Download Students Handbook

Department of Community Health &
Family Medicine
Kulliyyah of Medicine
STUDENT HANDBOOK
1
CONTENT
1. Introduction
2. Time Table of Posting
3. Public Health Posting

Objective

Learning Outcomes

Topics in Public Health

Learning Activities

References
4. Family Medicine Posting

Objective

Learning Outcomes

Topics in Public Health

Learning Activities

Desired Competency on Completion of Posting

References
5. Method of Assessment
2
INTRODUCTION
Welcome to the Department of Community Health and Family Medicine. There will be two postings
during you attachment in this department. It is Public Health (MED 4106) and Family Medicine (MED
4906) posting. During three months that you are with us, you will have five weeks attachment in Public
Health posting in Kuantan District Health Office and another five weeks in Family Medicine posting at
primary health clinics. There will be one week of revision and followed by examination week.
The Public Health posting is an extension of Introduction to Public Health course (MED 1407) in year
one. In this posting, you will have opportunity to understand the health seeking behavior of individual,
family and community, the family roles and functions in disease prevention and management, the
health services provided and the utilization of these services. You also will be exposed on Occupational
and Environmental Medicine practice in Malaysia where you will be introduced to various health
hazards and risk through field visits, proper occupational and environmental history taking and correct
approach in eliciting diagnoses for disease prevention and management. You will also be exposed to
ethical and legal responsibility issues in giving consultation to their patient/client.
The Family Medicine is a diverse clinical discipline that deals with the whole patient and his own family.
The family physician gives personal, primary, comprehensive and continuing care to the individual, their
family and community. In this posting, you will encounter different illness than those seen in hospital
wards. You will be dealing with undifferentiated problems and see diseases at early stage. Your clinical
problem solving skills are utmost importance in helping you making diagnosis and to formulate patient
centered management plan, which take into account the medical, social and psychological factors.
You will also have the opportunity to be involved in health promotion and health activities including
preventive aspect of care through your attachment in health clinic. In this posting, you will be attached
to primary health clinic under supervision and guidance of a lecturer and family physician. Various
teaching and learning activities have been planned for you over the next four weeks clinical attachment
and we hope you will find this posting an enjoyable and rewarding experience.
Hopefully you will enjoy the both postings.
Assoc. Prof. Dr. Jamaluddin Abdul Rahman
Head,
Department of Community Health
Kulliyyah of Medicine, IIUM
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TIME TABLE OF POSTING
Overall Time Table
Sub Group
Week 1-5
Week 6-10
Week 11
Week 12
1
Public Health
attachment
Family
Medicine
Family Medicine posting
Revision
Exams
2
Public Health attachment
posting
Weekly Time Table for Public Health Posting
Day
Morning
Afternoon
8.30 AM-12.30 PM
2.30 PM-5.00PM
Monday
Health unit attachment/Field visit
Lectures
Tuesday
Health unit attachment/Field visit
Community Survey
Wednesday
Health unit attachment/Field visit
Self Directed Learning (SDL)
Thursday
Health unit attachment/Field visit
Community Survey
Friday
CPC
Interactive Sessions
IRK
Weekly Time Table Family Medicine Posting
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Morning
8:30-11:30 AM
11:30AM-12.30PM
Clinic Activity
Case discussion
Clinic Activity
Case discussion
Clinic Activity
Case discussion
Clinic Activity
Case discussion
CPC
Interactive Sessions/Seminar
Home visits/ Community Survey
Afternoon
2.00-5.00PM
Interactive sessions /
Video-commentary
Seminars
Tutorial/ Role-playing
Tutorial / VideoIRK
commentary
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PUBLIC HEALTH POSTING
Objectives
1. To enable students to identify and describe the influence of the physical as well as mental,
social, occupational and spiritual factors apart from chemical and biological aspects of a given
environment on the health of the individual, family and community.
2. To enable students to proposed preventive and control measures in the community and
occupational settings.
Learning Outcomes
At the end of the course, the student will be able to:
1. Define the concept of health and sickness in a community setting and the factors that influence
this process.
2. Define the underlying principles of prevention and control measures at personal, family and
community level.
3. Describe the need to address psycho-social factors in the provision of comprehensive health
care.
4. Identify the health management as applied in rural and urban areas.
5. Describe the provision of primary health care as provided in the overall health care system in
Malaysia.
6. Apply the principles of communication in health education, environmental health as applied in
health centres.
7. Assess the provision of health care in a cost-effective and acceptable socio-economic
community setting.
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Topics in Public Health
1. Introduction to Public Health Medicine

