SAUDI BOARD FOR FAMILY MEDICINE

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4 5 6 7 8 9 10 11 12 R1 Introductory Course 1 month Family Medicine (I) 3 months Internal Medicine 6 months Orthopedics 1 month VACATION R2 Pediatrics 4 months Ob/Gyn 3 months Surgery 2 months Emergency Medicine 2 months VACATION R3 Community Medicine 3 months Psychiatry 3 months Dermatology 1 mo Ophthalmology 1 month E N T 1 month Emergency Medicine 1 month Elective 1 month VACATION R4 Research 1 month F a m i l y M e d i c i n e (II) 10 months VACATION SAUDI BOARD IN FAMILY MEDICINE INTRODUCTION: The Kingdom of Saudi Arabia is in great need of very well trained physicians, Who will work at the level of primary heath care (PHC). The PHC physician is supposed to be the leader of the primary care team in the health centre, at the level of the Directorates of Health Affairs, and at the level of the Ministry of Health. With the wide spread implementation of primary health care programmes, there is an obvious need for higher studies programmes in this specialty. Such programmes will produce competent family physicians who can improve standard of services and training provided, and established a more recognized career structure. The Aim of the Saudi Board of Family Medicine is to Graduates a Competent Family Physician who should: 1. Adequately and approximately diagnose, manage and treat common problems faced in the primary health care field. 2. Demonstrate the appropriate attitude of a caring physician; dedicated to developing good relationship with patients, families, and the community, meeting their needs and recognizing their expectations. 3. Provide effective comprehensive and continuing health care for individuals families and the community through the development of excellent problem solving skills. 4. Apply acceptable principles and practices related to health service planning, organization, administration, research, and quality assurance (Q.A.) at the level of the primary health care delivery system. 5. Through a system of referral / or consultation, serve as a point of entry into the secondary / or tertiary health care system, and use these systems effectively and efficiently. 6. Determine the disease patterns of the community and subsequently implement and evaluate the most cost-effective anticipatory care programmes (prevention and/or health education). 7. Promote the autonomy of the individual, the Family and the Community by providing continuous health education aimed at improving health status at these levels. 8. Recognize the social, cultural and psychological factors which influence health and disease and apply principles of medical ethics. Saudi Board in Family Medicine Introduction to Family Medicine Duration: 1 month Introduction: It would seem both appropriate and necessary at the very beginning of the Family Medicine Programme that residents experience an intensive course focused on the concept and elements of PHC, Family Medicine and Community Medicine and the distinction between these. This will not only overtake them to their chosen career and their future role, but also put into perspective the learning opportunities provided therefore by the entire Saudi Board programme. The aims of this course are: To orient the resident of the concepts and methods of the program; to enable them to appreciate the importance of family and its role in the health care system and prepare them to what they should expect out of the program and what is required from them. Objectives: At the end of the course, the resident should be able to: 1. Recognize the concepts, principles and elements of PHC and Family and Community Medicine and relate these to the health care in Saudi Arabia. 2. Define the role of Family and Community Medicine in promoting the health of the people. 3. Understand the various aspects of the four year program. 4. Demonstrate an ability to use common principles of communication, relationship and ethics in any professional setting. 5. Show a positive attitude towards the specialty, the profession and other professionals in primary care. 6. State what is expected from him/her in order to succeed in the program, and what she/he should expect out of the program. 7. Understand the various aspects of medical ethics relevant to the practice of medicine. 8. Work as a effective member in primary health care setting Statement: Encourage self-directed, learner 3 out Learning and avoid didactic teaching. Contents: Each session is 2 hours 1. Concepts, principles and methods of PHC and Family Medicine. (3 sessions) 2. Introduction of the residency program, its history, development, content and requirements. (2 sessions) 3. The role of PHC and Family Medicine in promoting the health of the people (2 sessions) 4. The future career of the residents (2 sessions) 5. Introduction to the system of PHC delivery of Saudi Arabia. (1 sessions) 6. Introduction to the role of Family Physician worldwide and in the Kingdom (2 sessions) 7. Introduction to Medical Ethics (5 sessions) [see details of the course] 8. Common health problems in family medicine (7 sessions) e.g hypertension, diabetes mellitus and migraine 9. Medical Consultations: Theory, principles and practice (5 sessions) 10. Communication skills: Principles and practice (2 didactic and 2 practical sessions) 11. Behavioral and social sciences (8 sessions) [see details of the course] 12. Team work and team spirit (2 sessions) 13. Practical assignments (8 sessions) [see the attached questionnaire] 14. The system of primary health care in family medicine. (5 sessions) - Medical records (1 session) - Referral to secondary care (1 session) - Preventive activities - health education (1 session) - immunization (1 session) - Maternal and Child Health (1 session) - Learning how to learn (4 sessions ) Process of Learning: 1. Meeting with teaching staff and trainers to introduce the students to the staff. 2. An open discussion about the programme, its components, process of training and evaluation and to respond to student questions and listen to their views. 3. Lecture with audiovisual aids. 4. Group discussion. 5. Problem oriented seminars. 6. Visits to health centres. There is a great deal of flexibility in the way this month is conducted as long as a balance between different topics is maintained (i.e the number of sessions per subject). Evaluation consists of: 1. Continuous assessment (40% attendance, participation, reports) 2. Written examination at the end of the course (60%) The pass mark is 70% of the aggregate. Bibliography: 1. John Fry, John Hasler. Primary Health Care, The year 2000. 2. Al-Mazrou Y.Y. Al-Shehri S and Rao M. Principles and Practice of PHC. 3. Barbara Starfield. Primary Care Concept, evaluation and policy 1992. 4. Rakel. Essentials of Family Practice 5. Stott and Davis. Primary Health Care. Bridging the gap between theory and practice. 6. Jarma B. Primary care. Student review 1988. 7. David Morrell. The Art of General Practice Oxford University Press 1991. 8. Frazer R. The clinical methods in general practice. 