Teaching and learning about community orientation in family medicine/general practice
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Transcript of Teaching and learning about community orientation in family medicine/general practice
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Teaching and learning about community orientation in family medicine/general practice
Dr. Yonah YapheDepartment of Family Medicine
Rabin Medical Centre andSackler Faculty of Medicine,
Tel Aviv University, Israel
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Objectives At the end of this
presentation the learner will:
Know the definition of community and community orientation
Know how the community effects medicine and vice versa
Value a community orientation in teaching and learning family medicine
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Community A collection of
people with common social characteristics and generally geographical proximity
The physical surroundings in which we are usually located
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Why is this important? Context is everything Engel’s bio-psycho-
social model Systems theory –
interaction between higher and lower levels
Advances in health through social progress
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How is this done Epidemiology –
the big picture Social medicine
and public health – social engineering
Community orientation by the family doctor
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What do we expect from our graduates in family medicine?
Clinical knowledge Clinical skills,
communication skills, management skills
Holistic approach to the care of a wide range of problems in the context in which our patients live
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Ho do we teach this? Practical
experience Direct
supervision Classroom
learning Projects Reflection
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How do we assess this? Formative and
summative assessment
Written and oral knowledge tests
Demonstration of competence in OSCE’s
Direct and indirect observation of performance (video, medical records)
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Final examination for specialization in family medicine in Israel
After 2 years - 150 MCQ’s - knowledge
After 4 years – 4 hour oral exam Two hours of clinical
topics including standardized questions
One hour family presentation
One hour community presentation
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Community presentation Age-sex distribution of
practice Chronic disease register Physical layout of clinic Structure of health care team Relations with community
services Prevention and health
promotion activities Future plans for practice
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Examples of outputs Age-sex distribution
(graph) Chronic diseases (list) Practice organization
and staffing (diagram) Medical records
(charts) Sample questions to
candidates (tables)(Thanks to Dr. Vered Ezra
for her clinic data.)
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Age distribution (n=600)
0
10
20
30
40
50
15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Ages
%
National Clinic
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Age distribution How does your data differ from
national data? What are the implications for
practice of an older or younger population?
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Country of birth (n=600)
ISRAEL52%
ETHIOPIA32%
EUR-USA1%
USSR7%
ASIA-N.AFRICA8%
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Ethnic mix How does the ethnic mix of your
practice affect morbidity? What do you and your staff need to
know about your population?
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Chronic Disease Prevalence
0
5
10
15
20
%
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Chronic disease prevalence Questions to the candidate:
Compare with national data What does this mean? Why are there more or less
cases?
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Changes in HBA1C Q1-Q3 2005
0%
10%
20%
30%
40%
50%
<7 7 to 9>9
HBA1C level
Q1
Q3
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Quality improvement Describe a health problem in your
community and the means that you used (or plan to use) to address it.
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Conclusions Community orientation can
be integrated into the training of future family practitioners.
The are innovative ways to teach and assess the acquisition the knowledge, skills and attitudes that make up this element of general practice.
In this course we will explore and experience this further with the aim of expanding this further in our own contexts.