Family Medicine Residency Program ( F P R P )
Family Medicine
Family Physicians possess unique attitudes, skills & knowledge that qualify them to provide continuing & comprehensive medical care in a personalized manner, health maintenance & preventive services to each member of a family regardless of sex, age or type of problems, be it biologic, behavioral or social and are best qualified to serve as each patient's advocate to all health – related matters including the appropriate use of consultants, health services & community resources.
Coordination & integration of all necessary health services with the least amount of fragmentation & the skills to manage most medical problems allow family physicians to provide cost – effective health care.
Devotion to continuing, comprehensive, personalized care to early detection of diseases and the maintenance of health & to the ongoing management of patients in a community setting uniquely qualifies the family physician to deliver primary care.
The rewards in family practice come largely from knowing patients intimately over time & sharing their trust, respect and friendship.
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Family Medicine Residency Program
Mission
To produce fully competent community oriented physicians capable of providing high quality care to their patients and skilled in the principles and practice of family medicine.
Structural Frame Work
The Family Medicine Residency Program (FMRP) is a four years training program both in accredited family medicine training centers and hospitals.
Towards this end the residents must learn togather essential & accurate information about patient and use it together with up-to-date scientific evidence to make decisions about diagnosis and therapeutic intervention. The residency program must ensure that its residents by the time they graduate provides appropriate, effective & compassionate clinical care.
Principles and implications of Family Practice
The FPRP is built upon the principles of the specialty. At the end of the training program the family physician will be expected to:
1- Demonstrate clinical excellence in identifying and managing all the medical problems (both acute & chronic) presented by his / her patients seen:
* In the health center or doctor's office.
* At the patient's home.
* In hospital.
2-Provides continuing, comprehensive, compassionate & confidential care to all individuals with emphasis on the family unit, irrespective of age, sex or diseased organ or system.
3- Demonstrate the commitment to the person rather than to a particular knowledge, group of diseases or special technique (personalized care).
4-Demonstrate competence in serving the public as physician of first contact and means of entry into the health care system (gate keeper).
5- Applying methods of disease prevention, health promotion and screening.
6- Demonstrate abilities to act as the patient's and family advocate in all health related matters and services.
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7- Demonstrate the ability to integrate the behavioral, emotional, social and environmental factors of families in promoting health and managing disease.
8- Demonstrate the ability of mastering skills in:
a- Consultation
b- Counseling
c- Resources management
d- Communication
e- Of breaking bad news
f- Uncertainty
g- Of dealing with conflict, dubious request & grief
9-Develop mutually satisfying physician, patient relationship, recognizing the impact of patients' background, beliefs and expectations on:
* Problem identification* Problem solving
* Compliance* Patient education
10-Demonstrate the ability to cope with chronic disease.
11-Recognize the importance of continuing education after graduation as an absolute necessity to maintain excellence in medical care.
12-Understand and evaluate the findings of published research and to apply its results to one's own medical practice.
13-Perform self assessment and identifying learning needs and monitoring of quality of performance (Audit).
14-Demonstrate competence in dealing with somatization strategies of prevention &management.
15-Seek to understand the context of illness and attach the importance to the subjective aspects of medicine (many of the illnesses seen can't be fully understood unless they are seen in their personal, family & social context).
16- Understanding & application of the knowledge & skills required for evidence based practice and be able to use best evidence in critical decision making (Evidence based medicine).
17-Demonstrate the ability of mastering resources management skills which includes the skills of practice management and of consultation and referral (Familyphysician is a manager of resources).
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18-Demonstrate a basic approach to ethical and medico-legal dilemmas.
19-Mastering the skills concerning patient safety.
Practical Skills
The resident should perform general clinical examination of organ systems, including digital rectal & vaginal examination.
Proficient use of the following:
* Auroscope* Ophthalmoscope
* Sphygmomanometer* Stethoscope
* Fetal stethoscope & / or sonicaid* Thermometer
* Tuning Fork* Visual acuity and colour tests
* Proctoscope* Vaginal speculum
* Patellar hammer
Proficiency in the following:
* Cardio-pulmonary resuscitation including use of a defibrillator.
* Controlling a hemorrhage.
* Venipuncture.
* Giving intravenous, intramuscular, subcutaneous or intradermal injections including via a syringe driver.
