06A Guidebook FAMMED GUIDEbook Batch2007-DepDean-Final

Guidebook for

Family MedicineCourse(MED 4068 8 Credits)

Year 4 MBBS (Batch 2007)This guidebook belongs to: Name: Group: Sub-group: Handphone:

Family Medicine Course Guidebook, 3rd Edition, 2010

CONTENTS

Section 1

Topic INTRODUCTION AND OVERVIEW OF THE FAMILY MEDICINE COURSE HOW TO USE THIS HANDBOOK? COURSE PRE-REQUISITES AIMS OF COURSE LEARNING OUTCOMES / OBJECTIVES COMMON CONDITIONS IN FAMILY MEDICINE LEARNING ACTIVITIES IN FAMILY MEDICINE COURSE ASSESSMENT LEARNING RESOURCES A. Directory of Teaching Staff (Family Medicine) B. List of 4th Year Students

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2 3 4 5 6 7 8 9 Appendix Appendix

3 4 4 5 7 9 22 28 31 31

Any absence due to sickness or any unforeseen circumstances must be notified to the Course Coordinator as soon as possible and must be supported by suitable documentation e.g. sick certification.

Family Medicine Course, CUCMS (Year 4, MBBS, Class 2007)

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SECTION 1

INTRODUCTION AND COURSE OVERVIEWOn behalf of the members of the family medicine fraternity of CUCMS, I warmly you welcome to the Family Medicine Unit! Being the only family medicine course in the undergraduate CUCMS medical program, the scope of this course is rather wide as it covers important basic concepts and topics pertaining to care of patients and their families in ambulatory clinical settings. Family medicine is the clinical and academic discipline whose practitioners aim to make an early diagnosis, taking into account the physical, psychological and social factors which may affect the people under his care. Bridging the delivery of healthcare between the community and hospitals, this course teaches students the details of clinical delivery of preventive, curative, educative and rehabilitative healthcare to individuals (and family) from birth to death. Ambulatory care management of common conditions as well as the skills required to distinguish between serious and non-serious conditions would be enhanced. During these eight weeks of Family Medicine Course, you will be seeing the whole spectrum of local family medicine or primary care services. These include services in both urban and rural areas, whether government-funded or privately run. CUCMS is proud to be affiliated with Klinik Kesihatan Bangi, Klinik Kesihatan Dengkil,Klinik Kesihatan Puchong as well as other private general practices in delivery of this learning experience to you. Various teaching-learning methods are utilised which include clinical experiential learning, clinic assignments, task-based learning, student seminars and clinical skills workshops. Students are expected, as well as given opportunity to participate in all clinical and other learning activities to obtain good overall experience of the discipline. We believe this course will enable you to have basic family medicine knowledge to function competently as a future junior doctor. All the best and wishing you an enjoyable course! Dr Noor Azizah Tahir Coordinator, Family Medicine Course, Division of Community Health and Frontline Medicine Faculty of Medicine, CUCMS. Acknowledgement to all founder members of the Family Medicine Discipline especially to the previous Family Medicine Course Coordinator and currently the Deputy Dean of Clinical Sciences, Assoc Prof Dr Yong Rafidah A Rahman for contributions in development of this guidebook: Assoc Prof Dr Yong Rafidah A Rahman Dr Norlehan Abdul Samad Dr Hairel Anuar Selamat Dr Siti Norhafizah Md Khapid Dr Lakshmi Sivashunmugam Dr Hazian Hamzah 2


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HOW TO USE THIS GUIDEBOOK?General information: This guidebook serves to guide and assist you throughout this course. Main feature of this guide is the learning objectives expected of you at the end of this course. These are indeed not a list of facts and information about the topics listed, but important points to help you plan your learning. This guide is not to replace the recommended readings or the other learning opportunities provided during this course. You are expected to participate and perform the various teaching-learning activities described, as well as other activities explained by your lecturers. Make an effort to always record and reflect on your consultations / experiences throughout this course. Do identify your own questions to better appreciate these topics. Do use the internet to get your answers. Otherwise, please present and share your cases/questions during the debriefing/reflection session each week. Should you wish, you may even explore these topics deeper from the list of further reading materials, books, journals and internet websites provided in the Course Guidebook. Please do not hesitate to contact the Head of Department / Course Coordinator / lecturers for any enquiries or assistance. (Contact numbers are provided in Appendix A)

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SECTION 3

COURSE PRE-REQUISITESThis course needs to be built on the knowledge and skills acquired during your basic undergraduate pre-clinical training during the following courses: All Year 1, 2 and 3 courses Clinical & Health Exposure and Training Clinical Skills Training/Clinical Correlation Problem-based learning sessions You may wish to refresh your memory by looking through your old notes / portfolios on the above.