9. Mc Winniney. Textbook of Family Medicine 10. Murtagh J. General Practice Journals and Websites: 1. American Family Physician site: www.aafp.org 2. Canadian family Physician 3. American Family Physician Management 4. British Journal of General Practice 5. Family Practice 6. Journal of Family Practice See also References for Medical Ethics Behavioural Science Courses (Appendix To: Introduction to Family Medicine A and B) Appendix To: Introduction to Family Medicine A. THE BEHAVIORAL SCIENCES FOR FAMILY PHYSICIAN RATIONALE: The World Health Organization defined health as not merely an absence of disease but as a state of complete physical, mental and social well-being. Therefore the practice of medicine has moved from the biomedical paradigm, which was seeing the health as the absence of biologic damage or injuries, to the biopsychosocial approach. The biopsychosocial approach, deals with the concept of health and illness as related to, or resulted from biological, psychological and social components. The Family Physician should be equipped with understanding of human bahaviour in health and disease, how people react to illness (illness behaviour), and how this will affect the way he deals with patients. Also the Family Physician should learn about behavioural therapy within the context of family practice. OBJECTIVES: " To help the resident understand and develop the dynamics of the patient-physician relationship, particularly within the medical setting. " To help the resident develop an understanding of the roles of the family, social, cultural and spiritual context of patients 9 lives, and to provide some intervention techniques for use where indicated. " To enable the resident develop an understanding of the roles of individual behaviour on the patients 9 lives, and to provide some intervention techniques for use where indicated. " To help the resident acquire skills in professional relationship. This course is designed to give residents a thorough understanding of the following areas: " Human behaviour throughout the family life cycle. " Management of individuals and families who experience life stress issues " The common behavioural and psychosocial problems seen in family practice e.g., child abuse, and chemical dependencies. " The effects of acute and chronic illness on individuals and families. This course content will be covered in the introductory month: Lectures, Seminars Group discussion will be used as a format for instruction. CONTENTS OF THE COURSE: 1. Human behavior throughout the family life cycle. 2. The effects of acute and chronic illnesses on individuals and families. 3. Illness behaviour. 4. Difficult patient encounter 5. Interpersonal relationship 6. Counseling Skills 7. Stress Management 8. Patient non-compliance Appendix to: Introduction to Family Medicine B NB: For better utilization of resources and standardization, this course should be taught at the regional level. Appendix to: Introduction to Family Medicine B. ETHICS FOR FAMILY PHYSICIAN As a practitioner the family physician will provide care for individuals in the context of the family, where his / her ultimate concern must be the welfare of his / her patients. The family physician is required to make health care decisions, sometimes on behalf of his / her patient, Based on both ethical issues and medical parameters. During training the family physician should be equipped with the ability to understand, comprehend and analyze ethical issues pertinent to common situation at the level of primary health care. Objectives: At the end of this course the family physician should be able to: A. Understand the principles of Islamic medical ethics. A. Understand his / her role in patient care and doctor patient relationship in the context of the family. B.Appreciate the value and dignity of human life. C. Be committed to ethical practice in each encounter with every patient. D. Understand the rules and regulations of practicing medicine in Saudi Arabia. Topics to be covered (10 Sessions) 1. Principles and sources of medical ethics in Islam. 2. Patients and family 9 s rights. A. Truth 3 telling and withholding information B. Confidentiality C. Informed Consent 3. Patient refusal of treatment 4. Doctor 3 patient relationship 5. Care of patients with terminal illness 6. Professionalism and doctor 3 health care professionals relationship. 7. Codes of ethics and Codes of conduct in Saudi Arabia. Process of Teaching: All these sessions should be conducted in a problem-based and case- based, self 3 directed format. The trainees should be provided with a background reading materials and this will form the basis for discussion during the sessions. Lecturing should be kept to the minimum. Evaluation: Modified Essay Case 3 based questions and the end of the course. Bibliography: NB: This course should be taught at the regional level. SAUDI BOARD IN FAMILY MEDICINE ROTATION IN FAMILY MEDICINE (I) Duration: 3 months (first Year) Pre-requisite: Introduction to Family Medicine INTRODUCTION: Early introduction of the resident in Family Medicine Programme to the specialty is important. This rotation will take place during the first two years of the programme. The resident will be introduced to clinical and non-clinical problems in a primary care setting. He will learn approaches to problem solving and management in this setting. AIMS: Aims of the rotation: A. To introduce the resident to the specialty of Family Medicine at an early stage. B. To help trainee to acquire communication, interviewing and relationship skills. C. Introduce residents to clinical problem-solving in a primary care setting. D. Provide comprehensive care for individuals, families and the community. OBJECTIVES: By the end of the rotation the trainee is expected to: 1. Properly communicate with and interview patients attending the clinics. 2. Establish good relationship with patients 9 families 9 and the community and to meet their needs and expectations as far as possible. 3. Understand and deal with the physical, psychological and social dimensions of the patient 9 s problem. 4. Demonstrate appropriate clinical skills in respect to diagnosis and management of problems commonly presented in a primary care setting. 5. Show ability in health promotion programmes, including health education, maternal and child care and immunization. 6. Understand the organization of primary health care in relation to other levels of care. 7. Show a positive attitude towards the specialty, the profession and other professionals in primary health care and teamwork. PROCESS OF TRAINING: During this period the resident will be assigned to a primary health care centre with a trainer. It is preferable that training takes the form of a one-to- one relationship between the teacher and the trainee. INDUCTION PERIOD: The first two weeks of the assignment will be devoted to knowing and understanding the atmosphere in which the resident is going to work. This includes knowledge about the health centre, its organization, personnel and methods of teaching and instruction. CONSULTATION: The resident will learn, at this stage, the basis of consultation, interviewing and communication skills. He will be referred to the current appropriate literature on the consultation and asked to produce a model for his / her own personal consultation process. CLINICAL COMMITMENT: The resident will work in the health centre under close supervision of the trainer. This should take the form of one-to-one teaching. TEACHING WILL INCLUDE: " Clinical tutoring " Case-presentations and discussion " Group discussion " Clinical and non-clinical