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INTRODUCTION TO COMPREHENSIVE HEALTH CARE MODULE

                                       MEDICINE & SOCIETY II B

                      COMPREHENSIVE HEALTH CARE MODULE (FFFF2622)



I.         DIRECTORY OF TEACHING STAFF



NO.        NAME OF LECTURERS/TUTORS                    TEL NO.               E-MAIL



A.        Department of Family Medicine

     1.    Dr Rashidi Mohd Pakri                      012-3945786   Drrashidi5377@yahoo.com

     2.    Dr Hizlinda Tohid                          019-2222109    hizlinda2202@gmail.com

     3.    Dr Aida Jaffar                              9145 6126      aida.jaffar@gmail.com

     4.    Dr Tan Chai Eng (Module Coordinator)        9145 6126     tce@ppukm.ukm.edu.my
                                                      012-3343145

     5.    Dr Saharuddin Ahmad                        012-3838204     bulat1977@yahoo.com

     6.    Dr Mohd Fairuz Ali                          9145 6116       phere1@gmail.com

     7.    Dr Zuhra Hamzah                             9145 6124       zuhradr@yahoo.com

     8.    Dr Syahnaz Mohd Hashim                      9145 6124      syahnaz74@gmail.com

     9.    Dr Noorlaili Mohd Tauhid                    9145 6120      lailitauhid@yahoo.com




B.        Faculty of Pharmacy

     1.    Dr Noraida Mohamed Shah                                  noraida_mohamedshah@yah
                                                       9289 8038             oo.com

     2.    Puan Siti Azdiah Abd Aziz                   9289 7964      sitiazdiah@yahoo.com

     3.    Dr Adyani Md Redzuan                        9289 7987     adyani.hairul@gmail.com

     4.    Cik Adliah Mohd Ali                         9289 7964     adliah_ali@yahoo.com.sg




                                                  1
C.    Department of Nursing

 1.    Puan Gurbinder Kaur a/p Jit Singh       9145 6254    gurbin@ppukm.ukm.edu.my

 2.    Cik Hasnah Yahaya                       9145 6261    hasnah@ppukm.ukm.edu.my

 3.    En. Che Salim Sulaiman                  9145 6260   chesalim@ppukm.ukm.edu.my

 4.    Puan Nour Dhiaeyah Supuan Zaki                      Nour.dhaeyah@ppukm.ukm.edu
                                               9145 6266               .my




D.    Department of Parasitology

 1.    Dr „Azlin Muhammad @ Mohd Yassin        9289 7229      azlinoshin@yahoo.co.uk

 2.    Dr. Aishah Hani Bt Azil                 9289 7209    aishahhani@medic.ukm.my




E.    Department of Community Health

 1.    Prof Madya Dr Azmi Mohd Tamil           9145 5890        drtamil@gmail.com

 2.    Dr Azmawati Mohammad Nawi               9145 6404       atienawi@yahoo.com

 3.    Dr Jamsiah Mustafa                      9145 5906     Jamsiah_jkm@yahoo.com

 4.    Dr Ahmad Taufik Jamil                   9145 5888        atjamil@gmail.com




E.    Department of Medical Education



 1.    Dr Mohd Arif Kamaruddin                 9145 6241      drmdarif@hotmail.com

 2.    Dr Mohd Nasri Awang Besar               9145 6241     drmohdnasri@gmail.com

 3.    Dr Md Nurman                               019-         mdnurman@yahoo.com
                                                2272269

 4.    Pn Siti Mariam Bujang                      013-         Eentan80@yahoo.com
                                                3335233




                                           2
II.

       This module is aimed to introduce the concept of comprehensive health care according
       to the modern medical principle. It includes the principle of solving health problems at
       the individual, family and community level. The module discusses the holistic approach
       in patient management. It also emphasizes on the concept of patient, family and
       community interactions from the aspect of health. The students will be exposed to the
       needs of patient with chronic diseases and how it is assessed and managed
       comprehensively. Functions of health organizations and health facilities at various
       levels in the community are also discussed.



       PRE-REQUISITES

       The students should have prior knowledge of

       1.   Medicine & Society I

       2.   Medicine & Society IIA



III.   MODULE OBJECTIVES

       This is a 2 credit module (80 hours of students learning time) conducted throughout 16
       weeks during semester 4 of the undergraduate medical program. Second year medical
       students and third year pharmacy students will participate in this module. Students will
       be divided into small groups consisting of 5 -6 students. Each small group will be
       assigned to a patient with chronic illness. Students are required to work as a team to:



       1. Identify and describe the impact of the illness on the patient as well as on the family
          and community.

       2. Identify their roles as health professionals in addressing the bio-psycho-social
          issues faced by the patient, from the aspect of health promotion, prevention,
          treatment and rehabilitation.