SECTION 4

AIMS OF COURSEThe Family Medicine Course aims to: 1. equip learners with fundamental knowledge and skills in managing common problems presenting to ambulatory healthcare, with an emphasis on prevention and screening, continuity, and biopsychosocial issues. 2. inculcate elements of patient-centred and effective communication and professionalism when working with patients in family practices. 3. introduce learners to the roles of family doctors within Malaysian healthcare in order for them to function as competent holistic junior doctors upon graduation.


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SECTION 5

LEARNING OUTCOMES / OBJECTIVESThe CUCMSs Family Medicine Course pivots around four areas of learning outcomes, as the following: 1. 2. 3. 4. Preventive Healthcare Primary and Tertiary Prevention Curative Patient Care Acute and Chronic Illness Interpersonal Communication and Professionalism The Basis of Family Medicine

Upon completion of the Year 4 Family Medicine Course, the student should be able to: 1. Preventive Healthcare Primary and Tertiary Prevention a) Identify prevalent diseases, injuries, and conditions in which prevention plays a role. b) Define primary, secondary, and tertiary prevention. c) Define characteristics of a good screening test d) Describe roles of rehabilitative care within family medicine services e) Describe preventive services to special groups: school-children, adolescents, premarital, elderly, travellers f) Provide preventive health care to the following groups: Well children (e.g. developmental screening, nutrition, immunization) Well adults (e.g. smoking, hypertension, hypercholesterolemia, diet/obesity, diabetes mellitus, coronary artery disease, injury prevention) Maternity care (antenatal, postnatal care and family planning) g) Counsel patients and their families on behavioural change strategies (e.g., smoking cessation, breastfeeding, healthy lifestyle) to support patient wellness, recognizing cultural and socio-economic influences on health promotion and disease prevention 2. Curative Patient Care Acute and Chronic Illness a) Describe the prevalence and natural history of common problems and illnesses over the course of individual and family life cycles. b) Integrate and apply the basic and clinically supportive sciences, appropriate to the discipline of family medicine. c) Gather appropriate information (history & physical examination) for acute and continuing care of common illnesses* d) Incorporate appropriate psychosocial, cultural, and family data into patient management plan (investigative, non-therapeutic and therapeutic). e) Propose management plan (investigative, non-therapeutic and therapeutic) for common illnesses* using a focused, problem-oriented assessment. f) Demonstrate an analytic thinking approach to clinical situations and problem solving (clinical reasoning). g) Discuss and reflect upon the complexity of providing longitudinal, comprehensive, and integrated care for patients with common, chronic medical problems. h) Participate in a chronic disease management plan in partnership with the patient, patient's family, and other health care professionalsFamily Medicine Course, CUCMS (Year 4, MBBS, Class 2007)

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i) Counsel and educate patients and families about care of acute and chronic illnesses. j) Demonstrate competence in common office-based procedures under supervision of a family physician.

3. Interpersonal Communication and Professionalism a) Demonstrate the ability to communicate effectively with patients and families utilizing a patient-centred approach b) Document appropriate information for acute and continuing care in the patient record. c) Participate in consultation and referral to other health care professionals. d) Demonstrate effective, respectful communication with other health care professionals and clinical faculty. e) Demonstrate punctuality and participation in all teaching-learning sessions. f) Demonstrate integrity, responsibility and trustworthiness g) Demonstrate self-assessment and reflective learning / life-long learning abilities h) Discuss the ethical responsibilities in being a family doctor

4. The Basis of Family Medicine a) Describe the principles and content (persons and conditions) of family medicine b) Explain and discuss the various settings in which family physicians provide care and the integration of care that occurs across these settings. c) Describe and compare the role of the family physician as coordinator of care, in various family medicine settings d) Discuss and compare the barriers to coordination of health care and recommend improvements, in various family medicine settings e) Discuss and compare appropriate consultation resources, both medical and nonmedical, in various family medicine settings f) Discuss the family physician's continuing role and responsibility in the care of patients during the process of consultation and referral. g) Discuss the laws and regulations that govern family practices h) Discuss and compare the role of family doctors as practice managers in various family medicine settings

*Note: List of common illnesses and conditions seen in Family Medicine are listed under Section 6


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SECTION 6

COMMON CONDITIONS IN FAMILY MEDICINEThe following table lists common complaints and conditions that are seen in family medicine. Conditions marked (***) are considered of particular emphasis in undergraduate studies and hence this course. These reflect what are fundamental to the content of family medicine conditions which are common but significant, relevant, preventable and treatable. At the end of the Family Medicine Course, you are expected to be able to apply and integrate the basic sciences such as anatomy, pathophysiology, aetiology into formulating differential diagnosis and proposal of management options of each of these. Common Presentations / Conditions in Family Medicine (Part 1): Acute Minor Illnesses: Headache*** Dizziness*** Sore throat / mouth*** Cough & rhinorrhea*** Fever and chills *** Dyspepsia*** Abdominal pain*** Nausea & vomiting*** Diarrhoea*** Constipation*** Haemorrhoids*** Musculoskeletal / joint pain & swellings*** Low back pain*** Tiredness/ Sleep problems*** Ear pain, discharge & wax*** Minor infections (boil, stye etc)*** Minor lumps (lipoma, sebaceous cyst, breast lumps) Foreign bodies in ENT & others Red eye*** Frequency & dysuria*** Vaginal discharge*** Menstrual complaints*** Abnormal vaginal bleeding Breast/lactation problems*** Jaundice in neonates*** Acute rashes*** Itchiness*** Minor skin wounds / injuries*** Non-specific symptoms and signs Acute Major Illnesses: Syncope & loss of consciousness*** Chest pain*** Breathlessness*** Palpitations*** Oedema*** Acute abdomen appendicitis, gallstones, peptic ulcer disease, etc*** Bleeding during pregnancy*** Acute cerebrovascular accident Diabetic emergencies Severe home accidents, MVA & injuries Severe depression Substance poisoning/parasuicide Snake/insect bites


