Introduction to Primary Care

FFAAMMEE CoursesCourses Family Medicine Essentials -The Center of Post Graduate Studies in Family Medicine-

Three day module # 6 Common problems in FM: Gynecologic- Obstetric Problems

(Module # 6) Trainers’ Manual

A Course of The Center of Post Graduate Studies in Family Medicine, Riyadh

September-October, 2010 Introduction to Family Medicine: A Course of the Center of Post Graduate Studies in FM

Main Authors

The FAME courses are an initiative of the “Center of Post Graduate Studies in Family Medicine, Rabwah”. This work is supervised by Dr. Tarek Ibrahim Al Megbil. Authors involved are;

1. Dr. Abdul Sattar Khan 2. Dr. Abdulmohsen Al Tuwijri 3. Dr. Basema Al Khudair 4. Dr. Zekeriya Akturk 5. Dr. Maysoon Al Amoud 6. Dr. Sami Al Ayed

List of contributors in revision of materials of FAME 2010 (Names are mentioned in alphabetical order)

1. Dr. Abdulwahab G. Al Ghamdi MBBS. , SBFM , ABFM Consultant Family Physicain Trainer at the Joint Program of Family Medicine, Al Madinah

2. Dr Abdulrahman Saeed Abudahish MBBS,DKFFC,FKFFC,SBFM,ABFM Family Medicine consultant Supervisor of Home Health Care, Eastren province

3. Dr. Abdullah Mohamed Dhafer Al-Shahrani (MBBS / CABFM) Consultant Family Medicine & Diabetologist Al-Manhal Family Medicine Center Aseer KSA

4. Dr. Abdullah Ali Abdullah Khawaji (MBBS / CABFM/ SBFM) Consultant Family Medicine & Diabetology. Al-Manhal Family Medicine Center Aseer KSA

5. Dr. Abdullah Musleh Al Juhani MBBS(KAAU) , ABFM , JBFM Consultant Family Medicine Family Medicine Diploma supervisor-Al Madina

6. Dr Abdulelah Tali Alshairi KFFCM Deputy supervisor of post graduate for fellow ship of family medicine department

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7. Dr. Eman Matoog Al- Salman

MBBS,Saudi and Arab Borad Family Medicine

Trainer in Psotgraduate Family Medicine Diploma Program- Eastern Province – MOH

8. Dr. Faten A. AL-Rudaini MBBS, SBFM, ABFM Senior Registrar Centre for postgraduate studies in Family Medicine, Riyadh

9. Dr. Khalid O. Bawakid , Consultant Family Medicine , Head of Training & Continues Medical Education, Secretary General of the Saudi society of family and community medicine

10. Dr. Khalid Saad Al-Ghamdi consultant family and community med. supervisor of the postgraduate training program for family med Al Medina AlMunawara

11. Dr. Khalid Ali Al-Jifry Consultant, Family medicine (Arab board , Jordanian board). Research methodology diploma (American university, Cairo). Supervisor , PHC , north sector ,Makkah. Trainer in PHC training center, Makkah

12. Dr. M. Al-Doghaither MBBS, SBFM, ABFM, Fellowship-Canada Consultant Family Physician & Trainer Centre for postgraduate studies in Family Medicine, Riyadh

13. Dr: Mahameed Al Iraqi Al Alfi Consultant Family Physician Trainer in Al Fayziah Training Center For Post Graduate Family Medicine Diploma, Qassim Region, KSA

14. Dr.Mohammed A. AL-Eithean MBBS, SBFM, ABFM, JBFM EXECUTIVE SUPERVISOR OF OMRAN PRIMARY HEALTH CARE SECTOR SUPERVISOR OF PRIMARY CARE DEVELOPMENT PROGRAM IN AL- HASSA.

15. Dr.Montaser A. Bu-KHAMSEEN MBBS,SBFM, ABFM, JBFM EXECUTIVE SUPERVISOR OF HOFUF PRIMARY HEALTH CARE SECTOR COORDINATOR OF DIABETES CONTROL PROGRAM IN AL-HASSA

16. Dr.Mohammad Nahel Al Sawaf Consultant family medicine A.B.F.M \ Assistent clinical Prof. Al Qassim University

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17. Dr-Mohsin Abdu Adawi MBBS,SPFM,ABFM Consultant Family Physician Cheif of Training and clinical supervison of JIZAN

18. Dr Noura mohammed rashed al.harby working at PHC al.mahjar jeddah SSC-FM(Saudi Board of Mdical Specialization in Family Medicine) ABFM(Arab Board of Family Medicine)

