FAMILY MEDICINE SYSTEM

UNDERGRADUATE MEDICAL DEGREE PROGRAM

FACULTY OF MEDICINEUNIVERSITAS PADJADJARAN

2012

Rasionalisasi

KIPDI II KIPDI IIIKurikulum berbasis

kompetensi

Kurikulum Berbasis Kompetensi

• Standar Kompetensi dokter yang disusun mengacu pada gambaran dokter yang dibutuhkan

7 AREA KOMPETENSI

1. Keterampilan komunikasi efektif2. Keterampilan klinik dasar3. Keterampilan penerapan dasar-dasar ilmu biomedik, klinik,

perilaku & epidemiologi dalam praktek kedokteran keluarga4. Keterampilan pengelolaan masalah kesehatan individu, keluarga

ataupun masyarakat dengan cara yang komprehensif, holistik, bersinambung, terkoordinir & bekerja sama dalam konteks pelayanan kesehatan primer

5. Keterampilan pemanfaatan, penilaian secara kritis dan pengelolaan informasi

6. Mawas diri dan pengembangan diri/belajar sepanjang hayat7. Etika, moral & profesionalisme dalam praktek

4 – Pengelolaan Masalah Kes. Individu, Keluarga & Masy.

Kompetensi Inti: Diagnosa, pengelolaan & pencegahan mslh

individu yg umum dlm konteks hub. keluarga & masy. scr komprehensif, holistik, berkesinambungan serta dg bekerja sama

Mengelola mslh kes. individu mll keterampilan clinical reasoning utk menjamin hsl maksimal

Educational Objectives of Medical Doctor Program (at Unpad)

1. to communicate effectively with patient, family, community, and other health professionals

2. to perform basic clinical skills3. to apply principles of basic biomedical,

clinical, behavioral sciences and epidemiology in the practice of medical profession

4. to manage professionally and ethically common health problems at individual, family and community level in a comprehensive, holistic, and continuous manner

5. to access, critically appraise and manage medical and health information to improve his/her quality professional task leading to be a lifelong learner

6. to be self-aware, self-care and self-developed professional.

Educational Objectives of Medical Doctor Program (at Unpad) (cont’d)

Curriculum Structure 2008

I II III IV V VI VIIFBS I (4) RPS (10) EMS

(7)DMS

(8)CVS (8)

GUS (7)

TM (7)

FBS II (4) NBS (10)

HIS (8) RS (7) GIS (7) FM

(7)

FBS III (4) CSP I (2) CSP II (2)

CSP III (2)

CSP IV (2)

CSP V (2)

CSP VI (2)

FBS IV (4)

PHOP I (1)

PHOP II (2)

PHOP III (1)

PHOP IV (1)

PHOP V (1)

PHOP VI (2)

PHOP VII (1)

CRP I (1) CRP II (2) CRP III (1)

CRP IV (1) CRP V (1) CRP VI (2) CRP VII (2)

BHP I (2) BHP II (3)

BHP III (1)

BHP IV (1)

BHP V (1)

BHP VI (1)

BHP VII (1)

20 19 22 21 20 21 20

FAMILY MEDICINE APPROACH TO MANAGE THE CASES

Personal

Primary

Continuing

Comprehensive

A care delivered with a close rapport b/w patient and the doctor

First contact care

Care of chronic medical problem, care of complications

Preventive, promotive, curative and rehabilitative

The Principles

FAMILY PHYSICIAN

DEDICATED TO THE PERSON

UNDERSTAND THE CONTEXT OF ILLNESS

ALL CONTACT WITH PATIENTS AN OPPORTUNITY FOR PREVENTION & HEALTH

EDUCATION

THE PRACTICE AS A POPULATION AT RISK

DOES COMMUNITY NETWORKING

LIVE IN COMMUNITY/ A PART OF THE COMPLEX OF FAMILY

RELATIONSHIP

HOME VISITS (SEES PATIENTS AT HOME)

SUBJECTIVE ASPECTS OF MEDICINE (SENSITIVITY TO FEELINGS, EMOTIONAL ETC)

