The Specialist Training in Family Medicine Curriculum
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The Specialist Training in Family Medicine Curriculum Malta College of Family Doctors Revised by the Curriculum Board 2019-2021 1 Dedication To all GP trainees and their GP trainers, and to all those who support them in their mission, making our common vision for the future of Family Medicine in Malta come to fruition. In living and loving memory of an affable colleague, the late Dr Saviour Cilia, whose infective enthusiasm to see the STPFM take off, will be fondly remembered by all those who had the privilege of making his acquaintance. 2 Authors First edition 2010 Dr Alessandra Falzon Camilleri Dr Daniel Sammut Second edition 2021 Editor Dr Natalie Psaila Authors Dr Jurgen Abela Prof Pierre Mallia Dr Jason Bonnici Dr Ian Psaila Dr Christopher Deguara Dr Natalie Psaila Dr Maria Deguara Dr Anne-Marie Scerri Dr Simone Deguara Dr Jean Karl Soler Dr Marco Grech Dr Jacob Vella Dr Marilyn Harney Dr Dorothy Zammit 3 Peer Reviewers Prof Dr Med Erika Baum, Universität Marburg, Germany Prof Christophe Berkhout, MD, MSc, PhDR, France Prof Francesco Carelli, University of Milano, Italy Prof Dr Ayşe Çaylan, Trakya University Medical School, Turkey Prof Dr Med Jean-François Chenot, MPH, Germany Dr Ana Rita de Jesus Maria, MD, Portugal Prof Lyubima Despotova-Toleva, MD, PhD, Bulgaria Assoc Prof Rositsa Dimova, MD, PhD, Bulgaria Dr Filipa Granado, USF Reynaldo dos Santos, Portugal Dr Marina Guisado Clavero, MD, PhD, Spain Assistant Prof Bruno Heleno, Universidade Nova da Lisboa, Portugal Assoc Prof Didem Kafadar, MD, PhD, Turkey Prof Oleksii Korzh, Kharkiv Medical Academy of Postgraduate Education, Ukraine Dr Mohammed Morad, MD, Israel Enda Murphy MA, RGN, RPN, DipREBT, MCBPI, MICP. MEAP., Ireland Dr Leonardo Muscovici, MD, PhD, Brazil Dr Kathryn Nicholson, PhD, Canada Dr Henry M.F. Palandeng, MD, M.Sc, FISPH, FISCM, Indonesia Dr Ferdinando Petrazzuoli MD, PhD, Italy Dr Modesto Martinez Pillado, MD, PhD, MSC, Spain Dr Celina Silvia Stafie, Lecturer, PhD, Romania Prof Victoria Tkachenko, MD, PhD, Dr.Sc. in Medicine in General Practice, Ukraine Prof Jose M Valderas, University of Exeter, UK Dr Tiago Villanueva Gutierrez Arruda Marques, USF Reynaldo dos Santos, Portugal Prof Shlomo Vinker MD, PhD, Israel 4 Acknowledgements We wish to thank the current MCFD council for its support. We also extend thanks to the Postgraduate Training Coordinators, Dr Gunther Abela and Dr Mario Sammut for their advice and contribution. We are grateful for the assistance and encouragement we have always received from our RCGP IDA Dr Jeremy Stupple. Last but not least, we remain indebted to the help given to us by the EGPRN and its members to carry out a peer review of this curriculum. 5 Contents Dedication 2 Authors 3 Peer Reviewers 4 Acknowledgements 5 Section A: Introduction, Definition and Implementation of the Curriculum 1. Core Competencies 10 2. Educational Tools 20 Section B: Key Features of Family Medicine 3. The Consultation 27 4. Patient Safety 35 5. Medical Ethics 41 6. Healthcare Law 51 7. Evidence-based Medicine 62 8. Pharmacotherapeutics and Prescribing 69 9. Social Problems, Services and Benefits 78 10. Chronic Disease Management 90 11. Disease Prevention and Screening 96 12. Information Management and Technology 104 13. Teamwork, Leadership and Referral 109 14. Practice Management 114 15. Personal and Professional Development 120 16. Research, Theory and Practice 131 17. Teaching, Mentoring and Supervision 140 6 18. Nutrition 144 19. Occupational Health 155 20. Transcultural Medicine 163 21. Complementary and Alternative Medicine 169 22. Palliative Care 175 23. End-of-Life Care: Ethical, Legal, Social issues and Communication 182 24. Smoking, Alcohol and Substance Misuse 188 25. Environmental Health 199 Section C: Clinical Medicine 26. Applied Genetics 212 27. Paediatric and Adolescent Health 220 28. Men's Health 232 29. Gynaecology and Breast Disease 240 30. Obstetrics 251 31. Care of Older Adults 257 32. Cardiovascular Health 263 33. Respiratory Health 273 34. Gastrointestinal Health 279 35. Neurology 289 36. Diabetes, Endocrinology and Metabolism 295 37. Rheumatology 309 38. Orthopaedics and Sports Medicine 318 39. Renal Medicine and Urology 325 40. Infectious Disease 337 41. Haematology and Immunology 347 42. Emergencies 356 7 43. Sexual Health 365 44. Mental Health 374 45. Ear, Nose and Throat 384 46. Ophthalmology 394 47. Dermatology 403 Appendix 1: List of Acronyms 411 8 Section A: Introduction, Definition, and Implementation of the Curriculum 9 Chapter 1. Core competencies Author: Dr Daniel Sammut Update by: Dr Natalie Psaila Peer reviewers The following experts critically reviewed this document: Dr Marina Giusado Clavero MD, PhD, Spain Dr Celina Silvia