الزمالة المصرية لطب الأسرة

الزمالة المصرية لطب الأسرة

يمكن تقييم المحتوى العلمي والسريري والتدريبي لطب المسنين عن طريق قراءة وتحليل المنهج وكتاب الأنشطة وخريطة الدوران التدريبي وبالطبع الأمر يحتاج لإستكشاف على أرض الواقع ودراسة مسحية للمتخرجين.

المنهج

الأجزاء المهتمة برعاية المسنين موزعة على 3 أماكن: طب المسنين والطب النفسي وطب الطوارئ.

منهج طب المسنين

Egyptian Fellowship Board - Family Medicine Training Curriculum المنهج

Geriatric Medicine Training Curriculum - Family Medicine Egyptian Fellowship Board

Knowledge

By The end of training, trainees should have good understanding of :

1. 1. The underlying physiological "normal aging" changes in the various body systems, including diminished homeostatic abilities, altered metabolism and effects of drugs, and other changes that directly relate to the assessment and treatment of elderly patients.
2. 2. The normal psychological, social and environmental changes of aging, including reactions to common stresses and changes such as retirement, bereavement, relocation and ill health, and the changes in family relationships that affect health care of the elderly.
3. 3. The unique modes of presentation of elderly patients for care, including altered and nonspecific presentations of specific diseases.
4. 4. The tendency of elderly patients toward iatrogenic disease, immobilization and its consequences, dependency or long-term institutionalization while in the process of receiving medical care
5. 5. The place of the house call, its indications and benefits.

Intellectual and professional skills

By The end of training in internal medicine rotation, trainee should be able to:

1. 1. Take history and perform appropriate clinical examination for elderly patients presented with various complaints to The family health center.
2. 2. Manage common elderly medical problems and refer appropriately to specialist care when indicated
3. 3. Identify the various types of long-term care facilities, foster homes and alternative housings available to the elderly
4. 4. Manage the pitfalls of geriatric care such as poly-pharmacy, iatrogenic illness, overdependency, inappropriate institutionalization, non-recognition of treatable illness, over treatment, inappropriate use of high technology and the unsupported family.
5. 5. Evaluate the functional status of the elderly patient
6. 6. Identify the various types of long-term care facilities, foster homes and alternative housings available to the elderly and The specific regulations related to The care of patients in long term facilities
7. 7. Evaluate the financial aspects of health care of the elderly and the way these influence health care patterns and decisions.

………………… ….

24 Page

Attitudes and behaviors

1. 1. React with compassion and humanism, balancing realism and practicality in the consideration of inevitable decline and loss.
2. 2. Promote dignity through self-care and self-determination.
3. 3. Recognize the importance of family and home in the overall life and health of patients and the importance of a multi-disciplinary approach to the enhancement of individualized care.
4. 4. interfere minimally with appropriate limitation of investigation and treatment for the benefit of the patient with care to cost containment.
5. 5. Appreciate and commit himself for continuity of care and accessibility to his/her patients

Skills related to health promotion and disease prevention

1. 1. Promote and maintain elderly people health through screening, preventive care, early diagnosis and assessment of health factors
2. 2. recognize The range of services available to promote rehabilitation or maintenance of an independent lifestyle for elderly people
3. 3. Identify means to actively promote health in the elderly through exercise, nutrition and psycho-social counseling.

Achievement

Expected year of achievement is the first year of training during health center and internal medicine rotations

Methods of teaching and learning

1. 1. On The job training and self- study
2. 2. Lectures and tutorials
3. 3. Patients encounters during family medicine center training

Methods of assessment:

1. 1. Logbook
2. 2. Final exam
3. 3. Trainer’s evaluation

Family Medicine Egyptian Fellowship Board ……………………

25 Page

Geriatric Medicine cases

Topics and lectures

• Normal aging
• Common presentation of elderly patients
• Long term care facilities
• Intellectual impairment and Alzheimer
• Incontinence
• Falls
• Immobility and mobility deterioration
• Iatrogenic drug reactions
• Fecal impaction

التعدد الدوائي غير مذكور والدمنشيا موجودة في جزء الطب النفسي والهذيان موجودود مدموج مع الغيبوبة في طب الطوارئ

• All topics are expected to be covered by lectures and journal clubs during The family health center and internal medicine rotations.
• Prove of attendance will be signed by your family medicine trainer.