       3. Identify relevant community and other facilities and services available for the
          patient.

       4. Provide relevant advice to the patient regarding the use of these facilities and
          services.




                                               3
IV.   METHODS OF ASSESSMENT

           Continuous assessment based on

           o    Family Case Study Presentation (group work)           30%

           o    Family Case Study Report (group work)                  30%

           o    Reflective writing (individual)                        25%

           o    Peer Assessment                                         5%

           o    Facilitator‟s Report                                    5%

           o    Attendance                                              5%

                Total                                                100%

       Note:
        Students are required to submit their Family Case Study Report (group work)
        and reflective writing (individual) on-line by week 15 (10th May 2013 by
        2400hrs). Please avoid sending in your assignments on the date line because your
        actions may “freeze” the system. (http://www.medicine.ukm.my/apps/e.learning)
        Family Case Study Presentation, Family Case Study Report and reflective
        writing assignments are marked by the respective facilitators.

      Satisfactory attendance is only considered when students attend at least 80% of all
      teaching-learning activities (Lectures, Small group discussions, Visits).



V.    RESOURCE MATERIALS



      1.       Reagan, P.A. Brookins-Fisher, J. Community Health in the 21st Century.       2nd
               Edition. San Francisco: Pearson Education, Inc; 2002.
      2.       Phoon, W.O. Chen, P.C.Y. Textbook of Community Medicine in South East Asia.
               Singapore: John Wiley & Sons; 1986.
      3.       Mc Whitney, I. R. Freeman T. A Text Book of Family Medicine. 3rd ed. Oxford
               University Press; 2009.
      4.       Rakel, R.E. Text Book of Family Medicine. 7th ed. Philadelphia: Saunders; 2007.

      5.       Taylor, R. Fundamentals of Family Medicine: The Family Medicine Clerkship
               Textbook. 3rd ed. Springer Pub. Co; 2003.
      6.       Unwin BK, Jerant AF. The Home Visit. American Family Physician. 1999; Vol 60:
               1481-8.




                                                  4
VI.   TEACHING-LEARNING TOPICS AND SPECIFIC OBJECTIVES



      Concept Lectures



      At the end of the lectures, students should be able to:



L1    Comprehensive Health Care I & II
&
        describe characteristics of comprehensive health care at the individual, family and
L2.     community level
        describe the function of family and „at risk‟ family
        describe various stages of disease prevention at the individual, family and
        community level

L3.   Family Case Study

        approach and discuss the patient‟s problems in a holistic manner
        identify and analyze the health problems in relation to the patient, family and
        community
        appreciate that any health issues have an impact towards the patient, family and
        community
        understand the management of relevant health problems by means of health
        promotion, prevention, and appropriate treatment and rehabilitation measures with
        appropriate and effective use of resources
        recognize the value of home visits in assisting health personnel to assess patient‟s
        condition at home (e.g.: family dynamics, surroundings etc).
        realize the importance of adopting a non-judgmental attitude and being sensitive to
        religious and cultural diversity as well as differing moral values and beliefs.


L4.   Holistic Approach to Medicine

        define the meaning of `holistic‟
        discuss the concept of `mind-body medicine‟
        recognize the importance of a holistic approach in patient care
        understand how to practice holistic patient care




                                              5
Small Group Discussion (SGD)

During the following SGDs, students should:

SGD 1        - Receive information regarding their assigned patients

             - Learn how to organize a home visit and respective organizational visit.

             - Plan their activities during each visit

SGD 2&3 - Update their facilitator and discuss the progress of their family case study

            - Clarify particular issues or problems they are facing.
            - Arrange corrective measures to overcome these problems
            - Discuss with their facilitator regarding the family case study presentation.

SGD 4        - Present their Family Case Study

            - Prepare their Family Case Study Report.




Visits

A.       Home Visit

         During the home visit, students should:

           Evaluate holistically patient‟s problems and status (e.g. health and functional) at
           home.
           Evaluate patient‟s home environment (e.g. physical conditions, social environment
           such as family dynamic, safety issues etc) and assess the impacts of this
           environment on his/her health and function.
           Identify „at-risk‟ patient (e.g. at-risk of abuse, neglect or social isolation).
           Identify potential home-based interventions that are suitable for the patient.
           Evaluate patient‟s support system and functions of family members.
           Evaluate coping behavior of the patient and family members.
           Identify medical, psychosocial, environmental and financial problems faced by the
           patient and family members.
           Identify impacts of patient‟s illness on his/her own life, family and community
           Identify and promote disease prevention and health promotion to the patient and
           family members.
           Plan appropriate management (e.g. treatment, rehabilitation measures etc) for the
           patient, family members and community
           Demonstrate non-judgmental attitude and sensitivity to religious and cultural diversity
           as well as differing moral values and beliefs.




                                                   6
B.   Visit to relevant organizations that provide aftercare to the respective patient
     (where applicable)

        identify appropriate resources (e.g. NGOs, facilities, programs etc) available for the
        patient in his/her community
        identify the roles and functions of these resources
        incorporate the related community resources in the patient‟s rehabilitation plan




Reflective Writing



     Each student is required to write a reflection on:

     Working together with other healthcare professionals in patient care




                                             7
STUDENT’S ASSIGNMENT

Format for Family Case Study Presentation
(Duration of presentation: 15 – 20 minutes)
    Title of Slides                 Description

1. Title slide                      Title of case study
                                    SGD group and name of members
2. Introduction                     Patient Demographic Data
                                    (Why do you think it is important to know about this case
                                    and to approach it in a holistic/ comprehensive manner?)