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Common Presentations/Conditions in Family Medicine (Part 2): Chronic Illnesses: Diabetes mellitus*** Hyperlipidaemia*** Anaemia*** Obesity*** Hypertension*** Coronary Heart Disease*** Heart failure Bronchial asthma*** Chronic Obstructive Airway Disease Allergies Thyroid disorders Osteoarthritis*** Chronic skin conditions*** eczema, scabies, fungal infection, acne Infertility Cerebrovascular disease (after-effects) Epilepsy Chronic mental illness anxiety, depression*** Mental retardation Substance abuse Preventive Care & others: Childhood immunization*** Child development surveillance*** Antenatal check-ups and pregnancyrelated care*** Postnatal care*** Breastfeeding and related problems*** Family planning / contraception*** Cervical/PAP smears*** Periodic health check-up & cardiovascular risks screening*** Pre-employment medical examination*** Adult immunization Pre-travel assessment Rehabilitation - post-AMI, post-CVA Smoking cessation*** Injury prevention*** Counselling on healthy lifestyle*** Domestic violence Miscellaneous advice & counselling Medication monitoring Social agenda e.g. MC request

Source: 1. Stephenson A. A Textbook of General Practice 2nd Editon, Edward Arnold, 2004. 2. Murtagh J. General Practice, 4th Edition. McGraw Hill, 2007. 3. Practice profile Assoc Prof Dr Yong Rafidah AR, 1989-2009


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SECTION 7

LEARNING ACTIVITIES IN FAMILY MEDICINEOverview:The Family Medicine Course utilizes various teaching-learning methods to achieve the aims and objectives indicated for this course. These include: 1. clinical teaching in family medicine clinics 2. clinical attachments and service duties in family clinics and related services (including after-hours clinic) 3. interactive lectures 4. task-based learning sessions 5. student seminars / group assignments 6. skills workshops - communication and procedural skills 7. assigned individual reading 8. group reflection session / study circles 9. individual reflective learning

Details of learning activities in family medicine are as the following: 1 Clinical teaching in family medicine clinicsClinical teaching sessions with lectures will be conducted in Klinik Kesihatan Bangi, Klinik Kesihatan Dengkil and Klinik Kesihatan Puchong from Week 2 onwards. Students are divided into 6 subgroups with 6 to 7 members. The placement of each group is as per time table provided during the first week of the course. Two subgroups will be sent to each teaching centre. The two groups will rotate between lecturer percepting clinics and service duty clinics and every group will have at least 6 percepting clinics with the lecturers. Responsibilities of students: Students assigned to Lecturers Clinic are expected to perform the following tasks: i) Prepare the assigned room / area for clinic session. Please arrive as early as 7.45 am to ensure cleanliness of the room, as well clinic equipments are assembled ii) Liaise with peer assigned to registration area for invitation of patients to Lecturers Clinic. Please take note that every patient invited need to have a verbal consent iii) Perform consultation of patient/s presenting to the clinic under observation and supervision of the lecturer (Section 8 of Logbook) Students are to take turns. It is expected that for each morning session, each student would be able to conduct at least ONE consultation under supervisionFamily Medicine Course, CUCMS (Year 4, MBBS, Class 2007)

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Consultation tasks would include taking history, physical examination as well as proposing investigation/s and management where appropriate Please refer to prior training in Family Medicine on how to conduct consultations on ambulatory patients.

iv) Assist lecturer in management of patient or other appropriate tasks These include performing procedural skills, writing prescriptions, medical certificates, referrals, appointment and record keeping v) Request assessment and feedback from lecturer, as well completion of Sections 3 and / or 8 of Logbook where appropriate vi) Organise short reflection session before end of clinic session all students need to attend this experience sharing session this is a half hour session before lunch break vii) Ensure safekeeping of equipments and cleanliness of clinic area at the end of clinic session

2 - Clinical attachments and service duties in family clinics and related servicesUnderstanding of your patients and clinical competence comes from not merely observing but getting involved and participating in care of patients and its relevant delivery of healthcare. This is one unique experience that you will gain in Family Medicine the chance to be part of the healthcare team!

