Learning in family medicine Dr. JAWAHER AL-AHMADI MB. ABFM. SBFM,MSc

DEFINATION OF PHC –Essential health care –Based on practical, scientifically sound and social acceptable methods & technology acceptable methods & technology –Accessible to individuals & families –It is their first level of contact –Cost that the community & country can afford –It forms an integral part for both the country ’ s health system & the overall social & economic development system & the overall social & economic development

ELEMENTS OF PHC PROMPOTIVE : Health Education Health Education Food supply & proper nutrition Food supply & proper nutrition Maternal & Child care Maternal & Child carePREVENTIVE: Immunization Immunization Prevention & control of locally endemic diseases Prevention & control of locally endemic diseases Adequate supply of safe water & basic sanitation Adequate supply of safe water & basic sanitation

ELEMENTS OF PHC CURATIVE: Treatment of common diseases & injuries Treatment of common diseases & injuries Provision of essential drugs. Provision of essential drugs. ADDITIONAL ELEMENTS: Dental care Dental care School health School health Home health care Home health care

PHC PRINCIPLLES Equity in distribution : Equity in distribution : Services to all & more services to the needy Services to all & more services to the needy Appropriate Technology: Appropriate Technology: That the people can use & afford. That the people can use & afford. Multisectoral approach: Multisectoral approach: Municipalities, Ministry of agriculture, Education Municipalities, Ministry of agriculture, Education

PHC PRINCIPLLES Community participation : Community participation : - Social awareness & community self reliance. - Social awareness & community self reliance. - The people has the right and duty to participate - The people has the right and duty to participate in the process for the improvement and in the process for the improvement and maintenance of health. maintenance of health. Support from higher levels of care : Support from higher levels of care : - Hospitals has to share the social goal of making essential health services. - Hospitals has to share the social goal of making essential health services. - Referral - Referral

Pandleton seven tasks To establish & maintain Dr-pt relationship To define the real reasons for pt attendance To consider other problems To choose with the pt appropriate action for each problem To achieve a share understanding To involve pt in the management To use time & resources effectively

PRACTICAL Prior to the consultation Prior to the consultation Relationship Relationship Anxieties Anxieties Common language Common language Translation Translation Interaction Interaction Converting insight into action Converting insight into action Agreement check, safety netting Agreement check, safety netting Leave from consultation, time for reflection Leave from consultation, time for reflection

Communication skills &Patient interviewing skills A good interview should result in an accurate &comprehensive history

pitfalls Hurried manner Interruption Lack of eye contact Lack of feed back

Dr – Pt Relationship

Management option (CRAPRIOP) C larifications R eassurance A dvice P rescribing R eferral I nvestigation O bservations P revention

Course objectives 1-Define terminologies used in Family Medicine and primary health care (PHC) and explain principles and concepts related to them. 2-Acquire and practice skills of establishing good relationships with patients, families and the served community and as far as possible meet their needs and cope with their ideas, concerns and expectations.

3-Develop appropriate professional knowledge, skills and attitude pertaining to the management of health problems encountered by the Family Physician in daily practice, adopting the bio-psychosocial model and the WHO definition of health. 4-Acquire the essential knowledge, skills and attitudes regarding the provision of continuing, comprehensive care to individuals and family, including anticipatory, common, chronic, and emergent problems care and demonstrate appropriate problem solving and referral decisions.

5-Conduct holistic consultations with patients in a primary care setting, and show abilities of establishing patient ’ s reason for consulting, the nature of the problem, how it affects his lifestyle and family and to determine the management options available. 6-Get acquainted to the different sections of a PHC Center and other practices work dynamics and functions including the well baby clinic, pharmacy, Lab …..etc. 7-Attain the skills and attitudes for self directed life-long learning, critical evaluation and self assessment.

Simulated clinic Subjective Subjective Objective Objective Assessment Assessment Plan Plan

LIST OF CASE SCENARIOS 1.Breaking Bad News. Example: Malignancy, bad prognostic 1.Breaking Bad News. Example: Malignancy, bad prognostic congenital anomalies, serious hereditary diseases … etc. congenital anomalies, serious hereditary diseases … etc. 2.Health Education Skills. Example: Patients use of peak 2.Health Education Skills. Example: Patients use of peak flow meters, inhalers, glucometers, growth charts ….etc. flow meters, inhalers, glucometers, growth charts ….etc. 3.Health Appraisal. (Verifying & Projecting the potential health risks of an individual). Examples: Newly diagnosed hypertensive or diabetics, close relative of patients with colon cancer ….etc. 3.Health Appraisal. (Verifying & Projecting the potential health risks of an individual). Examples: Newly diagnosed hypertensive or diabetics, close relative of patients with colon cancer ….etc.

4.Health Promotion. Example: Smoking Cessation, Physical exercise. 4.Health Promotion. Example: Smoking Cessation, Physical exercise. 5.Dealing With Specific Request. Examples patient coming insisting on specific referral, refills, MRI, CT Scans,...etc. 5.Dealing With Specific Request. Examples patient coming insisting on specific referral, refills, MRI, CT Scans,...etc. 6.Dealing With Difficult Patients. Example: Angry Patient. The Shopper, talkative patients, multiple complainer...etc. 6.Dealing With Difficult Patients. Example: Angry Patient. The Shopper, talkative patients, multiple complainer...etc. 7.Counseling A Patient With A Newly Discovered Chronic 7.Counseling A Patient With A Newly Discovered Chronic Disease. Example: Diabetes, Hypertension, Bronchial asthma, ….etc. Disease. Example: Diabetes, Hypertension, Bronchial asthma, ….etc. 8.Giving Dietary Advise. Example: In cases of antenatals, Hypertension, Obesity, Diabetes, Dyspepsia …..etc. 8.Giving Dietary Advise. Example: In cases of antenatals, Hypertension, Obesity, Diabetes, Dyspepsia …..etc.

Adult Learning Self-Directed Learning Critical Reflection Experiential Learning Learning to Learn

Self-Directed Learning Self-directed learning focuses on the process by which adults take control of their own learning, In particular how they set their own learning goals, locate appropriate resources, decide on which learning methods to use and evaluate their progress.

Critical Reflection As an idea critical reflection focuses on three interrelated processes; (1) the process by which adults question and then replace or reframe an assumption that up to that point has been uncritically accepted as representing commonsense wisdom, (2) the process through which adults take alternative perspective on previously taken for granted ideas, actions, forms of reasoning and ideologies, (3) the process by which adults come to recognize the hegemonic aspects of dominant cultural values and to understand how self-evident renderings of the 'natural' state of the world actually bolster the power and self- interest of unrepresentative minorities.

Experiential Learning Adult education was, therefore, “ a continuing process of evaluating experiences ”

Learning to Learn The ability of adults to learn how to learn to become skilled at learning in a range of different situations and through a range of different styles

Emergent Trends Cross Cultural Adult Learning Practical Theorizing Distance Learning