الزمالة المصرية لطب الأسرة

Egyptian fellowship of family medicine webpage April 2015

الزمالة المصرية لطب الأسرة

عن زمالة طب الأسرة

بدأت في 2007 وتم إعتمادهاا في 2009

على الرغم من معادلتها مع زمالة كلية الممارسين العامين البريطانية إلا أن محتوى طب المسنين بها دون المستوى (رغم أنه شئ جيد أنه موجود وله مكان في المحتوى والأنشطة إلا أنه يحتاج مزيد من العمل والتحسين).

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

المنهج مكون من عدة قطاعات الأجزاء المهتمة برعاية المسنين موزعة على عدة أماكن:

• الطب النفسي به الإكتئاب والحزن والفقدان والقلق.
• طب الطوارئ به الهذيان
• الطب الباطني به هشاشة العظام وخشونة المفاصل
• النساء والولادة به إنقطاع الطمث (نتمنى أن يتم تغطيته جيدا ولا تطغى مشاكل الحمل والولادة وتنظيم الأسرة عليه لأنه مثلا موجود في الحالات لكنه غير موجود في مواضيع المنهج النظري)
• الجلدية به عدوى الجلد (على الأغلب تشمل الإلتهاب الخلوي Cellulitis)
• الجراحة مذكور به التعامل مع القرح لكن ربما من ناحية القدم السكرية أو قصور الدورة الدموية أو الغرغرينا لأن هذه الحالات مذكروة في منهج الجراحة لكن ليس هناك أي ذكر لكلمة قرحة الفراش أو قرحة الإنضغاط تماما
• العظام مدموج مع طب الطوارئ إشكالية الدمجيون
• الرمد يشمل على المياه البيضاء Cataract والمياه الزرقاء Glaucoma
• الأنف والأذن والحنجرة يشمل على الصمم Deafness والدوار Vertigo

هناك بعض عدم التوفيق في توزيع المنهج مثلاً:

• دمج جراحة العظام مع طب الطوارئ والأفضل طبعاً فصلها أو دمجها مع الجراحة.
• أيضاً دمج طب المسنين مع الطب الباطني.
• أيضاً توزيع الدمنشيا في الطب النفسي رغم أن من يفيده أكثر هو طب المسنين.

مقارنة منهج جزء الأطفال وحالاته ومواضيعه من حيث الكم والنوع والعدد والزمن مع منهج طب المسنين يشعر بالأسى وكأن المسنين لا يشكلون فئة ذات خصوصية مثل الأطفال أو كأن المسنين فئة نادرة في الرعاية الأولية مثل مرضى الذئبة الحمراء مثلاً.

المواضيع Topics

Medical consultation activities (for all ages and both sexes):

• Acute and chronic illness or complaint diagnosis, management &/or referral
• Chronic disease follow-up
• Nutritional education
• Psychosocial management
• Disability management &/or referral and follow-up
• Elderly health and home care visiting

يلاحظ دمج الطب المنزلي مع صحة المسنين وهذا وصم لأنه يشمل الأطفال مثال أمراض الأعصاب والعضلات والشباب مثل مرضى الحوادث والإصابات ومرضى القلب والصدر في أي سن.

• Medical recording

Diagnosis and treatment of injury and primary management of medical emergency activities (for all ages and both sexes) include:

• Emergency case appropriate examination and investigation when possible
• immediate case management and/or referral of indicated cases
• observation and follow-up of managed cases
• epidemic management
• crises management activities
• Recording and reporting

Family practice quality management activities include:

• Family Folder opening (Basic Family Data Sheet - History & Physical Examination Sheets for all Family Members - Social and Housing Surveying Sheets)
• regular family file completion/and or updating
• computer feeding and register updating
• periodical PHC packages assessment
• periodical PHC principals assessment
• periodical PHC manpower skill assessment
• periodical family satisfaction assessment
• periodical PHC resources assessment
• continuous PHC quality improvement activities

Monitoring and follow up of environment sanitation and hygiene activities include:

• Health Education (HE) and Community Mobilization (CM) for essential aspects of environmental health and food hygiene
• HE and CM field campaign recruitment organization and follow up
• Intersect oral coordination, etc.,

Medical counseling activities for all ages and both sexes

Provision of essential drugs activities as:

• • Retrospective disease incidence calculations
• • retrospective drug consumption rate calculation
• • prospective drug requirement calculations
• • prospective vaccine requirement calculation
• • patient prescription explanation
• • minimal drug use health education
• • drug abuse control
• • drug recording and report writing, or management, etc.,

يلاحظ عدم الإهتمام بالتعدد/الإفراط الدوائي

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

• 

  يلاحظ عدم ذكر الدمنشيا في المواضيع النظري رغم وجود حالات تطبيقية بل أن الدمنشيا مذكورة كحالة لتطبيق أثر الحزن حسبما يوحي الجدول في الصورة.

Topics and lectures

• Somatization
• Anxiety
• Depression
• Eating and sleep disorders
• Psycho Sexual problems
• Mental illness e.g. Schizophrenia.
• Hyperactive disorders, learning difficulties and mental disorders.
• The effect of bereavement and loss and their complications.
• Continuing care of chronic conditions (manic-depression illness or mental handicap).