* Performing & interpreting an electrocardiogram.
* Performing basic respiratory function tests.
* Administering oxygen safety.
* Use of a Nebulizer.
* Near patient testing e.g. urine analysis.
* Removal of ear wax.
* Introducing a urinary catheter.
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* Performing a cervical smear.
* Collecting other relevant samples including endocervical or per-nasal swabs.
* Suturing a wound.
* Minor surgical procedures e.g. cryotherapy, joint injection & aspiration and surgical excisions as appropriate.
Seriously ill Patients
The resident should develop knowledge of handling, managing & appropriate referral of seriously ill patients.
* Cardiovascular problems including cardiac arrest, acute myocardial infarction, acute left ventricular failure, severe hypertension, life-threatening arrhythmias & dissecting aneurysms.
* Respiratory problems including acute severe asthma, pulmonary embolus, pneumothorax, pneumonia, epiglottitis, bronchiolitis, foreign body aspiration & respiratory failure.
* Central nervous system problems including cerebrovascular problems such as strokes, seizures including febrile convulsions, infections such as meningitis or encephalitis & signs of other significant intracranial pathology such as tumors.
* Gastrointestinal problems including gastroenteritis especially in childhood, hemorrhage, acute abdominal pain & liver failure.
* Infectious diseases e.g. malaria, TB.
*Shocked patients including septicaemia, cardiogenic & anaphylactic shock, hemorrhage & burns.
* Unconscious patients including those with diabetic problems such as hypoglycemia, hyperglycaemic ketoacidosis & hyperosmolar non-ketotic coma.
* Psychiatric problems including acute psychoses, acute organic reactions the suicidal patient, psychological crises.
* Urological problems including torsion of the testis, priapisms, paraphimosis, gross hematuria, ureteric colic & acute retention of urine.
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*Women's problems including severe vaginal bleeding & / for pelvic pain e.g. Ectopic pregnancy & emergencies associated with pregnancy e.g. placenta abruption or eclampsia.
*Terminally ill patients including symptomatic & palliative care.
*Sudden unexpected death including sudden infant death syndrome, confirmation of death & dealing with relatives (breaking bad news).
Complex & Undifferentiated Conditions
The resident should develop knowledge of handling undifferentiated conditions (skills of uncertainty).
*including symptoms & ill – defined conditions for which no diagnosis classifiable elsewhere in recorded.
*Tiredness all the time / malaise / Fatique / weakness / Lassitude.
*Funny turns / dizziness / giddiness / blackouts / ataxia / gone off legs.
*Anorexia and / or weight loss.
*Weight gain and / or obesity & conditions which may be associated with obesity.
*Swelling: localized, mass, lump including single lymph nodes.
*Non – specific rashes.
*Fever including pyrexia of unknown origin.
*Allergic problems.
*Confusion, memory loss, poor concentration & forgetfulness.
*Frequency of micturation including metabolic causes.
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Trauma / Injuries / Toxic Effects
The resident should develop knowledge of handling, managing and appropriate referral of traumatic, injured patients.
* Wounds (including surgical) and lacerations: management & principles of care.
* Fractures, sprains, strains & other significant soft-tissue trauma: recognition & principles of management.
* Head injuries including minor with or without loss of consciousness, concussion & more serious cranial or intracranial injuries.
*Internal injuries of the chest, abdomen or pelvis: recognition & principles of management.
* Poisoning including drugs, foods & other chemicals & including adverse effects of prescribed drugs.
* Post operative complications including those related to the procedure, infections.
* Miscellaneous including epistaxis, foreign bodies, burns.
Medicine
The resident should develop competence for initial diagnosis, management & appropriate referral criteria for common medical illnesses.
*Approach to the undifferentiated conditions.