2A - Service duties in health clinics During your attachment to the health clinics during Week 2 to 6, you will be assigned, on rotation basis to Service Duties stations. These stations will include: Assistant Lecturer / Medical Officers Service Clinic Registration counter (OPD & MCH) Pharmacy / Laboratory Procedure room / A & E Screening counter / X-Ray Home visit After-hours clinic session (one session compulsory for each student) The allocation of service duty station will depends on the teaching centres and you will be briefed on what stations available in each Klinik Kesihatan later.


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Students need to: Check your rotation roster regularly for information on Service Duties assignments When assigned, please report to the health clinic staff in-charge of respective station, latest by 8.00am. Ask what to be done and volunteer your assistance. At the end of session, do request for proof of attendance Record and reflect on your experience in Section 6 of your Logbook

2B Private General Practice ExperienceYou will have the unique opportunity to be attached to a private-run general practice throughout Week 5 or Week 6 of this course. Students will be attached to appointed general practitioners also known as Family Medicine Teachers. Although it is only a 32 hours attachment, students will gain a lot of learning experience from it. Students will have the chances to closely observe a family doctor who works in feefor-service environment at work. You will have the opportunity to compare and contrast some areas of family medicine in the private health care system with the government primary care. Important differences to be looked into include: o o o o presentation of diseases /conditions management of common acute and chronic condition communication between Doctor-Patient / Doctor-Patient Relationship health problems and presentation in the local context including cross cultural issues. o managerial and entrepreneurial aspect of general practice as well as medical ethics , law and legislation in private family medicine. There also some interesting areas that could be explored during the GP course like: o What make the GP open up a private practice? o What services are offered by the clinic? o What are the strengths, weaknesses, opportunities and threats of a private general practice? o Why do patients visit private practice instead of government clinics? o Is it true that GP has autonomy in life? o Is it true that GP is a dying profession?

You will also have to carry a small group assignment looking at issues in general practice. This is done as through your subgroup. You will need to present a proposal of the project prior to your attachment and the proposal need to be documented in hard and soft copies of Part A of Section 7 of your logbook. A final presentation of your group general practice assignment will be done usually at least a week after completing your attachment. Marks will be given for the group presentation as per in Section 9 of your logbook.


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The Family Medicine Teacher will also assess you. You are required to make sure you assessment during the GP experience is concluded by the end of the course. Please refer to Section 10 of your logbook. All of your learning experience will need to be reflected in as your GP experience perception in Part B and C of Section 7. Further details and instructions for the GP course will be given before the attachment by your GP Course Coordinator.

2C Tips for Learning during Service Duties and Private GP ExperienceLearning in family clinics has been known to be daunting to medical undergraduates due to huge number of patients seen at a rapid pace, different consultation styles used by family doctors (e.g. short-cut history-taking), as well a great variety of patient presentations. You would be expected to be on your own during this component of teachinglearning activity, with perhaps very minimal supervision form CUCMS lecturers. The following tips would serve to help you gain the most from this experience: i. Remember that patients seen in family medicine almost always fall under either one of these categories of presentation: - Acute illnesses either acute minor ailments or major diseases - Chronic illnesses - Preventive care (e.g. maternal & child health) and early detection of illness (e.g. health screening & medical check-ups) - Rehabilitative care - Miscellaneous reasons for medical encounter

ii. Try to classify the patients that you come across into one of the above and make notes under each heading when you are in the clinics. Remember to read around the presentations later. Try to figure out and understand common similarities among the presentations, rather than going into depth and trying to memorize minute details of each conditions that you see. iii. Remember that you can learn from many various resources and angles not only learn when you are with the CUCMS lecturers. This is the true concept of self-directed learning. Examples of questions that can be asked and how you can learn at various service stations include: Registration counter (OPD & MCH): o Why are medical records important? o How medical records are kept and filed? What are the strengths and difficulties of the system? o Try to empathize with feeling of staff working at front desks o What can this experience help when you become doctor later?


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Screening counters / procedure room: o What is the function of this counter / section? o What procedures are carried out? o Try to talk to or ask history as much as possible from the patients that you come across here. Make records of them. Even though you might not be able to examine them, just listening from patients stories will help you remember conditions and related facts better. o Try to offer to perform as much procedure as possible, under supervision of the healthcare staff or even any of the CUCMS lecturers Laboratory: o What services are available in front-line health care system such as in the health clinics or private general practices? o These investigations are normally very common and important ones so get to know the indications of the tests, how these are performed and possible reasons for errors o Reflect on the cost of each test or investigation and try to figure out the total price of each patients consultation, including tests and medications. What thoughts you have on health economics Pharmacy: o What are the medications / drugs available? o The medications in family medicine are common drugs. Get to know their classes, at least. Revise what you have earlier learnt in Pharmacology Course or elsewhere regarding medications. o Try to understand the role of staff at the Pharmacy and training they have received. o Observe closely how the staff educate or counsel patients regarding usage of medications and try to learn from them o How are drugs kept and recorded? o What are the problems faced by the Pharmacy staff and how they overcome them. Home visit: o This can be a once-a-lifetime opportunity. Take this assignment seriously and try to plan your visit with the staff incharge. Do make appropriate travel plans at least a day ahead. Offering to drive the healthcare staff in your own transport would be most welcome. o Read the patients records, if possible, and try to understand the reason for home visit. o Do observe the patient-staff interaction during the visit o Do try to understand the patients environment and how this influences health of the patient