assignments 3 follow up of a group of families (family study). " Individual and group feedback. " Observation of consultations of senior residents and trainers " Daily clinical work. (7 clinical sessions) PREVENTIVE MEDICINE AND PUBLIC HEALTH. The residents will be introduced to all the preventive activities at the training health centre or any other affiliated centre. This will include maternal and child care, health education and other preventive activities. The supervision should be as follow: 1. The trainer should be available for the trainees and supervise them very closely for the first two to three week. 2. The supervisor will then be available during the seven clinical sessions to respond to the trainees calls and referrals of the trainees (Residents in R4 can help in the supervision). EVALUATION: 1. Continuous Assessment (40%) This will be based on the evaluation of tutors during the period of the competence and performance of the trainee. It should cover the following: - Attendance and participation - Assessment of theoretical knowledge, and attitudes - Assessment of clinical skills - Assessment of assignments - Assessment of organizational and management abilities. - A log book of the cases and activities should be provided by the trainee and reviewed periodically by the trainer. The residents will be given a feedback in formal session throughout the rotation and areas of strengths and weakness should be discussed. Satisfactory performance in the continuous assessment in mandatory before the candidate is allowed to sit for the final examination. 2. Final Examination (60%) This will take the form of: - Written examination (20%) [MCQ: Problem-based] - Clinical examination (40%) - This will take the form of OSCE with 10-15 Stations and at least 2 consultations with patients that will be evaluated by the trainers. Bibliography: 1. Conn, Rakel and Johnson. Family Practice 1995. 2. Goroll. Primary Care Medicine. An Office Management of Adult Patient. 3. Rakel. Textbook of Family Practice 4. Taylor. Family Practice 5. Murtagh J. General Practice 6. Pendelton. The Consultation 7. Paul Freeling. The doctor 3 patient relationship. 8. Michael Mcad. Tutorials in General Practice. 9. Farser. Clinical Methods. A General Practice approach 1992. 10. McWinney. Textbook of Family Medicine 11. Bibliography for the course: Introduction to Family Medicine and Family Medicine I. 12. Fowel G. Preventive Medicine in General Practice. Oxford Series. 13. Geofrey Rose. The Strategy of Preventive Medicine 14. Sloane. Essentials of Family Medicine A TYPICAL WEEK DURING FAMILY MEDICINE (I) ROTATION AM PM Saturday Morning Activity (1 hour) Clinic Clinic Sunday Case Discussion Clinic Mentor (1 hour) Clinic Monday Feedback (1 hour) Clinic HDRC Tuesday Case Presentation (1-1/2 hour) Clinic Activities (Tutorials) Wednesday SDL Feedback (1 hour) Clinic Thursday Clinic SDL: Self Directed Learning HDRL: Half-Day Release Course Number of Clinics: 7-8 per week SAUDI BOARD IN FAMILY MEDICINE ROTATION IN INTERNAL MEDICINE DURATION: 6 Months Introduction: After their graduation, Family Physicians will be exposed to a variety of acute and chronic medical problems that they should be able to deal with and treat effectively. It should be ensured that all graduates are able to fulfill the responsibilities for medical care of doctors of first and continuing contact. Objectives: At the end of the rotation, the trainee should acquire knowledge, skills, and attitudes and demonstrate competence in: 1. Taking a proper clinical history. 2. Performing proper physical examination 3. Diagnosis and management of commonly faced clinical problems including the indication for referral. 4. Dealing with common medical emergencies, e.g. M.I., diabetic ketoacidosis, severe acute asthmatic attack and GIT bleeding. 5. Continuing care of chronic conditions, e.g. diabetes and hypertension. 6. Diagnosis and management of common clinical problems in the elderly. 7. The changes in the normal range of laboratory values and other investigations including medical imaging. 8. Understanding factors associated with absorption, metabolism, excretion of drugs. 9. Understanding hazards of drug treatment, drug interactions and new advances in therapeutics relevant to internal medicine 10. Ability to use the Ophthalmoscope to examine the fundi. 11. Use of office clinical measurements such as peak flow meter, inhalers and nebulizer. 12. Reading and interpreting ECG. 13. Use of sphygmomanometer. 14. Aspiration of joints. 15. Beside Microscopy, e.g. in U.T.I. 16. Exhibiting appropriate attitudes to the care of people and manifest these attitudes in the doctor 3 patient relationship. 17. Ability to read and interpret common radiological investigations. The Process of Training: 1. A sufficient time for formal teaching is needed by the trainees, particularly induction arrangements at the beginning of the rotation. 2. Every trainee should work under close supervision of senior staff till the trainee acquires enough knowledge and competence to work more independently. 3. A balance between the service work and the protected time for postgraduate medical education should be maintained. 4. The half-day release course held weekly as part of the Family Medicine training organized by the concerned Department of Family and Community Medicine should be attended regularly by the trainees. 5. A greater community element of the training is needed. Opportunities to work in outpatient clinics should be provided. A multidisciplinary approach to caring for some physical illness, showing the role of nurses, social workers and physiotherapist is very useful. 6. On-call duties should be an average of one every three to four nights (4-7 calls per month). The residents are full time with the Department of Internal Medicine and participate in the service and educational activities of the department except for the weekly half-day release course. Learning Situation: 1. Inpatients/Grand rounds. 2. Outpatient clinics. 3. Emergency. 4. Continuing medical education (CME) activities. Structure of Internal Medicine Rotation: In order to achieve the above aims, Family Medicine residents will spend the six months rotation in Internal Medicine as follows: 1. Three months in a general medical unit. (if this available) 2. Two months in a specialized unit relevant to Family Medicine. Preferably, if residents are given a choice, they should spend these two months in two of the following units (cardiology, endocrinology, pulmonary, gastroenterology). (4 weeks each) 3. There should be more out patient training during the whole rotation and in addition one month should be spent in outpatient clinics as a full time. (at least 2 months after the beginning of the rotation in internal medicine). Evaluation: The Department of Internal Medicine in collaboration with the Department of Family and Community Medicine will assess the resident according to the following criteria: 1. Continuous assessment. 