3. Clinical Summary                 Summary of the clinical history and physical findings
                                    from your own observation or clinical examination –
                                    please do not copy from the case note.(list it in
                                    chronological order)

4. Investigations                   List appropriate investigations and interpretation of the
                                    results.

5. Home Visit/Visit to relevant     Students are expected to synthesize important / relevant
   organization                     data from the home visit as well as visit to relevant
                                    organization and apply them appropriately into their case
                                    study in a holistic perspective for the patient‟s overall
                                    care and quality of life.

6. Summary and Problem list         Summary of the patient‟s condition and “List of
                                    problems” (according to the bio-psycho-social model).

7. Management & Discussion          Non-pharmacological and pharmacological management
                                    (short/long term)
                                    Multidisciplinary care and community resources
                                    Important points of discussion

8. Reflection & Conclusion          Conclusion and recommendations for further or better
                                    care (as appropriate).
                                    Add your reflection on how this Family Case Study can
                                    help you in the future, your learning issues, how would
                                    you deal with this patient differently.

9. References                       List them in UKM or Vancouver style.
                                    References should be the most recent available.


Additional instruction:
       Present using Microsoft Office PowerPoint.
       Discuss with facilitators as to what to present and flow of presentation.
       As the Family Case Study is a report of events that happened in the past, it should
       be written in the past tense.
       Please ensure consistent formatting, line spacing and choice of fonts.
       Photos of the house, lesions/disease, and surroundings may help in your case
       presentation. (Only with permission from the patients)
       Do „spelling and grammar‟ check.


                                              8
Format for Family Case Report
(3000 words, include relevant photos only)

SGD Group:
Name of members:
Facilitator‟s name:

Demographic data

Date of clerking:
Name:                                               Registration No:
Contact Address:
Contact Number:
Primary Care Giver details: (where applicable)

    Title                                    Description

1   Introduction                             Why do you think it is important to know about this
                                             case and to approach it in a holistic/
                                             comprehensive manner?
2. Summary of clinical history and           History: presenting complaint, history of present
   physical findings (from your own          illness, systemic reviews.
   observation or clinical examination       Past history: medical/surgical/obstetric history
   – please do not copy from the case        Menstrual history
   notes).                                   Growth & developmental history
                                             History of allergies:
    (List in chronological order)            Drug history/medications (indications) - over the
                                             counter medication/prescribed drugs/street drugs
                                             etc.
                                             Smoking, Alcohol, Assessment of Risk behaviors.
                                             Social history& Financial history
                                             Dietary history
                                             Progression of disease (as appropriate)
                                             Physical examination (with your interpretations of
                                             what abnormal findings means and its relevance)
3. Investigations:                           List of all appropriate investigations based on your
                                             own knowledge and clinical judgment (If results
                                             are available, state the dates when the tests were
                                             done, normal ranges and your interpretation of the
                                             results)
4. Home Visit/Visit to relevant              Floor plan, neighborhood, exterior &interior of
   organization                              home ( crowding, housekeeping, homely
   Synthesize important / relevant data      environment, privacy)
   from the home visit and visit to          Water, electricity, sewage, air circulation,
   relevant organizations. Apply them        windows, toilets.
   appropriately into the case study in      Any animals or pets
   a holistic perspective for the            Assess to transportation (private or public)/ other
   patient’s overall care and quality of     basic amenities.
   life.




                                                9
Title                                  Description

5. Summary and Problem list               Summary of the patient‟s condition and “List of
                                          problems” (according to the bio-psycho-social
                                          model).
                                          Impact of the disease
                                             o On the patient
                                             o On the family
                                             o On the community

6. Management & Patient’s                 Non-pharmacological and pharmacological
   progress                               treatment/management
                                          Multidisciplinary care / role of other support
                                          groups / NGO‟s.
                                          Long term management plans (as appropriate)
                                          Any recommendations specific to the disease
                                          (other drugs, simpler regimes, less costly
                                          alternatives, etc.).
                                          Disease related complications
                                          Response to treatment or deterioration in clinical
                                          condition

7. Discussion                             Patient‟s bio-psycho-social-spiritual
                                          issues/problems
                                          Impact on the patient, family and community, and
                                          management
                                          Students should incorporate Evidence-based
                                          Medicine and cite the sources of information.
                                          Discuss these relevant to the case.
8. Conclusion                             Conclusion and recommendations for further or
                                          better care (as appropriate).
                                          Thoughts:
                                          Add your reflection on how this Family Case
                                          Study can help you in the future, your learning
                                          issues, how would you deal with this patient
                                          differently.


8. References                             List them in UKM or Vancouver style.
                                          References should be the most recent available.


Additional instruction:

       As the Family Case Study is a report of events that happened in the past, it should
       be written in the past tense.
       Assessment is based on the ability to identify the bio-psychosocial and spiritual
       issues of the patient and how it has impacted the patient, family and community.
       Add photos of the house and surroundings (if possible and with permission of patient)
       Do NOT discuss medical information like a textbook. Do NOT cut and paste from
       websites or reference materials.
       Please ensure consistent formatting, line spacing and choice of fonts.
       Do „spelling and grammar‟ check.