Geriatric Medicine Topics

Cases #

• intellectual impairment (dementia) Alzheimer 5
• incontinence 5
• fecal impaction 1
• Parkinsonism 2
• Nutritional problems 2
• Falls, stroke and TIA (Internal medicine) 5

• Cases are expected to be seen during Internal medicine and healthcare center rotation
• The number mentioned is The minimum number of cases to be seen by The trainees under supervision

يلاحظ عدم وضع الدمنشيا في طب المسنين ووضعها في الطب النفسي

منهج الطب النفسي

تابع أيضاً جزء النفسية 3- Psychiatry

Knowledge

By The end of training, trainees should have good understanding of

1. 1. The emotional, intellectual, and social development of the individual from infancy to adult life
2. 2. The clinical manifestations of common psychiatric disorders affecting adults, elderly and children
3. 3. Important mental and emotional disorder and in particular:
   1. • Acute disorders that are threatening life of the sufferer (suicidal depression) or of others (aggressive reactions in the psychopathic patient).
   2. • Disorders which if recognized early may be managed or whose complications may be reduced e.g. school refusal, psychosomatic illnesses and postnatal mental illness
   3. • Disorders that are not normally dangerous but become dangerous in certain situations

Intellectual and professional skills

1. 1. Recognize mental disorders through accurate history taking , The proper use of consultation skills and assessment of mental status
2. 2. Initiate treatment in some cases through drug prescription and appropriately use relaxation techniques
3. 3. Advice family and arrange for interviews to modify behavior if indicated
4. 4. Referral for specialist advice to ascertain what further investigations are required and to make an accurate diagnosis

Attitudes and behaviors

1. 1. appreciate The therapeutic value of doctor patient relationship
2. 2. Be aware of the effects o£ the- attitudes of the- doctors and those-who-work with him upon the patient and the management of the illness
3. 3. Work in collaboration with psychiatrists and mental health professionals
4. 4. Be aware of national regulations and acts regarding drug misuse and mental illness

Methods of teaching and learning

1. 1. On The job training during psychiatry rotation and family health center
2. 2. Lectures, tutorials and self study
3. 3. Clinical rounds

Methods of assessment

1. 1. Logbook
2. 2. Trainer’s report
3. 3. Summative exam

Family Medicine Egyptian Fellowship Board …………………… …………………… 27 Page

Psychiatry Topics and Cases

Topics and lectures Cases #

• Somatization Psychosomatic disorders 5
• Anxiety Anxiety 6
• Depression Reactive Depression 5
• Eating and sleep disorders Eating & sleep disorder 3
• Psycho Sexual problems Sexual disorders 5
• Mental illness e.g. Schizophrenia. Major psychotic disorders
  • Schizophrenia
  • Manic-depressive illness
  • Paranoid state
• Hyperactive disorders, 5
• learning difficulties and mental disorders.
• The effect of bereavement and loss and their complications.
• Dementia and Alzheimer 5
• Continuing care of chronic conditions (manic-depression illness or mental handicap). ADHD, autism and learning disabilities 5

Suggested titles for psychiatry journal clubs

1. 1. Screening for depression across the life span
2. 2. Avoiding Pitfalls in Diagnosing and Managing Major Depression
3. 3. Depression in Children and Adolescents
4. 4. Postpartum Major Depression: Detection and Treatment
5. 5. Generalized Anxiety Disorder

يلاحظ عدم وضع الدمنشيا في النادي الأدبي

كتاب الأنشطة

كتاب الأنشطة Family Medicine logbook

الدوران Rotation

• 

  دوران فروع تدريب الزمالة المصرية لطب الأسرة في كتاب المنهج

• 

  دوران فروع تدريب الزمالة المصرية لطب الأسرة في كتاب سجل الأنشطة

دوران فروع تدريب (من كتاب سجل الأنشطة أخر صفحة ومن كتاب المنهج) الزمالة المصرية لطب الأسرة يلاحظ فيه إشكالية الدمجيون حيث طب المسنين على الرغم من فصله كعنوان إلا أنه مدموج مع الطب الباطني في الدوران وعلى الأغلب لن يأخذ حقه. وذلك على الرغم من تخصيص دوران كامل للطب النفسي.

شرح الدوران لا يتحدث تماما عن طب المسنين

شرح الدوران من كتاب المنهج وليس من كتاب سجل الأنشطة لا يتحدث تماما عن طب المسنين وهذا يعكس الواقع من أنهم لا يتدربوا عليه على الأغلب. كما يوجد فجوة ربما تعوق التدريب عليه وهو عدم إشتراط حضور أشياء رئيسية ولكن من الممكن عدم حضور 75% وعلى الأغلب ذلك يتضمن طب المسنين لأنه لا توجد أماكن للتدريب عليه.