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Private general practice: This is can also be once-a-lifetime experience. o Always have your ID and introduce yourself as a medical student to the general practice team and patients. o Always work under supervision of the Family Medicine Teacher. o Observe the Microsystems involved in GP set up. This includes the Human Resource System, Data Management System, Product Purchasing and Sales System, Quality Assurance System o Observe the unique doctor-patient relationship in GP environment as good GP is a superb role model. o Observe the different type of medicine available in the GP clinics as most of them are not available freely in government set up.

3 - Interactive lecturesFamily medicine may be dealing with common simple conditions, but is known to be a huge discipline that overwhelms young learners in medicine basically almost everything covered in the undergraduate medical school is relevant to family medicine! Week 1 of the course is dedicated to orientate and introduce you to the discipline and most of the information is given through briefings and lectures. Please pay particular attention to these sessions as your understanding will determine your success and enjoyment of the course. Details of the sessions are as scheduled in the Course Time-table.

4 - Task-based learning sessions Guidelines on Task-based Learning (TBL) Sessions Definition and Principles of TBLTask-based learning in CUCMS is the extension of problem-based learning (PBL) and student-directed team-based learning (SCTL) approaches utilised in the early medical program. The integration and synthesis of knowledge, skills and attitude into effective critical thinking is the primary goal of both PBL and TBL. In these approaches, apart from learning the knowledge of medicine, students also learn the following: how to identify their own learning needs how to undertake necessary studies to meet their needs how to make use of educational resourcesFamily Medicine Course, CUCMS (Year 4, MBBS, Class 2007)

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with time, can remedy the learning deficits for themselves

The key difference between PBL and TBL is that the focus for learning is not scenario presented on paper, but real tasks or work undertaken by doctor in clinical practice that will confront the new graduate in medical profession. Principles that surround TBL include: focussing the learning on a problem building new knowledge on what the student already knows active learning student-centred approach to learning

Preparation for TBL Sessions in Family MedicineStudents are advised to closely follow the following guidelines: 1. Each session is to be lead by a sub-group (i.e. to be actively conducted by 4 to 5 students per session) 2. The group leader in collaboration with all group members - will prepare a roster for sub-groups to lead TBL sessions, as well as area of topic to focus on. 3. Please prepare at least one-week before session by identifying the trigger i.e. patient presentation / problem to discuss. This needs to be from real patient seen during clinic attachments only summary of main problem, history and physical examination is needed.Note: The trigger can be chosen from the following groups of common/important reasons for consultations in family medicine: (refer Section 6 of Course Guidebook) i. patients for care of acute illness (5-6 topics symptom-based) example: An elderly with low back pain; Child with sore throat etc ii. patients for care of chronic illness (3-4 topics) example: Teenager with severe pimples etc iii. patient on rehabilitation care/follow-up iv. patient who attended well-child clinic v. patient for antenatal care vi. patient for adult preventive health vii. patient for family planning viii. patient for post-natal care (any 3 to 4 topics from items iii to viii)

4. Once the trigger / topic is agreed, members of the sub-group need to discuss among themselves and identify learning issues to be pursued (and later shared with the rest of other sub-groups). It is expected that each sub-group member to be assigned at least two learning issues or tasks to handle. These tasks / learning issues must: relate to the patient and problem under discussion. surround the various tasks that a doctor needs to perform when faced with a symptom or problem reflect achievement of the learning objective of the Family Medicine Course (refer Section 5 of Course Guidebook) . Tip the whole group isFamily Medicine Course, CUCMS (Year 4, MBBS, Class 2007)

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encouraged to maintain a checklist of achievement of learning objectives to ensure good coverage - Soft copy of learning objectives is available in the FM LMS. complement learning during clinic sessions / other session. To avoid redundancy, please do not repeat issues that have been extensively discussed. include reference to scientific basis of medicine/evidence-based medicine (Tip please utilise and quote Clinical Practise Guidelines as one of yourreferences Learning Outcome 2 b . List all your references in the last slide)

Example: Trigger: Managing a child with sore throat Examples of learning issues: Important history to be gathered to help in diagnosis Lab investigations the rationale / underlying scientific basis Important normal structure and function related to the likely diagnosis? What abnormal structure and function need to be reversed in management of this patient? How do we do the procedure needed in management of this presentation? What evidences are present regarding drug treatment? What advice do we give to this patient? What are important ethical/other considerations?

