Family medicine Diploma program
Residency rotation
Date / Duration / Department and hospitalTo / From
1
2
3
4
5
6
7
8
9
10
11
Goal:
The following objectives aim at fulfilling the mission of
ThiQar Medical college to graduate family physicians able to provide high standard medical care.
During their training, residents are expected to acquire knowledge, skills, and attitudes that guide them in their future practice. The curriculum aims to promote the principles of continuous, comprehensive, coordinated care in the context of family and community.
General Objectives:
At the end of the residency program the graduated residents should be able to:
1- Communicate effectively with patients and family members, including situations related to end of life issues, difficult patients and angry patient.
2- Demonstrate ability to carry a proper exam for all organs.
3- Provide continuing and comprehensive care to all individuals with emphasis on the family unit, irrespective of age, sex, or diseased organ system.
4- Apply the principles of effective counseling and education to the patient/family member.
5- Demonstrate competency in serving the public as the physician of first contact.
6- Carry a family assessment.
7- Recognize the importance of continuous education and practice evidence based medicine.
8- Perform certain diagnostic and therapeutic procedures relevant to primary care.
9- Demonstrate ability to use information technology pertaining to medical issue.
10- List the composition, effects, indications, and dosages of commonly used drugs.
Internal Medicine rotation(3months)
Duties / Numberrequired performed
1 / Outpatient clinic In patient duties and rounds / 60 days
2 / On call duties / 10days
3 / Others
4 / Others
Each resident should:
A-Acquire the following skills:
1- Take complete history, physicalexamination, perform and interpret diagnostic procedures commonly used in primary care level.
2-Interpret commonly used laboratory tests.
B- Diagnose and manage the following;
1-As related to Cardiovascular system
*Chest pain
*High blood pressure
*Syncope
*Leg edema
*Irregular rhythm
*Dyspnea
*Palpitation
*Heart murmurs
2-As related to respiratory system
*Dyspnea
*Cough
*Hemoptysis
*Pleural effusion
*wheezing
3-As related to Digestive system
*Heartburn
*Diarrhea
*Melena *Hematemesis
*Dysphagia
*Epigastric pain
*Constipation
*Abdominal distention
*Ascites
*Jaundice
*Nausea and vomiting
4-As related to Genitourinary system:
* Pyuria
*Hematuria
*Proteinuria
* Casts
* Dysuria
* Frequency
* Urgency
* Penile discharge
* Scrotal Pain, Masses, and swelling.
* Genital lesions
5-As related to musculoskeletal System
*Neck pain
*Shoulder pain
*Back pain
*Hip pain
*Knee pain
*Foot pain
*Arthralgia (s)
*Arthritis (monoarticular, polyarticular)
6-As related to Nervous system:
*Headache
*Dizziness and vertigo
*Tremor
*Seizures
*Dementia
*Coma
*Paresis and paralysis
7-As related to endocrine system
*Thyroid lump
*Enlarged thyroid
*Polyuria ,polydepsia
*Hypoglycemia
*polyphagia
*Weight problem
*Hirsutism
8-As related to hematopoietic system:
*Anemia
*Polycythemia
*Leukocytosis
*Leukopenia
*lymphadenopathy
* bleeding tendency
9-Constitutinal and non differentiated symptoms:
*Weakness and fatigue
*Weight loss
*Fever
C-Demonstrate fundamental knowledge of the management and follow up of the following chronic conditions:
1-As related to Cardiovascular
*ischemic heart disease
*Heart failure
*Valvular Heart Diseases-Both congenital and Acquired
*Arrhythmias and Coduction disorders
*Hypertention
*Thrombophlebitis
2-As related to Respiratory system:
*COPD
*Asthma
*Tuberculosis
*Lung cancer
3-As related to the digestive system:
*Peptic Ulcer
*Diverticulosis
*Inflammatory Bowel Disease
*Irritable Bowel Syndrome
*Malabsorption
*Liver Cirrhosis
4-As related to Genitourinary System:
*Nephrotic Syndrome
*Uremia
*Nephrolithiasis
5-As related to musculoskeletal system:
*Osteoarthritis
*Rheumatoid Arthritis
*Crystal induced arthritis
*Sero negative arthritis
*Osteoporosis
6-As related to Nervous system:
*Cerebrovascular disease
*Migraine and other Vascular Headache
*Other Headaches
*Facial nerve injury
*Multiple sclerosis
*Dementia
*Seizures Disorders
7-As related to the Endocrine System:
*Endemic Goiter
*Hypothyroidism
*Hyperthyroidism
*Thyroiditis
*Cushing Syndrome
*Addison's Syndrome
*Diabetes Mellitus Type 1 and 2
D-Demonstrate ability to deal with and support:
1-Chroniclly ill patient
2-Dying patient
3-Handicapped patient
E-Acquire the basic rehabilitation techniques in:
1-post MI
2-post stroke
3-Post neurological deficit
Obstetrics and Gynecology (2.5 months)
1-Acquire the following diagnostic skills
*Obtain a complete OB /GYN history.