30% 2. Final clinical examination. a. Written exam 20% (The candidate should score 60% of this mark) b. Clinical examination 50% The candidate should score 70% aggregate to pass the rotation. Those who will fail at the end-of-rotation examination will be referred to the local supervising committee to recommend whether they will repeat the rotation or part of it or only sit for another examination. This decision should be made in collaboration with the concerned departments. The residents will be appraised twice during the rotation by the senior staff with whom he worked. Satisfactory performance in the continuous assessment is mandatory before a candidate is allowed to sit the final examination. Bibliography: 1. Isselbacher, et al. Harrison 9 s Principles of Internal Medicine. McGraw Hill Book Company. 2. Goroll, et al. Primary Care Medicine. An office Management of the Adult Patient. 3. Rakel Textbook of Family Practice Saunders 4. Taylor. Textbook of Family Medicine. 5. Current Textbook of Medical Diagnosis and Treatment. 6. Ham RJ, Sloane PD, eds. Primary Care Geriatrics: A Case-Based Approach. 2 nd ed. St. Louis: Mosby Year Book, 1992. 7.Kumar.Medicine SAUDI BOARD IN FAMILY MEDICINE ROTATION IN PEDIATRICS DURATION: 4 Months INTRODUCTION: Pediatric problems represent a large proportion of primary health care. The family physician should be competent in initial assessment and management of the common Pediatric problems with emphasis on problem that are more prevalent at the primary care level. OBJECTIVES: At the completion of this rotation, the trainee should be able to: 1. Illustrate the important norms of physical, intellectual, emotional and social development and assess the growth development of children at different ages. 2. Diagnose common deviations from normal. 3. Diagnose and manage the following conditions: A. Acute conditions threatening life (e.g. infections like meningitis, acute respiratory disorders, acute abdomen, accidents and acute bronchial asthma). B. Conditions which, if not recognized early can lead to disability or premature death (e.g. respiratory infections, jaundice, congenital malformation, epilepsy and malignant disease). C. Common conditions (e.g. feeding problems, sleep problems, respiratory infections, diabetes and enuresis). D. Handicaps and their supervision (e.g. congenital handicaps). E. Chronic pediatric conditions (e.g. chrome diarrhea , Epilepsy) 4. Identify the effect of disease of children on the family. 5. Organize, plan, conduct and evaluate a well baby clinic (screening, records, and immunizations). 6. Provide the preventive measures and activities in Pediatrics (immunization, health education). 7. Take a proper history and perform a proper physical examination of new born infants, toddlers, children 9 s and adolescents. 8. Effectively prescribe for children in terms of dose, route, expected side effects and interactions. 9. Identify and appropriately use other agencies that can provide care for children (e.g. secondary care and social services). 10. Perform with skill those technical procedures common in Primary Care Practice (see skill list below). Process of Training: 1. Attachment to one of the units, where, he or she is expected to have full responsibilities for in and out patient care under the direct supervision of the senior registrar or the consultant of that unit. 2. Active involvement in the on-call rota. The range should be at least 7 on calls per month including one week end. 3. Adequate attendance participation and attendance in the departmental activities, e.g. handover round, case presentation, journal clubs, etc. (at least 80% of the activities) 4. Preparation of material to be discussed in a tutorial with a senior staff at least once every two weeks. 5. Performing and assisting in the common technical procedures e.g. (LP, intubation, use of nebulizer). 6. Attendance of the weekly half day activities in the Department of Family and Community Medicine. Learning Situation: 1. Inpatient/Grand rounds. 2. Outpatient clinics. 3. Accident and Emergency. 4. Continuing Medical Education (CME) activities. Structure of Rotation: - 2 months in inpatient general pediatrics unit. - 1 month in outpatient general pediatrics clinics. - 1 month in accident and emergency. Evaluation: The Department of Pediatrics in collaboration with the Department of Family and Community Medicine will assess the resident according to the following criteria. 1. Continuous assessment 30% 2. Final clinical examination a. Written exam 20% (The candidate should score 60% of this mark) b. Clinical examination 50% The candidate should score 70% aggregate to pass the rotation. Those who will fail at the end-of-rotation examination will be referred to the local supervising committee to recommend whether they will repeat the rotation or part of it or only sit for another examination. This decision should be made in collaboration with the concerned departments. The residents will be appraised twice during the course if their performance is unsatisfactory up to that time. Satisfactory performance in the continuous assessment is mandatory before a candidate is allowed to sit the final examination. LIST OF SKILLS TO BE LEARNED: 1. Plot height, weight and head circumference and interpret 2. Bladder catheterization and supra pubic aspiration 3. Newborn resuscitation 4. Lumbar puncture 5. Venesection Calculate maintenance and fluid and electrolyte requirements Bibliography: 1. Vangham/Makay/Behrman. Nelsons Textbook of Pediatrics. 2. David Hull. Essential Pediatrics. Churchill Livingstone (Latest edition). 3. Leon Polanay. Community Pediatrics. Churchill Livingstone (Latest edition). 4. Henderickse. Pediatrics in the tropics. Oxford U. Press. 5. Ebrahim. Pediatric Practice in Developing countries. McMillan Trop Comm. Health Manual 1981. 6. Rakel P. Essentials of Family Practice. Saunders. SAUDI BOARD IN FAMILY MEDICINE ROTATION IN PSYCHIATRY DURATION : 3 Months Introduction: The rotation in Psychiatry should help the family physicians to acquire knowledge, skills and attitude that will enable them to provide a broad range of services and to enable them to make clinical decisions related to common psychiatric problems encountered in the PHC setting as well as to refer when necessary. Objectives: By the end of this three months rotation, the trainees are expected to be able to: 1. Take a proper psychiatric history and conduct a proper mental status examination. 2. Recognize and manage patients with psychiatric complaints, and properly and timely refer those who need referral. 3. Recognize, assess, manage and follow-up chronic psychiatric conditions commonly dealt with in PHC settings including psychiatric emergencies 4. Identify social, economic, cultural factors affecting the aetiology, course and management of psychiatric and behavioural problems. 5. Recall the role of other professionals involved in the care of patients with mental disorders, e.g. psychologist, social worker and agencies involved in such care and be able to utilize their expertise. 6. Demonstrate an understanding of the role of preventive medicine in psychiatry and the role of the teachings of Islam in psychiatric and psychological disorders. 7. Recognize the importance, indications and application of common modalities of psychotherapy. 8. Competently make early diagnoses of problems in childhood development and within vulnerable groups. 9. Perform effective counseling and behavioural modifications appropriate to a primary care setting. 10. Understand the importance of rehabilitation in psychiatry. Process of Training: 1. In psychiatry, there is particular need for professional supervision including local discussion between family physician course scheme organizers, trainers and consultant psychiatrists to clarify many issues related to training. 