                                            10
Vancouver style referencing

You may refer to the following website:

http://www.library.uq.edu.au/training/citation/vancouv.pdf



UKM style referencing

You may refer to the following website:

http://www.ukm.my/pps/pdf/Penulisan%20Gaya%20UKM.pdf




                                              11
Format for Reflective Writing:

REFLECTION

Please write the learning points (BASED ON THE PROVIDED THEMES) you have picked
up during this session and relate it to the objectives of the Comprehensive Health Care
Module. (300 – 500 words)



…………………………………………………………………………………………….

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………




                                                                 Marks:……../ 10




                                           12
ASSESSMENT COMPONENTS
                           Family Case Study Evaluation Sheet

                                   Case Presentation

SGD Rooms:

Name of Group:

(Please refer to the list of names provided)

Facilitator:

Date of Case Presentation:

        Items                         Marks               Marks allocated

Content

- holistic and                         25
comprehensive in
approach

Style of presentation /                10
Overall presentation

Group work( active                      5
participation of other
group members)

Total                                  40



Facilitator‟s comments:




Facilitator‟s Signature:




                                            13
Family Case Study Evaluation Sheet

                                       Case Report

SGD Rooms:

Name of Group:



Facilitator:

Date of Family Case Study Received:

                                                        Marks   Marks allocated
1. Introduction & Demographic Data                       2
2. Clinical history & Physical Examination               10
3. Problem List / Diagnosis (bio-psycho-social           10
   model)
4. Patient‟s progress / Discussion & Management          30
5. Conclusion                                            5
6. References/Lay out                                    3
                TOTAL                                    60


Facilitator‟s comments:




Facilitator‟s Signature:




                                           14
Scoring System in Reflective writing


                           ELEMENT OF REFLECTION                                          SCORE

                             Brief description of event

Time, place, location, who were involved (the job title, not the name of the person)       0-1

                    Attending to feeling (during the incident)

              Explore your affective (feelings) reaction to the event
              What were your concerns and thoughts at that time?
                                                                                           0-1
What do you think other people (friends, facilitator) felt at that time, and how do you
                              know what they felt?

                                  Critical analyses

  Your thoughts, your assumptions, other people involved and the context (place,           0-3
                                  time, set-up)

                               Synthesis/Evaluation

 Weighing up different interest, room for dilemma and uncertainties, evaluate own
                            position and emancipation.
                                                                                           0-3
                      -What have you learnt from the event?
             How does this relate with your previous experiences?
    In what ways do theories or underlying knowledge explain the situation?

        Outcomes(learning needs, changed of perception, behavior or
                            acquired new skill)

           Given a similar situation in the future, how would you behave?
                                                                                           0-2
                      Has this changed your way of practice?
            What are your learning needs arising from this experience?
            What are your strategies to achieve those learning needs?



                                        Total                                              10




                                                15
Peer Assessment

Student‟s Name:                                                                Date:



Domains           Overall         Item
                  rating
Team work                         Able to establish a shared understanding among members.
                                  Actively participate in the activities
                                  Display individual accountability and responsibility
                                  Handle conflicts in a positive manner
                                  Being supportive towards each other.
Communication                     Using terms or phrases that can be understood by all members ( no
                                  professional jargons)
                                  Actively participate in the discussion in a positive manner.
Task                              Participate actively in planning and preparation in a positive manner
management                        Able to complete the assigned task within the time frame and
                                  standards.
Leadership                        Able to display good leadership skills.
Professional                      Display punctuality.
Attitudes                         Being proactive and motivated.
Knowledge                         Able to gather relevant information required.
                                  Able to understand and interpret information gathered.
                                  Able to approach the case discussed in a comprehensive manner.
                                  Able to anticipate future requirements or demands relevant to the
                                  case discussed.
                                  Able to offer other options or new ideas relevant to the case
                                  discussed.

Standard: The standard should be judged against the standard expected at completion of the
stage of training based on the program objectives or outcomes.

***Rating scale:
    1- Very Poor; 2- Poor; 3- Average; 4-Good; 5- Excellent ;


   1- Very Poor: Performance potentially effects patient safety and quality care.
      Serious intervention plan and action is needed
   2- Poor: Performance indicated cause of concern, consider further improvement plan and
      action is needed.
   3- Average: Performance was of a satisfactory standard but could be improved.
   4- Good: Performance was consistent and at good standards, enhancing patient‟s safety
      and quality care.
   5- Excellent: Performance was consistent and at high standards, enhancing patient‟s safety
      and
      quality care. It could be a positive reference for others.