*Examine the female reproductive system.
.Child
.Adolescent girl
.Adult woman
.Post-menopause woman
*Perform a PAP smear
*Depend on risk assessment during prenatal follow up
*Assess pelvic adequacy for pregnancy and delivery
*perform and interpret fetal assessment test in the third trimester (NST)
*Evaluate fetal maturity and feto-placental adequacy
*Perform fetal monitoring
2-Aquire the following therapeutic skills:
*Cautery for benign lesions
* Administration, follow up, and side effect management of the following contraceptive methods
-Barrier Contraception: Condoms
-Intrauterinedevice
-Oral contraceptives
*Normal cephalic vaginal delivery.
*Episiotomy and repair
3-Acquire the following counseling techniques
*marital and family counseling
-Contraception including surgical sterilization
-Infertility and artificial insemination.
-Adaptation to child bearing.
-Impact of new infant on family life.
-Abortion and still-birth.
-Menopause.
*Nutritional assessment during and following pregnancy
*Drugs, Smocking, Substance abuse during pregnancy.
4-Evaluate and manage the following signs and symptoms:
A-Vaginal discharge
B-Vaginal itching
C-Pelvic pain including dysmenorrheal
D-Abnormal bleeding and amenorrhea
E-Pelvic masses: uterine and ovarian
F-Dysparunia
G-Incontinence
h- Menopausal symptoms
I-Infertility
5-Diagnose pregnancy and schedule antenatal visits.
6-Recognize early signs and symptoms of ectopic pregnancy
7-Diagnose and follow up common medical problems during pregnancy.
8-Diagnose and treat common problems of puerperium:
*Depression
*Mastitis
*Endometritis
*Thrombophlebitis
Procedures observed and done during obstetrics and gynecology course(2.5 months)
Procedure name / Dates / Observed / Performed / Supervisor’s signatureObtaining vaginal and Cervical cytology
*For female doctor must
*For male doctor optional / 1)
2)
3)
4)
5)
6)
Dilatation and curettage / 1)
2)
3)
Normal vaginal delivery
*For female doctor must
*For male doctor optional / 1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
Episiotomy repair / 1)
2)
3)
4)
5)
Induction of labor / 1)
2)
3)
4)
Insertion and removal of IUCD
*For female doctor must
*For male doctor optional / 1)
2)
3)
4)
5)
6)
Insertion of Foley catheter
*For female doctor must
*For male doctor optional / 1)
2)
3)
4)
Assistant in C/S / 1)
2)
3)
Pediatric (3 months)
Clinicalduties
At the end of pediatric course rotation, each resident should:
A-Demonstrate ability to:
1- Take a complete history.
2- Perform an appropriate physical examination (newborn, Infant, Children).
3-Provide immediate care to the newborn by demonstrating ability to:
* Measure the Apgar Score.
* Suction the nasopharynx.
* Worm the new born.
4- Insert the IV line.
5- Resuscitation newborn, infant, and older children.
