Introduction to FM/GP as a specific medical discipline Introduction to FM/GP as a specific medical discipline. Principles of Family Medicine: Continuity, comprehensiveness, coordination of care Nino Kiknadze MD, PhD Georgia Francesco Carelli MD, MSc, PhD Italy EURACT Council, Trinity College, 8 September 2016

Objectives We try to give example of blended learning for teachers in family medicine - how to transform minimum core curriculum N4 topic to E-learning module. The purpose of the course is to acquaint trainees with the essence of family medicine; to demonstrate comprehensive approach within this specialty and show specific qualities of family physicians in problem solving related to prevention and management of acute and chronic health problems as well as continuity and coordination of care Target auditory - Undergraduated Students –V or VI year

Learning Methodology - blended learning 1. E-learning - Case discussion 20-30min 2. Task groups - session 35 min 3. Traditional Lecture 10-15 min Ask trainees to work with E-case independently and than arrange traditional classroom session

1. E-Case real case from primary health care practice Patient: 56 y. old Caucasian man. He is new patient in your office. Known medical history: purely controlled arterial hypertension for last 6 y, medication: Enalapril 10 mg. hydrochlorothiazide 25mg. Patient lives with his wife. He is cooker in big restaurant and his job is very important for him. Smoker for 5-6 cigarettes day, don’t thinking that it is harmful, physically inactive. Examination: Arterial blood pressure 160/90mm.hg, pulse rate -70. BMI 25.3. Past medical history: not significant.

What kind of information is important to collect about this patient? Space for text and “NEXT” button for trainees Possible answers Family history Heart pain Cough Previous medication for hypertension Eating habits Another current medication for any problem Last lab test results – lipid profile, blood glucose Screening history? Urinary frequency/difficulties?

Manage this patient: including short term and long-term management plan Space for text and “NEXT” button for trainees Possible answers Cardiovascular risk assessment (including lab and instrumental tests) Healthy life style promotion, including eating habits, exercise and smoking cessation. Add new antihypertensive or increase Enalapril Secondary Prevention according age and sex ? Finding source to help patient in smoking cessation (groups or trained doctor)?

Button – “Check your answers “ Trainee can see in neighbour spaces his/her own answers and this list (for example see next slide) What kind of information is important to collect about this patient? Family history – Diabetes mellitus, otherwise nonsignificant Heart pain history - negative Previous medication for hypertension - same as now Eating habits more carbohidrats and salt, than recommended Another current medication for any problem - No Last lab test results – lipid profile, blood glucose last tests 10 y ago and normal Lower urinary tract obstruction symptoms – significant; patient thinks that this complaint is normal at his age, he speak about this with friends and they confirm, that more or less all of them have this kind of symptoms. According this information he think that it’s not important and don’t need any assessment Screening history – Not done

Example of “check your answer” My answers Family history Heart pain Cough Previous medication for hypertension Eating habits Another current medication for any problem Last lab test results – lipid profile, blood glucose Screening history?? Urinations frequency/difficulties ------- Correct answers and additional information Family history – Diabetes mellitus, otherwise nonsignificant Heart pain history - negative Previous medication for hypertension - same as now Eating habits more carbohydrates and salt, than recommended Another medication for any problem - No Last lab test results – lipid profile, blood glucose last tests 10 y ago and normal Lower urinary tract obstruction symptoms – significant, Patient think, that this complaints is normal for his age, he spoke about this with friends and they confirmed, that more or less all of them have this kind of symptoms. According this information he think that it’s not important and doesn’t need any assessment Screening history – Not done

Do you want to add something in management plan? At this point, Trainee has possibility to add more options in his/her old management plan

Check your answers and additional information (1) short term and long term management (Trainee Can see in neighbour spaces his/her own answers and this list as shown in slide N8) Cardiovascular risk assessment was done and add statin in treatment plan. Monitoring after 2 months For arterial hypertension add Enalapril 10mg. Monitoring after 2 months Diet, exercise, smoking cessation – found trained doctor. Arrange next visit according smoking cessation plan. Urinary tract obstruction complaints - PSA - 35ng/ml (normal value < 3.5ng/ml) and prostatic US – enlargement Colonoscopy or occult bleeding test – planned

Check your answers and additional information (2) multiple core biopsies of prostatic gland performed under transrectal ultrasound guidance; cytology: found prostatic adenocarcinoma in 2 from 16 samples from one lobe. No metastatic damages found before or during surgery. Radical prostatectomy performed and now patient is under monitoring of family doctor and urologist. Arterial hypertension and cholesterol are under control, PSA < 0.01 during last 1,5 y. Patient improves his eating habits and physical activity, smoking cessation was failed after 1 year and now he try to do it again.

Small group – 15min Presentation and Discussion 20 min Lecture-10 min

Small group session Give version 1 and version 2 pictures to trainees and ask tell story according these pictures Presentation of results: during presentation group members understand that their stories are incomplete, because they have not full information, show them film (2.52min) https://www.youtube.com/watch?v=qNseEVlaCl4 After film, ask what connections and similarities can they find between small group exercise and E-Case.

Introduction to FM/GP as a specific medical discipline Introduction to FM/GP as a specific medical discipline. Principles of Family Medicine: Continuity, comprehensiveness, coordination of care

THE EUROPEAN DEFINITION OF GENERAL PRACTICE / FAMILY MEDICINE General practice/family medicine is an academic and scientific discipline with its own educational content, research, evidence base and clinical activity, and a clinical specialty orientated to primary care

OVERVIEW OF THE DEFINITION 11 Characteristics a. First contact / all health problems b. Care co-ordinator + advocacy c. Person centred approach d. Doctor-patient relationship / consultation process e. Longitudinal continuity f. Decision making based on prevalence g. Early undifferentiated stages h. Acute & Chronic management i. Health & Wellbeing j. Responsible for health in the community k. Bio-Psycho-Social + culture and existential 6 Core Competencies 1. Primary Care Management 2. Person Centred Care 3.Specific Problem Solving 4. Comprehensive approach 5.Community Orientation 6. Holistic Modelling

WONKA TREE (revised 2011)

Principles of Family Medicine: Continuity, comprehensiveness, coordination of care Includes the ability: to manage simultaneously multiple complaints and pathologies, both acute and chronic health problems in the individual; to promote health and well being by applying health promotion and disease prevention strategies appropriately; to manage and co-ordinate health promotion, prevention, cure, care and palliation and rehabilitation.

Principles of Family Medicine: Continuity, comprehensiveness, coordination of care is responsible for the provision of longitudinal continuity of care as determined by the needs of the patient.

Principles of Family Medicine: Continuity, comprehensiveness, coordination of care makes efficient use of health care resources through co-ordinating care, working with other professionals in the primary care setting, and by managing the interface with other specialities taking an advocacy role for the patient when needed.

Sir William Osler (1849 - 1919) “The good physician treats the disease; the great physician treats the patient who has the disease”

Introduction to FM/GP as a specific medical discipline Introduction to FM/GP as a specific medical discipline. Principles of Family Medicine: Continuity, comprehensiveness, coordination of care Sourse: THE EUROPEAN DEFINITION OF GENERAL PRACTICE / FAMILY MEDICINE WONCA EUROPE 2011 Edition