                                             16
Facilitator’s Report

Student‟s Name:

Domains           Overall          Item
                  rating
Team work                          Able to establish a shared understanding among members.
                                   Actively participate in the activities
                                   Display individual accountability and responsibility
                                   Handle conflicts in a positive manner
                                   Being supportive towards each other.
Communication                      Using terms or phrases that can be understood by all members ( no
                                   professional jargons)
                                   Actively participate in the discussion in a positive manner.
Task                               Participate actively in planning and preparation in a positive manner
management                         Able to complete the assigned task within the time frame and
                                   standards.
Leadership                         Able to display good leadership skills.
Professional                       Display punctuality.
Attitudes                          Being proactive and motivated.
Knowledge                          Able to gather relevant information required.
                                   Able to understand and interpret information gathered.
                                   Able to approach the case discussed in a comprehensive manner.
                                   Able to anticipate future requirements or demands relevant to the
                                   case discussed.
                                   Able to offer other options or new ideas relevant to the case
                                   discussed.

Standard: The standard should be judged against the standard expected at completion of the
stage of training based on the program objectives or outcomes.

***Rating scale:
    1- Very Poor; 2- Poor; 3- Average; 4-Good; 5- Excellent ;


   1- Very Poor; Performance potentially effects patient safety and quality care.
      Serious intervention plan and action is needed
   2- Poor; Performance indicated cause of concern, consider further improvement plan and
      action is needed.
   3- Average; Performance was of a satisfactory standard but could be improved.
   4- Good; Performance was consistent and at good standards, enhancing patient‟s safety
      and quality care.
   5- Excellent. Performance was consistent and at high standards, enhancing patient‟s safety
      and
      quality care. It could be a positive reference for others.




Facilitator‟s Name & Signature :


Date:




                                              17

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Chc study guide 2012 2013

  • 1. INTRODUCTION TO COMPREHENSIVE HEALTH CARE MODULE MEDICINE & SOCIETY II B COMPREHENSIVE HEALTH CARE MODULE (FFFF2622) I. DIRECTORY OF TEACHING STAFF NO. NAME OF LECTURERS/TUTORS TEL NO. E-MAIL A. Department of Family Medicine 1. Dr Rashidi Mohd Pakri 012-3945786 Drrashidi5377@yahoo.com 2. Dr Hizlinda Tohid 019-2222109 hizlinda2202@gmail.com 3. Dr Aida Jaffar 9145 6126 aida.jaffar@gmail.com 4. Dr Tan Chai Eng (Module Coordinator) 9145 6126 tce@ppukm.ukm.edu.my 012-3343145 5. Dr Saharuddin Ahmad 012-3838204 bulat1977@yahoo.com 6. Dr Mohd Fairuz Ali 9145 6116 phere1@gmail.com 7. Dr Zuhra Hamzah 9145 6124 zuhradr@yahoo.com 8. Dr Syahnaz Mohd Hashim 9145 6124 syahnaz74@gmail.com 9. Dr Noorlaili Mohd Tauhid 9145 6120 lailitauhid@yahoo.com B. Faculty of Pharmacy 1. Dr Noraida Mohamed Shah noraida_mohamedshah@yah 9289 8038 oo.com 2. Puan Siti Azdiah Abd Aziz 9289 7964 sitiazdiah@yahoo.com 3. Dr Adyani Md Redzuan 9289 7987 adyani.hairul@gmail.com 4. Cik Adliah Mohd Ali 9289 7964 adliah_ali@yahoo.com.sg 1
  • 2. C. Department of Nursing 1. Puan Gurbinder Kaur a/p Jit Singh 9145 6254 gurbin@ppukm.ukm.edu.my 2. Cik Hasnah Yahaya 9145 6261 hasnah@ppukm.ukm.edu.my 3. En. Che Salim Sulaiman 9145 6260 chesalim@ppukm.ukm.edu.my 4. Puan Nour Dhiaeyah Supuan Zaki Nour.dhaeyah@ppukm.ukm.edu 9145 6266 .my D. Department of Parasitology 1. Dr „Azlin Muhammad @ Mohd Yassin 9289 7229 azlinoshin@yahoo.co.uk 2. Dr. Aishah Hani Bt Azil 9289 7209 aishahhani@medic.ukm.my E. Department of Community Health 1. Prof Madya Dr Azmi Mohd Tamil 9145 5890 drtamil@gmail.com 2. Dr Azmawati Mohammad Nawi 9145 6404 atienawi@yahoo.com 3. Dr Jamsiah Mustafa 9145 5906 Jamsiah_jkm@yahoo.com 4. Dr Ahmad Taufik Jamil 9145 5888 atjamil@gmail.com E. Department of Medical Education 1. Dr Mohd Arif Kamaruddin 9145 6241 drmdarif@hotmail.com 2. Dr Mohd Nasri Awang Besar 9145 6241 drmohdnasri@gmail.com 3. Dr Md Nurman 019- mdnurman@yahoo.com 2272269 4. Pn Siti Mariam Bujang 013- Eentan80@yahoo.com 3335233 2
  • 3. II. This module is aimed to introduce the concept of comprehensive health care according to the modern medical principle. It includes the principle of solving health problems at the individual, family and community level. The module discusses the holistic approach in patient management. It also emphasizes on the concept of patient, family and community interactions from the aspect of health. The students will be exposed to the needs of patient with chronic diseases and how it is assessed and managed comprehensively. Functions of health organizations and health facilities at various levels in the community are also discussed. PRE-REQUISITES The students should have prior knowledge of 1. Medicine & Society I 2. Medicine & Society IIA III. MODULE OBJECTIVES This is a 2 credit module (80 hours of students learning time) conducted throughout 16 weeks during semester 4 of the undergraduate medical program. Second year medical students and third year pharmacy students will participate in this module. Students will be divided into small groups consisting of 5 -6 students. Each small group will be assigned to a patient with chronic illness. Students are required to work as a team to: 1. Identify and describe the impact of the illness on the patient as well as on the family and community. 2. Identify their roles as health professionals in addressing the bio-psycho-social issues faced by the patient, from the aspect of health promotion, prevention, treatment and rehabilitation. 3. Identify relevant community and other facilities and services available for the patient. 4. Provide relevant advice to the patient regarding the use of these facilities and services. 3
  • 4. IV. METHODS OF ASSESSMENT Continuous assessment based on o Family Case Study Presentation (group work) 30% o Family Case Study Report (group work) 30% o Reflective writing (individual) 25% o Peer Assessment 5% o Facilitator‟s Report 5% o Attendance 5% Total 100% Note: Students are required to submit their Family Case Study Report (group work) and reflective writing (individual) on-line by week 15 (10th May 2013 by 2400hrs). Please avoid sending in your assignments on the date line because your actions may “freeze” the system. (http://www.medicine.ukm.my/apps/e.learning) Family Case Study Presentation, Family Case Study Report and reflective writing assignments are marked by the respective facilitators. Satisfactory attendance is only considered when students attend at least 80% of all teaching-learning activities (Lectures, Small group discussions, Visits). V. RESOURCE MATERIALS 1. Reagan, P.A. Brookins-Fisher, J. Community Health in the 21st Century. 2nd Edition. San Francisco: Pearson Education, Inc; 2002. 2. Phoon, W.O. Chen, P.C.Y. Textbook of Community Medicine in South East Asia. Singapore: John Wiley & Sons; 1986. 3. Mc Whitney, I. R. Freeman T. A Text Book of Family Medicine. 3rd ed. Oxford University Press; 2009. 4. Rakel, R.E. Text Book of Family Medicine. 7th ed. Philadelphia: Saunders; 2007. 5. Taylor, R. Fundamentals of Family Medicine: The Family Medicine Clerkship Textbook. 3rd ed. Springer Pub. Co; 2003. 6. Unwin BK, Jerant AF. The Home Visit. American Family Physician. 1999; Vol 60: 1481-8. 4
  • 5. VI. TEACHING-LEARNING TOPICS AND SPECIFIC OBJECTIVES Concept Lectures At the end of the lectures, students should be able to: L1 Comprehensive Health Care I & II & describe characteristics of comprehensive health care at the individual, family and L2. community level describe the function of family and „at risk‟ family describe various stages of disease prevention at the individual, family and community level L3. Family Case Study approach and discuss the patient‟s problems in a holistic manner identify and analyze the health problems in relation to the patient, family and community appreciate that any health issues have an impact towards the patient, family and community understand the management of relevant health problems by means of health promotion, prevention, and appropriate treatment and rehabilitation measures with appropriate and effective use of resources recognize the value of home visits in assisting health personnel to assess patient‟s condition at home (e.g.: family dynamics, surroundings etc). realize the importance of adopting a non-judgmental attitude and being sensitive to religious and cultural diversity as well as differing moral values and beliefs. L4. Holistic Approach to Medicine define the meaning of `holistic‟ discuss the concept of `mind-body medicine‟ recognize the importance of a holistic approach in patient care understand how to practice holistic patient care 5
