RCSI Department of GP and Medical Course 2024-2025 PDF

Department of General Practice Drs Emer O’Brien, Máirtín Ó Maoláin and Shane Dunlea Presented by Dr. Abeer Khalaf Family Medicine Lecturer GP Department- RCSI Bahrain 2024-2025 FFP1 MODULE LEARNING OUTCOMES 1. Use effective strategies (e.g., communication, collaborati...

Department of General Practice Drs Emer O’Brien, Máirtín Ó Maoláin and Shane Dunlea Presented by Dr. Abeer Khalaf Family Medicine Lecturer GP Department- RCSI Bahrain 2024-2025 FFP1 MODULE LEARNING OUTCOMES 1. Use effective strategies (e.g., communication, collaboration, interventions) as part of a team 2. Describe global trends in morbidity and mortality using Global Burden of disease study data 3. Display knowledge of the basic framework of the Calgary Cambridge Model in communication 4. Discuss the application of professionalism, leadership and resilience (i.e. the constructs of Personal and Professional Identity) to manage self and engage with patients, colleagues and communities. 5. Describe the biomolecular, cellular and biochemical fundamental to life, and the principles of pharmacology 6. Describe the social determinants of health and the breadth and function of the public health and health promotion role. 7. Explain the pathological and immunological processes underlying disease 8. Identify the characteristics of medically important microbiological organisms and pathogenesis of bacterial infections 9. Explain the principles of microbiological diagnostic investigation 10. Explain psychological principles of maintaining health. FFP1 MODULE LEARNING OUTCOMES 1. Use effective strategies (e.g., communication, collaboration, interventions) as part of a team 2. Describe global trends in morbidity and mortality using Global Burden of disease study data 3. Display knowledge of the basic framework of the Calgary Cambridge Model in communication 4. Discuss the application of professionalism, leadership and resilience (i.e. the constructs of Personal and Professional Identity) to manage self and engage with patients, colleagues and communities. 5. Describe the biomolecular, cellular and biochemical fundamental to life, and the principles of pharmacology 6. Describe the social determinants of health and the breadth and function of the public health and health promotion role. 7. Explain the pathological and immunological processes underlying disease 8. Identify the characteristics of medically important microbiological organisms and pathogenesis of bacterial infections 9. Explain the principles of microbiological diagnostic investigation 10. Explain psychological principles of maintaining health. LECTURE LEARNING OUTCOMES 1. Discuss the structure & access to the healthcare system in Ireland & the Kingdom of Bahrain 2. Outline what primary care is and how patients access this care 3. Discuss General Practice and how it fits in 4. Outline the role of the Department of General Practice in the medical programme 5. Recall how communication and examination skills are taught and assessed 6. Explain what Early Patient Contact is and its relevance to patient care 7. Explain Healthcare Symposia and what is expected of students 8. Discuss the importance of Professionalism and how it relates to medical students THE HEALTH SERVICE IN IRELAND STRUCTURE OF HEALTHCARE SERVICES Secondary and tertiary care Primary care Self care  Secondary and tertiary care Primary care Self care Primary care is an approach to care that includes a range of services, designed to keep people well, from promotion of health and screening for disease to assessment, diagnosis, treatment and rehabilitation as well as personal social services. The services provide first level contact that is easily accessible and has a strong emphasis on working with communities and individuals to improve their health and social well-being. The term ‘primary care’ is often used synonymously with ‘general practice’ (GP) or 'family medicine' but also includes other services.  