for more visit: http://fayzarayes.com

1. FM III
2014
Introduction &
Orientation

2. Objectives:
1.
Allocation of responsibilities
2.
Agreement on the method of training
3.
Get the maximum benefit from this rotation

3. Contents (4 hours):
1.
The curriculum for FMII rotation
2.
Educational activity timetable
3.
How to maximize your benefit from PHC clinic
training
4.
Evaluation and final exam
5.
Simulated clinic assignment (workshop)

4. Family Medicine III Rotation
1st February – 17th April 2014
Morning
Break
Sunday
Clinic
Clinic
Monday
Educational Activity
HDRC
Tuesday
Educational Activity
SDL
Wednesday
Clinic
Clinic
Thursday
Clinic
Logbook Discussion
Every candidate need to set with his/her supervisor in the
program every week to discuss his /her portfolio and any
other personal or educational issues

5. Educational Activities


Logbook Sessions
Clinical problems:
 Chronic diseases: DM / Hypertension / Asthma
 10 other common clinical problems







Physical examination workshop
Data interpretation 2 workshop
Consultation skills : 3 sessions
MEQs : 3 sessions
EBM : 3 sessions
Session arranged by trainees: 2 sessions
Information Technology: 1 session

6. Common Clinical Problems

7. Educational Activity FM III 2014

8. How can you detrmine your
specific, relevant and important
learning needs ?
The more time you invest in planning of
learning, the more likely it is that you will
focus your learning effectively. You will then
spend the precious time you have learning
about things that are relevant

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

11. www.fayzarayes.com
1. Family Medicine Rotation Facebook group
2. Special for R3 FM Rotation (JPFCM3)
3. References for the educational activities
4. Communication tool between us
5. ……

12. How can you maximize
your benefit from PHC
clinic training
?

13. > 10 Ways to maximize your
benefit from PHC clinic training
1. Discover your learning needs
2. Write 3-5 challenging questions
everyday and direct your reading to
these questions
3. Write interesting pt’s scenario for
future discussion (in your logbook)
4. Discuss interesting patients with your
seniors

14. > 10 Ways to maximize your
benefit from PHC clinic training
5. Study your pt’s results of investigations
(e.g. ECG, blood test, X-Ray)
6. Practice proper physical examination
(and evaluate your performance using SHCS forms)
7. Practice health education with every
patient (and evaluate your performance)
8. Practice health promotion with every
patient (and evaluate your performance)

15. > 10 Ways to maximize your
benefit from PHC clinic training
9. Make photos for interesting signs
10. …….????
11. ……..????

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

17. Video Tape Your Consultation
1. You need written permission from the patient
2. You need to pay attention to the sound quality
3. Video at least three consecutive consultation
to discover your pattern of consultation
4. Review the videos with your supervisor and
discover your learning need
5. Work in your learning need and repeat the
experience to monitor your progress

18. >10 Ways to maximize your
benefit from PHC clinic training
11. ……..?
12. ……..?
13. ……..?

20. Meet your supervisor:
Arrange the exact time with your academic supervisor
Meeting Agenda:
 Review your
portfolio
 Discussion of interesting experience in your current
training
 Discussing educational needs & personal
development plan
 Solving any current issue in your training & psychosocial support
 ……….????

21. Address
their
educational
needs
Identify
their
strength
and
weakness
Provide
motivation
Explore
options
with their
trainee
Act as
challenger
Encourage
reflection

22. Portfolio Contents
In your clinical training you need to do
 4 CBD.
 4 Mini CEX and
 4 DOPS
and document this in your portfolio

23. Logbook
Clinical cases you
have seen in your
clinic
Example of
learning
needs ??

24. SDL & Portfolio
Discussion
???

25. FM 1 Rotation - SDL Documentation
Candidate Name:………………………………………………… Supervisor:……………………………………..
Date
1
2
3
4
5
6
7
8
9
10
Summary of the activity
Supervisor
signature