  • 6. Small Group Discussion (SGD) During the following SGDs, students should: SGD 1 - Receive information regarding their assigned patients - Learn how to organize a home visit and respective organizational visit. - Plan their activities during each visit SGD 2&3 - Update their facilitator and discuss the progress of their family case study - Clarify particular issues or problems they are facing. - Arrange corrective measures to overcome these problems - Discuss with their facilitator regarding the family case study presentation. SGD 4 - Present their Family Case Study - Prepare their Family Case Study Report. Visits A. Home Visit During the home visit, students should: Evaluate holistically patient‟s problems and status (e.g. health and functional) at home. Evaluate patient‟s home environment (e.g. physical conditions, social environment such as family dynamic, safety issues etc) and assess the impacts of this environment on his/her health and function. Identify „at-risk‟ patient (e.g. at-risk of abuse, neglect or social isolation). Identify potential home-based interventions that are suitable for the patient. Evaluate patient‟s support system and functions of family members. Evaluate coping behavior of the patient and family members. Identify medical, psychosocial, environmental and financial problems faced by the patient and family members. Identify impacts of patient‟s illness on his/her own life, family and community Identify and promote disease prevention and health promotion to the patient and family members. Plan appropriate management (e.g. treatment, rehabilitation measures etc) for the patient, family members and community Demonstrate non-judgmental attitude and sensitivity to religious and cultural diversity as well as differing moral values and beliefs. 6
  • 7. B. Visit to relevant organizations that provide aftercare to the respective patient (where applicable) identify appropriate resources (e.g. NGOs, facilities, programs etc) available for the patient in his/her community identify the roles and functions of these resources incorporate the related community resources in the patient‟s rehabilitation plan Reflective Writing Each student is required to write a reflection on: Working together with other healthcare professionals in patient care 7
  • 8. STUDENT’S ASSIGNMENT Format for Family Case Study Presentation (Duration of presentation: 15 – 20 minutes) Title of Slides Description 1. Title slide Title of case study SGD group and name of members 2. Introduction Patient Demographic Data (Why do you think it is important to know about this case and to approach it in a holistic/ comprehensive manner?) 3. Clinical Summary Summary of the clinical history and physical findings from your own observation or clinical examination – please do not copy from the case note.(list it in chronological order) 4. Investigations List appropriate investigations and interpretation of the results. 5. Home Visit/Visit to relevant Students are expected to synthesize important / relevant organization data from the home visit as well as visit to relevant organization and apply them appropriately into their case study in a holistic perspective for the patient‟s overall care and quality of life. 6. Summary and Problem list Summary of the patient‟s condition and “List of problems” (according to the bio-psycho-social model). 7. Management & Discussion Non-pharmacological and pharmacological management (short/long term) Multidisciplinary care and community resources Important points of discussion 8. Reflection & Conclusion Conclusion and recommendations for further or better care (as appropriate). Add your reflection on how this Family Case Study can help you in the future, your learning issues, how would you deal with this patient differently. 9. References List them in UKM or Vancouver style. References should be the most recent available. Additional instruction: Present using Microsoft Office PowerPoint. Discuss with facilitators as to what to present and flow of presentation. As the Family Case Study is a report of events that happened in the past, it should be written in the past tense. Please ensure consistent formatting, line spacing and choice of fonts. Photos of the house, lesions/disease, and surroundings may help in your case presentation. (Only with permission from the patients) Do „spelling and grammar‟ check. 8
  • 9. Format for Family Case Report (3000 words, include relevant photos only) SGD Group: Name of members: Facilitator‟s name: Demographic data Date of clerking: Name: Registration No: Contact Address: Contact Number: Primary Care Giver details: (where applicable) Title Description 1 Introduction Why do you think it is important to know about this case and to approach it in a holistic/ comprehensive manner? 2. Summary of clinical history and History: presenting complaint, history of present physical findings (from your own illness, systemic reviews. observation or clinical examination Past history: medical/surgical/obstetric history – please do not copy from the case Menstrual history notes). Growth & developmental history History of allergies: (List in chronological order) Drug history/medications (indications) - over the counter medication/prescribed drugs/street drugs etc. Smoking, Alcohol, Assessment of Risk behaviors. Social history& Financial history Dietary history Progression of disease (as appropriate) Physical examination (with your interpretations of what abnormal findings means and its relevance) 3. Investigations: List of all appropriate investigations based on your own knowledge and clinical judgment (If results are available, state the dates when the tests were done, normal ranges and your interpretation of the results) 4. Home Visit/Visit to relevant Floor plan, neighborhood, exterior &interior of organization home ( crowding, housekeeping, homely Synthesize important / relevant data environment, privacy) from the home visit and visit to Water, electricity, sewage, air circulation, relevant organizations. Apply them windows, toilets. appropriately into the case study in Any animals or pets a holistic perspective for the Assess to transportation (private or public)/ other patient’s overall care and quality of basic amenities. life. 9
  • 10. Title Description 5. Summary and Problem list Summary of the patient‟s condition and “List of problems” (according to the bio-psycho-social model). Impact of the disease o On the patient o On the family o On the community 6. Management & Patient’s Non-pharmacological and pharmacological progress treatment/management Multidisciplinary care / role of other support groups / NGO‟s. Long term management plans (as appropriate) Any recommendations specific to the disease (other drugs, simpler regimes, less costly alternatives, etc.). Disease related complications Response to treatment or deterioration in clinical condition 7. Discussion Patient‟s bio-psycho-social-spiritual issues/problems Impact on the patient, family and community, and management Students should incorporate Evidence-based Medicine and cite the sources of information. Discuss these relevant to the case. 8. Conclusion Conclusion and recommendations for further or better care (as appropriate). Thoughts: Add your reflection on how this Family Case Study can help you in the future, your learning issues, how would you deal with this patient differently. 8. References List them in UKM or Vancouver style. References should be the most recent available. Additional instruction: As the Family Case Study is a report of events that happened in the past, it should be written in the past tense. Assessment is based on the ability to identify the bio-psychosocial and spiritual issues of the patient and how it has impacted the patient, family and community. Add photos of the house and surroundings (if possible and with permission of patient) Do NOT discuss medical information like a textbook. Do NOT cut and paste from websites or reference materials. Please ensure consistent formatting, line spacing and choice of fonts. Do „spelling and grammar‟ check. 10