19. Dr. Nawal Al- Qhatani

MBBS,Saudi and Arab Borad Family Medicine

Trainer in Psotgraduate Family Medicine Diploma Program- Eastern Province – MOH

20. Dr. Nadira Abbas Al-Baghli, consultant family & community medicine, Professions Medical EducationDr

21. Osama Mohammed alwafi MBBS, SAUDI BOARD OF FAMILY MEDICINE, ARAB BOARD OF FAMILY MEDICINE

22. Dr. Sami Saleem AL-Rehaily MBBS, SBFM, ABFM, DOHS - Ca Senior registrar, Family Medicine Trainer in joint Residency training Program of Family Medicine, Medina Head of Occupational Health department. MOH, Medina Director of the southern sector, PHC, Medina

23. Dr. Sami. Saleh Eid Head of Primary Health Care centers Affair - Jeddah Consultant Family Medicine

24. Dr. Saleh Abdel Fatah ALGabbany MBBSC , JMCFM,ABFM Ass. Clinical Professor-Al-Qaseem University Deputy Director of Training Program & Research Executive Director of Screening Program for Breast Cancer

25. Dr. Saud Hamed AL Zahrani Consultant Family Medicine-SBFM/ABFM/JBFM

26. Dr Wafa Allauddin Abdul Ghani Sheikh working at PHC al awali center al madinah al munawrah SSC-FM(Saudi Board of Mdical Specialization in Family Medicine) ABFM(Arab Board of Family Medicine)

27. Dr. Walid M. Al-Harbi MBBS , SBFM, ABFM

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Consultant Family Physician & Trainer

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28. Dr. Yahia Mater Al-Khaldi (MBBS / CABFM) Consultant Family Medicine Al-Manhal Family Medicine Center Aseer KSA

29. Dr. Wedad Mahmoud Bardesi Consultant family physician, ( Saudi &Arab board Family Medicine), Prince abdulmajeed health centre, Trainer in Post graduate centre of family medicine Jeddah

30. Dr. Zulfa Al-Rayees Consultant Family Physician Supervisor-Training programs I Training & Scholarship department MOH-Riyadh

31. Dr. Zeinab Ahmed Elzaldeen Khalaf Consultant Family Medicine (Saudi Board ,Arab Board ) Post graduate Diploma in total quality management for health care reform – American university in Cairo

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The need for postgraduate education for GP’s: Receiving high quality of health care is the fundamental right of every individual. However, due to the very diverse background of primary care doctors in KSA, we cannot speak of a standardized service for all regions. Although there are a lot of CME activities, it is necessary to have a centrally organized training, prepared and provided by family physicians with the viewpoint of family medicine and primary care to cover the real needs of the GPs and patients applying to them.

Structure of FAME courses: General aim of the FAME courses is to assist primary care physicians gaining the essential knowledge, skills, and attitudes for their daily practice. There will be a series of courses in a modular approach (Figure 1), each concentrating on a specific area but with integration within the different courses. Modules will concentrate on the main concepts in family medicine and the management of the most common problems encountered in daily practice.

As an example, the first module is a three days course for GPs. It is designed to give theoretical information on some main areas of family medicine including the definition and scope of family medicine, communication skills, consultation and referral, and the clinical method in family medicine. Each topic area starts with a lecturing and continues with group work, discussions and other interactive learning activities. The course is mainly constructed to enable interactive learning with opportunities of peer learning, brainstorming, small and large group discussions, didactic lecturing with audiovisual support as well as problem based approaches. Group discussions, role plays, and case discussions will be used to facilitate behavioral changes. As a distinct approach, this course is highly learner oriented with much emphasis on practical performance; one whole day is reserved for role playing and case discussions. Other modules will be run on a similar fashion.

Conclusion: We believe that the FAME courses will establish a well structured training facility for primary care physicians enabling them to gain theoretical knowledge as well as concrete and solid information, which they can directly apply at work. Long term result of the courses will be standardized and high quality physician work force in primary care.

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Module 1 Introduction to family medicine

Definition and basic concepts of family medicine, Communication skills, , Consultations, Approach to common diseases,Clinical methodUndifferentiated problem

Module 2 General concepts in family medicine

, Patient management, Screening PHE, Referrals, Malpractice, Ethical issues, Rational drug use, Medical records, s, Team work, Motivation

Module 3 Common problems in FM: Chronic disorders in FM

CHD, Hypertension, Diabetes, Obesity, Smoking, Respiratory problems

Module 4 Common problems in FM: Communicable diseases

Upper RTI, Lower RTI, Otitis media, UTI, Childhood infections (MMR, Chickenpox…), Vaccination, Gastroenteritis, Parasitic diseases

Module 5 Common problems in FM: Neurol./Mental/Musculos. Problems

The management of Stroke, Headache, Musculoskeletal disorders, Depression, and Somatoform disorders in primary care

Module 6 Common problems in FM: Gynecologic-Obstetric Problems

Preconceptional care, Pregnancy follow up, AUB, Dysmenorrhea, Family planning, Safe motherhood

Module 7 Professional Development in Family Medicine

Continuous professional development, Continuous quality improvement in FM

Figure 1: Topics and main contents of the FAME courses.