First Year

1. 1- The trainee should spend the first five months in accredited family health centers, four months in internal medicine rotation and two months in psychiatry rotation. One month could be spent as an elective at any specialty related to family medicine.
2. 2- Candidate should attend and study the curriculum of family medicine, community medicine, internal medicine and psychiatry during this year. He should attend at least 75% of lectures in these subjects. He should pass successfully through the first part Fellowship Exam before being promoted to the second year of training.
3. 3- He should be actively involved and fully responsible for patient care including sharing in making decisions about diagnosis and management under supervision of the consultants.
4. 4- He must attend 75% of weekly meetings including clinical rounds, tutorials and journal clubs His performance will be monitored by his trainer & his scientific supervisor and a report made of his performance on monthly basis to The Egyptian Fellowship Board.

الحالات

Clinical condition # Clinical Condition #

• Hypertension 5
• Common vaginal infections 4
• Diabetes 5
• Poisoning 2
• Bronchial asthma 3
• Anxiety 2
• Irritable bowl syndrome 3
• Depression 2
• Osteoarthritis 3
• Sexual problems 2
• Low backache 3
• Skin infections 4
• Hyperlipidemia 2
• Psoriasis 2
• Abscess 2
• Acne 3
• Incontinence 2
• Urticaria 2
• Falls 3
• Common venereal diseases 2
• Family planning 6
• Eczema and contact dermatitis 3
• Menopause 2
• Seborrhea 3
• Dysfunctional uterine bleeding 4
• Eye infections 3
• Infertility 3
• Eye allergy 2
• Otitis externa 4
• Red eye 4
• Sinusitis 3
• Rhinitis 2
• Otitis media 5

Internal medicine & geriatrics

Geriatric Medicine cases #

• intellectual impairment (dementia) Alzheimer 5
• incontinence 5
• fecal impaction 1
• Parkinsonism 2
• Nutritional problems 2
• Falls, stroke and TIA (Internal medicine) 5

Family medicine procedures Log

Procedure - Number - Trainer’s signature

Observed & date - Performed Under Supervision - Performed Independently

• IUD insertion
• ECG
• Ophthalmoscope exam
• Nail extraction
• Normal labor
• Suturing
• Abscess drainage
• wound debridement
• Resuscitation
• Cauterization of skin lesions
• Removal of skin lesion under local anesthesia
• Burns
• Male circumcision

Family medicine club titles / seminars

Title - Date Trainer’s - signature

• Standards of Medical Care in Diabetes
• Practice guidelines for asthma management and prevention
• The guide to clinical preventive services
• Self-Monitoring of Blood Glucose
• Inappropriate Prescribing for Elderly in a Large Outpatient Population
• Time Management
• Infection control practical guide For primary health care Family planning
• How to Manage Difficult Patient Encounters
• Screening for Depression across the Lifespan
• The Geriatric Patient: A Systematic Approach to Maintaining Health
• The Psychiatric Review of Symptoms: A Screening Tool for Family Physicians.
• Hormone Replacement Therapy in Postmenopausal women
• Quality of life measurements
• Obesity: Assessment and Management in Primary Care
• Cause-of-death certification
• Using Peer Review for Self-Audits of Medical Record Documentation

طب نفسي تابع

Cases#

• Psychosomatic disorders 5
• Anxiety 6
• Reactive Depression 5
• Eating & sleep disorder 3
• Sexual disorders 5
• Major psychotic disorders 5
  • • Schizophrenia
  • • Manic-depressive illness
  • • Paranoid state 5 Major psychotic disorders
  • • Schizophrenia
  • • Manic-depressive illness
  • • Paranoid state
• Dementia and Alzheimer 5
• ADHD, autism and learning disabilities 5

Psychiatry journal club titles / seminars

Title - Date Trainer’s - signature

• Screening for depression across the life span
• Avoiding Pitfalls in Diagnosing and Managing Major Depression
• Depression in Children & Adolescents
• Postpartum Major Depression: Detection and Treatment
• Generalized Anxiety Disorder

يلاحظ إهمال الدمنشيا

Emergency Medicine cases

Cases #

• Chest pain 5
• Coma and delirium due to various causes 5
• Convulsions 5
• Acute abdomen 5
• Multiple trauma 10
• Soft tissue injury 5
• Poisoning due to various causes including drug
• overdosage 5
• Respiratory distress 5
• Allergic Reactions including anaphylaxis 5
• Burns 5
• Sprain, fracture 5

يلاحظ إشكالية الدمجيون في دمج الهذيان/الإختلاط مع الغيبوبة .

روابط

• http://www.egyfellow.mohealth.gov.eg/Fileupload/019%20%D8%B7%D8%A8%20%D8%A7%D9%84%D8%A3%D8%B3%D8%B1%D8%A9.pdf