Weekly outline
GENERAL ORIENTATION TO THE COURSE
Welcome to FCH 250.1
This is the continuation of your learning series for Family and Community Medicine which started with HS 201 in LU3 where you learned about basic information and principles used in the discipline, followed by HS 202 where we focused on approach to illness. In this year level, you enter the clinical years and in FCH 250.1, we introduce to you the basic concepts in the clinical practice mainly of the Family Medicine component of FCH. The community component will be the focus of FCH 250.2.
Please go through the general orientation slides and make notes to ask for clarifications or ask any question. I have simplified the competencies as stated in the instructional design, described the activities that we have designed for you as well as the requirements we need as proof of learning. You will have both synchronous and asynchronous activities. If for some reason, a student fails to join a required synchronous activity, make-up can either be Zoom sessions to be arranged with a preceptor or the submission of an individual report.
I hope you will have a meaningful and enjoyable experience.
THE FCM CLINICAL HISTORY
Family Doctors with a biopsychosocial perspective will include patient context in the gathering of the patient's data. This context refers mainly to the social determinants that impact on the patient's health status. This is done to be able to identify both the biomedical problems as well as the psychosocial concerns of the patient. The history must also be comprehensive to enable the physician to include preventive measures in the recommendations. Students are enjoined to listen to the lecture on clinical history taking given by Dr PJ Francisco [video]
Students will go to the outpatient clinic for 1 half-day during the rotation and will be assigned 1 patient. After taking the patient’s history and performing a physical exam, the student will formulate their primary working impression and propose a management plan, including diagnostic exams, pharmacologic and non-pharmacologic interventions, as well as preventive care recommendations. Findings will be discussed with the preceptor.
The evaluation tool that will be used for the activity can be downloaded freely from this site.
PRIMARY CARE CASE DISCUSSIONS [PCCD]
Students shall be given a list of 3 chief complaints that each student must study and may then share with the small group of 3 simulating a study group. The chief complaint shall be the focus of the PCCD. Students also have the option to study on their own.
For the primary care SGD, you will be divided into groups of three. Each group shall be given one preceptor for the discussion of one case. The patient's general data and chief complaint shall be given to you during the orientation to the course. SGDs will be scheduled at the convenience of the students and the preceptor, either via Zoom or face-to-face.
Students are to use the S-O-A-P format during the discussion. In the preceptorial, the faculty plays the role of the patient in the case. During the SUBJECTIVE part, students shall in effect get the clinical history from the faculty. This is a simulation of sorts.
The physical exam cannot be performed, but the students can request for the findings of the PE from the faculty preceptor. What is not asked will not be given automatically.
Once the clinical data has been gathered, the students then present to the preceptor their analysis of the case and what they think are the medical problems of the patient. Take note that the patient may have more than one problem. Each of these problems must then be addressed in the presentation of their proposed management of the case.
The discussion can include differential diagnoses, confirmatory diagnostic tests and management principles. The preceptors may ask the students any pertinent clinical questions. In turn, the students may also ask their preceptors questions they might have regarding the case. The discussion should enable the preceptor to evaluate student performance as well as provide additional knowledge to the students.
The evaluation tool that will be used for the primary care discussion shall be given to the faculty preceptor in Google form. A copy is available here.
CLINICAL REFERENCES FOR BLOCK 6
All blocks are going to be given a set of 5 reading materials. This will include review articles on a chief complaint and clinical practice guidelines/pathways.
For ALL blocks, the CPG on hypertension and diabetes mellitus will always be included.
The other reading materials included here are solely for the current block going through the rotation. One chief complaint shall be discussed in the PCCD session of each group.
All required reading materials shall be used in the end-of-rotation exams. The full list of clinical references will be made available in a separate section, if interested to browse or read.
(1) Chronic constipation*
Sadler K, Arnold F, Dean S. Chronic Constipation in Adults. American Family Physician. 2022 Sep;106(3):299-306.
Link to full article/PDF: Chronic Constipation in Adults - ClinicalKey
(2) Peripheral Edema*
Patel H, Skok CC, DeMarco A. Peripheral Edema: Evaluation and Management in Primary Care. American Family Physician. 2022 Nov;106(5):557-64.
Link to full article/PDF: Peripheral Edema: Evaluation and Management in Primary Care - ClinicalKey
(3) Weight loss in older adults*
Gaddey HL, Holder KK. Unintentional weight loss in older adults. American Family Physician. 2021 Jul;104(1):34-40.
Link to full article/PDF: Unintentional Weight Loss in Older Adults - ClinicalKey
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*Login to www.clinicalkey.com while on UP Manila internet or VPN and choose login via your institution (search for University of the Philippines Manila)
PREVENTIVE CARE
The annual physical examination is distinct from the periodic health examination. The former is a standard battery of tests irrespective of the patient’s age sex and health condition - often required by an institution - whereas the latter is a more personalized package of services. It involves a meticulous history taking focused on the identification of both risk and protective factors, an assessment of the patient’s risk in acquiring preventable diseases through a cost-effective selection of screening tests as well as a study of the patient’s immunization status. A tailored package of services that includes lifestyle change recommendations, periodic screening, vaccination, and the appropriate use of pharmacologic agents aimed at preventing complications or the onset of unwanted medical problems.