6- Give immunization shot
7- Take throat swab
8- Perform an ECG and interpret the finding
9- Identify infant in distress
B-Demonstrate fundamental knowledge of growth and development and methods of assessments:
* Physical, motor and adaptive behavior
*Speech
*Personal and social behavior
C-Demonstrate fundamental knowledge in regard to feeding of newborn, infant and children.
*Nutritional assessment :( premature, full term)
*Breastfeeding vs. Formula feeding
* Weaning period.
D- Demonstratediagnoseand manage the following :-
A- Newborn
-Premature and small for date
-Jaundice
-Respiratory distress and apnea
-Feeding problems: Choking, vomiting
-Failure to pass stool
-pallor, cyanosis
-Edema
-Distended abdomen
-Petechia and purpura
- Seizure
-Bulging fontanel
-Mass in the abdomen or back
-Hypothermia
-Heart murmur
-colic
-Birth injuries
-Fever
B- Infants:
-Fever
-Excessive crying and irritability
-Vomiting
-Diarrhea
-Constipation
-Mass in the abdomen
-Rectal bleeding
-Failure to thrive
-hematuria
-Tachypnea
-Stridor
-Wheezing
-Cough
-Heart murmur
-Hypertention
-Microcephale and macrocephale
-Seizures
-Strabismus
-Cataracts
-Rash: Diaper rash, Eczema, Infectious purpura and petechia
-pallor
-Enlarged lymphnodes
-In-toeing and out-toeing
-Undescended testes
C-Children:
-Abdominal pain
-Mass in the abdomen
-Diarrhea
-Constipation
-Rectal bleeding
-Rectal itching
-Hematurea
-Frequency,Dysurea
-Sexual precociousity
-Short stature
-Obesity
-Enuresis
-Polyurea and polydepsia
-Fever
-Sore throat
-Ear ache
-Recurrent URTI
-Snoring
-Wheezing
-Tachycardia
-Heart murmur
-Hypertension
-Arthritis
-Knee pain and leg pain
-Lump
- Scoliosis
- Convulsion
-Headache
-Coma
-Vertigo
-Rashes and itching
-Learning disabilities
d) Adolescent
-Acne
-Short stature
-Obesity
-Abdominal pain
-Headache
-Anorexia, weight loss
-Polyurea, polydepsia
-Behavioral problems
5-Demonstrate fundamental knowledge in regard to preventive pediatrics
a)-Prenatal care
b)-Postnatal care
-Periodic medical evaluation
-Nutritional supervision
-Immunization
-Prevention of accidents and poisoning
-Anticipatory guidance and counseling
6-Demonstrate fundamental knowledge in regard to the recognition of
-Minimal brain dysfunction
-Mental retardation
-Disorders of language, speech and hearing
-Reading disability
-Congenital anomalies
-Chronic disease
Procedures observed and done during pediatrics coarse (3 months)
Procedure name / Dates / Observed / Performed / Supervisor’s signatureECG taking and interpretation / 1)
2)
3)
4)
5)
6)
CXR interpretation / 1)
2)
3)
4)
5)
Lumber puncture
(observed) / 1)
2)
Insertion of Foleys catheter / 1)
2)
3)
4)
Canulla insertion and starting IV lines / 1)
2)
3)
4)
5)
Resuscitation of newborn and children / 1)
2)
3)
Bladder tap / 1)
2)
3)
All types of injection
a _ Intradermal inj. / 1)
2)
3)
b _ Subcutaneous / 1)
2)
3)
c _ i.m. / 1)
2)
3)
d _ i.v. / 1)
2)
3)
Nebulizer / 1)
2)
3)
4)
Surgery (2.5 months)
Clinical duties
At the end of the surgery rotation,each resident should be able to:
1) Generalities
a) Implement sterile techniques
b) State the stages of wound healing and care
c) List the characteristics of different suture materials
d) Apply local and digital block anesthesia
e) Name the indications and complications of different surgical techniques
f) State the alternative for the surgical procedure carried when applicable
2) Perform the following office surgical procedures:
a) Suturing of simple wound
b) Excisions of skin and subcutaneous lesions: moles, skin tags, epidermoid cyst, lipomas