2. The resident shall be attached to a unit where he/she should work under close supervision until his/her consultant trainer is satisfied that he/she has the knowledge and ability to work more independently. 3. A sufficient time for formal teaching is needed by the trainees, particularly induction arrangements at the beginning of the rotation. 4. Participation in departmental activities, e.g. grand rounds, lectures, tutorials, journal clubs, etc. 5. Preparing material of relevance to primary care to be discussed and presented in the form of a tutorial at least once a week. 6. The half-day release course held weekly on one afternoon by the Department of Family and Community Medicine should be attended regularly by the trainees. 7. A greater community element of the training is needed. Opportunities to work in outpatient clinics and a multi-disciplinary approach to caring for patients should be emphasized. Learning Situation: 1. OPD clinics. 2. Accident and emergency. 3. CME activities. 4. Inpatient grand rounds. 5. A multidisciplinary approach to caring for mental illness in PHC is particularly important, so that joint training sessions with nursing and social workers colleagues are of particular value for trainee family physicians. Basic Knowledge: 1. Normal and abnormal psychological growth and development across the life cycle, and variants. 2. Recognition of interrelationships among biologic, psychologic and social factors in all patients. 3. Reciprocal effects of acute and chronic illnesses on patients and their families. 4. Factors that influence adherence to a treatment plan. 5. Family functions and common interactional patterns in coping with stress. 6. Awareness of one 9 s own attitudes and values, which influence effectiveness and satisfaction as a physician. 7. Stressors on physicians and approaches to effective coping. 8. Ethical issues in medical practice, including informed consent, patient autonomy, confidentiality and issues quality of life. Mental Health Disorders: 1. Disorders principally diagnosed in infancy, childhood or adolescence a. Mental retardation b. Learning disorders c. Motor skills disorders d. Communication disorders e. Attention deficit and disruptive behavior disorders 2. Delirium, dementia, amnestic and other cognitive disorders 3. Substance-related disorders, e.g. alcohol, amphetamines, opioids, etc. 4. Schizophrenia and other psychotic disorders 5. Mood disorders a. Major depressive disorder b. Dysthymic c. Bipolar disorders, including hypomanic, manic mixed and depressed 6. Anxiety disorder a. Panic attack b. Phobias c. Obsessive/compulsive disorder d. Generalized anxiety disorder 7. Somatoform disorders a. Somatization b. Pain c. Hypochondriasis 8. Eating disorders a. Anorexia nervosa b. Bulimia nervosa 9. Sleep disorders a. Insomnia b. Hypersomnia c. Narcolepsy d. Parasomnias 10. Adjustment disorders a. Depressed mood b. Anxiety c. Mixed anxiety and depressed mood d. Disturbance of conduct 11. Personality disorders 12. Problems related to abuse or neglect Evaluation The Department of Psychiatry in collaboration with the Department of Family and Community Medicine will assess the resident according to the following criteria. 1. Continuous assessment 30% 2. Final clinical examination a. Written exam 20% (The candidate should score 60% of this mark) b. Clinical examination 50% The candidate should score 70% aggregate to pass the rotation. Those who will fail at the end-of-rotation examination will be referred to the local supervising committee to recommend whether they will repeat the rotation or part of it or only sit for another examination. This decision should be made in collaboration with the concerned departments. The residents will be appraised twice during the course if their performance is unsatisfactory up to that time. Satisfactory performance in the continuous assessment is mandatory before a candidate is allowed to sit the final examination. Bibliography: 1. AC Markus, C Murry Parkes, P Tomson, M Johnston. Psychological Problems in General Practice. Oxford. Oxford University Press. Walton Street, Oxford OX26 DP. 1989. 2. Rees. A New Short Textbook in Psychiatry. Hodder and Stoughton. 3. Goldberg, et al. Psychiatry in Medical Practice, Routlege. 4. Gelder M. Oxford Textbook of Psychiatry. Oxford University Press. 5. Royal College of General Practitioners. Primary Care for People with Mental Handicaps. 6. Goldman LS, Wise TN and Brody DS (Eds) Psychiatry for Primary Care Physicians Chicago: American Medical Association. 1998. 7. Diagnostic and statistical manual of mental disorders, fourth edition: primary care version/in collaboration with representatives of American Academy of Family Physicians. 1 st ed. Washington, DC: American Psychiatric Association, 1995. 8. Primary Care Clinics in Office Practice: Mental Health, Stuart, MR and Liberman JA III (Eds) 26 32 6/1999. Web sites: 1. American Psychiatric Association: www.psych.org 2. American Psychological Association: www.apa.org 3. he@lth; Mental Health Touches (Everyone): www.athealth.com 4. Psychwatch. Com; The; Online Resource for Professionals in Psychology and Psychiatry: Psychwatch. Com; The; Online Resource for Professionals in Psychology and Psychiatry: www.psychwatch.com SAUDI BOARD IN FAMILY MEDICINE ROTATION IN OBSTETRICS AND GYNAECOLOGY DURATION: 3 Months Introduction: The Obstetrics/Gynaecology practice occupies a central position in whole- family care. A significant proportion of problems dealt with in primary care practice is 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 Gynaecological problems. Objectives: At the end of the training, the resident should be able to: 1. Provide quality antenatal care including the promotive and preventive aspects. 2. Undertake the initial management of common and life-threatening problems during pregnancy. 3. Identify high risk patients, apply proper intervention and arrange an appropriate referral. 4. Provide health education during pregnancy, child birth and care of the newborn. 5. Recall the methods by which congenital malformation of the fetus may be detected. 6. Manage common conditions for which pregnant women are admitted to hospital e.g. premature labour, preeclampsia, multiple pregnancy, fetal growth retardation, antepartum haemorrhage, and maternal disease. 7. Manage normal delivery. 8. Demonstrate an understanding of the management of other abnormalities of labour e.g. shoulder dystocia, breech, twins and multiple pregnancies. 9. Train mothers on how to establish and maintain breast feeding. 10. Plan management of physical and psychosocial problems of the mother in postnatal period e.g. puerperal depression. 11. Plan arrangements needed for home confinements. 12. Use of accurate and detailed records in all aspects of obstetric care and recognize the value of such records in clinical audit. 13. Take a gynaecological history, carry out a full and appropriate examination and conduct appropriate investigations. 14. Advise, investigate and where appropriate refer patients with problems relating to infertility. 15. Manage common problems relating to menstruation. 16. Manage patients suffering from infections of the genital tract, including sexually transmitted disease. 