FAMILY MEDICINE SYSTEM UNDERGRADUATE MEDICAL DEGREE PROGRAM FACULTY OF MEDICINE UNIVERSITAS PADJADJARAN 2012

Kurikulum berbasis kompetensi Rasionalisasi KIPDI II KIPDI III Kurikulum berbasis kompetensi

Kurikulum Berbasis Kompetensi Standar Kompetensi dokter yang disusun mengacu pada gambaran dokter yang dibutuhkan

7 AREA KOMPETENSI Keterampilan komunikasi efektif Keterampilan klinik dasar Keterampilan penerapan dasar-dasar ilmu biomedik, klinik, perilaku & epidemiologi dalam praktek kedokteran keluarga Keterampilan pengelolaan masalah kesehatan individu, keluarga ataupun masyarakat dengan cara yang komprehensif, holistik, bersinambung, terkoordinir & bekerja sama dalam konteks pelayanan kesehatan primer Keterampilan pemanfaatan, penilaian secara kritis dan pengelolaan informasi Mawas diri dan pengembangan diri/belajar sepanjang hayat 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) to communicate effectively with patient, family, community, and other health professionals to perform basic clinical skills to apply principles of basic biomedical, clinical, behavioral sciences and epidemiology in the practice of medical profession

Educational Objectives of Medical Doctor Program (at Unpad) (cont’d) to manage professionally and ethically common health problems at individual, family and community level in a comprehensive, holistic, and continuous manner to access, critically appraise and manage medical and health information to improve his/her quality professional task leading to be a lifelong learner to be self-aware, self-care and self-developed professional.

Curriculum Structure 2008 I II III IV V VI VII 20 19 22 21 FBS 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

FAMILY MEDICINE APPROACH TO MANAGE the CASES

Personal Primary Continuing A care delivered with a close rapport b/w patient and the doctor Personal First contact care Primary Care of chronic medical problem, care of complications Continuing Comprehensive 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

THE HEALTH OF THE FAMILY AS AN UNIT BIO – PSYCHO –SOCIAL ECONOMY MODEL OF ILLNESS INDIVIDU IS A PART OF THE FAMILY, AND FAMILY AS A PART OF THE COMMUNITY LIFE CYCLE CARE FAMILY DOCTOR

A model of human ecosystem Community Culture The Mandala of Health A model of human ecosystem Community lifestyle Personal behavior Psycho-socio- Economic Environment spirit Sick care system work body mind Physical environment Human biology Human-Made Environment Biosphere

Pre-pathogenesis Pathogenesis Interaction of HOST & STIMULUS The health enhancement continuum 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 & HOST together, or produce a disease-provoking STIMULUS in the human HOST Early pathogenesis Discernable early lesions Advanced disease Convalescence Interaction of HOST & STIMULUS HOST reaction STIMULUS & AGENT becomes established & increases by multiplication or increment Tissue & physiologic changes Signs & symptoms Illness Disability Defect Chronic state DEATH RECOVERY Immunity & resistance Health promotion & Spesific protection Early detection & prompt treatment Disability Th/ & Rehabilitation PROMOTIVE CURATIVE PREVENTIVE PROMOTIVE REHABILITATIVE PREVENTIVE CURATIVE REHABILITATIVE

Anamnesis – patient centered anamnesis Family APGAR Genogram Aspek personal Pasien Family Map Aspek klinis Dinamika Keluarga Family life cycle Aspek risiko internal Anamnesis – patient centered anamnesis Family APGAR Aspek risiko eksternal Family SCREEM Pemeriksaan fisik Rumah Pemeriksaan penunjang Lingkungan Pekerjaan DOUBLE DIAGNOSIS Diagnosis HOLISTIK Diagnosis Medis Diagnosis Psikososial Intervensi Medis Penatalasanaan KOMPREHENSIF Intervensi psikososial

BMP: Preclinical phase Molecular Cellular Tissue Organ System Organ Normal Structures Normal Functions Congenital Neoplasm Infection/ Inflammation Abnormality Trauma Others Principles of diagnostic Pathogenesis Principles of management Patophysiology Complication Signs-Symptoms S-S S-S

Family Medicine approach Normal Structures Normal Functions Neoplasm Congenital Trauma Infection/ Inflammation Abnormality Others Family Medicine approach Principles of diagnostic Pathogenesis Patophysiology Complication Signs-Symptoms S-S S-S APPLIED PRINCIPLE

Scenario Problems (1st page/s) Hypotheses Mechanism direction to meet with embedded-Learning Issues of Fam Med Problems (1st page/s) generate Hypotheses (un-implemented theory –week theme – diseases or psychosocial problems).

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   Topic Newly married and Infancy, childhood Preventive care 1 Pre-conception care and Family planning 2 Failure to thrive Adolescence/ teenagers 3 Weight management and nutrition Adult Biopsychosocial approach 4 Behavioral problems in teenager 5 Insomnia

Week-theme Lifecycle Theme Topic Adult Chronic Diseases 6 Hypertension   Topic Adult  Chronic Diseases 6 Hypertension 7 Cataract Elderly care 8 Stroke Elderly 9 Osteoporosis Palliative and domiciliary care 10  Cervical cancer

The activities Mini lecture Tutorial -Overview of the system Pre-conception care and Family planning Failure to thrive Weight management and nutrition Refraction error Behavioral problems in teenager Somatic disorder Hypertension Stroke Osteoporosis Cervical cancer Tuberculosis Hearing 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 Skills’ lab Lab activity Create a genogram Breast care for pregnant women, post delivery General physical examination Direct ophthalmoscope examination Detection for mental health problems Counseling skill Bed turning and bed positioning Breaking bad news Skills’ lab Create a genogram Meal planning and food replacement Writing referral letter Health care maintenance Create physical activity Medical audit Prescribing Develop medical record Lab activity