  • 11. Vancouver style referencing You may refer to the following website: http://www.library.uq.edu.au/training/citation/vancouv.pdf UKM style referencing You may refer to the following website: http://www.ukm.my/pps/pdf/Penulisan%20Gaya%20UKM.pdf 11
  • 12. Format for Reflective Writing: REFLECTION Please write the learning points (BASED ON THE PROVIDED THEMES) you have picked up during this session and relate it to the objectives of the Comprehensive Health Care Module. (300 – 500 words) ……………………………………………………………………………………………. …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… Marks:……../ 10 12
  • 13. ASSESSMENT COMPONENTS Family Case Study Evaluation Sheet Case Presentation SGD Rooms: Name of Group: (Please refer to the list of names provided) Facilitator: Date of Case Presentation: Items Marks Marks allocated Content - holistic and 25 comprehensive in approach Style of presentation / 10 Overall presentation Group work( active 5 participation of other group members) Total 40 Facilitator‟s comments: Facilitator‟s Signature: 13
  • 14. Family Case Study Evaluation Sheet Case Report SGD Rooms: Name of Group: Facilitator: Date of Family Case Study Received: Marks Marks allocated 1. Introduction & Demographic Data 2 2. Clinical history & Physical Examination 10 3. Problem List / Diagnosis (bio-psycho-social 10 model) 4. Patient‟s progress / Discussion & Management 30 5. Conclusion 5 6. References/Lay out 3 TOTAL 60 Facilitator‟s comments: Facilitator‟s Signature: 14
  • 15. Scoring System in Reflective writing ELEMENT OF REFLECTION SCORE Brief description of event Time, place, location, who were involved (the job title, not the name of the person) 0-1 Attending to feeling (during the incident) Explore your affective (feelings) reaction to the event What were your concerns and thoughts at that time? 0-1 What do you think other people (friends, facilitator) felt at that time, and how do you know what they felt? Critical analyses Your thoughts, your assumptions, other people involved and the context (place, 0-3 time, set-up) Synthesis/Evaluation Weighing up different interest, room for dilemma and uncertainties, evaluate own position and emancipation. 0-3 -What have you learnt from the event? How does this relate with your previous experiences? In what ways do theories or underlying knowledge explain the situation? Outcomes(learning needs, changed of perception, behavior or acquired new skill) Given a similar situation in the future, how would you behave? 0-2 Has this changed your way of practice? What are your learning needs arising from this experience? What are your strategies to achieve those learning needs? Total 10 15
  • 16. Peer Assessment Student‟s Name: Date: Domains Overall Item rating Team work Able to establish a shared understanding among members. Actively participate in the activities Display individual accountability and responsibility Handle conflicts in a positive manner Being supportive towards each other. Communication Using terms or phrases that can be understood by all members ( no professional jargons) Actively participate in the discussion in a positive manner. Task Participate actively in planning and preparation in a positive manner management Able to complete the assigned task within the time frame and standards. Leadership Able to display good leadership skills. Professional Display punctuality. Attitudes Being proactive and motivated. Knowledge Able to gather relevant information required. Able to understand and interpret information gathered. Able to approach the case discussed in a comprehensive manner. Able to anticipate future requirements or demands relevant to the case discussed. Able to offer other options or new ideas relevant to the case discussed. Standard: The standard should be judged against the standard expected at completion of the stage of training based on the program objectives or outcomes. ***Rating scale: 1- Very Poor; 2- Poor; 3- Average; 4-Good; 5- Excellent ; 1- Very Poor: Performance potentially effects patient safety and quality care. Serious intervention plan and action is needed 2- Poor: Performance indicated cause of concern, consider further improvement plan and action is needed. 3- Average: Performance was of a satisfactory standard but could be improved. 4- Good: Performance was consistent and at good standards, enhancing patient‟s safety and quality care. 5- Excellent: Performance was consistent and at high standards, enhancing patient‟s safety and quality care. It could be a positive reference for others. 16
  • 17. Facilitator’s Report Student‟s Name: Domains Overall Item rating Team work Able to establish a shared understanding among members. Actively participate in the activities Display individual accountability and responsibility Handle conflicts in a positive manner Being supportive towards each other. Communication Using terms or phrases that can be understood by all members ( no professional jargons) Actively participate in the discussion in a positive manner. Task Participate actively in planning and preparation in a positive manner management Able to complete the assigned task within the time frame and standards. Leadership Able to display good leadership skills. Professional Display punctuality. Attitudes Being proactive and motivated. Knowledge Able to gather relevant information required. Able to understand and interpret information gathered. Able to approach the case discussed in a comprehensive manner. Able to anticipate future requirements or demands relevant to the case discussed. Able to offer other options or new ideas relevant to the case discussed. Standard: The standard should be judged against the standard expected at completion of the stage of training based on the program objectives or outcomes. ***Rating scale: 1- Very Poor; 2- Poor; 3- Average; 4-Good; 5- Excellent ; 1- Very Poor; Performance potentially effects patient safety and quality care. Serious intervention plan and action is needed 2- Poor; Performance indicated cause of concern, consider further improvement plan and action is needed. 3- Average; Performance was of a satisfactory standard but could be improved. 4- Good; Performance was consistent and at good standards, enhancing patient‟s safety and quality care. 5- Excellent. Performance was consistent and at high standards, enhancing patient‟s safety and quality care. It could be a positive reference for others. Facilitator‟s Name & Signature : Date: 17