26. Rules & Regulations
Family Medicine Rotation
Welcome to Family Medicine Rotation.
In this rotation you are going to have
1. 4 clinical sessions every week. Totally 40 clinics in 10 weeks
2. 1 Logbook discussion with your trainers at the health center every week
3. 3 Educational activities in the program (Monday morning and full Tuesday). Totally 30
theoretical sessions in this rotations (10 weeks)
4. 1 Self-Directed Learning session every week. Totally 10 Self-Directed Learning (in 10 weeks)
5. You need to meet your academic supervisor once a week. If your supervisor is on leave or
commitment outside the program, you can communicate with him/her through e mail or
mobile. Or you can ask him/her to refer you to another supervisor to report to him/her your
progress every week , and you need to document this in your portfolio
6. In your clinical training you need to do 4 CBD. 4 Mini CEX and 4 DOPS and document this in
your portfolio
Rules & Regulations:
1. Delay more than 15 minutes from any session will be considered as absence
2. Any delay or absence with acceptable excuse will be counted as (2 excuses =1 absence)
3. SDL should be reported to your supervisor every week, any misreporting will be consider as
absence and will affect your portfolio evaluation (40% of the final evaluation)
4. If you are absence more that 25% of the time according to SCHS regulation you will
not be allowed to sit for the end of rotation exam and you will repeat the rotation next year

27. Facebook Group
Family Medicine Rotations Jeddah
https://www.facebook.com/groups/794017410624305/

28. End of Rotation Assessment
1. Portfolio ………………..….…….
40%
(including attendance of meeting supervisor sessions)
1. Continues assessment from the PHC center
trainers….……..............…….….
2. Written Exam ………..……..….
3. OSCE ………..…………….……….
30%
15%
15%

29. Written Exam
 30 MCQs
 3 Data
 3 MEQ & CRQ

30. Break

31. Simulated Clinic Assignment
Every candidate will prepare one simulated
clinic as part of self-directed learning activity

32. General Advantages of
Simulated Patients &
Role-Play
 Drama is an attractive way of learning
 Application of theory into practice
 Encourage interaction
 Encourage spontaneity and problem solving
 Teaching attitude & skills
 Increase self-confidence
 Learning by doing- Increase retention up to 90%

33. Simulated Patient
Advantages :
 Rehearsal
 Flexibility
 Standardization (in exam)
 Customization
 Specific issues and difficult situation
 Availability
 Time efficiency
 Feedback
 Facilitation, instruction and evaluation

34. Developing Simulated Patient
 Presenting situation
 Profile of patient
 Emotional tone
 History of present illness
 Additional information (Smoking. Drug ..)
 Past medical history
 Psychosocial history (ICE & hidden agenda)
 Physical examination
 Equipment needed

35. Example of an OSCE station
CONTRACEPTION
Instruction for patient
 You are a 30 year old nurse attending with your
husband . You have been building up courage to
come and see the doctor and have decided to open
with "I'd like to go on pill". You have 6 children.
Your husband is hesitant about the pill as he thinks
contraceptive pill can cause infertility
 You smoke 10 cigarettes a day and have regular
periods and no past medical or gynaecological
problems.

36. MARKING SCHEDULE
A
HISTORY (10 marks)
Sexual /Contraceptive / Relationship / Medical/ Family/ Gynaecological
Rubella / Smears / Smoking
EXPLORING (10marks)
Patient's ideas and concerns
EXAMINATION (10MARKS)
BP / Breasts / Pelvic / Weight/Height / Rubella
EXPLANATION (10 marks)
Other Methods of Contraception
How pill works / Advantages and disadvantages of pill
Clarify false beliefs about the pill
How to take the pill / What to do if you forget
When it will not work e.g. antibiotics and D & V, first 2 weeks
How pill works and disadvantages of pill
Starting on 1st day
Leaflet to build up information
Advice about smoking
Smear test
When to seek medical help? / Any questions?
OTHER (10 MARKS)
Communication with two party (wife & husband)
Clear use of language understandable to a 30 years old nurse.
Supportive attitude about seeking contraceptive advice.
Appropriate use of time.
Overall result:
Clear pass
Pass
Borderline
Fail
B
C