17. Plan management of the menopause. 18. Counsel couples in child spacing and assist in family planning clinics. 19. Describe the steps required for the early diagnosis of neoplasia of the genital tract and the Family Physician 9 s role in management. 20. Apply preventive methods in Obs/Gyn. 21. Perform technical procedures commonly practiced in primary care (see the skill list below). Process of Training: The clinical rotation in obstetrics and gynaecology is designed to provide a set of learning experiences in the hospital in order to foster the acquisition of the competencies required for the practice of the discipline with special emphasis on conditions common in primary care, whenever possible. The resident must work on a full-time basis as a member of the obstetrics/gynaecology team, participates in the service and educational activities of the department and develops good interpretational skills in dealing with patients. The resident must meet all the objectives and be available for all the requirements of rotation. The system of admitting room experience (in out-patient, referral and antenatal clinics), in-patients experience (in the obstetrics and gynaecology wards, labour wards and operating theaters) and follow-up experience (in the referral or consultant clinics), provide an excellent opportunity for continuity of patient care which is essential to the practice of primary health care. Learning Situation: 1. In patient. 2. Out-patient Clinics (ANC and Gynaecology Clinics). 3. Delivery room 4. Emergency 5. Continuing Medical Education (CME) activities Content of Training: Areas of knowledge expected to be taught in the course of the rotation. § Normal antenatal care: diagnosis, establishing dates, screening, assessment of progress, patient education. § Identification of high risk pregnancy; with proper management and referral. § Normal labor and delivery. § Medical problems during pregnancy i.e. diabetes and thyroid disease. § Genetic counseling. § Problems of labor and delivery i.e. obstructed labor, infections, fetal distress, postpartum and intrapartum bleeding. § Obstetric emergencies. § Ectopic pregnancy. § Abortion and antenatal bleeding. § Preterm labor and premature rupture of membranes. § Hypertension of pregnancy, pre-eclampsia, and eclampsia. § Indications for cesarean section, and other assisted delivery procedure (e;g ventouse and forcepse) § Postpartum care and follow up. § Breast feeding, child spacing and sexual advice. Evaluation: The Department of Obstetrics and Gynaecology in collaboration with the Department of Family and Community Medicine will assess the resident according to the following criteria. 1. Continuous assessment 30% 2. Final clinical examination a. Written exam 20% (The candidate should score 60% of this mark) b. Clinical examination 50% The candidate should score 70% aggregate to pass the rotation. Those who will fail at the end-of-rotation examination will be referred to the local supervising committee to recommend whether they will repeat the rotation or part of it or only sit for another examination. This decision should be made in collaboration with the concerned departments. The residents will be appraised twice during the course if their performance is unsatisfactory up to that time. Satisfactory performance in the continuous assessment is mandatory before a candidate is allowed to sit the final examination. LIST OF SKILLS TO BE LEARNED: 1. Obtaining vaginal and cervical cytology 2. Colposcopy 3. Cervical biopsy, polypectomy 4. Cryosurgery/ cautery for benign lesions 5. Microscopic diagnosis of urine and vaginal smears 6. Dilatation and Curettage 7. Limited ultrasound examination and interpretation 8. Management of labor 9. Pudendal and local anaesthesia 10. Induction of labor 11. Neonatal resuscitation 12. Assistance in cesarean section Bibliography: A. Obstetrics: 1. Brews and Holland. Manual of Obstetrics. Churchill London. 2. De Swiet, M. (et al) Manual Disorder in Obstetric Practice. Black well Scientific Publications, Oxford. 3. Pritchard, J.A. and MacDonald, P.C. Williams Obstetrics Crafts, New York. B. Gynaecology: 1. Jones. H.W., Jones G.S. (Ed): Novak 9 s Text Book of Gynaecology, Williams and Wilkins, Baltimore. 2. Tindall, V.R., (Ed): Jeffcoate 9 s Principles of Gynaecology, Butterworth, London. 3. J.C. Mclure and J.K. Lewis. Post-graduate Obstetrics and Gynaecology. 4. David N. Danforth, J.B. Lippincott. Obstetrics and Gynaecology. 5. Women 9 s sit right problems in General Practice. Oxford Series. General: 1. Gorol. Primary Care medicine. 2. Rakel Saunders, Text Book of Family Practice. SAUDI BOARD IN FAMILY MEDICINE ROTATION IN SURGERY Duration: 2 months (6 weeks in General Surgery and 2 weeks in Urology) Introduction: The rotation in Surgery should help the family physicians to acquire knowledge, skills and attitude that will enable them to provide a broad range of services and to enable them to make clinical decisions related to common surgical and orthopedic problems encountered in the PHC setting. Objectives: By the end of this 2 months rotation, the trainees are expected to: 1. Be able to recognize and manage common surgical problems and emergencies which may need referral to a surgeon (part of this is covered during rotation in emergency care ). 2. Be competent to perform minor surgical procedures, e.g. incision of abscesses, circumcision, banding of internal hemorrhoids, suturing, dressing, and removal of foreign bodies. 3. Acquire basic knowledge of anaesthesia used in different surgical procedures in a PHC setting and its complications, e.g. local anaesthesia and interaction with drugs. 4. Understand how patients are managed pre-and pos-operatively, e.g. explaining to patients about surgery, taking consent, dressing and cleaning wounds, etc. 5. Be involved in management related to mutilating surgical procedures like total colectomy, total gastrectomy, mastectomy, amputation and RTA, especially for psychological consequences. Process of Training: 1. The resident is to be attached to a unit where he / she should work under close supervision by senior staff till he acquire enough knowledge and the ability to work more independently. 2. Participation in departmental activities, e.g. grand rounds, lectures, tutorials, journals clubs, etc. 3. Performing and assisting in common surgical procedures under the direct supervision of a consultant or senior registrar and taking full responsibility at in-patient and out-patient care. 4. Residents should be given opportunities to perform minor surgical procedures, particularly those done in out-patient under local anaesthesia. 5. Preparing material of relevance to primary health care to discussed with senior staff and presented in a form of tutorial once a week. 6. A balance between the service and training should be maintained. 7. The half-day release course held weekly in one afternoon by the Department of Family and Community Medicine should be attended regularly by the trainees. 