Principles of Epidemiology

Epidemiology of Communicable Diseases

Epidemiology of Non Communicable Diseases

Outbreak Control

Family Health & Development

Occupational Health Medicine

Environmental Health Medicine

Health Promotion

Nutritional Health
2. Research Methodology & Biostatistics

Literature search

Research designs

Sampling & sample size

Data management

Statistical analysis

Scientific report writing
3. Public Health programmes in Malaysia

Communicable Disease Control Programme

Non Communicable Disease Control Programme

Vector Borne Disease Control Programme

Family Health & Development Programme

Enforcement Unit

International Health (visit to Seaport)

Environmental Health Programme (BAKAS)

Drinking Water Quality Control (KMAM)

Food Quality Control (FQC)

Environmental and Occupational Health (KPAS)
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Learning Activities
i.
#
Field Visits & Public Health Attachments
Programme
Learning Outcomes
(At the end of the visit, students should be able to…………..)
1. Discuss the health services provided by the government to
the rural area and how it differs from the urban area
2. Discuss how the services are delivered to the rural
population in terms of:
a. delivering vaccine and the importance of cold chain
b. appointment systems
c. transport systems
3. Communicate with the rural populations and describe their
health seeking behaviour
4. Discuss how the health services, population’s demographic
features and its environment play their roles in
determining the health status of its population
1.
Mobile Health Team in Ulu
Tembeling
2.
HIV/AIDS Screening
Programme (KK Beserah)
1. Discuss HIV screening programme at the centre
2. Explain the types of HIV screening test and confirmatory
test
3. List out other target group for HIV/AIDS/STD screening
programme
4. Discuss the criteria for good screening test
5. Describe the notification process
3.
International Health
programmes at Kuantan Port
4.
Occupational Health –Factory
Visit
1. Describe the activities at the Kuantan seaport:
a. Communicable Disease Control programme
b. Vector Control Programme
c. Food Safety and Quality Control Programme
2. Describe the laws and regulations related to seaport.
3. Discuss the International Health Activities at the Kuantan
Port
1. Identify hazards at workplace
2. Conduct a simple risk assessment at workplace
3. Discuss the possible occupational safety and health
problems due to hazards exposure
4. Discuss the guidelines, acts and regulations related to
occupational health and safety issues.
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5.
Drinking Water Quality
Programme (KMAM) at
Water Treatment Plant
1. List out the objectives of the unit.
2. List the stages involve in water treatment plant process
3. Describe how the sampling is done (field analysis, the
sampling points, the schedule and the parameters being
monitored).
4. Describe the integration of different agencies in supplying
clean and adequate water supply to the public.
5. Discuss how water pollution can effects our drinking water
quality
6.
Environmental Sanitation and
Water Supply (BAKAS)
Programme
1. List out the objectives of the unit
2. Describe the target area and population of the services
provided under this unit
3. Describe how the services being delivered to the
population
4. Discuss the importance of the activity.
5. Discuss the problems and challenges faced by this unit.
7.
Food Safety and Quality
Control Unit (KKMM)
Programme
1.
2.
3.
4.
5.
8.
Dengue Control Programme
1. Describe the history of Dengue Control Programme in
Malaysia
2. List out the objectives of the programme
3. Describe and compare different types of dengue
surveillance activities
4. Discuss indicators for Aedes surveillance
5. Discuss types of Aedes control measures
6. Describe Aedes life cycle
7. Identify adult Aedes as well as its larva form
8. Describe laws related to the programme
9.
Malaria Control Programme
1. Describe the history of Malaria Control Programme in
Malaysia
2. List out the objectives of the programme
3. Describe and compare different types of malaria
surveillance activities
4. Describe and identify common Anopheles sp related to
malaria in Malaysia
5. Discuss types of vector control measures
6. Describe laws related to the programme
List out the objectives of the unit.
Discuss the scope of activities in the unit.
Describe how the food sampling is done