37. Steps in preparation of
simulated clinic
1. It is preferable to chose patient’s scenario
from your real practice
2. Clinical problem + Behavioral problem
3. Write a draft and modify it with your
supervisor
4. Apply it as a role-play to insure its practicality
5. E-mail it to me as soon as it become ready

38. Patient Brief Record
Case Title:
NAME:
AGE:
SEX:
OCCUPATION:
SUMMARY OF MEDICAL RECORD:

39. Patient Scenario
AGE:
SEX: Male
OPENING STATEMENT:
SAY VOLUNTARILY (Without Asking)
SAY WHEN DOCTOR ASKS YOU:
BEHAVIOUR DURING THE CONSULTATION:
TASKS TO TEST”
1.
2.
3.

40. Marking Schedule
CANDIDATE SHOULD COVER THE FOLLWING A B
C
1- INFORMATION GATHERING
2- DOCTOR/PATIENT INTERACTIONS
4- MANAGEMENT
5- EFFECTIVE USED OF CONSULTAT
A = Complete answer
B = Partial Answer
C = Not answered to mostly inappropriate answer.
Final Grade: ---------- %
Examiner comments if any: ……………………………………….

41. Simulated Clinic Assignment

Every candidate will do one simulated clinic in the coming 7 weeks

21 simulated clinics will be come in the end of rotation exam

42. Simulated Clinic Assignment
Benefits:
 Active learning of the consultation skills
 The best way to pass the exam is to think like the
examiner
 You will learn one simulated clinic in depth
 You will learn 20 other simulated clinics from your
colleagues

43. Simulated Clinic Assignment
Simulated Clinic
1. DM
2. Hypertension
3. Asthma
4. Pt with Red Eye
5. Pt with Fever of Unknown Origin
6. Family Planning
7. Metabolic Syndrome
8. Elderly with Multiple Pathology
9. Pt with Thyroid Disease
Trainees

44. 10. Pt Refusing Treatment
11. Patient with Dermatological Problem
12. Adolescent with behavioral Problem
13. Adolescent with URTI
14. Infant with Jaundice
15. Infant with Failure to Thrive
16. Pt with Acne
17. Counseling Smoker with IHD
18. Counseling Obese Patient
19. DM Health Education
20. Patient with Sinusitis

45. Simulated Clinic Workshop
1. Discussion and writing (20 min)
2. Demonstration (10 min)
3. Feedback & comments

46. Simulated Clinic Discussion & writing
28-old teacher with migraine and stress at work
requesting sick leave
Work as 3 groups independently
Every group will discuss and writ the following:
1. Patient Brief Record
2. Patient Scenario
3. Marking Schedule

47. Simulated Clinic Exam

48. Workshop
Simulated Clinic Exam
Patient
Physician
Evaluator
Supervisor
1.



FMII will be distributed to 3 groups
Blue group 7 candidates
Yellow group 7 candidates
Red group 7 candidates
2. There is going to be 7 stations . 15-20 minutes in each
station (10 minutes for role-play and 5-10 minutes for
feedback)
3. Every 3 stations every group will shaft their role (the
evaluator group will be the patient and the patent will be
the physician and the physician will be the evaluator)
4. The one who play the patient role will use his
checklist

49. The Role of the Evaluator
1. He/she will use the checklist for evaluation
2. He/she will give comment on the simulated
doctor performance and decide about the
mark (%)

50. The Role of the Supervisor
1. Comment on the forms (scenario and the
checklist)
2. Comment on the simulated patient
performance
3. Comment on the simulated doctor
performance
4. Comment on the simulated evaluator
performance
* Every 3 stations the supervisor will move to another
stations but opposite to the candidate movement direction

54. 10 minutes break every one hour
10 minutes

55. Preparation of Educational
Activity Sessions
Workshop
In small groups try to make use of the learning needs
questionnaire and reflect on you previous practical
experience to determine the most important
educational gaps you need to address in your
educational activity sessions and generate questions