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Aim of the course

This course is designed to give an introduction to the basic principles of family medicine. It is anticipated that some further knowledge and skills will be build upon this base with other similar courses or other teaching and learning activities.

Participants of this course are expected at the end of the course to improve their knowledge, skills and attitudes on the definition and basic principles of family medicine, the approaches of primary care physicians in managing diseases, and basic methods of communicating with the patient. Attention is given to the most important clinical problems and situations general practitioners face at their daily life. Concrete information accumulation, which will be usable right after the course during daily clinical practice is aimed in the management principles of most common problems. Specific Objectives of the course

At the end of course, the participants will be able to:

Understand the general concept of family medicine Differentiate between patient centered and disease centered approach Understand holistic approach Demonstrate the good communication skills Apply consultation models in general practice Apply the recommended national/international guidelines for common health problems Utilize recommended screening/periodic health examination Apply the evidence based management for all common problems Have positive attitude for ethical approach Perform good practice management Manage total quality control in practice Aware about the research concept in family practice Know to how to develop him/herself professionally

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Specific objectives for Module 6 At the end of this session, the trainees will be able to;  explain the importance for preconception care .  explain importance of ; o Vaccination against Hep A,&B o Vaccination against Rubella. o Vaccination against Tetanus.  recognize the importance of the mandatory premarital check-up.  encourage patients for physical as well as emotional readiness for pregnancy.  llist referral criteria in preconceptional care  enumerate differential diagnosis and management for anemia.  explain how to calculate the EDD.  explain how to fill the ante-natal card .  enumerate investigations during the antenatal visit and the normal variations for each  define high risk pregnancy according to the latest guidelines  explain the indication for referral.  explain the importance of postnatal visit .  aware of importance of breast feeding explain lactation management principles  list the contraindication to breast feeding  define abnormal vaginal bleeding  discuss the path physiology of the menstrual cycle  enumerate different causes of ovulatory / anovulatory vaginal bleeding.  discuss the management of AUB  discuss the indication, contraindication & side effects for the following methods of contraceptive methods

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Program

Module 6 – Common problems in FM: Gynecologic-Obstetric Problems

Day 1 08:00-08:15 Warming up 1 08:15-08:30 Opening and Introduction 08:30-08:40 Needs assessment 08:40-08:45 Program presentation 08:45-09:15 Pre test 09:15-09:45 Presentation 1: Safe motherhood 09:45-10:00 Break 10:00-10:45 Group work 1: Safe motherhood 10:45-11:15 Presentation 2: Preconceptional care 11:15-12:00 Group work 2: Preconceptional counseling 12:00-13:00 Break 13:00-14:00 Group work 3: Iron deficiency anemia 14:00-14:30 Summary of day 1 Day 2 08:00-08:15 Warming up 2 08:15-08:45 Presentation 3: Normal pregnancy and antenatal care 08:45-09:45 Group work 4: Normal pregnancy and antenatal care 09:45-10:00 Break 10:15-11:00 Presentation 4: Postnatal care 11:00-12:00 Group work 5: Postnatal care 12:00-12:45 Break 12:45-13:15 Presentation 5: Breastfeeding 13:15-14:00 Group work 6: Breastfeeding 14:00-14:30 Summary of day 2 Day 3 08:00-08:15 Warming up 3 08:15-08:45 Presentation 6: Abnormal uterine bleeding 08:45-09:45 Group work 7: Vaginal discharge 09:45-10:15 Break 10:15-11:00 Presentation 7: Dysmenorrhea 11:00-11:30 Presentation 8: Family planning 11:30-12:30 Break 12:30-13:15 Group work 8: Family planning counseling 13:15-14:00 Group work 9: Well baby Care 14:00-14:30 Summary of day 3 14:00-14:30 Post test 14:30-15:00 Course evaluation and closing remarks

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Module 6 (Sessions, Objectives, Teaching methods, and Materials)