Chest pain, syncope, palpitation, leg oedema
Dyspnoea, haemoptysis
Dyspepsia, abdominal pain, Jaundice
Dizziness, Blackout, Faints
Anorexia & weight loss
Tiredness, Fatique, body aches
Headache, seizures, coma
Anemia, lymphadenopathy
Backache, Arthralgia & arthritis
Pyrexia of unknown origin
Non-specific rashes
Haematuria & proteinuria
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*Cardiovascular System
Congenital heart disease
Ischaemic heart disease, Hyperlipidemia
Hypertension
Heart failure
Arrythmias & Conduction defects
Valvular heart disease
Thrombo-embolic disorders, peripheral vascular disease
Carditis , Cardeomyopathy
Rheumatic fever, Infective endocarditis
Hypovolaemic shock, Cardiogenic shock, dissecting aneurysm of aorta
*Respiratory System
Acute bronchitis, chronic obstructive pulmonary disease (COPD)
Bronchial asthma & wheezy chest , allergic alveolitis, allergic rhinitis
Lobar pneumonia, bronchopneumonia, atypical pneumonia
Pulmonary abscess & ephymia
Tubercullosis, Aspergillosis
Broncgenic carcinoma, Adenoma, metastasis, mesothelioma
Pulmonary fibrosis & interstitial lung diseases
Pneumothorax
Bronchiectasis
Pleural effusion & pleuricy
Occupational lung diseases
Deformities of chest wall
Respiratory failure
Sleep apnoea syndrome
Pulmonary embolism
*Gastrointestinal tract
Gastroesophageal reflux, dysphagia, diffuse spasm of oesophagus
Carcinoma of oesophagus, Achalasia, slinding hiatus hernia, Paraoesophagel hernia
Peptic ulcer disease, Gastritis, upper gastrointestinal hemorrhage
Acute perforation, pyloric obstruction, Zollinger-Ellison syndrome
Carcinoma of stomach
Non-ulcer dyspepsia, irritable bowel disease
Malabsorption, Coeliac disease, Tropical sprue
Crohn's disease, ulcerative colitis, lactose intolerance
Acute abdomen (surgical & Medical) , Ischaemic colitis
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Diverticular disease, Angiodysplasia of colon
Neoplastic polyps, familial adenomatous polyposis, carcinoma lymphoma
Diarrhoea (acute & chronic) , Dysentery
Constipation, laxative abuse
Ascites
Nausea & / or vomiting & / or diarrhoea
Rectal bleeding & pain
Abdominal masses
Abdominal pain
*Liver & Biliary System
Jaundice (hemolytic, Hepatocellular & cholestatic)
Acute & chronic hepatitis
Chronic parenchymal liver disease, infection, Toxin, alcohol & drugs
Biliary obstruction
Cirrhoss of liver, hepatic encephalopathy, portal hypertension & Ascites
Alcoholic liver disease
Tumours of liver (primary & secondaries)
Liver abscess
Haemochromatosis, Wilson's disease, fibrocystic disease
Gall bladder diseases
Pancreatitis
*Diseases of the Kidneys
Urinary tract infection (Asymptomatic & symptomatic)
Glomerulonephritis
Nephrotic syndrome
Acute renal failure
Obstruction of urinary tract
Renal stones
Tumors of the kidney & urinary tract
Congenital abnormalities of kidneys & urinary tract
Haematuria
Proteinuria
Dysuria
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*Endocrine & Metabolic diseases
Hypopituatarism, Growth hormone deficiency, tumours of pituitary glands
Acromegaly, cushing disease, Hyperprolactinoma, Diabetes Insipedus
Hyperthyroidism, subclinical hyperthyroidism
Hypothyroidism, subclinical hypothyroidism
Subacute thyroisitis, post partum thyroiditis
Simple goiter, solitary thyroid nodule
Thyroid tumours (benign & malignant)
Hyperparathyroidism, Hypoparathyroidism, Tetany
Addison's disease
Conn's Syndrome
Phaechromocytoma
Hypogonadism, impotence
Diabetes Mellitus
Hyperlipidemia
Hirsutism
*Haematology
Iron deficiency anemia
Megaloblastic anemia
Haemolytic anemia
Haemoglobinopathies, sickle cell anemia, Thalassemia
Polycythemia
Lymphoma
Neutropenia
Leukemias (Acute & chronic)
Bleeding disorders, Thrombocytopenia
Coagulation disorders, Haemophilia (A & B)
Acquired bleeding disorders
Disseminated Intravascular coagulation
*Neurology
Cerebrovascularaccidents (CVA) (Ischaemia, hypertension, haemorrhage & Arteriovenous malformation) & Transient Ischaemia Attack (TIA) seizures disorders
(CNS) Cranial Peripheral nerves infections
(meningitis, Encephalitis, Neurosyphilits & brain abscess.