8. A log book should be maintained by the resident and signed by a senior staff on the activities he attended and skills he performed. Learning Situation: 1. Out-patient clinics 2. Day Surgery 3. Accident and emergency 4. Academic activities (Journal Clubs, Tutorial etc.) 5. In-patient / Grand 3 rounds Surgical skills to be acquired during the rotation: " Rapid assessment of an acutely-ill patient. " Suturing and laceration repair. " Incision and drainage of superficial abscesses. " Biopsy and removal of superficial masses " Wound debridement and wound management. " Local anaesthesia techniques " Nasogastric tube insertion " Fine needle aspiration. Contents of Training: " Preoperative evaluation and management. " Acute abdomen in children and adults. " Hemorrhoids and other ano-rectal problems like fissures and abscesses, etc. " Gall bladder disease. " Approach to patients with neoplasms of the chest, breast, abdominal cavity and gastro-intestinal tract, etc. " Trauma and wound management. " Varicose veins. " Postoperative care " Prostatic disease " Management of burn " Peripheral vascular disease " Urinary stones Evaluation: The Department of Surgery in collaboration with the Department of Family and Community Medicine will assess the resident according to the following criteria. 1. Continuous assessment 30% 2. Final clinical examination a. Written exam 20% (The candidate should score 60% of this mark) b. Clinical examination 50% The candidate should score 70% aggregate to pass the rotation. Those who will fail at the end-of-rotation examination will be referred to the local supervising committee to recommend whether they will repeat the rotation or part of it or only sit for another examination. This decision should be made in collaboration with the concerned departments. The residents will be appraised twice during the course if their performance is unsatisfactory up to that time. Satisfactory performance in the continuous assessment is mandatory before a candidate is allowed to sit the final examination. Bibliography: 1. Rakel, Saunders Textbook of Family Practice. 2. Primary Car Medicine, Office Evaluation and Management of the Adult Patient. Goroll et al 3 rd Edition. 3. Minor Surgery, A Test and Atlas, 2 nd Edition 1993, J.S. Brown. 4. Oxford Handbook of Clinical surgery, 1990. G.R. MacLatchie. 5. General Surgery at the District Hospital, 1988. john Cook et al. WHO. 6. System of Orthopedics and Fractures A. Graham Apley. 7. An Introduction to the Symptoms and Signs of Surgical Diseases Normal L. Browse. 8. Minor surgery in General Practice. Information Folder. Royal College of General Practitioners. 9. Surgical procedures in primary care. Bull M.J.V. and Gondenir P. 1995 Oxford University Press. 10. Brian A. Maurice, Surgery for General Practitioners. Turnbridge Weils, Kent U.K. Castle House Publication (LTD), 1989. SAUDI BOARD IN FAMILY MEDICINE ROTATION IN ORTHOPAEDICS Duration: 1 month Orthopedic problems represent a sizeable workload in primary health care setting. The Family physician is required to deal with these problems efficiently and competently. The goal is to help the trainee to identify patients with orthopedic problems who can be managed in primary health care setting and those who require specialist care. Objectives: By the end of the rotation, the trainee is expected to: " Acquire basic knowledge in orthopedic problems. " Be able to recognize and manage common orthopedic problems and emergencies. " Demonstrate proper understanding and application of diagnostic and therapeutic technical skills in relation to orthopedic problems. " Be able to recognize and manage common fractures, their diagnosis, proper management and prompt referral to the specialist. " Be able to perform orthopedic examination and interpret its findings. " Recognize the role of radiological investigation in the diagnosis of orthopedic problems. " Be able to apply casts and plaster of pairs to common fractures. " Recognize the importance, indications and applications of physiotherapy, occupational, and rehabilitation therapy in orthopedic problems. Process of Training: 1. The resident is to be attached to a unit where he / she should work under close supervision by senior staff till he acquires enough knowledge and the ability to work more independently. 2. Participation in departmental activities, e.g. grand rounds, lectures tutorials, journal clubs, etc. 3. Performing and assisting in common surgical procedures under the direct supervision of a consultant or senior registrar and taking full responsibility at in-patient and out-patient care. 4. Residents should be given opportunities to perform minor surgical procedures, particularly those done in our patient under local anaesthesia. 5. Preparing material of relevance to primary health care to be discussed with senior staff and presented in a form of tutorial once a week. 6. a balance between the service and teaching should be maintained. 7. The half-day release course held weekly in one afternoon by the Department of Family and Community Medicine should be attended regularly by the trainees. 8. A log book should be maintained by the resident and signed by a senior staff on the activities he attended and skills he observed and / or performed. Content of Training: " Proper history taking in orthopedic practice. " Proper orthopedic examination. " Arthritis " Bursitis and tendonitis " Carpal tunnel syndrome " Common fractures and soft tissue syndrome " Low back pain " Shoulder pain " Cervical pain " Congenital hip dislocation (CHD) " Osteomyelitis " Septic arthritis " Aspiration and injections of joints and bone Skills to learn: " Complete joint and spine examination " Appropriate use and interpretation of X-rays in orthopedic problems. " Bandaging of sprained joint. " Safe transport of orthopedic trauma. " Safe and effective splinting of fracture. " Aspiration and injection of joint. Evaluation: The Department of Orthopedics in collaboration with the Department of Family and Community Medicine will assess the residents according to the following criteria. This will take the form of continuous assessment during the rotation including a clinical examination (either a clinical examination or OSCE) The candidate should score 70% aggregate to pass the rotation. Those who will fail at the end-of-rotation examination will be referred to the local supervising committee to recommend whether they will repeat the rotation or part of it or only sit for another examination. This decision should be made in collaboration with the concerned departments. The residents will be appraised twice during the rotation by the senior staff with whom he worked. SAUDI BOARD IN FAMILY MEDICINE ROTATION IN DERMATOLOGY DURATION: 1 Month Introduction: A significant proportion of problems dealt with in primary health care practice is related to the specialty of Dermatology. The family physician should be competent in initial assessment and interim management of these cases and in the overall management of common dermatologic problems. He/she should also be familiar with the contribution of specialists and subspecialists in dermatology, so that he will make appropriate referrals. Objectives: At the end of the rotation, the resident should be able to: 1. Diagnose, assess and manage acute and chronic Dermatological conditions commonly dealt with in primary health care settings with timely and appropriate referrals for conditions that need special procedures equipments or expertise (e.g. hypothyroidism, DM, vitamin deficiency). These should include: a. Pruritus b. Urticaria c. Purpura d. Pigmentation Disorders e. Acne f. Contact Dermatitis g. Eczematous Dermatitis h. Scabies and Pediculosis i. Alopecia j. Psoriasis k. Fungal skin infection l. Manifestation of Systemic Disease m. Cutaneous Leishmaniasis n. Dry skin o. Pyoderma and Cellulitis p. Warts, Viral infection and bacterial infection q. Insect bites r. Sexually transmitted disease s. Neoplasm of the skin t. Photo sensitivity disorder 2. Independently perform Dermatological procedures which are common in primary care practice (see list of skills to be learned) 3. Describe the social, economical, and cultural factors affecting skin problems. 