Stafie, Lecturer, PhD, Romania The author and editor extend their thanks for their voluntary contribution 10 The aim of this curriculum is to help improve and build skills of family doctors. Qualities should be evident to the doctor and their patients, the doctor’s family and peers, as well as to society at large. The WONCA Europe 2011 definition of general practice specifies the core competencies that are essential to the family doctor. Core competencies Primary care management Includes the ability: To manage primary contact with patients, dealing with unselected problems To cover the full range of health conditions, including primary first aid To coordinate care with other professionals in primary care and with other specialists To master effective and appropriate care provision and health service utilisation 11 To enable the free access of all patients to the appropiate services To act as advocate for the patient Person-centred care Includes the ability: To adopt a person-centred approach in dealing with patients; to listen actively in an empathic manner To use the general practice consultation to bring about an effective doctor– patient relationship, with respect for the patient’s autonomy To communicate, set priorities and act in partnership with the patient To provide long-term continuity of care as determined by the needs of the patient, referring to continuing and coordinated care management Specific problem-solving skills Includes the ability: To relate specific decision-making processes to the prevalence and incidence of illness in the community To selectively gather and interpret information from history-taking, physical examination and investigations, and apply it to an appropriate management plan in collaboration with the patient To adopt appropriate working principles (e.g. incremental investigation, using time as a tool) and to tolerate uncertainty To intervene urgently when necessary To manage conditions that may present early and in an undifferentiated way To make effective and efficient use of diagnostic and therapeutic interventions 12 Comprehensive approach Includes the ability: To manage simultaneously multiple complaints and pathologies, both acute and chronic health problems To promote health and wellbeing by applying health promotion and disease prevention strategies appropriately To manage and coordinate health promotion, prevention, cure, care, rehabilitation and palliation Community orientation Includes the ability: To reconcile the health needs of individual patients and the health needs of the community in which they live, balancing these with available resources Holistic modelling Includes the ability: To use bio-psycho-social models, taking into account cultural and existential dimensions Implementation areas related to competencies To practice the specialty, the competent practitioner should implement these competencies in three important areas. 13 Daily clinical tasks Manage the broad field of complaints, problems and diseases as they are presented Master long-term management and follow-up Communication with patients Structure the consultation properly Provide information that is easily understood and to explain procedures and findings Deal adequately with different emotions Management of the practice Provide appropriate accessibility and availability to the patients Organize, equip and financially manage the practice, and collaborate with the practice team Cooperate with the other primary care staff and with other specialists Fundamental features related to competencies As a person-centred scientific discipline, three background features should be considered as fundamental for the family doctor: 1. Contextual Use the context of the person, the family, the community, and their culture in diagnosis, decision-making and management planning 14 Show personal interest in the patient and their environment and be aware of the possible consequences of disease for the family members and the wider environment (including working environment) of the patient 2. Attitudinal Based on the awareness of one’s own capabilities and values Identifying ethical aspects of clinical practice (prevention/ diagnostics/ therapy/ factors influencing lifestyles) Clarifying personal ethics Being aware of the mutual interaction of work and private life and striving for a good balance between them 3. Scientific Being able to access, read and assess medical literature critically Being familiar with the general principles, methods, concepts of scientific research, and the fundamentals of statistics Having a thorough knowledge of the scientific backgrounds of pathology, symptoms and diagnosis, therapy and prognosis, epidemiology, decision theory, theories of the forming of hypotheses and problem-solving, preventive healthcare Adopting a critical and