PRIMARY CARE TEAMS GP Podiatrist Nurse/midwife Community welfare Healthcare assistant officer Home help Community pharmacist Physiotherapist Dentist Occupational therapist Social worker Dietitian Receptionist Psychologist/therapist Clerical assistant Speech & language Administrator therapist  ACCESS TO HEALTHCARE IN IRELAND PRIMARY HEALTHCARE Medical cards: They are ‘means tested’ (* some discretionary cards based on ‘exceptional’ Eligibility to health care medical need) in Ireland (%) FREE GP care (including out of hours) FREE primary care services (but waiting lists and some services not available) FREE medications (small fee; ‘prescription GPcharge’) visit cards (General): Means tested; age 8-69 can apply ~35% FREE GP care (including out of hours) PAY for other primary care services (e.g. ~55% physio) PAY for medications (*maximum ~€80/ month ~ 10% per family = Drug payment scheme) GP Visit Cards (Specific): Under 8, Over 70, Carers Expansion to certain categories of population GMS patients (medical card patients) GP Visit Card patients Private: PAY for GP care ? ~€55 per consultation Private patients PAY for primary care PAY for medications (*maximum9 ~€80 / month per family = Drug payment scheme) GENERAL PRACTICE IN IRELAND Approximately 4000 GPs in Ireland: – Approximately 200 GP trainees qualify each year – But…. 700 GPs due to retire in the next 5 years. – Roughly 50:50 gender split Most GPs work in group practices with GP clinics (surgeries) located in health centres, primary care centres, purpose-built buildings or converted houses.  CHARACTERISTICS OF GENERAL PRACTICE Barbara Starfield identified what she considered to be the four central features of effective primary care: First Contact Continuous Comprehensiv Coordination care e The point of Coordination of first Contact Person- Comprehensiv care. for all patients focused e care for all care rather than provided for needs. disease- all needs that focused are common  10.15am Jane F 18/12 Cough and A TYPICAL MORNING IN A Costa temperature DOCTOR’S Time Patient CLINIC Gend Ag Primary complaint name er e 9.00am Jane M 68 Short of breath Bloggs 9.15am Joe Bloggs F 72 Multiple chronic illnesses (diabetes, IHD, HF) for follow up 9.30am Joe Smith M 26 Severe anxiety and panic attack symptoms 9.45am Jane Smith It’s F 8.45am, you are in the practice and you 4/1 Childhood immunisation don’t know2 what complaints the patients will 10.00am Joe Murphy M 54 bring Needs up prescription for asthma 10.15am Jane F 21 Concern regarding a STI Murphy 10.30am Jo Brady F 24 Insertion of an intra-uterine device 10.45am Jane Brady F 62 Painful left shoulder 11.00am Joe Ahmed M 74 Couple attend- concerned regarding Jo’s memory Minority needed investigations 11.15am Jane F 34 Antenatal check-up 32/40 pregnant 25-30 patients Ahmed per day One referral (to physiotherapy); no referrals to hospital 12-15 mins/ Joe patient M All 52 known Surgeryto to the 11.30am GP toenail Variety ofO’Reilly presentations First time patients present to the healthcare 11.45am Jane F 35 Addiction to opiates and comes for methadone service O’Reilly prescription GENERAL PRACTICE IN BAHRAIN General Practice  Family Medicine  Primary Care Family Physicians/Consultant Family Physicians Family Medicine in Bahrain – Following 1-year internship -> 4-year residency training program Arab Board certification – 2-year ‘clinical masters’ program (with AGU) – F>M Public sector – Primary Care Centers – Approx. 28 in total (Nine 24/7 primary care centers available) Private sector – Family Physicians, GPs GENERAL PRACTICE IN BAHRAIN Primary healthcare – cornerstone of healthcare in the Kingdom of Bahrain – Kingdom of Bahrain has adopted the Universal Declaration of the Alma-Ata in 1978 and the Astana Declaration in 2018 to achieve universal health coverage* Access to primary care is pivotal to achieving health for all via global strategy ACCESS TO GP IN THE KINGDOM OF BAHRAIN – Primary Care is the first point of contact for individuals Free for all citizens to access Management of acute illnesses, management and follow up of chronic illnesses, urgent care Laboratory & X-ray services, Pharmaceutical services, Social services, Physiotherapy & Dental services Referral services (if applicable) to secondary care hospitals Preventative Services » Antenatal Services » Periodic Child Screening » Immunization » Post-natal/post-miscarriage services » Family Planning Services » Periodic Women’s Screening Services » Pre-marital Services » Ultrasound screening for pregnant women RCSI DEPARTMENT OF GP AND THE MEDICAL COURSE GP DEPT TEACHING IN YEAR 1 AND 2 Communication Skills Examination Skills PROFESSIONAL ISM Introduction