General Practice II (RGA_019)
About Study Course
Objective
To provide theoretical knowledge and practical skills in general practice, while according to the regulations of the specialty, in order to prepare the doctor for cerftification in general practice.
Learning outcomes
1.1. Primary health care organization / management:
- to manage and present facts about epidemiological knowledge, about problems in primary health care,
- demonstrate knowledge in regular, continous chronically ill patient care,
- demonstrate in-depth knowledge and understanding of preventive work and its organization in a general practice,
- demonstrate knowledge about the work organization of a primary health care institution,
- demonstrate an understanding of the importance of communication ability, when working with patients or with general practice staff,
- demonstrate knowledge about the organization of healh care system and its functioning in relation to primary health care,
- to improve knowledge of communication skills, with special emphasis on the doctor - patient cooperation.
2. Person centered care:
- demonstrate knowledge of patient centered care, also understand its importance in relation to the patient, his problems and living conditions,
- demonstrate knowledge in the understanding of the processes, that are related to the growth, development, adulthood and aging of an individualdemonstrate knowledge and understanding of a functioning family, its role in society, also the impact of social and cultural peculiarities on family values,
- understand the patient centered general practitioners consultation model, communicate with patients as equal partners,
- demonstrate knowledge on the process of developing relations with the patient, assess priorities when making decisions,
- demonstrate knowledge about formation of a continous, long-term, successive care.
3. Specific problem solving skills:
- knowledge in specific problem solving, decision making, skill to evaluate the spread of the disease and the incidence in a given population,
- skill to assess a given populations specifity, habits (age, gender distribution, incidence of chronic diseases),
- knowledge of how to acquisit and interpret information from anamnesis and from patients physical and laboratory examinations,
- skill to ask specific, disease related questions, while during patients investigation, and skill to use known medical anamnesis of the patients family, social conditions,
- knowledge of the given problems available investigation and treatment options,
- knowledge about evaluating emergency situations and about making decisions in them, emergency assistance is needed, emergency treatment measure organization, in which case is it possible to carry out the diagnostic and treatment procedures on a planned basis,
- skill to evaluate a diseases symptoms and signs, clinical findings, fast and additional tests, while being in diagnostic and treatment process,
- the ability to orientate in diagnostic and therapeutic manipulation costs and to assess the need for these manipulations in the given situation, also to understand the effect specific treatment has on a human body.
4. A comprehensive approach to problem solving:
- understanding and knowledge about the concept of "multimorbidity",
- knowledge about variable, simultaneously existing disease treatment options,
- knowledge about guidelines and possible applications of evidence based research,
- knowledge of health promotion activities, disease prevention strategies, the concept of health,
- an understanding of the role a general practitioner and his team has in promotion of public health,
- ablity to recognise peculiarities of ethnic nature and identify them in a society,
- knowledge and ability to involve general practices staff members in an individual's treatment, care process, palliative care, in the organising of a rehabilitation process, also the ability to understand the role of each staff member in this process and to implement an individual approach to each patient, while coordinating teamwork.
5. Community oriented health care:
- knowledge of resources available in the given environment, ability to coordinate indiviual needs with the needs of the community they live in,
- understanding of public health as a whole, while using epidemiological knowledge of the given situation,
- understanding of the correlation of health care and social care,
- understanding the effect ethnicity, epidemiological situation and poverty leaves on health,
- understanding health care systems structure and its economical possibilities,
- ability to evaluate the work of other specialists and to be able to find opportunities of cooperation with them,
- understand how the health care system could be used to the benefit of the patient and general practitioner (referral procedure, patient payments, sick leaves, legislation).
6. Holistic approach:
- knowledge and understanding of holistic care principles and its use in general practice,
- ability to perceive and work with the patient as a psycho-social being,
- knowledge and ability to interpret and use the information obtained, while being in diagnostic and treatment process, about the patients' culture and ethnic characteristics,
- knowledge of how to use the patients experience, expectations and confidence in doctor about the health care process.
1.The skills acquired are:
1. Primary health care organization / management:
- the ability to apply knowledge, when organising and carrying out preventional work,
- the ability to investigate an dto take care for a patient with multiple, yet non differentiated health problems,
- the ability to provide emergency medical care and to organise care for patients with acute and chronic illnesses,
- the ability to carry out and to organise palliative health care,
- skills in the diagnostic process of a disease: obtaining medical history, physical examination of a patient, the use of additional diagnostic tests,
- therapeutical skills, that include knowledge of both pharmacological and non-pharmacological therapy,
- the ability to group problems according to priority,
- good communication skills when working with a patient, staff members of a primary health care institution, also when working with other primary health care doctors and specialists,
- the ability to organise work of a primary health care team,
- communication skills, the ability to train patients and their family members in the process of diagnostics and treatment,
- the ability to organise correct patient data input in ambulatory cards, process information
- Practice management skills, ability to carry out the practice of job quality audit,
- Skill to act in a patient's interests
- The ability to conduct negotiations with the patient in finding a compromise,
- The ability to evaluate primary health care from a family physician positions, the patient's ability to understand the uncertainty characteristics, curiosity, the ability to be a diligent, hard-working.
