1. 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

2. 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

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

4. 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.

5. 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?

6. 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)?

7. 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

8. 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

9. 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

10. 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

11. 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.

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

13. 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)
After film, ask what connections and similarities can they find between small group exercise and E-Case.

14. 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

15. 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

16. 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

17. WONKA TREE (revised 2011)

18. 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.

19. 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.

20. 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.

21. Sir William Osler ( )
“The good physician treats the disease; the great physician treats the patient who has the disease”

22. 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