Day 1

Time Activity Aims-Objectives Method Materials 08:00-08:15 Warming up 1 Aim: At the end of this session, it is aimed to One of the warm up activities are chosen and  Warm-up refresh the participants and prepare them applied method physically and emotionally for the course. 08:15-08:30 Introduction of Aim: At the end of this session, it is aimed to Using an entertaining introduction method,  Introduction participants and introduce the course participants and trainers to the participants are introduced to each other method trainers each other, enable a trusting atmosphere and and warmed up. becoming ready for the course. 08:30-09:00 Pre test Aim: At the end of this session, it is aimed to Multiple choice questions (MCQ) will be  An MCQ test of measure the knowledge of participants regarding distributed and collected after 15 minutes. 10 questions the areas to be processed in this course. The trainees can put an anonymous mark on their paper to recognize and evaluate it later. At the end of the first day, trainers will type the results of the exam into a data sheet which will be used at the next morning. 09:00-09:10 Needs Aim: At the end of this session, it is aimed to Brainstorming.  Flip chart, assessment evaluate the learner needs and make the learner One trainer leads the discussion, another  Flip chart aware of the important learning areas of their trainer writes the ideas on a flip chart. The pencils peers. trainer asks the group “What are your expectations from this course? What kind of knowledge, skills or attitudes are you planning to receive in this course?” Participants are given 4-5 minutes to think

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and then responses are taken. At the end of this session, the flip chart is hanged on the wall, available till the end of the course. 09:10-09:15 Program Aim: To present the course program the The program, written on a flip chart is hanged  Course program presentation participants and discuss it’s matching with the on the wall and matched with the needs on flip chart learner needs. expressed by participants. Nonmatching areas  Course are discussed. If necessary program objectives on modifications are planned. flip chart 09:15-09:45 Presentation 1 Aim: At the end of this session, the participants Interactive presentation using audiovisual  Power point Safe are expected to have knowledge on preconception tools presentation: motherhood care. Presentation handouts will be provided to the Preconceptional Objectives: At the end of this session, the participants at the beginning of the lecture. care trainees should;  Data projector  be able to explain the importance for  Computer with preconception care . Microsoft Power  be able to xplain importance of ; point installed o Vaccination against Hep A,&B  Laser light pen o Vaccination against Rubella. o Vaccination against Tetanus.  recognize the importance of the mandatory premarital check-up.  encourage patients for physical as well as emotional readiness for pregnancy.  be able to list referral criteria in preconceptional care 10:00-10:45 Group work 1 Aim: At the end of this session, the participants Case scenario will be distributed to the  Case scenario Safe are expected to have knowledge on trainees (10-weeks pregnant lady (lady who wants motherhood preconceptional care. primigravida who came for registration). Ten to conceive)

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Objectives: At the end of this session, the minutes will be given for the trainee  Reference trainees should; individually then trainer will discuss the case materials  be able to counsel couples before and write the trainee notes on flip chart  Flip chart with marriage & before conception on the topics to chose following areas :  Paper and pencil o Smoking for the groups o Diet  be able to discuss antenatal program  be able to draw family genogram  be able to provide genetic counseling 10:45-11:15 Presentation 2 Aim: At the end of this presentation the Interactive presentation using audiovisual  Power point Preconceptional participants will have knowledge on safe tools presentation: care motherhood. Presentation handouts will be provided to the Safe motherhood Objectives: At the end of this session, the participants at the beginning of the lecture.  Data projector trainees should;  Computer with  be able to define of safe mother hood Microsoft Power  be able to discuss family planning point installed counseling principles.  Laser light pen.  be able to discuss the importance of safe motherhood to reduce maternal morbidity & mortality  be able to explain safe delivery principles 11:15-12:00 Group work 2 Aim: At the end of this session, the participants The Participants are divided into 5 groups  Case scenario Preconceptional are expected to have knowledge on safe each group chose a case scenario or a task. A  Flip chart counseling motherhood. time of 15 mints is given to prepare the Objectives: At the end of this session, the task .Then during the next 30 mints each trainees should; group present their task. Or role play their  be able to define of safe mother hood counseling session with Case scenario about  be aware of the importance of safe (lady who wants to conceive) and the others

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motherhood and its components are observing and writing their notes. Then  list safe motherhood components the trainer asks participants one by one to o Family planning, read out their opinions. Results are written on o Antenatal care, flip charts by the trainer. o Clean –safe delivery Any objections to the presented materials are o Essential obstetric care discussed if necessary.  be able to counsel mothers regarding: o Diet. o Vaccination. o Medication o Exercise. o Smoking  be able to prepare the mother physically and psychologically for labor.  be able to prepare the mother for breast feeding. 13:00-14:00 Group work 3 Aim: At the end of this session the participant Large group discussion will be applied. The  Flip chart. Iron deficiency should have knowledge on the management of following questions will be addressed:  Flip chart pens anemia iron deficiency anemia. . How to diagnose IDA? Objectives: At the end of this session, the . What are the differential diagnoses? trainees should; . What are the relevant points in the  be able to give the normal values for history? hemoglobin levels for males and females. . What the relevant investigations?  be able to enumerate differential . How do you manage IDA? diagnosis for anemia. The trainer will write down the answers on  be able to discuss appropriate flip chart and then modify what is needed. investigations  be able to discuss pharmacological and