Discuss the group of parameters being monitored
Describe how the food premise is rated
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10. Communicable Disease
Control Programme
1.
2.
3.
4.
5.
6.
List out the objectives of the programme
List out infectious diseases monitored routinely
Describe CDCIS
List all notifiable diseases
Describe how disease is notified
Describe laws related to the programme
11. Health Enforcement Unit
1. List out the acts and regulations related to Public Health
2. Discuss the procedure related to enforcement activities
3. Discuss the importance of enforcement in the prevention
and control activities
4. Describe problem and challenges enforcing health laws
12. School Health Programme
1. List out the objectives of the unit
2. Discuss the scope of activities involved
3. Describe how the services being delivered
13. Family Health &
Development Programme at
Community Polyclinics
1. Describe the difference between Family Health and Family
Medicine
2. Discuss Quality Assurance Programme (QAP) implemented
in the polyclinic
3. Discuss the District Specific Approach (DSA) implemented
in the polyclinic
4. Describe the Quality Assurance Programme Indicators.
14. Dental Health Programme
1. Describe the organization structure of this unit
2. List out the services provided to the public
3. Discuss the dental health promotion programme.
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REFERENCES
Required Text
1. K. Park. Park’s Textbook of Preventive & Social Medicine. M/s Banarsidas Bhanot Publishers,
Jabalpur, India. 18th edition. 2005.
2. WHO. Health Research Methodology: A Guide for Training in Research Methods. WHO Regional
Office for the Western Pacific. Manila. Second Edition. 2001.
3. http://www.wpro.who.int/publications/pub_929061157X.htm (Accessed on 9th April 2007)
4. Douglas G. Altman. Practical Statistics for Medical Research. Chapman & Hall/CRC; 1 edition. 1990
5. M. Bland. An Introduction to Medical Statistics. Oxford Medical Publication. 2nd edition. 1996.
6. B.R. Kirkwood. Essentials of Medical Statistics. Blackwell Scientific Publications.1989.
7. Joseph La Dou. Current Occupational and Environmental Medicine. McGraw-Hill Professional, Third
Edition 2003.
8. Barry S. Levy & David H Wegman. Occupational Health. Recognizing and Preventing Work-related
Disease and Injury. Lippincott Williams & Wilkins, Fourth Edition, 2000.
9. Environmental Health by Monroe T. Morgan, Published by Brooks Cole; 3 edition (November 15,
2002)
10. W. W. Daniel. Biostatistics: A Foundation for Analysis in The Health Sciences. John Wiley & Sons, Inc.
Six edition. 1995.
11. T. Colton. Statistics in Medicine. Little, Brown and Company Boston. 1990.
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FAMILY MEDICINE POSTING
Objective
1. To enable the student to appreciate the importance of primary care in health and in illness by
familiarizing them with the common health care problems seen at the primary care level.
2. To develop the appropriate knowledge, skills, value and attitudes for the student to participate
in its holistic and comprehensive delivery with health care team.
Learning Outcomes
At the end of the postings, the students should be able to
1. Identify and manage common acute and chronic health care problems seen at primary health
care facilities with a patient centred approach.
2. Reinforce the problem-solving and clinical decision making skills in diagnosing and managing
patients appropriately at the primary care level.
3. Identify patients who required specialized care and make the appropriate referral.
4. Integrate promotive and preventive care in the day-to-day clinical management of patients.
5. Apply knowledge of the influence of the family, psychosocial, cultural, spiritual and economic
factors on health in the patients.
6. Develop interpersonal skills for ethical doctor-patient relationship such as effective
communication and counseling skills.
7. Develop effective team work for cost-effective care.
8. Develop skills in health promoting and maintenance activities in well people such as in children,
adolescence and geriatric.
9. Be aware of the services available and desirable in the community for comprehensive patient
care.
10. Show respect for the patient as a person and treats him/her as whole person.
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Topics in Family Medicine
1. Introduction to Family Medicine

