General practice (family medicine)
Organizational principles of Family Medicine for 6th year students
OF FAMILY MEDICINE
Program of the course
for 6 th year students of Medical Faculties
for higher medical educational institutions of
III – IV accreditation levels
Specialties : 7.110101 “General Medicine”
7.110105 “Medical and Preventive Care”
Kyiv – 2010
The program is drawn up by Head of the Department of General Practice (Family Medicine) of Bogomolets National Medical University, Doctor of Medical Sciences, Professor O.M. Hyrina; Head of the Department of Outpatient Care and Family Medicine at Horbachevsky Ternopil State Medical University, Doctor of Medical Sciences, Professor V.B. Hoshchynsky, Head of the Department of General Practice – Family Medicine at Kharkiv State Medical University, Doctor of Medical Sciences, Professor L.M. Pasiyeshvili, Head of the Department of Family Medicine at Odessa State Medical University, Doctor of Medical Sciences, Professor H.S. Popik, Head of the Department of Outpatient Care and Family Medicine at Lviv National Medical University named after D. Halytsky, Doctor of Medical Sciences, Professor Ye.Ya. Skliarov; Head of the Department of Outpatient Therapy and Family Medicine at Pyrohov Vinnytsya National Medical University, Doctor of Medical Sciences, Professor V.M. Chernobrovy.
L.I. Ostapiuk – H ead of Curriculum & Instruction Department , Assistant professor of the Department of H uman Anatomy at Bogomolets National Medical University , Candidate of Medical Sciences, member of the working group of the Ministry of Health of Ukraine on implementation of the Bologna Declaration in the educational process in higher medical (Pharmaceutical) educational institutions (Order of the Ministry of Health of Ukraine dated 17.06.2004 №309 and dated 04.12.2008 №721 );
H.I. Lysenko – Professor and head of the Department of Family Medicine of the National Medical Academy of Postgraduate Education named after P.L. Shupyk;
A.S. Svintsitsky – Professor and head of the Department of I nternal Medicine №2 of Bogomolets National Medical University.
The program was discussed and approved at a meeting of Heads of Departments of General Practice – Family Medicine of higher medical educational institutions of the Ministry of Health of Ukraine dated 16-17.03 . 2010 and 19.04.2010 .
(Kyiv, Bogomolets National Medical University)
1. Explanatory note
Program of the course “Organizational foundations of family medicine” for Ukrainian higher medical educational institutions of III-IV accreditation levels was drawn up for specialties 7.110101 “General Medicine”, 7.110104 “Pediatry”, 7.110105 “Medical and Preventive Care” with preparation direction in 1101 “Medicine”. Training in “Organizational foundations of family medicine” is carried out during 6 th year of education, when there is corresponding profiling according to the field of study.
Primary care was assigned a leading role in ensuring health maintenance of the population in conditions of adapting Healthcare Service of Ukraine to the new economic relations.
There is a need for restructuring this branch based on evidence-based needs of urban and rural areas population in different types of medical care and priority development of such aid on the basis of family medicine. 80% of all patients begin and finish their primary care treatment and only 20% of them are to be hospitalized.
Family medical practice should be seen as providing long-term care for the health of an individual and all his family members, irrespective of the type of disease, state of organs and systems of the body in all periods of life.
The Ministry of Health of Ukraine having learned international experience and being aware of responsibility for serious problems in the system of Healthcare Service and based on National program of development of primary health care according to the principles of family medicine for the period until 2012, approved on January 30, 2010 by the Verkhovna Rada of Ukraine, proposes major efforts focus on the development of primary health care on the basis of general practice – family medicine, which is one of the main priorities of the development of national healthcare systems, particularly in conditions of shortage of financial resources.
The program is drawn up on the basis of following regulations:
1. Order of the Cabinet of Ministers of Ukraine No.989 dated 20.06.2000 “On comprehensive measures of implementation family medicine into healthcare system”;
2. Order of the Cabinet of Ministers of Ukraine No.214 dated 11.09.2000 “On comprehensive measures of implementation family medicine into healthcare system”;
3. Law of Ukraine “O n higher education” dated 17.01.2002;
4. Order of the Cabinet of Ministers of Ukraine No.35 dated 24.02.2002 “On a pproval the features of education level with medical direction, and educational and qualification characteristics of medical specialist by training in “ Medicine”;
5. Educational and qualification characteristics (EQC) and professional educational training program (PETP), approved by Order of the Ministry of Education of Ukraine No.239 dated 16.04.2003 “On approval components of industry-specific standards of higher education in training area 1101 – “ Medicine";
6. E xperimental curriculum designed on the principles of the European Credit Transfer System (ECTS) and approved by Order of the Ministry of Health of Ukraine dated 31.01.2005 No.52 “On approval and introduction of new curriculum for training specialists with educational and qualification level “Specialist” and specialty “Doctor” in Ukrainian higher educational institutions of III – I V accreditation levels with specialization in “General Medicine”, “Pediatry” and “ Medical and Preventive Care”;
7. Guidelines for the development of new curriculum and courses, approved by Order of the Ministry of Health of Ukraine dated 24.03. 2004, No. 152 “On approval guidelines for the development of t new curriculum and courses” as amended by Order of the Ministry of Health of Ukraine dated 12.10.2004 No.492 “On making amendments and additions to the guidelines for the development of new curriculum and courses”;
8. Instructions for grading system of educational activities of students under conditions of credit-modular system of organization of training process (Medical education in the world and in Ukraine. Approved by the Ministry of Health of Ukraine as a study guide for teachers, masters, postgraduate students and students. Kyiv. Knyha plus. 2005);
9. Order of the Ministry of Health of Ukraine dated 23.07.2007 No.414 “On approval and introduction of new curriculum for training specialists with educational and qualification level “Specialist” and specialty “Doctor” in Ukrainian higher educational institutions of III – I V accreditation levels with specialization in “General Medicine”, “Pediatry” and “ Medical and Preventive Care”;
10. Annex dated 11.11.2008 No.08.01-22/2222.
Term of training with specialization in “General Medicine” 7.110101, “Pediatry” 7.110104 , “ Medical and Preventive Care” 7.110105 – 6 years. The ultimate goals of discipline for all course units are similar, so the only one program on organizational bases of family medicine was drawn up. According to the curriculum training is carried out during the 6 th year of study.