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non-pharmacological therapies in IDA.  be able to discuss the role of family physicians in prevention.  be able to discuss referral criteria in IDA. 14:00-14:30 Summary 1 Aim: At the end of this session, the participants Summary of day 1  Flip chart will have the opportunity to consolidate the Self sticking papers are distributed to the  Self sticking knowledge they received in day 1. participants and requested to write down one cards of around and home work: literature on common antenatal sentence they learned during the day. The 15x10 cm problems( Anemia,preeclampsia, ante partum participant reads out loud what he/she wrote  The WHO hemorrhage) and sticks it on the flip chart. guidelines on After the summary, the WHO guidelines on high risk high risk pregnancies literature will be pregnancies distributed to the participants and asked to literature read by tomorrow.

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Day 2

Time Activity Aims-Objectives Method Materials 08:00-08:15 Warming up 2 Aim: At the end of this session, it is aimed to One of the warm up activities are chosen and  Warm-up refresh the participants and prepare them applied method physically and emotionally for the course. 08:15-08:45 Presentation 3 Aim: At the end of this session, the participants Interactive presentation using audiovisual  Powerpoint Normal will have knowledge on normal pregnancy and tools presentation: Pregnancy and antenatal care. Presentation handouts will be provided to the Normal antenatal care Objectives: At the end of this session, the participants at the beginning of the lecture. pregnancy and trainees should; antenatal care  be able to discuss principles of proper  Data projector history taking.  Computer with  be able to explain how to calculate the Microsoft EDD. Powerpoint  be able to explain how to fill the ante- installed natal card .  Laser light pen  be able to enumerate investigations during the antenatal visit and the normal variations for each  be able to define high risk pregnancy according to the latest guidelines  be able to explain the indication for referral.  be able to explain the importance of postnatal visit .  be aware of importance of breast feeding. 08:45-09:45 Group work 4 Aim: At the end of this session, the participants Participants are divided into 4 groups. A case  Case scenario: Antenatal care will be able provide appropriate antenatal care. scenario (lady with missed period) is given to amenorrhea

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Objectives: At the end of this session, the the groups. Trainers will support when  Antenatal card trainees should; necessary.  Paper and pencil  be able to discuss the symptoms of In each group one participant will act as the pregnancy & how to manage them patient in the case scenario and another one  be able to calculate EDD will play the doctor. The antenatal card will  be able to fill the antenatal card properly . be filled by the doctor.  be able to discuss the principles of clinical Other participants will give feedback at the examination end of the consultation.  be able to write a referral letter for high If time allows, participants will be rotated to risk pregnancy do the same exercise. 10:15-11:00 Presentation 4 Aim: At the end of this presentation, the Interactive presentation using audiovisual  Powerpoint The postnatal participants will have knowledge on postnatal tools presentation: care care. Presentation handouts will be provided to the The post natal Objectives: At the end of this session, the participants at the beginning of the lecture. care trainees should;  Data projector  be able to explain the importance of  Computer with postnatal visit . Microsoft  be able to discuss important issues for Powerpoint heath education during post natal visit installed (breast feeding, pelvic floor exercise)  Laser light pen  be able to discuss the importance of social during this period  be able to discuss management principles for o wound infection o mastitis o bleeding problems o postnatal blues o breastfeeding problems

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 be able to discuss referral criteria during the postnatal period 11:00-12:00 Group work 5 Aim: At the end of this session, the participants Role playing. Case scenario on postnatal  Case scenario: Postnatal care will be able to conduct postnatal care. patient. postnatal care Objectives: At the end of this session, the Participants are divided into 4 groups.  Paper and trainees should; In each group one participant will act as the pencils  be able to take proper history. patient in the case scenario and another one  Guideline on  be able to discuss the process of proper will play the doctor. postnatal care physical postnatal examination (BP, Other participants will give feedback at the abdominal examination). end of the consultation.  be able to do health education about The doctor should be emphasized to address o caring for episiotomy, the following questions: o breast feeding, 1: What are important points to be asked in the o diet, history? 2: Which physical examination will you do? o exercise 3: Would you suggest any laboratory  be able to discuss how to manage investigation diagnosis? . problems such as 4: What kind of feelings may the patient wound infection o have? o mastitis 5: What kind of social factors may have an o bleeding problems effect on his/her condition? o postnatal blues 6: What are the psychological aspects of this o breastfeeding problems case?  be able to discuss referral criteria during If time allows, participants will be rotated to the postnatal period do the same exercise. 12:45-13:15 Presentation 5 Aim: At the end of this presentation, the Interactive presentation using audiovisual  Powerpoint Breast feeding participants will have knowledge on advantages tools presentation: of breast feeding and common problems with Presentation handouts will be provided to the Breast Feeding breast feeding. participants at the beginning of the lecture.  Data projector

