Family Medicine Junior Clerkship

Introductory Seminar & Orientation

Department of Family Medicine
and Primary Care (FMPC)

Aims of the FM Junior

Clerkship
To enable students to learn and
practice the skills of problem
identification and clinical problem
solving
To enable students to gain an
insight into the work of family
doctors in the community
NOT the management of specific
diseases
2

Learning Outcomes
1. Be able to take a relevant history and
identify the reasons for consultation
2. Be able to describe the interrelationship of psychosocial and
physical factors of the illness for each
individual patient
3. Be able to explore how family members
may influence a patients health
4. Be able to explore how family members
may be affected by a patients illness
3

Learning Outcomes
5. Be able to adopt the hypothetical
deductive method of clinical problem
solving for the diagnosis of
undifferentiated symptoms presenting to
primary care
6. Be able to identify the nature of the
doctor-patient relationship and its
therapeutic potentials
7. Be able to explain the different roles of
family doctors
8. Be able to synthesize the diagnosis/
problems of common illnesses presenting
to primary care
4

FM Junior Clerkship
Handbook
Download Handbook from Faculty
web
Programme & Schedule (**the
one we give you today is the
most up to date)
Case Commentary Form
template
References (reading pack
available from FMPC and Main
medical library)

FM Junior Clerkship
Programme
2 x seminars (today)
6 x whole class sessions (QMH)
2 x supervised consultations at family
medicine clinics - at ALCC, Aberdeen, SYP or
VP GOPC
2 x video review sessions - at ALCC
2 x 2 family practice attachments (FPA) in
the community
FM workshop A (Problem solving) at Faculty
FM Workshop B (Working with Family) at
Faculty
Debriefing/ sharing session at Faculty
6

FAMILY
MEDICINE
WHOLE CLASS
SESSIONS

FM Whole Class
Sessions
Topic

Date

Speaker

Principles and concepts of Family Medicine 07-11-14 (Mon)

Prof. Cindy LK lam

Clinical problem solving in Primary Care

25-11-14 (Tue)

Prof. Daniel TP Lam

Common problems in Primary Care I:

Upper respiratory tract infections

26-11-14 (Wed)

Dr. Colman Fung

Common problems in Primary Care II:

Differentiating the normal from the
abnormal

27-11-14 (Thu)

Dr. Julie Chen

Common mental health problems in

primary care

28-11-14 (Fri)

Dr. Weng Yee Chin

Health promotion and disease prevention

in primary care

29-11-14 (Sat)

Dr. William Wong

FAMILY
MEDICINE
CONSULTATIO
NS TEACHING

Consultations at FM
Clinics
The addresses are shown on your
timetable (ALCC, Aberdeen, SYP,
VP GOPC)
Please remember to sign your
attendance
Ask the nurse in charge for
directions to the designated
consultation rooms
Teacher in charge will supervise
your consultations
10

Patient-centred interview &

Physical Exam
1. Explore the chief complaint &
history of the presenting problem
2. Find out the reason for consultation
3. Assess the effect of illness on the
patient
4. Identify & clarify the patients
ideas, concerns and expectations
(ICE)
5. Erect your hypotheses (physical,
psychological and social) on
patients diagnosis/problems
11

Cues
(Clinical, behavioral, contextual)

Hypothesis(es)
(probability Vs possibility)
Revise

Unexpected
cues

Search
(Further History, P/E, Ix)
Diagnosis

Management
12

VIDEO
REVIEW
CONSULTATIO
NS TEACHING

13

Video Review Consultations

Please meet our staff member in
Consultation room 1 of ALCC at
1.50pm for a briefing session on
how to work the video recorder
and patient recruitment
Please be PUNCTUAL
Wear your clean white coat with
your name badge & a surgical
mask
14

Video Review
Consultations
Each student will interview a
patient for 6 minutes, which will
be video-taped.
Please do not examine or manage
patient
Patient will be seen by the doctor
after students interview
15