The periodic health exam may require more than one consultation. The students in this activity will only conduct the initial interview and make recommendations based on the data they gathered. The follow-up care will be given by the faculty preceptor, course coordinator or maybe referred to any UPHS consultant.
FAMILY CARE
Family care is the foundation of the practice of Family Medicine. The family is still the most important health unit throughout all and any changes in society. Many medical conditions are determined by family genetics and/or lifestyle. Family has been defined as “any group of people related either biologically, emotionally or legally” [McDaniel et al 2005]
The PFC matrix has been introduced to you as a useful tool to analyze patient and family dynamics in the context of their community. In first year, this was introduced with examples but in second year you were asked to gather salient data from a given clinical scenario and to place them on the matrix -- and like a jigsaw puzzle -- to come up with a complete picture. In this year level, where data gathering is a much-valued skill, you shall be given a clinical scenario but with missing data. You then are supposed to gather the additional information by appropriate questioning. This raises the difficulty somewhat higher in accordance with their year level of medical training.
You will be given the clinical scenario mainly of the index patient. As family-oriented medical students, you will then ask the important question that will assist you in coming up with a better picture of the family dynamics. This will enable you to prepare the PFC matrix.
END OF ROTATION EXAM
On the last Friday of the second week, an end-of-rotation exam shall be given. The written exams can have MCQs, short answer essay questions, enumerations or True or False questions.
The topics of the exams shall include the following:
1. Family Medicine notes from LU3 and 4
2. MacDaniel (2005). Family-oriented primary care [Chapters 1-3]
3. Adult preventive services
4. Recommendations for adult vaccinations from PFV
5. Clinical references specific to the block
COURSE EVALUATION BY STUDENTS
Kindly accomplish the forms for all your SGD faculty as well as for the course. Please find the links below to the Google forms of Student Evaluation for Teaching Effectiveness (SET) and Course Evaluation by Students (CEBS):
CEBS - https://forms.gle/EhJ2s1BS2fNAcoEz7
SET - https://forms.gle/RyurwDYmmYD4niCt9
Thank you!
PRIMARY CARE READING MATERIALS, INCLUDING THOSE FOR THE OTHER BLOCKS
(1) Pruritus*
Rupert J, Honeycutt JD. Pruritus: Diagnosis and Management. American Family Physician. 2022 Jan;105(1):55-64.
Link to full article/PDF: Pruritus: Diagnosis and Management - ClinicalKey
(2) Weight loss in older adults*
Gaddey HL, Holder KK. Unintentional weight loss in older adults. American Family Physician. 2021 Jul;104(1):34-40.
Link to full article/PDF: Unintentional Weight Loss in Older Adults - ClinicalKey
(3) Chronic cough
Michaudet C, Malaty J. Chronic cough: evaluation and management. American family physician. 2017 Nov 1;96(9):575-80.
Link to full article/PDF: Chronic cough: Evaluation and management | AAFP
(4) Anemia in older adults
Lanier JB, Park JJ, Callahan RC. Anemia in older adults. American family physician. 2018 Oct 1;98(7):437-42.
Link to full article/PDF: Anemia in Older Adults | AAFP
Arnold MJ. Microscopic hematuria in adults: updated recommendations from the American Urological Association. American family physician. 2021 Dec;104(6):655-7.
Link to full article/PDF: Microscopic Hematuria in Adults: Updated Recommendations from the American Urological Association (clinicalkey.com)
(6) Gas, bloating and belching
Wilkinson JM, Cozine EW, Loftus CG. Gas, bloating, and belching: approach to evaluation and management. American family physician. 2019 Mar 1;99(5):301-9.
Link to full article/PDF: Gas, Bloating, and Belching: Approach to Evaluation and Management | AAFP
Sadler K, Arnold F, Dean S. Chronic Constipation in Adults. American Family Physician. 2022 Sep;106(3):299-306.
Link to full article/PDF: Chronic Constipation in Adults - ClinicalKey
Bryce C. Persistent night sweats: diagnostic evaluation. American Family Physician. 2020 Oct 1;102(7):427-33.
Link to full article/PDF: Persistent Night Sweats: Diagnostic Evaluation | AAFP
(9) Chronic diarrhea
Burgers K, Lindberg B, Bevis ZJ. Chronic diarrhea in adults: evaluation and differential diagnosis. American Family Physician. 2020 Apr 15;101(8):472-80.
Link to full article/PDF: Chronic Diarrhea in Adults: Evaluation and Differential Diagnosis | AAFP
(10) Peripheral Edema*
Patel H, Skok CC, DeMarco A. Peripheral Edema: Evaluation and Management in Primary Care. American Family Physician. 2022 Nov;106(5):557-64.
Link to full article/PDF: Peripheral Edema: Evaluation and Management in Primary Care - ClinicalKey
Gaddey HL, Riegel AM. Unexplained lymphadenopathy: evaluation and differential diagnosis. American Family Physician. 2016 Dec 1;94(11):896-903.
Link to full article/PDF: Unexplained Lymphadenopathy: Evaluation and Ddx | AAFP
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*Login to www.clinicalkey.com while on UP Manila internet or VPN and choose login via your institution (search for University of the Philippines Manila)