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Objectives: At the end of this session, the  Computer with trainees should; Microsoft  be able to understand the physiology of Powerpoint lactation. installed  be able to enumerate advantages of breast  Laser light pen feeding.  be able to explain the principles of “Baby Friendly Hosptal”  believe on the importance of health education about breast feeding even before conception .  be able to list medications contraindicated in pregnancy  be able to explain lactation management principles  be able to list the contraindication to breast feeding 13:15-14:00 Group work 6 Aim: At the end of this group work, the One voluntary participant will play the doctor  Simulated case Breast feeding participants will be able to provide breastfeeding who is giving counseling on breastfeeding to scenario breast counseling. another participant (15 min). feeding Objectives: At the end of this session, the Other participants will observe the  Flip charts trainees should; consultation and take notes.  Flip chart pens  value the importance of breast feeding At the end of the consultation, the trainer will  Paper and  be able to give breastfeeding counseling guide a feedback session. Positive remarks pencils  be able to discuss the advantages of and areas to be improved will be mentioned breastfeeding (20 min).  explain common problems with breast Major points will be summarized at the end feeding (10 min) o Sore nipples

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o Engorged breast. 14:00-14:15 Summary 2 Aim: At the end of this session, the participants Summary of Day 2 will have the opportunity to consolidate the The trainer prepares a powerpoint knowledge they received in day 2. presentation with multiple choice questions, open ended questions, and YES/NO questions. Each slide contains one question. With around 20 questions. He/she  directs the questions to the class and waits for a reply from somebody  tells the name of a participant and asks him/her to read and answer the question or  reads the question and then asks a participant to respond

Case scenarios for day 3 will be distributed here and trainees will be asked to prepare to play, interview, and observe the case practices.

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Day 3

Time Activity Aims-Objectives Method Materials 08:00-08:15 Warming up 3 Aim: At the end of this session, it is aimed to One of the warm up activities will be applied  Warm-up refresh the participants and prepare them method physically and emotionally for the course. 08:15-08:45 Presentation 6 Aim: At the end of this session the participants Interactive presentation using audiovisual  Abnormal Abnormal should have knowledge on abnormal uterine tools vaginal bleeding uterine bleeding bleeding (AUB). Presentation handouts will be provided to the  Data projector Objectives: At the end of this session, the participants at the beginning of the lecture.  Computer with trainees should; Microsoft  be able to define abnormal vaginal Powerpoint bleeding installed  be able to discuss the pathophysiology of  Laser light pen the menstrual cycle  be able to enumerate different causes of ovulatory/anovulatory vaginal bleeding.  be able to discuss the management of AUB 08:45-09:45 Group work 7 Aim: At the end of this session, participant will Participants are divided into 3 groups. Case  Flip chart Vaginal have knowledge on the management of vaginal scenarios with vaginal discharge and vaginal written on it the discharge discharge. discharge treatment guidelines will be four tasks. Objectives: At the end of this session, the distributed to the groups.  Pens trainees should; Groups will select a reporter, a moderator and  Case scenario  be able to discuss diagnosis of bacterial a writer. Vaginal vaginosis Each group will be asked to work on Discharge o history, preparing a management plan for their case o examination, scenario (30 min). o investigation Group reporters will share their cases and

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 be able to discuss the treatment of management plans with other groups. bacterial vaginosis Reflections will be taken (30 min).  be able to discuss the symptoms of At the end the trainer will summarize vaginal candidiasis important points in the management of  be able to discuss the treatment of vaginal vaginal discharge (15 min).(WHO , BMJ candidiasis algorithms)  be able to discuss differential diagnoses of vaginal discharge  be able to discuss principles of vaginal hygiene  be able to discuss health education regarding prevention of vaginal infections 10:15-11:00 Presentation 7 Aim: At the end of this session, participants will Interactive presentation using audiovisual  Powerpoint Dysmenorrhea have knowledge on the management of tools presentation: dysmenorrhea. Presentation handouts will be provided to the Dysmenorhea Objectives: At the end of this session, the participants at the beginning of the lecture.  Data projector trainees should;  Computer with  be able to define primary and secondary Microsoft dysmenorrhea. Powerpoint  be able to list causes of dysmenorrhea installed  be able to enumerate important points to  Laser light pen ask about in the history  be able to list drug groups used for dysmenorrhea  be able to discuss dymenorrhea-associated signs and symptoms 11:00-11:30 Presentation 8 Aim: At the end of this session participant should Interactive presentation using audiovisual  Powerpoint Family have knowledge on family planning principles in tools presentation: planning FP. Presentation handouts will be provided to the Family Planning