c) Incision and drainage of abscesses
d)Emergency care of burns
3) Manage (stabilize, transport and perform life-saving procedures) for the following condition:
a)Penetrating trauma to the neck, thorax or abdomen
b) Blunt trauma to head
c) Multiple fractures
d)Pneumothorax
e)Hemothorax
f) Fractures of the spine
4) Diagnose and refer acute surgical condition:
a)Acute abdomen
-Perforating peptic ulcer
-Appendicitis
-Cholecystitis
-Volvulous
-Mesenteric Ischemia
b) Acute arterial occlusion
c) Torsionof the testes
d) Incarcerated hernia
5) Diagnose and manage other conditions that need surgery
a)Breast lump
b)Thyroid nodule
c)Benign prostatic hypertrophy
d)Hydrocele
e)Varicocele
f)Undescended testicle
Procedures observed and done during surgery coarse (2.5 months)
Procedure name / Dates / Observed / Performed / Supervisor’s signatureSuturing of simple wound / 1)
2)
3)
Removal of ingrowing toe nail / 1)
2)
Excision of skin and subcutaneous lesions / 1)
2)
3)
Taking biopsy
(observed) / 1)
2)
3)
Incision and drainage of abscesses / 1)
2)
Circumcision / 1)
2)
Performance of proctoscopy*if available / 1)
2)
Urethral catheterization / 1)
2)
3)
Apply local and digital block anesthesia / 1)
2)
3)
Others / 1)
2)
Others / 1)
2)
3)
Others / 1)
2)
3)
Others / 1)
2)
3)
4)
Dermatology :( 3 weeks)
At the end of dermatology rotation, the resident should be able to :
1- Take a relevant history and perform a thorough dermatological exam
2- Diagnose and treat the following conditions:
a) Acne formeruption
b)Dermatitis
c) Bacterial, viral, fungal and parasitic infections
d)Sexually transmitted diseases
e)Papulosquamouserruption: Psoriases, lichens planus
f)Drug erruption
g)Nail disorders: Acute and chronic paranochia
h)Miscellanous: dry skin, dermographism, calloses and corns.
3-Recognise the cutanuous manifestation of systemic disease
4-Diagnose the following condition
a)Disturbance of pigmentation
b) Reaction to environmental agents
c)Hair disorders
d)Tumors of the skin
Procedure name / Dates / Observed / Performed / Supervisor’s signatureremoval of epidermal growths / 1)
2)
3)
Mulloscum / 1)
2)
warts / 1)
2)
3)
skin tags / 1)
2)
3)
Others / 1)
2)
Local injections / 1)
2)
Ophthalmology (2 weeks)
At the end of the Ophthalmology Rotation, the resident should:
1.Demonstrate ability to:
a)Examine the external ocular structure
b)Test visual acuity and color vision
c)Evaluate of the extraocular muscles
d)Use direct ophthalmoscope
e)Test Visual Fields (confrontational)
f)Use Fluorescence Test
g)Use the Pinhole Test
h)Carry a Cover- Uncover Test
2.Be acquainted with the indications, contra-indications and side effects of eye
medications:
a)Mydriatics and Cycloplegics
b)Topical Corticosteroids
c)Topical Antibiotics
d)Topical Anesthesia
3. Formulate a differential diagnosis to the common signs and symptoms of the eye:
a)Red eye
b)Blurred Vision
c)Eye Pain
d) Photophobia
e) Loss of Vision
f)AmaurosisFugax
g) Floaters
h)Discharge
i) Visual field defect
j)Tearing.
4.Recognize ocular emergencies and provide first line management prior to
Referral:
a)Angle-closure glaucoma
b)Intraocular and orbital infections
c)Foreign bodies, injuries and lacerations
5.Diagnose, treat, and refer when indicated the following conditions:
a)Disorders of the eyelids and lacrimal apparatus: Ectropion, Entropion, Hordeolum, Chalazion, Blepharitis, Dacrocystitis, Dryness of the Eye, Excessive Tearing.
b)Conjunctivitis: Viral, Bacterial, Allergic and Chemical. Ophthalmianeonartum, Trachoma.