Principle of Family Medicine

The family psychosocial dynamic

Whole person approach

Diagnostic approach in primary care

Consultation and Communication skill

Periodic health examination and Screening

Prevention and Health promotion

Palliative care

Practice management
2. Child Health and Adolescent Health

Cold chain and immunization

Child with special needs

Engaging adolescent

Substance abuse
3. Maternal Health Clinic/ Reproductive Health

Pre pregnancy, antenatal and postnatal care

Family planning

Infertility

Menopause

Abnormal uterine bleeding
4. Men’s health

Erectile dysfunction
5. Geriatric Health

Geriatric assessment

Common problems in elderly
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6. Expanded scopes programs in primary care

Obesity program in community

Chronic diseases management in primary care

Psychiatric rehabilitation in the community

HIV/AIDS in primary care

Modified syndrome approach for Sexual Transmitted Disease
Learning Activities
1. Departmental teaching (Lectures, tutorials and seminars)
2. Video-commentary
3. Role-playing
4. Attachment to primary care clinics

Outpatient clinic

Maternal child health clinic
5. Visit to community rehabilitation centre

Psychosocial Rehabilitation Centre at Polyclinic Temerloh

Geriatric Rehabilitation Centre or Old folk home.
6. Perception / Case-based discussions
7. Family case write-up
8. Log book
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Primary Health Clinic Attachment
There will be five/six students posted to the Health Clinic for five weeks duration. The student will be
divided into smaller group of two/three students for rotational attachment to various units in the clinic
such as in outpatient, maternal child health clinic, laboratory, dispensary and rehabilitation.
Attachment
1. Outpatient Clinic

Learning Activities
i)
Each group of student
will be attached at
outpatient clinic for two
and half weeks.
Clerking patients
 Each of students will be required to clerk at least one or two
patients during each clinic session. Do not take more than 10
minutes per patient. You may clerk it before or with your
lecturer.
 Do not examine the patient on your own but check the pulse,
blood pressure and temperature if indicated.
 Present the patient to the lecturer or medical officer who will
examine the patient together with you and discuss the cases
with you.
ii) Screening of patients
The students may screen the patients before they are called in to
see the doctor. This will involve:
 Asking the patient reason for attendance
 Taking the temperature, blood pressure, weighing when
indicated.
 Checking visual acuity in Diabetes Mellitus patient if due.
 Sending the patient for urine tests and/or glucometer if
patient come for diabetic clinic follow-up.
iii) Management and Health Education
 Explain to patients the nature of their problem(s) and the
management plan.
 Counsel the patients and their families when necessary
 Give appropriate advice to patient
 Discuss the most suitable medication for the patient with the
doctor
 Give the appointment and investigations if needed.
iv) Log Book
 Record all cases clerked or seen
 Discuss cases with your peers/lecturer
2. Maternal and Child Health Clinic