5. Please seek the approval of the Course Coordinator and respective facilitator for all topics and learning issue for TBL discussions. 6. Please liaise with your respective facilitators on logistic arrangements (e.g. changes in venue & time). Deadline: 3 working days before session. 7. Once approved, do proceed to prepare for the TBL session. Use Power Point to aid your discussion / presentation. 8. It is the sub-groups responsibility to seek assessment and feedback from facilitator after the TBL session (refer Section 9 of Logbook assessment is based on performance of the sub-group) 9. Please contact Course Coordinator for enquiries and general guidance

Developed by Assoc Prof Dr Yong Rafidah, Head, Family Medicine Department, January 2009


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5 - Student seminars / group assignmentsThese are mainly group presentations of the General Practice Experience as well as Task-based Learning sessions. Marks will be given for the seminars/ TBL/ group assignments presentation in your logbook Section 9.

6 - Skills Training in Family Medicine 6 A - Competency in procedural skillsIt is to be noted that, by the end of this course; the student needs to demonstrate competence in common office-based procedures under supervision of a family physician as indicated by one of the objectives of this course. Ample opportunities for training, practice and assessment are provided throughout this course to facilitate achievement of the above objective. Training is provided through multiple resources (books, internet), as well as dedicated procedural skill workshops during the course. Details of the sessions are as scheduled in the Course Time-table. Items to be filled in the log book relate to procedural skills that are common in family medicine. These are nothing new students might have observed or performed personally in previous courses. (Please refer to Logbook - Section 4 - for details) Assessment of competency is performed throughout this course to empower students once certified competent in a particular skill to continue performing the acquired skills on ambulatory patients during the course. However, students are reminded to always seek permission from the patient and supervising staff before performing any procedures on patients. Procedural skills that are commonly done in family medicine include: Investigative procedures: Vital signs measurement - temperature & pulse Blood pressure measurement (adults and children) Body Mass Index calculation (to include weight and height measurement; interpretation and recommendations) Weight and height measurement in children (to include interpretation and recommendations) Waist circumference Glucometer Venepuncture (adults only) Pap smear Urine dipstick Urine pregnancy test Peak flow meter measurement ECG recordingFamily Medicine Course, CUCMS (Year 4, MBBS, Class 2007)

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Therapeutic procedures: Metered dose inhaler administration Aerosol nebulizer administration Intramuscular injection Management of minor skin wounds (dressing) Crepe bandage application

Apart from the above, there are at least a dozen more frequently performed procedures done in family medicine, such as foreign body removal, suturing of minor skin injuries, incision and drainage of abscesses, management of other sporting injuries (e.g. dislocations), first aid and resuscitation and others. Students are highly encouraged to observe and assist in all these procedures whenever possible, even though assessment of competency not indicated.

6 B - Communication skills training in Family MedicineCommunication skills competence is indeed one of the CUCMS Learning Outcomes as well regarded a very important element of care in family medicine. This outcome in Family Medicine Course is detailed in page 6. Achievement of competency in doctor-patient communication is given emphasis and assessed thoroughly in this course. Other elements of communication communication with family, peers, record keeping and referral letter are also covered.


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7 - Assigned individual reading (AIR)Reading assignments aims to empower the student on self-learning. These cover topics that are important to the discipline but well covered in book, as well as need slow internalization by the student. List of topics for assigned individual reading: No. Topic No. AIR 1 The Family (Chapter 2-Murtagh) Preparing to Practise (Chapter 15Stephenson) Common Illnesses in General Practice (Chapter 4- Stephenson) A Safe Diagnostic Strategy (Chapter 18-Murtagh) Prevention in General Practice (Chapter 9 - Murtagh) AIR 6

Topic Health promotion and patient education (Chapter 11- Murtagh) Whole person approach to management (Chapter 13- Murtagh) Research and Evidencebased Medicine (Chapter 15 - Murtagh) Being a General Practitioner (Chapter 16- Stephenson) -

AIR 2

AIR 7

AIR 3

AIR 8

AIR 4

AIR 9

AIR 5

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Notes: Resources for AIR: (These books are available in CUCMS Library) 1. Murtagh: Murtaghs General Practice 4th Edition, by John Murtagh 2. Stephenson: A Textbook of General Practice 2nd Edition by Anne Stephenson For each AIR, students need to briefly describe in the Logbook TWO most important issues that you have learnt from this reading

8 - Group reflection session / study circlesStudents will meet at least once in two weeks with either academic supervisor/ mentor, Course Coordinator or Head of Family Medicine. Discussion will surround: 1. reflection on past weeks experiences 2. discussion on plans of coming week/s 3. feedback from students regarding the course 4. feedback regarding students performance 5. a range of preset issues that will require own research, problem-solving and preparation that need to be completed during the 8-week course e.g. spiritual and professional issues to be shared among group members. Note: please bring your Logbook / Weekly Study Plan etc for this session meetings are to be recorded in Section 5 of logbook