History- taking form

Patient identifiers: age, sex, initials
Key history of presenting problem:
presenting problem and HPC
Reason for consultation (why has the
patient really come?)
intolerance of symptoms,
intolerance of anxiety,
problems of living (environmental stress, unable
to cope or social problems)
administrative reasons

ICE
Problem list including DDx
Most likely dx / important problem
Next step (what PE, Ix)
Learning issues

16

Video Review of
Consultations
Complete the history-taking form
immediately after your consultation
Write a summary of the consultation
on the white board in the rooms
Your teacher will arrive at 3.005:00
pm in Consultation rooms 1+2 of Ap
Lei Chau Clinic
Review the videotaped consultations
with a teacher to analyse the
problem solving process and receive
feedback on your consultation
17

Video Review Consultations

WHILE watching the consultations
of your group-mates, complete the
peer assessment form
WHILE watching the playback of one
group members video consultation,
you can also complete an additional
history-taking form for practice
You are expected to have the
required CIPS
18

PROBLEM
SOLVING
WORKSHOP
(FM
WORKSHOP A)

19

Clinical Problem Solving.

Identification of the reason for
consultation
Clarification of the chief complaint
and presenting problem
Interpretation of key information
Generation of diagnostic hypotheses

20

.Clinical Problem Solving

Elicitation of relevant history to
confirm the diagnosis and exclude
other DDx
Synthesis of problems
Medical record keeping
Communication of information to
another health professional

21

WORKING
WITH FAMILIES
WORKSHOP
(FM
WORKSHOP B)

22

Working with Families

Systemic perspectives in caring for
individuals and their families
Different levels of doctors' family
involvement for different health problems
Important concepts in working with families,
such as family life-cycle stages and family
organization (subsystems, boundaries,
hierarchy, coalitions, etc.)
The essentials in interviewing individuals
and their families
Role-plays, case vignettes, and videos will be
employed
23

FAMILY
PRACTICE
ATTACHMENT/
PRISON
HEALTH
SERVICE VISIT

24

FPA/ prison health visit

Consolidate problem solving skills
Complete 1 history taking form per
attachment to be handed in to each FPA
teacher for assessment (supervised
consultation)
May be based on self conducted patient
interviews or observation of
consultations done by the FPA teacher
25

Interview one patient/ FPA

Complete history taking form
Name : Date : Student No. :
Chief complaint / presenting problem :
Reason for consultation :
Key information in history :
Differential and problem list:
Most probable diagnosis :
Learning issues :

26

Prison Health Services

Visit
1 pair of male students and 1 pair of female
students will have the opportunity to have
an attachment with the Correctional Services
Health Service as one of their FPA
attachments
Students will be expected to share their
experience with their group members during
the debriefing session

27

Student Evaluation on FPA

Please complete the pink
evaluation form, one for each FP
Please bring along and hand in
the form at the debriefing session
May mark the form confidential if
you do not wish the form to be
returned to the doctor

28

EXTENDED
CASE
COMMENTARY

29

Expanded Case
Commentary
One patient seen during the FPA/
consultations to illustrate the
principles of family medicine in
one or more of the following: primary care
continuing care
comprehensive care
whole person care

30

Expanded Case Commentary

(Instruction and template downloaded from FM Handbook)

No more than 1000 words

Brief summary of patients
significant medical & psychosocial
history
Discussion on how the principles
of family medicine are/ can be
applied to this specific patient
A conclusion on what you have
learned from this patient, esp the
roles of FP
Submit via Turnitin

31

Turnitin Plagiarism
Software
You have all been enrolled on the Turnitin
under your HKU portal email address.
Please check your HKU portal e-mail to
make sure that you have received an email from Turnitin confirming that you
have been registered.
If you have not received an e-mail
from Turnitin within 1 week, please
e-mail Dr. Weng Chin at
chinwy@hku.hk
32

Dear student name,

You have been enrolled in the Turnitin class 20122013_JCBC _FM_Rn" by your instructor Family Medicine
Unit.
To start using this class, go to http://www.turnitin.com and
log in using the following temporary information:

Email address: HKU email address

Password: 2r47087z
Once you log in you will be taken through a step-by-step
start-up process, and you will also have the chance to
change your password and any other personal information.
Keep in mind that the temporary password above is casesensitive: we recommend that you paste it directly into
your browser.
Thank you for using Turnitin,
The Turnitin Staf

33

2014-2015_JCBC_FM_R1

Click the class the name

2012-2013 JCBC FM R1

2012-2013 JCBC FM R1

Extended Case Commentary

Click submit

Step 1: Type in Extended Case Commentary

Case Commentary

Step 2: Browse for your

saved document

Step 3: Click upload

Step 1: Review the document

Step 2: Click submit if OK

If you forget or lose your

password, log onto:
www.turnitin.com and click
Retrieve Password.
A link will be sent to your HKU
portal email allowing you to create a
new password.

Once submitted, the

homework cannot be resubmitted
Due dates for submission (last
day of rotation)
Rotation 1: Dec 12, 2014
Rotation 2: Feb 13, 2015
Rotation 3: April 17, 2015
39

DEBRIEFING/
SHARING
SESSION

40

Debriefing & Feedback

(Venue addresses on timetable)

Reflection on the learning and

experience of the FPA
the roles & limitations of family doctors
in primary care
the importance of Dr-Patient
relationship

Appraisal of variations in
family practices
Discuss the ethics of family
practice
Feedback and suggestions

41

Debriefing

& Feedback

Please submit the following at this

session:
2 x pink FPA evaluation forms (one for
each doctor)

42

JCBC
LOGBOOK

43

Logbook
Identifies the expected learning
outcomes (helps identify learning
gaps)
Record of clinical encounters
Reflection consolidates learning (ask
why)
Written self reflection encourages
deeper and/ or wider thought
Faculty Office to assess effort on
reflective thought only (part of
Block C continuous assessment)
44
Information on learning gaps,

45

46

ASSESSMENT
S

www.hku.hk/fmunit/

47

Continuous Assessment
100% Attendance
absence due to sickness needs to be
certified
absence due to other reasons should
be explained in writing & subject to
approval

Video Review of
Consultations
Family Practice Attachments
Extended Case Commentary
FM OSCE station x2

48

OSCE
2 stations:
Station 1: (6 min)
Take a history from a simulated
standardized patient
Take a focused history directed at
identifying the reason for consultation,
ICE, problem list, D.Dx and most likely
diagnosis
Station 2: (8 min)
Complete a history taking form and
answer the questions
49

STUDENT
PROFESSIONAL
ISM

50

Medical Professionalism

Honesty & personal integrity

Respect to patients, (especially

safety)
Punctuality
Clinical manners & appropriate
attire
Interest in learning (asking
questions)
Respect to staf and colleagues
51

Recommended Texts &

References
Fraser R. Clinical Method: A
General Practice Approach
McWhinney I.R. Clinical problem
Solving in Family Practice, Chapter
19 in, Rakel R.E. (Ed). Textbook of
Family Practice *** (8th edition
available as e-textbook through MD
Consult data base via HKUL)
Murtagh J. General Practice
52

Infection Control - Yellow

Alert
Wear a clean white coat in all
clinical sessions
Wear a surgical mask in all
clinical sessions, please bring
your own mask and dispose it
properly
Be alert if patient has fever and
travel, occupation, contact or
cluster (TOCC) risk

53

Before &
after each
patient
contact,
wearing/
removing
your mask,
and before
leaving a
clinic

Wash your hands

www.hku.hk/fmunit/

54

Infection Control
DO NOT come to class and consult a
doctor if you have any of the
following:
Fever or chills
Respiratory symptoms
Diarrhoea
Suspected or known contacts with
any serious infectious diseases

55

Ground Rules

56

ANY QUERIES
Dr Esther Yu
(JCBC coordinator for FM)
ytyu@hku.hk

Ms Crystal Wong
(Admin staff for FM JCBC)
sauwai@hku.hk
Tel 2518 5654

57