56. List of Sessions in FMII Rotation
1. Osteoporosis
9. Ischemic Heart Disease
2. Dyspnea
10. Common behavioral problems in
3. Anxiety
children
4. Obesity
11. Growth & development
5. Back Pain
12. Joint pain & Injuries
6. Vaginal Bleeding
13. Abdominal/ Pelvic Pain
7.
Vaginal Discharge
14. Data interpretation workshop
8.
Hyperlipidemia
15. Physical Examination workshop

57. Workshop objectives:
1.
To find out together our educational gaps
2.
To be selective in your reading
3.
To prepare in depth about the topic
4.
To move from theories to practice applications
(from just knowledge to attitude and skills)
Using the result of the learning needs questionnaire
& reflecting on our previous clinical experience

58. Q. How can you find out your
educational gaps
(specific learning needs)
Review
Reflect

59. How can you find out your educational gaps
(specific learning needs)
Review:
 Reviewing the curriculum and picking up your
educational gaps (core contents & core skills …)
 Reviewing quick reference guideline and picking
up all unfamiliar recommendations in the
guideline

60. Example: Learning needs in OA
SAUDI BOARD OF FAMILY MEDICINE CUURICULUM

61. How deep do we need to know ?
Joint Injection is it
A. very important to know ?!
B. nice to know ?!
C. no need to know ?!

62. Learning Needs:
knee injection
skill
Steps in learning new skill:
1.
2.
3.
4.
5.
6.
Reading
Watching (real patient or video)
Training in the skill lap
Performing the skill under supervision
Performing the skill independently
Teaching others (Mastering the skill)

63. Learning Needs
OA Management Options

64. Every Body Responsibility
1. To read short review about the topic before the
session:
 Symptoms , signs & DD
 Risk factors and prevention
 Evidence based stepped-care management
2. Try to find out answers for the challenging Qs
3. To share with the group any new interesting Qs
or pt’s scenarios
4. Participate effectively during the session
5. Add the new learning needs in his/her action
plan

65. Example: Learning needs in OA

66. How can you find out your educational gaps
(specific learning needs)
Reflect:
 What is the deference
between undergraduate
(KSA) and postgraduate ?!
 What is the deference
between practicing GP
and consultant family
physician ?!

67. How can you find out your educational gaps
(specific learning needs)
Reflecting on your clinical experience
 Not feeling 100% satisfaction with my
performance ??!!
 Difficult patient / difficult decision / mystiques ??!!
 New information / new skill ??!!

68. Educational Needs
Reflecting on my clinical experience
Q1. How can I advise an elderly obese to do exercise?
Q2. What is my role as FP for early diagnosis intervention ?
Q3. The effectiveness of local treatment?!
Q4. When do I advise pt to go for surgery? The short term and long
term prognosis of artificial joints? The update in OA surgery?
Q5.The prevalence of this problem in KSA? Any relevant local study in
this issue?
Q6.Managment Pt. with PU and OA ?
Q7. Management of elderly pt with severe OA who can not go for
surgery?
Q8. High-heel shows and OA?
Q9. EB Management of OA?
Q10. ….

69. How can you bridge your educational gaps
Active Learning:

70. Bridging the Learning Gap
Bridging the Learning Gap
 Motivating learners
 Interactions
 Audio-Visuals
 Exercises
 Scenarios
 Simulations
 Feedback
 Memory tools
 Practice with spaced-repetition
 Sessions that don't bore you out of your minds!

