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THE ROLE OF FAMILY PRACTICE IN THE ROLE OF FAMILY PRACTICE IN UNDERGRADUATE MEDICAL EDUCATIONUNDERGRADUATE MEDICAL EDUCATION

Trakya University Medical Faculty,

Edirne, Turkey

Zekeriya Aktürk, MD

Nezih Dağdeviren, MD

Erkan Melih Şahin, MD

Cahit Özer, MD

Title

and

Staff

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Why Famiy Practice in Medical Education ?

• Medical education: 90 % hospital

• Turkish doctors: 60 % primary careİntroduction

Primary

Secondary

Tertiary

Education Practice

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Current Condition in Turkey

• Population: 65.000.000

• Medical faculties: 47

• Family practice departments involved in education: 7 (15 %)

• This year Family Practice Department at Trakya University has started lectures to phase I.

Current State

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Introduction to Clinical Practice (ICP)

• Phase I: 135 students

• First semester– 16 hours theory– 16 hours practice

• Second semester– 16 hours theory– 32 hours practice

ICP

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First Semester Lectures

Lecture Load• Needs assessment 1• Medicine as a profession 2• Health and Illness 1• The effect of community on health 1• Cultural factors and health 1• Quality in health services 1• Health promotion 1• Preventive health care 2• Communication skills 2• Interviewing methods 1• Patient education and counseling 1• History taking skills 1• Evaluation 1

Curriculum

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First Semester Practices

Lecture Load (h)

• National internet resources 2• IM and IV injection techniques 2• Arterial blood pressure measurement 2• Health unit observation (services) 2• Health unit observation (policlinics) 2• Approach to the trauma patient: 2• Evaluation 4

Curriculum

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Second Semester Lectures

Lecture Load (h)

• Principles of physical examination 1• Periodical health examination 1• Functional health status 2• Clinical problem solving 2• Consultations 2• First aid 4• Common diseases at primary care 2• Tobacco and other harmful substances 2

Curriculum

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Second Semester Practices

Lecture Load (h)

• Urethral catheter insertion 4• Communication (History taking) 4• Communication (Examination) 4• Communication (Drama) 4• CPR 4• Sterile dressing 2• Suture techniques 2• Evaluation and feed-back 8

Curriculum

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Staff and Setting

Staff and Setting

• Lecturers– Family medicine– Public health– Anesthesiology

• Theory: large group education

• Practice: groups of 30-35 students

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Teaching Materials and Methods

Teaching Method

• Lectures– Lecturer– Slides– Video– Discussion

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Teaching Materials and Methods

Teaching Method

• Practice– Communication

• Small group education: 3-4 students

– CPR, blood pressure etc• Simulators

• Health unit observation– 3-4 students for each service or policlinic– Guided by an educator

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Student Evaluation

Evaluation

• Lectures– Two interval exams– One final exam for each semester

• Practice– OSCE

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Curriculum Evaluation

• SETh course rating scales– Didactic– Interactive

Feed-back

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Our Experiences

• Primary care should be involved in all phases of medical education

• The role of family practice is limited with phase I• Some of the topics shoul be tought to higher

classes• We had to prepare a curriculum to cover as

much areas as possible. • Some practices necessitate baseline medical

knowledge.

Experiences

Curriculum

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Our Experiences

• Lecture load should be enough to cover all necessary areas

• The lecture load reserved for ICP was not enough to cover all headings of primary care.

• Some important topics like fever measurement and wound care had to be omitted.

Experiences

LectureLoad

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Our Experiences

• Enough teaching material should be available

• Suture techniques, IV injection, urethral catheterization

• Simulators • Abdominal palpation • Heart auscultation

Experiences

Material

Quantity

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Our Experiences

• Teaching material should be of high quality

• Firm structure of the simulators disable– abdominal palpation – urethral catheter insertion.

• Leakage from the simulator reservoirs.

Experiences

Material

Quality

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Our Experiences

• Enough educators should be available

• Teaching staff – 5 educators for the lectures – 3 educators for the practices.

Experiences

Educators

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Our Experiences

• Effective Feed-Back should be taken

• We obtained overall good feed-back results. • SETh

– Didactic 3,76 ± 0,73– Interactive 4.02 ± 0.66

Experiences

Feed-back

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Our Experiences

• Accurate evaluations should be done

• Multiple choice questions as well as OSCEcould be applied successfully.

• Faculty regulations: mean score above 60 %• All students passed• Mean passing score: 62.6 ± 14.89.

Experiences

Evaluation

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Our Experiences

• In General

• Medical students have difficulties in making a picture in their mind about what medicine is and what they will face after 6 years when theygraduate.

• ICP is a good means to make things clear and maintain the motivation of students to become a good doctor.

Experiences

General

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Conclusion

• Implementing family medicine in medical educations is an inevitable step in order to educate doctors who are able to respond the needs of the population.

• To achieve this goal – An experienced staff

(sufficient in quality and quantity)– Lecture series continuing troughout all

phases of medical education, – Teaching material

Conclusion