6.Diagnose:
a)Degenerative diseases of the conjunctiva: Pinguecla, Pterigium
b)Disorders of cornea and sclera : Corneal abrasions, Foreign bodies, Chemical burns, Corneal ulcers, Keratitis (bacterial and herpes simplex)
c)Glaucoma
d)Cataract
e)Ocular disorders associated with systemic diseases:
Hypertension
Diabetes
Thyroid
Autoimmune Disorders
7. Have knowledge of ocular complications of systematically administered drugs.
8.Have a basic knowledge of refractive errors, use of eyeglasses, contact lenses.
9. Have knowledge of available resources for the visually handicapped.
10. Have knowledge of recent available methods of managing refractive errors:Radial Keratotomy Excimer Laser Photorefractive Surgery, AutomatedLamellar
Keratoplasty (ALK).
Mental health (3 weeks)
1-knowledge :
A significant proportion of problems dealt with in a primary care practice are related to the discipline of psychiatry.
At the end of mental health rotation, each resident should know the following:
1-Obtain good psychological history.
2-Perform a mental status examination
3-Provide supportive psychotherapy
4-Be familiar with the bellow techniques
5-Diagnose and treat the following common psychiatric disorders
A-Mood disorders (major depressive disorder, dysthymic, adjustment disorder, disturbance of conduct, bipolar disorder).
B-Anxiety disorders (panic attack, phobias, obsessive/compulsive disorder, generalized anxiety disorder).
C-Somatoform disorders (somatization, psychogenic pain disorder and hypochondriasis).
D-Cognitive disorders (dementia, delirium, amnestic disorder) E-Substance related disorders (alcohol, opioid)
F-psychotic disorders schizophrenia.
G-Sleeping disorders (insomnia, sleep apnea, hypersomnia)
H-Eating disorders (anorexia nervosa, bulimia nervosa)
I-Diagnose personality disorder
-Compulsive
-Histrionic
-Paranoid
-Passive –Aggressive
-Antisocial
-Borderline
J-Pediatric behavioral abnormalities (learning disorders, hyperactivity, mental retardation, language problems, autism)
2-Procedures observed or done
Supervisor`s
signature / Performed / Observed / Dates / Procedure name
Minimental state examination
1)
2)
3)
4)
1) / Counseling skills
2)
3)
4)
5)
6)
1) / Cognitive treatment
2)
3)
4)
5)
6)
1) / ECT( observed)
2)
Otolaryngology (2 weeks)
KnowledgeA significant proportion of problems dealt with primary health care are related to the specialty of ENT. The family physician should be competent in initial assessment and management of common ENT problems. At the end of the ENT rotation, each resident should know:
1-How to evaluate and manage the following:
a-Earache
b-Ear discharge
c- Hearing problems
d-Tinnitus
e-Vertigo
f-Stuffy nose, nasal obstruction
g-Acute and Chronic nasal congestion and discharge.
h-Mouth breathing
i-Acute and chronic sinusitis
j-Epistaxis
k-Strider
l-ENT trauma
2- Demonstrate basic knowledge related to:
a-Anatomy of ENT
b-ENT Examination
c-Hearing tests
2-Procedures observed or done
Supervisor`s
signature / Performed / Observed / Dates / Procedure name
Ear wax removal
1)
2)
3)
1) / Wick application and removal
2)
1) / Ear syringing
2)
3)
1) / Nasal packing for epistaxis control
2)
1) / Audiogram interpretation
2)
3)
1) / Forign body removal from ENT tracks
2)
2) / Observation of tracheostomy
Public health dept. training (2 weeks).
PHC training curriculum (14weeks) in the medical units (On job training)
Programs / Duration / SignatureIMCI strategy/ARI and CDD / 2 weeks
School health services / 1 week
Maternal and child health care / 2 weeks
Family planning / 1 week
Communicable disease programs / 2 weeks
Non Communicable diseaseprograms
EPI program / 1 week
Health promotion
Mental health
Filing system / Daily(2 hours)
Breast feeding / 1 week
Sexually transmitted infections
Nutrition
DOTS
Guidelines of PHCs services in Iraq / 4 weeks
1