to Prescribing Early Patient Contact and Clinical Decision Making GP DEPARTMENT IN LATER YEARS Y3 Student Selected Y4 GP Compone module nt 6-week rotation COMMUNICATION SKILLS IN YEAR 1 Resourc Format Content es Calgary Cambridge Systems Lecture consultatio Folders n model Formal Small History Patient group taking Scenarios tutorials structure EXAMINATION SKILLS IN YEAR 1 Resourc Format Content es BMF – Knee and PNS Systems Lecture Exams Folders CVS Exam Small group Task Lists tutorials RESP Exam ASSESSMENT IN YEAR 1 Knowled Clinical PPID ge Skills Clinical Clinical Knowledg Skills Skills e Checks Evaluation Evaluation s* s* *Exa m Skills Only Progress OSCE OSCE Tests ATTENDANCE EARLY PATIENT CONTACT There is something different about studying Medicine. What exactly is it? EARLY PATIENT CONTACT There is something different about studying Medicine. What exactly is it? The public trust (most trusted profession) Responsibility bestowed on us, as doctors Privilege Potential to help...and also harm… so we need to be humble Challenges… so we need to reflect Confluence of science and social science There is uncertainty...this can make us uncomfortable Makes medicine intellectually interesting and rewarding  EARLY PATIENT CONTACT There is something different about studying Medicine. What exactly is it? she/they The public trust (most trusted profession) Responsibility bestowed on us, as doctors Privilege she/they Potential to help (and also harm)…. So need to be humble Challenges…. So we need to reflect Confluence of science and social science There is uncertainty That’s what makes Medicine so intellectually interesting and rewarding HEALTHCARE SYMPOSIA (HCS) Patient living with a chronic condition Experience of the healthcare system and the impact of illness on their lives and their families Opportunity to ask questions and learn more about these patients’ lives Respect patient confidentiality Do not record video or audio of these sessions NOT recorded on Moodle Year 1 Healthcare Symposia Year 2 EARLY PATIENT CONTACT Develop an appreciation of the ‘difference’ between study and experiential learning Understand how important it is to consider patient’s experience of their illness you will learn to put yourself in the patient’s shoes (compassion and empathy) Learn the power of listening to patients The importance of doctor’s professional responsibilities and learning about your own professional identity Learn the importance of the patient-doctor relationship and patient- centered care Your duty is to be respectful and professional, at all times Understand the importance of managing your own emotions and thoughts and caring for your own health; meeting patients can be challenging  EPC: THE ILLNESS EXPERIENCE Understanding the patient’s experience of illness is a key component to the successful practice of Medicine – will have lecture on this in FFP1 Calgary Cambridge model to communicate with patients Ideas – beliefs about the cause of illness Concerns – worries about the presenting illness Expectations – anticipated assistance for the illness Effects – the effect of illness on the patient’s life EPC: DOCTOR PATIENT RELATIONSHIP Continuity Respect Hope Patien Compassion Physicia t n Trust Self- awareness Healing Transference and Counter transference Patient-doctor relationship EPC: PATIENT-CENTRED CARE Good patient –doctor communicati on Accurate Good diagnosis rapport in and the patient- understandi doctor ng of illness relationship experience Effective Patient and treatment physician plan with satisfaction good adherence EPC: PROFESSIONALISM Punctuality: arrive on time Confidentiality: any information patients share with you must be kept strictly confidential Respect and behaviour: give the patient your undivided attention. Do not use mobile phones or laptops during these sessions. Do not speak amongst yourselves. PROFESSIONAL RESPONSIBILITIES http://www.medicalcouncil.ie/Education/Career-Stage-Under graduate/Guidelines-for-Medical-Schools-on-Ethical-Standar ds-and-Behaviour-appropriate-for-Medical-Students.pdf ADDITIONAL READING https://www.hse.ie/eng/services/list/2/primarycare/pcteams/ https://www.hse.ie/eng/services/list/2/primarycare/community-healthca re-networks/ https://www.hse.ie/eng/services/publications/corporate/cho-faq.pdf Any questions or comments? THANK YOU!