4. Give appropriate advice on promotive, preventive and rehabilitative aspects of skin diseases. 5. Use of topical agents in dermatology including steroids. 6. Recognize serious conditions and perform appropriate and timely referrals. Process of Training: The resident will work full time with the Department of Dermatology and participate in the services and educational activities of the department. Evaluation: The Department of Dermatology in collaboration with the Department of Family and Community Medicine will assess the residents according to the following criteria. This will take the form of continuous assessment during the rotation including a clinical examination (either a clinical examination or OSCE) The candidate should score 70% aggregate to pass the rotation. Those who will fail at the end-of-rotation examination will be referred to the local supervising committee to recommend whether they will repeat the rotation or part of it or only sit for another examination. This decision should be made in collaboration with the concerned departments. The residents will be appraised twice during the rotation by the senior staff with whom he worked. LIST OF SKILLS TO BE LEARNED 1. Diagnostic: - Biopsy - Scraping - Skin testing techniques 2. Therapeutic: - Acid Cauterization - Electrodesiccation and curettage - Cryosurgery - Punch biopsy - Excision of skin lesions - Intra-lesional injection of steroid - Incision and drainage - Treatment of ingrowing nails - Ultraviolet light therapy Bibliography: 1. Goroll et al. Primary Care Medicine. An Office Management of the Adult Management of the Adult patient. 2. Rakel, Saunders. Text Book of Family Practice. 3. Graham 3 Brown. Lecture notes in Dermatology. SAUDI BOARD IN FAMILY MEDICINE ROTATION IN OPHTHALMOLOGY DURATION: 1 Month Introduction : Eye diseases represent an important proportion of problems dealt with in primary health care practice. The family physician should be competent in initial assessment and interim management of these cases and in the overall management of common ophthalmology problems. He should also be familiar with the contribution of specialists and subspecialists in ophthalmology, so that he will make appropriate and timely referrals. Objectives: At the end of the course, the resident should be able to: 1. Assess and manage acute and chronic ophthalmological conditions commonly dealt with in primary health care settings. These should include: a. Red Eye b. Impaired vision c. Eye pain d. Common Visual disturbance e. Cataract f. Glaucoma g. Exophthalmos h. Retinopathy due to systemic diseases i. Abnormal ocular mobility (especially in children) j. Ocular emergencies (eye trauma, burns or corneal ulceration) Describe the common ophthalmologic condition seen in primary care setting 2. Select suitable cases for referral, work-up or both. 3. Independently perform ophthalmological procedures which are common in primary care practice and acquire the skills of appropriate usage and handling the essential ophthalmology examination instruments: § Direct battery hand-held ophthalmoscope § Hand-held flash light for ophthalmic exam § Snellen 9 s chart - Tumbling E. for adult § Allen 9 s figures for children § Pin hole disc § Corneal foreign body removal § Visual field examination. 4. Perform proper funduscopic examination with the use of a direct ophthalmoscope and recognize difference between normal appearance and major abnormalities, e.g. Papilloedema, Cupping nerve head, Diabetic retinopathy, Hypertension and Retinal detachment, etc. 5. Describe the social, economical, and cultural factors affecting ophthalmology problems. 6. Recognize serious condition and perform appropriate and timely referral. 7. Give appropriate advice on promotive, preventive and rehabilitative aspects of eye diseases. Process of Training: The resident will be a full time with the Department of Ophthalmology and participate in the services and educational activities of the department. The following break down is suggested: § 2 weeks in General Screening Clinic § 1 week in Pediatric Eye Clinic § 1 week in Refractive Errors Clinic Evaluation: The Department of Ophthalmology in collaboration with the Department of Family and Community Medicine will assess the residents according to the following criteria. This will take the form of continuous assessment during the rotation including a clinical examination (either a clinical examination or OSCE) The candidate should score 70% aggregate to pass the rotation. Those who will fail at the end-of-rotation examination will be referred to the local supervising committee to recommend whether they will repeat the rotation or part of it or only sit for another examination. This decision should be made in collaboration with the concerned departments. The residents will be appraised twice during the rotation by the senior staff with whom he worked. Bibliography: 1. Gorol et al. Primary care medicine. An Office Management of the patient. 2. Rakel, Saunders. Text Book of Family Practice. 3. Calbert I Philips. Basic Clinical Ophthalmology. 4. Gardiner. ABC of Ophthalmology. SAUDI BOARD IN FAMILY MEDICINE ROTATION IN OTOLARYNGOLOGY (ENT) Duration: 1 month Introduction: A significant proportion of problems dealt with in primary health care practice is related to the specialty of E.N.T. The family physician should be competent in initial assessment and interim management of these cases and in the overall management of common E.N.T. problems. He should also be familiar with the contribution of specialists and subspecialists in E.N.T. so that he will make appropriate referral. Objectives: At the end of the rotation the resident should be able to: 1. Recognize, assess and manage acute and chronic E.N.T. conditions commonly dealt with in primary health care settings. These should include. " Impaired Hearing, balance disorders and hearing aids. " Otitis (otitis media, external) " Sinusitis " Pharyngitis " Rhinitis " Chronic and nasal congestion and discharge " Dizziness " Epistaxis " Hoarseness of voice and disorders of voice. " Smell and taste disturbances " Stomatitis " E.N.T. Malignancies " E.N.T. emergencies (such as stridor, trauma and other air way obstruction problems). " Congenital defects 2. Take a proper ENT history. 3. Select suitable cases for workup and / or referral. 4. Demonstrate awareness of social, economical, and cultural factors affecting ENT diseases. Skills to be learned: " Appropriate ENT examination " Ear wax removal " Nasal packing for control epistaxis " Removal of foreign body from nose and external ear. " Observation of tracheotomy and care patient with tracheotomy. " Audiogram interpretation. Evaluation: The Department of Otorhinolaryngology (ENT) in collaboration with the

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