The program is structured into modules, content-related modules and themes.
“ The organizational bases of family medicine” as an academic discipline:
a) is based on students’ study of academic disciplines: internal medicine, infectious diseases, epidemiology, pediatrics, endocrinology, neurology, oncology, surgery, ophthalmology, otolaryngology, dermatology, clinical immunology and pharmacology, critical care medicine, social medicine and public health, hygiene and ecology, biostatistics, informatics, ethics and deontology and other morphological disciplines and integrates with them;
b) provides study of legal and organizational framework of primary health care;
c) promotes organization of preventive direction of future doctors’ activity, considering the possible impact of factors of different origin on the health status of the population;
d) specifies the methods of implementing a healthy lifestyle in the family;
e) promotes training of family doctor in basics of management of all family members during their lifetime.
During presentation of this discipline particular attention is paid to following issues: defining the health of the whole family, early diagnosis, treatment and prevention of patients in the prehospital phase, thereby increasing the quality of doctor’s training for the work in out-patient department of Health Care system.
Organization and management of educational process is carried out on the basis of credit-module system in accordance with the implementation of the Bologna Declaration in the system of higher medical educational institutions.
The program of the discipline is structured into 1 module, which consists of 3 content-related modules. Total hours – 135/ 4.5 credits (practical classes – 80, Student’s self-directed learning – 55).
ORGANIZATIONAL PRINCIPLES OF FAMILY MEDICINE
- Organization of outpatient care (continuity of pre-hospital and hospital stages);
- Organization of carrying out medical and social assessment;
- Preventive and syndrome-based approach in the practice of family doctor.
Content of study loads for student is described in credits ECTS, which are applied for student’s successful acquisition of course module.
Credit-modular system of the organization and management of educational process encourages students to systematical learning during academic year.
The types of learning activities of students according to the curriculum are: a) practical trainings; b) self-directed learning (SDL), in which consultation with teachers play very important role. Course schedule of lectures, practical trainings and self-directed learning ensure implementation of all those themes in the educational process, which are part of the content-related modules.
Types of training activity, according to the curriculum are:
a) practical trainings;
b) students’ self-directed learning;
c) review sessions.
Practical trainings conduct at clinical sites of the department (in out-patient clinic, in the departments of family medicine, family doctor out-patient departments and in-patient clinics); methodology of organization of practical trainings includes:
• make student a participant of the process of delivery of health care to a patient, his family members, be able to work in a team of students, physicians and other members of health care service;
• form a responsible attitude of students as future specialists for their level of training and its improving during training;
• it is necessary to focus on formation of skills: to assess the patient’s condition and all his family members; family physician should conduct communication with patient and his family; to assess patient’s health status and detect early deviations, associating them with risk factors in the family and environment;
- learn how to draw up program of management of outpatient patients of therapeutic profile based on three-stage medical care delivery;
- learn to conduct clinical examination of healthy and sick patients, make groups and plan monitoring;
- under the guidance of the teacher learn to organize for patients in- patient care at home for their early and appropriate management according to the current requirements of primary medical care;
- know principles of rehabilitation and be able to conduct sanatorium-resort selection;
- be able to involve the whole family to the prevention of disease, explaining benefits of a healthy lifestyle;
- be able to develop preventive graduated plans for the whole family;
- learn to organize “ School of Health” for
patients with chronic non-communicable diseases;
- to be able to fill out accounting documentation and assess the quality of medical care;
- identify approach during the examination of loss of labor capacity (temporary and permanent), fill out the relevant documents;
- student must be provided with detailed plan of his work in the department to implement all mentioned above;
- student must acquire all necessary modern research methods and study algorithms to be able to make genealogical family tree, identify health status and its deviations, plan gradual prevention, conduct early diagnosis, prepare a treatment planning according to the standards of evidence-based medicine, know how to provide necessary emergency assistance in the competence of family doctor;
- to be aware of good food and be able to implement preventive nutrition in most common diseases;
- during work in groups, clinical discussions and practical conferences to be able to report in details the history of management of out-patient;
- be able to come into contact with the patient, while collecting the history of life and disease by interview about his organs and systems;
- conduct physical examination of the definition of initial symptoms of health distress;
- conduct in-depth examination in the presence of disease of therapeutic profile;
- to form a diagnosis, prescribe treatment, determine primary and secondary preventive measures.
Students’ self-directed learning and individual work together make 40% of the curriculum and consist of:
• preparation for lessons ;
• processing of topics not included in the plan of in-class learning;
• students’ work in units of clinical sites of the department, departments of functional diagnostics and laboratories;
• mastering practical skills according to the list;
• work with computer software programs in preparation for licensed integrated exam Krok 2;
• execution of students’ self-directed learning.
Current educational activity of students is monitored at practical trainings for the purpose to meet specific goals.
We recommend using such means of assessment the degree of students’ training: computer tests, solving situational problems; the ability to review and assess the patient’s physical examination data, results of instrumental methods of examination and parameters characterizing functions of human body, its systems and organs’ to able to determine disability; the ability to communicate with family members and drawing up programs of preventive, if necessary, treatment and rehabilitation directions based on risk factors, age and social status of the family.
Final module control is exercised after completion of module’s learning.