MANAGER OF RESOURCES

BIO – PSYCHO –SOCIAL ECONOMY MODEL OF ILLNESS

THE HEALTH OF THE FAMILY AS AN UNIT

INDIVIDU IS A PART OF THE FAMILY, AND FAMILY AS A PART OF THE COMMUNITY

FAMILY DOCTORLIFE CYCLE CARELIFE CYCLE CARE

Personalbehavior

Psycho-socio-Economic

Environment

Human biology

Physicalenvironment

The Mandala of HealthA model of human ecosystem

Culture

Community

lifestyle

workSickcaresystem

Human-Made Environment

Biosphere

spirit

body mind

Pre-pathogenesis Pathogenesis

Before man is involved The course of the disease in man

Interrelation of the various: - AGENT - HOST - ENVIRONMENT factors

(known & unknown) which

bring AGENT & HOSTtogether, orproduce a disease-provokingSTIMULUS

in the human HOSTEarly pathogenesis Discernable early

lesionsAdvanceddisease Convalescence

Interaction ofHOST & STIMULUS

HOST reaction

STIMULUS & AGENT becomesestablished & increases bymultiplication or increment

Tissue & physiologicchanges

Signs & symptoms

IllnessDisability

DefectChronic state

DEATH

RECOVERY

Immunity & resistance

Health promotion & Spesific protection

Early detection & prompt treatment

Disability Th/ & Rehabilitation

PROMOTIVE

PREVENTIVE

CURATIVE REHABILITATIVE

PROMOTIVEPREVENTIVE CURATIVE

REHABILITATIVE

The health enhancement continuum

Pasien

Anamnesis – patient centered anamnesis

Pemeriksaan fisik

Pemeriksaan penunjang

Diagnosis HOLISTIK

Penatalasanaan KOMPREHENSIF

Aspek personal

Aspek klinis

Aspek risiko internal

Aspek risiko eksternal

Dinamika Keluarga

Lingkungan

Genogram

Family Map

Family life cycle

Family APGAR

Family SCREEM

Rumah

PekerjaanDiagnosis

MedisDiagnosis

Psikososial

Intervensi Medis

Intervensi psikososial

DOUBLE DIAGNOSIS

BMP: Preclinical phase

Normal Structures Normal Functions

- Molecular

- Cellular

- Tissue

- Organ

- System Organ

Pathogenesis

Abnormality

CongenitalInfection/ Inflammation

NeoplasmTrauma

Others

Patophysiology

Principles of diagnostic

Principles of management

Signs-Symptoms S-S S-S

Complication

Family Medicine approach

Normal Structures Normal Functions

Pathogenesis

Abnormality

Congenital

Infection/ Inflammation

NeoplasmTrauma

Others

Patophysiology

Principles of diagnostic

Family Medicine approach

Signs-Symptoms S-S S-S

Complication

APPLIED

PRINCIPLE

Scenario

Hypotheses (un-implemented theory –week theme – diseases or psychosocial problems).

Problems (1st page/s)

Mechanism

direction to meet with embedded-Learning Issues of Fam Med

generate

Concept mapping

Implementation of the concept

BMP FM

• Bioscience• Pathogenesis• Pathophysiology• Clinical aspect• Management

• Review Clinical aspect• Risk factor• Family as a unit of care• Biopsychosocial approach• Health care maintenance for individual

and family• Screening • Counseling • Immunization • Chemoprophylaxis

• Curative and rehabilitative

Stroke

BMP Kedokteran keluarga

• Describe the cause• Describe the pathogenesis• Explain risk stratification• Describe PE• Explain the principles of clinical and

laboratory assessment• Give basic treatment (non and

pharmacology)• Describe MOA

• Review the diagnosis of stroke• Describe the impact of illness to the

family• Describe the monitoring for patient • Describe the care for caregiver• Describe the concept for home care• Describe health care maintenance for

elderly (screening, counselling, immunization and chemoprophylaxis)

Week-theme

Lifecycle Theme   Topic

Newly married and

Infancy, childhood

Preventive care 1 Pre-conception care and

Family planning

  Preventive care 2 Failure to thrive

Adolescence/ teenagers Preventive care 3 Weight management and

nutrition

AdultBiopsychosocial approach

4Behavioral problems in teenager

  Biopsychosocial approach 5 Insomnia

Week-theme

Lifecycle Theme   Topic

Adult  Chronic Diseases 6 Hypertension

 Chronic Diseases 7 Cataract

Elderly care 8 Stroke

Elderly Elderly care 9 Osteoporosis

Palliative and domiciliary

care

10  Cervical cancer

The activities

Pre-conception care and Family planning Failure to thrive Weight management and nutritionRefraction errorBehavioral problems in teenager Somatic disorderHypertension StrokeOsteoporosis Cervical cancer TuberculosisHearing Loss

Tutorial-Overview of the system-Good parenting-The right to sight-Overview of behavioral problems-Complementary and alternative medicine-Management of physical activity for various diseases-Rational prescribing

Mini lecture

The activities

Breast care for pregnant women, post deliveryGeneral physical examinationDirect ophthalmoscope examinationDetection for mental health problemsCounseling skillBed turning and bed positioningBreaking bad news

Skills’ lab Create a genogram

Meal planning and food replacementWriting referral letterHealth care maintenanceCreate physical activityMedical auditPrescribingDevelop medical record

Lab activity