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9 - Individual reflective learningWhat is reflection? Reflection is a learning process of examining current or past practices, behaviours, or thoughts in order to make conscious choices about future actions. (Barnett, 2006)

Why Bother with Reflective Learning / Practice? The ultimate goal of undergraduate training of a healthcare professional is the preparation for the continuum of learning and being a life-long learner. Being selfdirected is the main principle towards this goal. Important traits of a self directed learner include: methodical and disciplined logical and analytical has information seeking and retrieval skills responsible, flexible, venturesome and creative self-sufficient, interdependent, confident, with positive self concept reflective and self-awareness, etc

The Reflective Process The essence of process in reflective learning can be summarized into these simple terms What? What have I gone through during the week So what? What have the experiences taught me? Now what? - What can I do similarly or differently in future Why keep a diary? Keeping a record of experiences and thoughts has been a proven tool towards being a reflective learner. If written and kept properly these records can be invaluable for students to reflect upon in future years.

Tasks for students As practised in Years 1, 2 and 3, students are to continue the practice of maintaining personal reflective diaries. Please used similar format weekly entries with narration of the weeks experiences, identifying strengths and weaknesses and plans for improvement. These are to be submitted to mentor at least twice during the course. For Family Medicine Course, reflective learning exercises are embedded throughout daily activities and logbook. This competency is a component of assessment in this course (refer objectives of course).


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SECTION 8 COURSE ASSESSMENTThere are formative and summative assessments during Family Medicine Course. Students are requested to consider formative assessment seriously as it is very essential in developing skills and attitude. It also guides students on areas to be emphasized in the breadth of knowledge to be covered in the syllabus.

1. FORMATIVE ASSESSMENT (Cognitive & Psychomotor )Formative assessment consists of 3 components as follows: A) Mid-Course Assessment B) Personal Supervisor/GP Teacher Assessment C) Peer assessment A) Mid-Course Assessment Mid-Course Assessment . The Mid-course assessment focuses on knowledge and content of the subject matter . It is also designed to expose students to the End of Course Examination format.

B) Personal Supervisor/GP Teacher Assessment Academic supervisors/mentors will be appointed during the first week of course Overall satisfactory comments by personal supervisor and General Practice Teacher are expected (refer Section 10 of Logbook) Assessment will be based on the following elements of professionalism: Attitude interest in work/studies, commitment to the profession Behaviour polite, courteous, respectful as expected of the medical profession Participation participate actively in group discussions/sessions Management organized time & work well Responsibility punctual,submit assignments, compulsory equipment available Reliability - perform duties/tasks assigned Maturity / self-assessment abilities identify own strengths, weaknesses and learning needs Communication good listener, express ideas clearly Resilient able to work under stress, coping skills Attire and tidiness as expected of the medical profession


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C) Peer assessment Students are required to assess each other based on the following criteria: Responsibility & reliability Teamwork and Participation Integrity Trustworthiness / honesty This will be done on periodic basis as indicated by the Course Coordinator (refer Section 11 of Logbook)


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2. SUMMATIVE ASSESSMENT

Students will have continuous assessment and end-of-course assessment in Family Medicine Course. The weightage of each component is 30% and 70% respectively. The two components are looking only at the psychomotor and knowledge development of the students. Summative assessment of Affective Domain is still being assessed throughout Family Medicine course but will be documented separately in the Affective Domain Assessment Logbook .

A. CONTINUOUS ASSESSMENT ( Psychomotor predominant 30%)Continuous assessment (CA) for this course is based on the eight sections of Learning Objectives indicated (see Section 4), with more weight-age on affective and psychomotor components. CA contributes to 30% of the Course assessment.

1. Patient consultation during clinical teaching

(10%)

Minimum of two (2) observed consultations per student is required. Marks will be calculated from best of two consultations from Weeks 2 to 7. Please record your presentations and assessment in the Logbook . (Section 8) Assessment will be based on ability to gather information, formulation of management plan, clinical reasoning, as well as process of consultation and communication skills.

2. Record of patient experience in Family Medicine

(10 %)

Students expected to maintain a satisfactory record of patients seen during the course. A record of 55 consultations - performed or observed - is expected. (refer Sections 3 of Logbook) Assessment will be based mainly on good record keeping and good coverage of core conditions, appropriate content (history, physical examination, investigation, diagnosis, principles of management) and reflective learning abilities. Procedures performed and other tasks throughout the course are prerequisite for end of course eligibility.(refer Section 4, 5 and 6)


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3. Assessment of group assignments

(7.5%)

These are group assignments for task-based learning sessions and student seminar / presentation Refer Section 9 of Logbook for details 4. General Practice Experience (2.5 %)

Students will have to submit the perception by the end of the course. The hardcopy has to be hand-written in Section 7 of the logbook. The softcopy need to be delivered to the course coordinator. The summary of the continuous assessment in relation to your log book is as follows:Section Section 1 Contents Attendance Section 2 Affective Domain Assessment