يلاحظ عدم ذكر الدمنشيا في المواضيع النظري رغم وجود حالات تطبيقية بل أن الدمنشيا مذكورة كحالة لتطبيق أثر الحزن حسبما يوحي الجدول في الصورة.

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
• Dementia and Alzheimer 5
• ADHD, autism and learning disabilities 5

Topics and cases are expected to be covered during The psychiatry rotation.

Prove of attendance and trainer signature is mandatory

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

منهج طب الطوارئ وجراحة العظام

Emergency medicine & Orthopedic

Knowledge

By The end of training, trainees should have good understanding of the causes, clinical manifestations and initial management of common surgical and medical emergencies that could be encountered by a family physician in health care centers.

Intellectual and professional skills

By The end of training in emergency rotation, trainees should be able to:

1. 1. Take proper history and perform appropriate clinical examination for emergency medical and surgical conditions presented to The health center
2. 2. Work effectively within multidisciplinary teams to request appropriate investigations and initiate management for acute emergency cases
3. 3. Identify emergency medical and surgical services that are available for referrals at his discrete
4. 4. Take valid decisions regarding referral to secondary and tertiary care emergency facilities
5. 5. Perform immediate life support measures when indicated 6. Integrate and efficiently utilize various community resources for The management of emergency cases

Methods of teaching and learning

1. 1. On the job training during emergency rotation and family health center
2. 2. Lectures, tutorials and self study

Methods of assessment

1. 1. Written and Clinical exam at the end of training
2. 2. Logbook
3. 3. Trainer evaluation

Emergency Medicine Topics

Topics and lectures

• chest pain
• Poisoning
• Coma and disturbed level of consciousness يلاحظ أن الهذيان ليس مذكور هنا لكنه مذكور في الحالات (إشكالية الدمجيون تتضح حيث يتم المرور عليه مرور الكرام كواحد من أسباب متعددة وكثير لإضطراب الوعي) وهذا شئ غريب رؤية حالة لم يتم تغطيتها في التدريس النظري بقدر كافي).
• Trauma Patients ( abdomen, head, chest, bone and spine)
• Acute abdomen
• Acute breathlessness
• Soft tissue injuries
• Convulsions
• Anaphylaxis
• Burns
• Stridor

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

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

• • Cases are expected to be encountered during emergency medicine rotation and in healthcare centers
• • Signature of trainers in The logbook to prove case attendance and participation in management is mandatory

يلاحظ ان الهذيان غير مذكور إلا في الحالات يعني ليس احد المواضيع أو المعارف.

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.

أنشطة الطب الباطني وطب المسنين

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

أنشطة الطب النفسي

الحالات

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

أنشطة طب الطوارئ وجراحة العظام

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 .

نبذة بسيطة عن الزمالة المصرية للطب الباطني

تفهم الزمالة المصرية للطب الباطني ذو صلة لتفهم طريقة تفكير الزمالة المصرية في تخصص طب المسنين وإمكانية عمل زمالة لطب المسنين.

كتاب سجل الأنشطة

حالات الطوارئ Emergency cases

سجل الأنشطة يتعامل مع طب المسنين على أنها ليست من فروع الطب الباطني والدليل أنه في الحالات تم تصنيف فروع الطب الباطني (القلب - الصدر - الجهاز الهضمي والكبد - الكلى - العصبية - الغدد الصماء - الأمراض المناعية بها الروماتيزم - أمراض الدم - أخرى بها الحساسية) وتم ذكر حالاتهم ولم يتم ذكر طب المسنين كفرع من الطب الباطني ولا تم توزيع حالاته على الفروع المشابهة له. كما أن الطب البااطني يتفرع منه أيضاً الطب النفسي والطب الطبيعي والتأهيل ومع ذلك تم تجاهلهم أيضاً.

حالات حسب أجهزة الجسم System based medical conditions

تشمل قلب - صدر - أعصاب - غدد صماء - تغذية - طب العظام - أمراض دم - أمراض معدية - كلى - جهاز هضمي وكبد - طب السفر والمتوطنة - أخرى تشمل الأمراض الجلدية والنفسية والمهنية. وهذا نموذج أخر لإشكالية إستبعاد طب المسنين من الطب الباطني وذلك على الرغم من الإعتراف وتمثيل وجودي للنفسية والجلدية.

النشاط التعليمي الأكاديمي

لا يوجد ذكر لأي شئ تابع لطب المسنين إلا في أنشطة النادي الأدبي حيث أحد مواضيعه هو هشاشة العظام. وأيضاص في جز السيمنارات Required Seminars

حيث تم ذكر السقوط في المسنين كأحد المواضيع.

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روابط

• http://www.egyfellow.mohealth.gov.eg/Fileupload/%D9%85%D9%86%D9%87%D8%AC%20%D8%B7%D8%A8%20%D8%A7%D9%84%D8%A7%D8%B3%D8%B1%D8%A9.pdf كتاب المنهج
• http://www.egyfellow.mohealth.gov.eg/Fileupload/%D8%A7%D9%86%D8%B4%D8%B7%D8%A9%20%D8%B7%D8%A8%20%D8%A7%D9%84%D8%A7%D8%B3%D8%B1%D8%A9.pdf كتاب الأنشطة
• 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 زمالة طب الأسرة