Neuropathies, Neuralgias, Motor neurone disease, Encepalopathies
Dementia, Migraine, cluster headache, Giant cell arteritis, Tension headache, Space occupying lesion (SOL) & brain tumours (Pry &2ry)
Parkinsonism
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Multiple sclerosis
Tremor, chorea, Tics
Sleep disorders
Delerium & Confusional states
Disorders of cerebellum
Head injury & spinal cord injury
Syringomyelia & syringobulbia
Muscular atrophies, myotonia, Myasthenia Grave's
*Musculoskeletal & Connective tissue disorders
Rheumatoid arthritis, Sjogren disease
SLE
Polyarteritis nodosa
Scleroderma
Mixed Connective tissue disease
Seronegative arthritis (Ankylosing spondylitis, psoriatic arthritis, Reiter's disease)
Arthritis with inflammatory bowel disease & Behcet's disease)
Osteoarthritis
Gouty arthritis, pseudogout
Infective arthritis
Polymyositis & Dermatomyositis
Polymyalgia rheumatica & Giant cell arteritis
Wegenr's granulomatosis
Eosinophilic fascitites
Bursitis, Tendinitis, Tennis elbow
Fibromyositis, Torticollis
Neck pain, shoulder pain, Osteoporosis, Osteomyelitis
Neoplasm of bones (primary & Secondaries)
Head pain & ankle sprain
Back pain including mechanical, disclesion or tumours
Neck pain including cervical spondylosis, torticollis or injuries
Sport medicine
*Infections & Parisites
Viruses e.g. AIDS, Measles, Rubella, Mumps, Chickenpox, infectious mononucleosisSTD
Bacteria e.g. scarlet fever, typhoid, Brucellosis, TB
Protozoa e.g. Malaria, Giardiasis, Amoebiasis, leishmaniasis
Helminth e.g. Bilharziasis, Ascaris, Thread worm, Tape worm
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Means & Control of transmission
Consent for testing issues of confidentiality
Role of public health services
*Health Promotion & Screening
Cardiovascular risk factors assessment,Hypertension, D.M, Exercise, Smoking Cessation, Stress, Alcohol, Cancer of colon, breast, cervix , prostate, body weight, lipids, salt intake, immunization,Harm minimization & promotion of a healthy life style.
*Serious Communicable Diseases
AIDS, TB, Hepatitis B & C
*Pharmaco-therapeutics
Application of the concept of rational prescribing especially with regard to patient safetyAwareness of drug combination, adverse effects, latrogenic disorders & potential interactionAwareness of the factors affecting dose, drug requirements, compliance & monitoringEvaluating independent evidence regarding the appropriateness of treatment (cost effectives drug management)
* Competency in recognizing & performing primary management for the following life threatening & emergency conditions
Acute MI, Pulmonary oedema, Acute respiratory failure, Malignant hypertension, G.I Haemorrhage, Shock, Anaphylaxis, Status asthmaticus, Status epilepticus, Acute renal failure, Diabetes ketoacidosis, hypoglycemia, Comatose patient
*The resident should be able to perform the following clinical skills
a) Procedures used in medical practice
ECG tracing & interpretation
Lumbar puncture
Arterial puncture
Peritoneal tap
Bone marrow aspiration
PPD testing & interpretation
Joint aspiration
Peak Flow Meter including pulmonary function tests
CPR
b) Interpretation of laboratory tests
c)Interpretation of CXR, abdominal x-ray , x-ray of bones & joints
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* Pediatrics
The resident should develop competence for initial diagnosis, management and appropriate referral criteria for common pediatric illnesses.