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Objectives: At the end of this session, the participants at the beginning of the lecture.  Data projector trainees should;  Computer with  be able to discuss the aim of family Microsoft planning Powerpoint  be able to describe the approach in installed patient counseling  Laser light pen  be able to describe different methods of contraception  be able to discuss the indication, contraindication & side effects for the following methods : o Oral contraceptives o Barrier methods. o Intrauterine Devices. o Injectable hormones o Implants hormones. 12:30-13:15 Group work 8 Aim: At the end of this group work, the Participants are divided into 4 groups.  Family planning Family participants will be able to provide family They will be given a task for) of 15-20 reading materials planning planning counseling. minutes duration for their peers. Material for  Two case counseling Objectives: At the end of this session the reading will be provided. Scenario participant should; Group 1: Please answer the following  Flip charts  be able to counsel couples for family questions:  Pens. planning. 1- What is family planning counseling?  be able to facilitate clients to choose the 2- Name an approach shown to provider suitable contraceptive method a good counseling .  be able to discuss individualized 3- What are the elements/principles of contraceptive needs this counseling approach?  be able to counsel clients regarding the 4- Discuss each of these element s. side effect for each method

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 be able to discuss failure rates for each contraceptive method. Group 2: Please answer the following questions: 1- List the methods of family planning? 2- What is the effectiveness of these methods? 3- Provide basic information of each method – mechanism of action, advantages and side-effects.

Group 3: a role-play Group 4: a role-play

The first two groups groups work for 10 minutes to prepare the answers. Then the first two groups will discus the question given to them. The third and forth group will present their role play and discus the answers given to them. A check-list will be provided for group three. Facilitators will be around to help. Summary will be done by the trainer (5 min) 13:15-14:00 Group work 9 Aim: At the end of this session, the participants  Flip chart with Well baby care will increase their knowledge on well baby care Participants will be divided into four groups topics to chose practice. and each group will have one article to  Paper and pencil Objectives: At the end of this session, the present at the end of the group work. for the groups trainees should; Each group chose a presenter and a leader and 3 articls about  describe how to interpret a growth curve discus their article for 5 minutes. child abuse , home for a child at well baby clinic On flip chart each presenter present his group accidents , child  describe what is magnitude of iron work in 5 mints. anemia

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deficiency anemia At the end 5 mints are given to reflections on  describe problems which accidents effect the work . babies in Home environment  discuss the role of primary care team in reducing child home injuries  describe the current situation in child abuse in Saudi Arabia 14:00-14:30 Summary of Aim: At the end of this session, the participants Summary of day 3  Flip chart day 3 will have the opportunity to consolidate the Self sticking papers are distributed to the  Self sticking knowledge they received in day 3 participants and requested to write down one cards of around and home work: literature on HRT will be given. sentence they learned during the day. The 15x10 cm participant reads out loud what he/she wrote  Current evidence and sticks it on the flip chart. for HRT After the summary, the cuurent evidence for treatment Flip HRT treatment will be submitted. Summary chart of day 3  Flip chart pen

14:30-15:00 Post test Aim: At the end of this session, the participants  are expected to have knowledge on what they learn in day 3

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Educational Activity Evaluation Form (for materials) FAME Courses – Module 6 G N I T

t r A e e l d l l s y e e e d e n i e g t R t c c b i e a g h i

k i h d a r t a v t v s d p L c i e t

d u o Please rate different c l t e r e r o

t l l e a t c a o c p w e h r A h f a w e r

c o u t u e dimensions of the activity by p

o r f

a n m h s R t s r e e n o t e k o s a r

E a c e writing scores to the

c w l l y o y p n

h l V l W t t o W t s a o e i e o m O n appropriate boxes. Use the r a h r g

w w w k j p

n d w

a i t

s s e e following key: e d n g e a a s m h r k

e t h n a w r o i

t W v

t e

c o d h t r e n c l o s e c e w o r a e d e

NA - Not applicable i s n

r r t a

I p

l f o a e d k u t a e 3 – yes t r

h r e c o l n

o r z / t u i s e

f G w

2 – to some exent u s y

p e b h l a d p

r e e p 1 – no g e u P r r r H o e a o o r

h e f t l g

T e

u e b d o

(PE=Physical environment) n d m i w a n t

a t n n s H o K i r i t F a t n e s e r

Topic: P Presentation 1: Preconceptional care Group work 1: Preconceptional counseling Presentation 2: Safe motherhood Group work 2: Safe motherhood Group work 3: Iron deficiency anemia Presentation 3: Normal pregnancy and antenatal care Group work 4: Normal pregnancy and antenatal care Presentation 4: Postnatal care Group work 5: Postnatal care Presentation 5: Breastfeeding Group work 6: Breastfeeding Presentation 6: Abnormal uterine bleeding Group work 7: Vaginal discharge Presentation 7: Dysmenorrhea Presentation 8: Family planning Group work 9: Well baby Care