2. The person directed care:
- The ability to assess the perception of the patient's disease,
- The ability to organize patient-oriented consulting, which is initiated by the patient's complaint hearing (ideas, worries, hopes), integrating into the doctor's proposals for future decisions by finding a common solution to the problem when drawing up the investigation and care plan for the future,
- The ability to analyze and present the patient in an understandable way the results of examinations, including explaining the patient further solutions in drawing up future treatment plan in collaboration with the patient,
- Skill to take any further decisions respecting the patient's interests and autonomy,
- Skill to avoid subjectivity in medical decision-making process,
- Skills and abilities for "doctor - patient" relationship formation,,
- Skills and abilities to establish a balanced (close spaced and at the same time) relationship with the patient,
- Skill to understand and a reality of continuity three main principles: 1) the relationship doctor - patient continuity throughout the treatment process, 2) recurring episodes of treatment, medical outreach and advocacy for patients, 3) family medicine services regularly available.
3. Specific problem solving skills:
- Specific decision-making skills (through instruments such as the clinical approach, decision-making algorithms)
- The ability to gather medical history, perform physical examination and interpret the data,
- The will and the ability to involve patients in the decision-making process,
- The general practice skills as understanding, compassion and care,
- The use of such diagnostic and therapeutic tools such as "time" relationship "patient-doctor" decision-making process,
- The ability to evaluate and understand the inevitability and no doubt the presence of primary health care problem-solving process as well as their skill tolerated,
- The ability to make a decision to provide assistance in an emergency,
- The ability to advise the "heavy" patients with serious health problems,
- The ability to navigate the therapeutic and diagnostic manipulation cost, to evaluate the need for manipulation of a given situation.
4. A comprehensive approach to problem solving:
- The ability to navigate a number of simultaneously existing health problems, set priorities, to study this disease interaction, choose the appropriate treatment tactics
- Ability to work with medical records, to use electronic information options
- Skill to use the latest scientific achievements, research data in practice,
- Promote health through prevention and health promotion programs in primary care,
- The ability to coordinate, organize family physician team members work with both curative and preventive measures, as well as through patient palliative care and the organization of rehabilitation measures.
5. Community-led health care:
- The ability to assess the health problems in a given society, taking into account the specific epidemiological situation,
- The ability to collaborate with other professionals working in the community, to understand their role,
- The ability to understand and use the health care system and the patient's own doctor's favor ably organizing their work,
- Skill to avoid shortcomings in the health care system.
6. A holistic approach:
- Ability to work with the patient as a bio-psycho-social being,
- The use of holistic care principles in practical work with patients
- The use of the patient's experience, expectations, confidence doctor healthcare process.
Family medicine training programs during stowage skills
Skills that strengthen family medicine education programs during - investigation, methods of treatment, disease prevention and health promotion measures:
1. Emergency:
- Resuscitation ABC,
- Respiratory passages,
- Depositing the patient in the correct position,
- Adult and children intubation,
- Prevention of pneumothorax,
- To stop bleeding (including posterior tamponade)
- Gastric lavage,
- Enema,
- Puncture cavity (ascites, pleural cavity)
- Cricotireodotomia,
- Infusion therapy.
2. The surgical procedure:
- Small outpatient surgery (wound sewing, opening abscesses, foreign bodies removal, wart excision, ablation of the nail)
- Local anesthesia,
- Wound decoration,
- Fracture fixation splint imposition.
3. Gynaecological procedures:
- Gynecological examination,
- Breast examination, palpation,
- Bacteriological and cytological swab removed from a vagina, cervix,
- Hormonal contraceptives question explanation,
- IUD insertion and removal,
- Advice on cervical ring imposition
- Timing of pregnancy,
- Deliveries
4. Children's investigation:
- Neonates, infants, children, grandchildren, preschool age, younger school age, the oldest school-age child investigative technique,
- Newborn primary maintenance
- Growth and development assessment,
- Advice on breast-feeding, breast-feeding technique
- Vaccination equipment, immunization,
- Tuberculin test;
- First aid in life-threatening situations (choking, drowning, burns, trauma)
- Contact with the older building, history collection,
- Basic knowledge of rehabilitation methods.
5. Skills in work with teenagers:
- Specific counseling skills, establishing links
- Impartial investigation (gynecological, andrologic), sexual evaluation,
- Confidentiality,
- Knowledge of legislation relating to the age of adolescence,
- The ability to advise on issues of contraception, sexual behavior, addictions (alcohol, nicotine, drugs).
6. Skills in women's care:
- Counseling on issues related to birth control,
- IUD Insertion and removal of cervical circumference Inserting and removing,
- Bladder catheterization,
- Oncocytology swab,
- Breast palpation,
- Pregnant women advice,
- Normal pregnancy diagnosis and management,
- Postnatal care period.