*Prenatal diagnosis
*Care of the new born babies, prematurity, birth asphyxia, Respiratory distress syndrome, Neonatal sepsis
*Approach to a child with Jaundice
*Approach to a child with Fever
*Approach to a child with stridor & wheezing
*Approach to a child with poor appetite
*Approach to a child with vomiting
*Approach to a child with generalized lymphadenopathy
*Approach to a child with vulvovaginitis
*Approach to a child with nocturnal cough
*Genetics & congenital abnormalities
*Pediatric nutrition, breast feeding, modified cow's milk formula, recommended daily requirements for protein carbohydrate, fat, vitamins & minerals
*Weaning & sleep disorders* Malnutrition * Failure to thrive
*Short stature* Obesity* Limping child * Non-accidental injury
* Poisoning & over dose *Bow leg
*Growth and developmental assays including knowledge of normal developmental milestones
*Child health surveillance & screening, squint, hearing hypothyroidism, CDH,undescended testes club foot
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*Vaccination*Infantile colic*Nocturnal Enuresis
* Behavioral disorders, learning disorders, mental retardation, language problems, hyperactivity
*Upper respiratory tract infections, sorethroat, pharyngitis, Earache, otitis media, Glue ear, deafness, Croup & epiglottitis
* Role of antibiotics in upper respiratory tract infections
* Lower respiratory tract infection, pneumonia, bronchopneumonia, Tuberculosis, bronchiolitis
* Bronchial asthma & Hay fever
* Viral illnesses measles, rubella, mumps, chicken pox
* Cardiovascular system heart murmurs, hypertension, congestive heart failure, arrythmias, congenital heart disease (cyanotic & acyanotic).
*Gastrointestinal system, gastroenteritis, vomiting, abdominal pain, acute and chronic diarrhoea, acute & chronic constipation, Gastroesophageal reflux, intestinal infestations, malabsorption, abdominal masses,acute abdomen, hepatitis & liver diseases, anal pain & fissure
*Central nervous system, meningitis, encephalitis, febrile convulsions, epilepsy, raised intracranial pressure, cerebral palsy, hyderocephalus.
*Haematology, iron deficiency anemia, sickle cell anemia, thalassemia, G6PDD, haemolytic crises, lymphadenopathy, leukaemia, bleeding disorders
*Endocrine disorders
Diabetes mellitus & its complication, hypothyroidism, hyperthyroidism, hypopituatarism, cushing disease, Dwarfism, Obesity.
* Urinary system: urinary tract infections, nephrotic syndrome, glomerulonephritis, hematuria, proteinuria, congenital anomalies, vesico-ureteric reflux, calculi & tumours
* Musculoskeletal system: Arthralgia, rheumatoid arthritis, SLE, septic arthritis, osteomyelitis, reactive arthritis
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*Skin disorders: Exanthmatous rash, diaper rash, eczema, impetigo, pediculosis, scabies, skininfection (viral, bacterial & fungal) , psoriasis
*Pediatric emergencies: Epiglottitis, chocking, Anaphylaxis, septic shock, Hypovolamic shock, status asthmaticus, seizures disorder, congestive heart failure, cyanotic heart disease, poisoning & overdose.
Woman Health
General training objectives for woman health
By the end of 6 months training and working in obstetric gynecology department and training PHC centers the family physician should be able to provide preventive, curative primary health care to all women before, during and after their reproductive age in all issues related to their reproductive system.
A-By the end of 6 months training the family physician residence should be able to:
- Obtain a comprehensive history & perform a complete & accurate physical examination.
- Understand anatomy & physiology of the female / reproductive system in all age groups, before & during pregnancy.
- Ability to recognize high risk pregnancy.
- Utilizing appropriate resources including consultation.
- Principles of preconceptual care.
- Principles of antepartum & post partum care.
- Recognition of mechanism of labor
- Thorough knowledge of fetal monitoring
- Recognition of abnormal labor.
- Knowledge of modalities used in managing complications of labor & delivery.
- Technical proficiency in handling instruments.
- Understanding & appropriate use of consultation & communication with consultants.
B- At the end of the residency each resident should be aware of the following
principles:
- Normal growth & development of female reproductive system & variants.
- Sexual counseling.
- Family planning counseling.
- Prenatal genetic counseling.
- Prenatal counseling on (diet, activities & exercise, alcohol, smoking & environmental hazards).
- General principles of prenatal conception & postnatal care.
- Immunization during pregnancy.
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- Screening during pregnancy.
- Drug use during pregnancy.
- Fetal monitoring.
- Infertility, primary & secondary.
- Osteoporosis risk assessment.
- Screening of cancer.
- Prevention of cancer.
- Menopause counseling.
- Breast diseases.
- Pelvic masses, cysts, fibroid & malignancy.
- Management of family violence.
- Raped patient.
C- Resident should be able to evaluate, Diagnose, manage & refer when need the