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Educational Activity Evaluation Form (for presenter) FAME Courses – Module 6

The presenter t t t r s s s s d G t s t c c a e n e e e u

Please rate different dimensions of the activity u n e v z N o i j l r i i i p o I t t c t o b n s

d c s T p f

by writing scores to the appropriate boxes. Use u a e s

n e e s r o A j r a g

u r b o e R the following key: e h h j q W o

o r t /

i a

, l t s L e l

d n w d L h m r e i

o p o i A a e c w d f

NA - Not applicable l n e s o s R n a u z m u i a e E u m o r i s 5 – Excellent c t s V n a s W i d a i a i v n

u s O d m

4 - Very good " a o

a i u

e m t f d h g o t u e

3 – Good a t u n

i n s S a M " d

k e

f 2 – Marginal e n a i o d n

h e e d t 1 - Insufficient e t

s e w , s i t o u h

s L s h i e e l S r v b i e t a t t c n s e (PE=Physical environment) i f E f d e e

g e a d r a u M o c n E Topic: Trainer: Presentation 1: Preconceptional care Group work 1: Preconceptional counseling Presentation 2: Safe motherhood Group work 2: Safe motherhood Group work 3: Iron deficiency anemia Presentation 3: Normal pregnancy and antenatal care Group work 4: Normal pregnancy and antenatal care Presentation 4: Postnatal care Group work 5: Postnatal care Presentation 5: Breastfeeding Group work 6: Breastfeeding Presentation 6: Abnormal uterine bleeding Group work 7: Vaginal discharge Presentation 7: Dysmenorrhea Presentation 8: Family planning Group work 9: Well baby care

29 / 33 Introduction to Family Medicine: A Course of the Center of Post Graduate Studies in FM Rules and Regulations

The course will be conducted according to the following rules and regulations:

1. This course will be run under the supervision and authority of the MOH. 2. In order to attend the all modules; the participants will have to attend Module 1 & 2. 3. Participants of the course are practitioners or family physicians working in primary care. 4. Maximum total number of participants is 25 persons for each course. 5. A written feedback from the trainees will be taken after each activity. 6. Each module should be run by at least 2 trainers. 7. Participants who pass the course will receive a participation certificate. 8. The learning environment will be decided by the trainers and trainees. A semicircle or U shape is suggested. 9. One of the trainers is responsible of taking notes during the sessions. He/she will write down observations, questions arising by the trainees, and problems encountered. 10. Every trainer prepares a written report on the course and presents it to the course leader. 11. The course leader prepares a report of the course including the opinions of the other trainers with suggestions of improvement and presents it to the Center of Postgraduate Studies, Riyadh. 12. Theory lectures are not aimed to give full depth content knowledge. Instead, the short lectures of 30 minutes should point towards the most important aspects of the issue and resources for learning. Hence we suggest presentation slides to be not more than 25 slides per session.

Course Evaluation

Each session of the course will be evaluated by the learners using the following course rating scales. Oral feedback will be taken from the learners at the end of the third day. Each trainer will prepare a personal report on the course mentioning possible areas to be improved. With the guidance of these reports, the course leader will prepare the final report of the course.

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Learner Evaluation

Learner evaluation will depend on the participation in the course. Learners are mandatory to attend 90% of the sessions. It is not possible to repeat the course for non attendees and they will not receive the course certificate. However, they can apply to future courses.

Reinforcement

Opportunities will be provided for the reinforcement of the learning. The trainers will be encouraged to apply the learned content and take contact with the training team whenever necessary. Continuous support will be promised and provided whenever necessary and possible. If desired and accepted by the trainees, e-mail or other contacts of the trainers as well as trainees will be exchanged to keep in touch. The trainees will be informed about future courses of the Training Center and they will be encouraged and prioritized in participating to these courses.

CME Credit and Course Certificate

The Ministry of Health is responsible for the arrangements of CME credits and course certificate. The course outline will be sent to the Saudi Commission for Health Specialties for approval and accreditation of CME credits. Successful participants will receive for each module their “course participation certificates”. Those who participate to all seven modules of the FAME courses will receive the “Basic Family Medicine Training Certificate”.

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References

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