of the logbook. The
softcopy need to be delivered to the course coordinator.
The summary of the continuous assessment in relation to your log book is as follows:
Section Contents
Section 1 Attendance
Affective Domain Assessment
Section 2 Reading Assignments in Family Medicine
Prerequisite for satisfactory course completion
Section 3 Record of Patient Experience in Family Medicine
Continuous Assessment – 10%
Section 4 Record of Procedural Skills In Family Medicine
Prerequisite for satisfactory course completion
Section 5 Record of Group Meetings Attended
Prerequisite for satisfactory course completion
Section 6 Record and Reflection on Service Duties
Prerequisite for satisfactory course completion
Section 7 Record and Reflection on General Practice Experience
Continuous Assessment – 2.5% (Individual Mark)
Section 8 Assessment of Family Medicine Consultations
Continuous Assessment – 10% (Average of best 2)
Section 9 Assessment of Group Assignments
Continuous Assessment – 7.5% (Group mark – 2 TBLs & 1 GP Seminar)
Section 10 Assessment by personal supervisor/GP teacher
Affective Domain Assessment
Section 11 Assessment by peers
Affective Domain Assessment
Section 12 Study Plans – Weeks 1 to 8
Affective Domain ( Formative)
Section 13 Certification of Eligibility for End-of-course Examination and Summary of Continuous
Assessment Marks (30%)
Prerequisite for satisfactory course completion / Continuous Assessment
Section 14 Perception of the Family Medicine Course
Prerequisite for satisfactory course completion
Note on Attendance:
E-books
Available via Books@Ovid
For access, visit:
http://library.cybermed.edu.my/cucms-library/c/LIBRARY%20RESOURCES
(Please request assistance form the CUCMS Librarian)
Note:
these books are available in CUCMS Library
For each AIR, students need to briefly describe – in the Logbook –
TWO most important issues that you have learnt from this reading
Internet Resources
Course Time-table
Please use this Guidebook hand-in-hand with the time-table. This is given to you at the
beginning of the course. Do scrutinise the time-table and as a group, plan your daily
activities - right from beginning of the course.
Study Plan
Success comes with organized planning and diligent work. To assist you in achieving the
learning outcomes of this course, you are advised to plan your learning weekly. Perform a
self-assessment at the end of each week and identify your weaknesses and area where
you need help. The format is available in the Course Logbook (Section 12)
Do show your study plan to your supervisor / mentor periodically. All the best to you!
~~~~~~~~~~~~~~~~~~~~~
CUCMS Lecturers
Name Hand phone Email
(Qualification/s & Designation)
Dr Noor Azizah Tahir 013- 3383837 noorazizahtahir@cybermed.edu
MBBS(Aust), MAFP(M’sia), FRACGP(Aust), .my
PG DipRepMed(UPM),Post Grad Cert Fam
Med Edu (M”sia)
(Senior Lecturer and
Coordinator of Family Medicine
Course)
Dr Hazian Hamzah 012-7377824 hazian.hamzah@cybermed.edu.
MBBCh. (Al-Azhar), MAFP(Mal), my
FRACGP (Aust)
(Senior Lecturer and Acting Head,
Family Medicine)
Assoc Prof Dr Yong Rafidah A.
Rahman 012 -6171963 yongrafidah@cybermed.edu.my
MBBS(Malaya), FAFP(M’sia), yongrafidah@gmail.com
FRACGP(Australia),
PG DipRepMed(UPM),
PG CertMedEd(Dundee),
ESME Cert in Med.Educ.
(Deputy Dean, Clinical Sciences &
Associate Professor of Family
Medicine)
Dr Norlehan Samad 012-698 1165 norlehan@ cybermed.edu.my
MD (UKM), MAFP(M’sia),
FRACGP(Australia),
(Lecturer & Course Co-Coordinator 1
– Skills Training and Assessment)
Through measures preventive, curative, and educative, with their primary care
team and in co-operation with specialist colleagues where appropriate, family
physicians seek to promote the health of the individual and family.
FW Peabody, MD
****************************
****************************
“With purity and holiness I will live my life and practise my art.
Into whatever houses I go, I will enter them for the benefit of the sick, and will
abstain from every voluntary act of mischief and corruption.
Whatsoever I see or hear in the life of men which ought not to be spoken of abroad,
I will not divulge, as reckoning that all such should be kept secret”
****************************
Advisors:
Prof Dr Mohd Hatta Shaharom
(Dean, Faculty of Medicine)
Coordinator
Assoc Prof Dr Muhammad Najib Mohamad Alwi
(Year 4 Coordinator)
Members:
Dr Hazian Hamzah
Dr Norlehan A Samad
Dr Lakshmi Sivashunmugam
Dr Hairel Anuar Selamat
Dr Siti Norhafizah Md Khapid
Puan Zaiful Liza Kassim (Secretariat)
Cik Daliena Laily (Secretariat)