71. 5 Groups / 4 candidates
1. Osteoporosis
9. Ischemic Heart Disease
2. Dyspnea
10. Common behavioral
3. Anxiety
problems in children
4. Obesity
11. Growth & development
5. Back Pain
12. Joint pain & Injuries
6. Vaginal Bleeding
13. Abdominal/ Pelvic Pain
7.
Vaginal Discharge 14. Data interpretation workshop
8.
Hyperlipidemia
15. Physical Examination workshop

72. 5 Groups / 4 candidates / 30 minutes
1. Osteoporosis
2. Obesity
3. Vaginal Discharge
4. Common behavioral problems in children
5. Abdominal/ Pelvic Pain
 10 minutes discussion followed by presentation and
discussion
 20 minutes discussion of the remaining 2 topics
 Presentation of the remaining 2 topics

73. 5 Groups / 4 candidates / 30 minutes
1. Osteoporosis
9. Ischemic Heart Disease
2. Dyspnea
10. Common behavioral problems in
3. Anxiety
children
4. Obesity
11. Growth & development
5. Back Pain
12. Joint pain & Injuries
6. Vaginal Bleeding
13. Abdominal/ Pelvic Pain
7.
Vaginal Discharge
14. Data interpretation workshop
8.
Hyperlipidemia
15. Physical Examination workshop

74. How to Prepare for the Session ?
1. How to prepare for the session ?
2. The role of the presenter
3. The role of the supervisor
4. Every body responsibility

75. How to prepare for the session ?
1st Step :Transfer the Qs in to objectives
Example: Q1. How can you advise elderly obese to
do exercise?
Objectives:
1. Communication with elderly pt
2. Special consideration in management elderly pt
with OA
3. Special physical exercises for elderly pt

76. How to prepare for the session ?
2nd Step : Categorize your objectives
How deep do we need to know ?
1. Very important to know
2. Nice to know
3. No need to know

77. How to prepare for the session ?
3rd Step :Transfer the objectives in to
Scenario
Scenario: Sada is an 80-y-old obese lady with OA,
how are you going counsel her?
4th Step : chose the appropriate methods
Method:
Case discussion ± Video demonstration ± Role-play

78. How to prepare for the session ?
5th Step :collect all objectives and methods
and arrange them in your lesson plan
 You may need to merge 2 objectives together
 You may need to postponed some objectives if you
do not have enough time or recourses
 You may encourage trainees to achieve some
objectives by active learning (reading before the session)

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

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

81. The role of the presenter
In collaboration with his/her supervisor:
1. Collect challenging questions and learning needs from
his colleagues
2. Transfer questions in to case scenarios
3. Search for answers of these challenging questions
4. Select high quality references and send it to his/her
colleagues
5. Prepare highly selective, short PowerPoint presentation
with special tips and valuable comments (No need to
present any well known knowledge)
6. Decide the session plan
7. Run the session , control the discussion & manage his
time

82. The role of the supervisor
Guide the presenter to:
1. Make the Qs and the scenarios more challenging
2. Make the answers more practical
3. Chose more selective material
4. Presentation rehearsal
During the session:
1. Watching most of the time
2. PRN comments
3. Discovering new learning needs
4. Giving feedback

83. Example of Data interpretation Qs

84. OA bilateral knee
OA of
the Knee
joint
knee replacement : Front view & Side view
A normal
health y
knee

85. Question
Use Case Scenarios
 An 81-year-old man presented to
your clinic with a 1-year history of
pain in his right knee. He stated that
the pain had become more severe
over the previous 2 months but
denied any acute trauma or injury.
The physical examination revealed
that the knee had limited range of
motion.
The accompanying anteroposterior
x-ray view of the patient's right knee
was obtained.
 What is your interpretation
 What is your management
?
?

86. Answer
X-ray shows
 Severe degenerative changes
 Joint-space narrowing most marked
in the medial compartment
 Subchondral sclerosis
 Osteophyte formation.
Diagnosis: degenerative joint disease.
Treatment
 Conservative measures
 pain medications & NSAI
 Injection therapy for patients who
want to delay surgery or for whom
surgery is not recommended
Video demonstration of knee injection

87. Every Body Responsibility
1. To read short review about the topic before the
session:
 Symptoms , signs & DD
 Risk factors and prevention
 Evidence based stepped-care management
2. Try to find out answers for the challenging Qs
3. To share with the group any new interesting Qs
or pt’s scenarios
4. Participate effectively during the session
5. Add the new learning needs in his/her action
plan