The student will be attached to these clinics for two and half week’s duration. They will follow
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all of these clinics in every day MCH clinic activities.
i)
Antenatal and Postnatal
Clinics
Antenatal Clinic
1. Perform the booking for first visit in antenatal mother
 Clerking patients and perform full physical examination.
 Perform routine investigations in first visit
 Give the appropriate appointment according the tagging
system
2. Perform the subsequent normal and high risk antenatal follow up.
 Clerking patients and review for any complications
 Perform full physical examination
 Do a relevant investigations and analysis the results if
available
 Give an appropriate management and appointment according
to the tagging system.
 Refer the patient to the lecturer or medical officer for high
risk antenatal follow up if indicated.
3. Follow the lecturer or medical officer for ultrasound investigation.
Postnatal Clinic
1. Clerking the postnatal patients and perform physical examination
2. Give an appropriate advice and medications to postnatal patients
such as haematinics if necessary.
Health Education
1. Participate in health education activities if available in the clinic
2. Counseling the patient accordingly such as
 Family planning
 Health screening e.g. Breast self examination and PAP smear
 Safe motherhood
 Sexual problems
Log Book
1. Record all cases seen
2. Review and discuss cases seen with your peers or lecturer
3. Read around the case seen
ii) Child Health Clinic
1. Perform a full clerking of the children
2. Do a physical examination
 Height, weight and head circumference
 Perform the developmental assessment where relevant
 Check immunization status
Management
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


Administer the appropriate immunization if indicated or due
(need supervised).
Educate and advice parents on immunization, nutrition,
prevention of accidents in the home and general aspects of
child care.
Observe/participate in child rehabilitation activities in
congenital abnormalities e.g. Down’s syndrome and a child in
child with disabilities or delay.
Health Education
Give health talks or counseling to parent on:




Breast feeding and weaning
Child nutrition
Immunization
Child care
Log Book
 Record all cases clerked or seen
 Discuss cases with your peers/lecturer
 Read around the cases seen.
3. Family Planning Clinic
1. Clerk the patient and emphasize on indications and
contraindication of family planning.
2. Perform full physical examination
3. Do a relevant investigation such as PAP smear and glucometer if
indicated.
1.
2. Management
 Discuss with patients the reasons for contraceptives, the
most suitable and available contraceptive methods for her.
 Explain to the patient on how to take the oral contraceptive
pills
 Observe/perform administration of intramuscular
progestogens injection. (needs supervised).
 Observe techniques of IUCD insertion and removal.
3. Follow-up care
 Check for complications
 Discuss alternative methods with the patient
 Discuss with patient on how to handle with ‘missed pills’
4. Log Book
 Record all cases clerked
 Discuss the cases with your peer/lecturer
 Read on the topics/issues arises on the cases seen.
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5. 4. Laboratory Posting

Students will be
attached to the
laboratory while they
do attachment at
maternal child health
(MCH).
1. Review all requests for laboratory tests For each laboratory test
requested, ask yourself the following question
 Has the forms been correctly and completed filled in?
 Why was the test requested?
 What will you look for in the result?
 How will the result affect the diagnosis?
 Will the test ultimately benefit the patient?
 Does the patient know why the test is being done?
2. Perform the following laboratory test, which usually available at
Level 1 Laboratory ( as in your log book)
3. Collection of specimen
 Give specific instructions to patient about the proper
collection technique such as how to collect mid-stream urine
or before collecting the specimen e.g. overnight fasting for
serum lipid level.
 Use or give the appropriate container to patient
 Avoid contamination
5. Treatment Room and
Dispensary
Treatment room
1. Observe how the following treatment procedures are done
 Incision and drainage
 Toilet and suture
 Removal of foreign body
 Cleaning and dressing wounds
 Removal of stitches
 Administer intramuscular/subcutaneous injections
 Administer nebuliser therapy
 Others
Log Book
1. Record all treatment procedures observed and performed in
your logbook
2. Identify the emergency trolley and it content. Participate in any
emergency procedures that arise.
Dispensary
1. Dispensing of drugs
 Observe initially and subsequently participate in the
dispensing of drugs
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2. Review each prescription received and pay attention to
 Format of the prescription chit
 Correct and complete entry of items required
 Type of medication prescribed and the duration
3. Explain to the patients about the medication prescribed
 Type
 Expected therapeutic effects
 How to take the medication
 Side effects
6. Community Base
Rehabilitation