7. Skills in men care:
- Prostate palpation,
- Bladder catheterization.
8. Skills care of the elderly:
- Obtaining adequate information from people with impaired memory, hearing and visual impairment,
- Patients with reduced mobility investigation
- The examinations necessary for evaluation of the amount of an old person (evaluating the information productivity, possible complications examinations).
- The ability to evaluate the tests and medical events.
- Communication skills with patients with chronic and incurable diseases.
- The ability to advise on the elderly health care, social rehabilitation,
- The elderly, the disabled rehabilitation possibility of knowledge.
9. Skills treat people with mental and behavioral disorders:
- History collection skills,
- Delirium, withdrawal treatment,
- Family therapy
- Advice of alcohol, drugs, drug dependence,
- Tactics of treatment and referral to a specialist.
10 Ear - throat - nose investigation:
- Otorinolaringoscopy,
- Audiometry,
- Sinus disease radiodiagnostic evaluation
- Ear rinsing,
- Removing foreign objects,
- Drip, ointments, rinse application in the treatment,
11 Eye examination:
- The outer part of the eye examination,
- Ophthalmoscopy,
- Visual acuity,
- Determination of color vision,
- Visual field testing,
- Intraocular pressure measurement,
- Emergency treatment of eye trauma and acute glaucoma,
- Removal of superficial foreign bodies.
12. Other manipulations:
- Injection (into a muscle, vein)
- ECG
- Spirometry,
- Veloergometry,
- Bladder catheterization, medication administration,
- Indwelling catheter insertion, replacement,
- Rectum and prostate palpable investigation
- Rectoscopy,
- Blockades,
- Skin biopsy,
- To take bacteriological material in case of urogenital tract infections.
13 Health Check and the related consultations:
- Knowledge of diagnostic methods,
- The physical working capacity assessment,
- Explaining the harmfulness of tobacco,
- Sexual education,
- Psychological counseling problem cases, stress management,
- Education on hormone replacement therapy for women during menopause,
14. Laboratory tests:
- Blood: hemoglobin, erythrocytes, leukocytes, ESR,
- Leucogramm, sugar levels, CRP,
- Evaluation of urinalysis (specific gravity, pH, color, sugar, protein, bilirubin, ketones, acetone, nitrites, sediment)
- Faeces (parasites, blood)
- Sputum (bacterioscopical investigation)
- Gynecological smear analysis: the purity of the vagina (vaginosis, Trichomonas vaginalis, gonorrhea, candida).
1.Competences of the general practitioner
Able independently formulate and critically analyse complex scientific and professional problems. The knowledge and skills of the general practitioner are seen in six key competencies:
1. Organisation of primary health care/management,
2. Person oriented care,
3. Specific problem solving skills
4. Comprehensive approach to problem solving,
5. Community oriented health care,
6. Holistic approach.
Acquired competencies allows to justify decisions, if need be, carry out additional analysis:
- Is able to explain the effect of environmental change on the spread of disease in a population, understand the use of preventive, diagnostic and therapeutic methods in this regard.
- Be able to evaluate the patient complaints, their connection to patient medical condition.Has a broad understanding of the diseases and their risk factors,understanding of common diseases in a population, chronic disease care, diseases causing disability, understanding of the conditions that require urgent assistance.
- Has understanding of the use of preventive and diagnostic manipulation in primary health care, which covers practically all specialties (pediatrics, gynecology,surgery, ear-nose-throat diseases, dermatovenerology, ophthalmology, neurology, psychiatry, cardiology).
- Ability to provide patient treatment in the primary care level, to organize the rehabilitation, if it is necessary.
- Understanding of diagnostic possibilities at primary and secondary health care level, understanding of the opportunities to send patient to a specialist, if need be.
- Ability to organize and conduct consultations on matters related to the organization of health care, in particular, for issues related to maternal and child health care, family planning.
- Understanding of the issues related to public health.
- Ability to understand the importance of positive doctor-patient relationship, ability to teach patient to understand their complaints, learn to live with them.
- Ability to work in a team with other memebers of primary health care team and other professionals.
Able to integrate different areas of knowledge:
- Understanding of the issues of the organization of health care in general and particularly for organization of primary health care.
- Knowledge of the laws and directives on health care, the ability to participate in their development.
- Knowledge and understanding of the special disciplines: clinical chemistry, physiology, microbiology, pharmacology, acute care, basic principles of the family medicine, ethical issues, psychology, epidemiology, statistics, use of research methods in general practice, performance of preventive work, etc. disciplines.
Able to contribute to the creation of new knowledge, to development of research or professional methods:
- Has a good knowledge of the basic principles of research methods. Able to use methods and principles of the study work in his work, understands the nature of the epidemiological study.
-Has the skills and the willingness to carry out independent researches.
Able to demonstrate understanding and ethical responsibility of scientific result or potential impact of professional activity on the environment and society:
- Able to organize researches independently, analyze their results, compare with research data of other countries.
- Ability to use research data in the practical work.