1. Participate in health activity or program run by the rehabilitation
centre.
2. Each student will be assigned to one/two elderly person
There will be two visits to
active community base
rehabilitation centres such
as Psychosocial
Rehabilitation Centre at
Community Polyclinic
Temerloh and Geriatric
Rehabilitation Centre at
Community Polyclinic Bukit
Goh or Rumah Ehsan at
Bandar AMBS Dungun.
3. The student will take a full clinical history including using Elderly
Activities Daily Living questionnaire.
4.



In old Folk Home , further history should emphasizing more on
When, how and why he or she got into this home
Is she/he happy and comfortable in this home
Any contact with the family and much support getting from them
5. Perform a mental state examination and other screening
methods such as Geriatric Depression Scale.
Desired Competency on Completion of the Posting
At the end of the posting the student will have acquired the following:

Knowledge
The student should achieve good understanding of the current scientific knowledge of common
symptoms and diseases, including the behavioral aspect. They also should achieve good understanding
of holistic approach in primary care with emphasis on prevention, screening and cost effective
treatment.
18

Communication skills
The student should communicate effectively with patients, not only for gathering relevant medical
history, but also in patient education. The student should strive to develop the patient-centered
communication skills of a competent family doctor that they have observed during their attachment in
the health clinics.

Clinical skills
The student should be able to achieve the following:
Diagnose clinical problems in primary care using an efficient diagnostic strategy. The student
should be able to identify the patient’s ideas, concerns and expectations (“Is there a hidden
agenda?”). The student should be able to make a Whole Person Diagnosis.
Provide an investigation and management plan for common symptoms and diseases in primary
care. The student should manage not only patient’s presenting problem but also his continuing
problems, and make use of the opportunity to promote health and modify his health-seeking
behaviour.

Professionalism, ethics, and personal development.
The student should be aware of the prevailing moral and ethical standards expected of doctors.
They should be able to distinguish between rights of the individual and public and be constantly
aware of the medico-legal and ethical dimension of doctor-patient contact. The student should be
able to assess their personal strengths and weaknesses as a human being and accommodate
patient's wishes and frailty.
19
REFERENCES
Required Text
1. John Murtagh,(1994). General Practice. Mc Graw – Hill International edition. (3 rd edition)
2. Mc Whinney. (1996). Textbook of Family Medicine 3rd Edition, Oxford Unversity Press.
Recommended Text
1. Alma Ata 1978. Primary Health Care: Report of the International Conference on Primary Health Care,
Alma Ata, USSSR 6-12 September 1978, WHO Geneva 1978.
2. Robin C. Fraser . 2nd edition(1987). Clinical Method: A General Practice Approach . Butterworths
3. Rakel. 3rd edition ( 1987). Textbook of Family Medicine. Saunders
4. Rakel, R. E. (2002) Textbook of family practice (6th ed.). Philadelphia: W.B.Saunders.
5. Pendleton, Hasler (1983). Doctor-Patient Communication. Academic Press.
6. Wilcock, G.K., Gray, J.A.M., & Longmore, J.M. (1991). Geriatric problems in general practice (2nd
ed.). New York: Oxford University
7. Mary M. Burke, Joy A. Larmie. Primary Care of Older Adult, A Multidisciplinary Approach. Mosby. 2nd
edition, 2004
20
METHODS OF ASSESSMENT
Assessment
Part I
Continuous Assessment – 40%
End of Posting Examination - 60%
Part II
Closed marking system
Public Health
Family Medicine


Critical appraisal -10%
Peer assessment – 10%

Log book -10%

Family cases write up-20%

Community survey – 20%

Video/Role-Play-10%

Perceptorships/Seminar-10%

Multiple Choice Question (MCQ)

Patient Management Problems (PMP’s)

Short notes

Objective Structured Clinical Examination (OSCE)