Reading Assignments in Family Medicine Prerequisite for satisfactory course completion

Section 3

Record of Patient Experience in Family Medicine Continuous Assessment 10%

Section 4

Record of Procedural Skills In Family Medicine Prerequisite for satisfactory course completion

Section 5

Record of Group Meetings Attended Prerequisite for satisfactory course completion

Section 6

Record and Reflection on Service Duties Prerequisite for satisfactory course completion

Section 7

Record and Reflection on General Practice Experience Continuous Assessment 2.5% (Individual Mark)

Section 8

Assessment of Family Medicine Consultations Continuous Assessment 10% (Average of best 2)

Section 9

Assessment of Group Assignments Continuous Assessment 7.5% (Group mark 2 TBLs & 1 GP Seminar)

Section 10

Assessment by personal supervisor/GP teacher Affective Domain Assessment

Section 11

Assessment by peers Affective Domain Assessment

Section 12

Study Plans Weeks 1 to 8 Affective Domain ( Formative)

Section 13

Certification of Eligibility for End-of-course Examination and Summary of Continuous Assessment Marks (30%) Prerequisite for satisfactory course completion / Continuous Assessment

Section 14

Perception of the Family Medicine Course Prerequisite for satisfactory course completion


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B. END OF COURSE EXAMINATION (Cognitive & Psychomotor) (70 %) The End of Course Examination (EOC) contributes to 70% of the Family Medicine Course assessment. This assessment will be carried out on the exam week i.e. after the completion of 2 successive courses. It consists of: 1. Written Assessment (40 %) : A combination of various types of questions: Multiple Choice Questions - 20% Single-best Answer Questions (SBAQ) Extended-matching Questions (EMQ) Short answer questions (SAQ) - 20%

2. Clinical Assessment (30 %) : The clinical assessment will be carried out in the form of Objective Structured Clinical Examination (OSCE) during the designated exam week. Further details will be provided by the Course Coordinator later.


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IMPORTANT NOTES

Note on eligibility for End-of-Course Examination and Assessment Regulations: 1. A student must satisfy the attendance requirement of 80% at all contact teaching sessions including ward / clinic duties, on-call / after hours duties, small-group sessions and other common teaching sessions; in ALL respective courses 2. A student must complete all course (course) assignments and responsibilities to be eligible to sit for the End-of-course Examination. 3. Achieve satisfactory level of professionalism as indicated by University Regulations / Senate. This means a Pass in the Affective Domain Assessment of each course / course. (details are as in Affective Domain Assessment Logbook) (Source: CUCMS Faculty of Medicine Assessment Regulation)

Note on Attendance: 1. Students who fail to attend two consecutive weeks in Family Medicine Course will not be allowed to sit for the examinations and will be required to attend the short semester for the course (except for reasons approved by Senate). 2. Full attendance and punctuality (clinic duties, teaching session, others) are expected (refer Section 1 of Logbook) 3. All permission for absenteeism must go through Course Coordinator before each teaching-learning session. 4. Sick leave will not be accepted without a valid medical certificate.


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SECTION 9

LEARNING RESOURCESMain textbooks - available at CUCMS Library:

1. A Textbook of General Practice 2nd ed. Anne Stephenson 2. Murtaghs General Practice 4th ed. John Murtagh

Other recommended textbooks - available at CUCMS Library:1. 2. 3. 4.

Essentials of Family Medicine 5th ed. Sloane P et al Essential Family Medicine - Fundamentals and Case Studies 3rd ed Rakel RE Oxford Handbook of General Practice - Simon C et al Textbook of Family Medicine, 7th ed. Rakel RE 2007 (available as e-book from www.mdconsult.com request assistance from librarian)

E-booksAvailable via [email protected] For access, visit: http://library.cybermed.edu.my/cucms-library/c/LIBRARY%20RESOURCES (Please request assistance form the CUCMS Librarian) 1. Manual of Family Practice, 2nd Edition Editor: Taylor, Robert B. Publisher: Lippincott Williams & Wilkins 2. Field Guide to Urgent & Ambulatory Care Procedures, 1st Edition Editor: James, David M. Publisher: Lippincott Williams & Wilkins 3. The 5 Minute Consult Clinical Companion to Women's Health, 1st Edition Editor: McGarry, Kelly A.; Tong, Iris L. Publisher: Lippincott Williams & Wilkins

Textbooks for Reading Assignments (AIR) in Family Medicine1. A Textbook of General Practice 2nd ed. Anne Stephenson 2. Murtaghs General Practice 4th ed. John Murtagh Note:

these books are available in CUCMS Library For each AIR, students need to briefly describe in the Logbook TWO most important issues that you have learnt from this reading


27

Womens Health Textbooks1. Loh KY, Yong Rafidah AR, Kwa SK, Nurjahan MI. Practical Management of Womens Primary Health Care Problems in Malaysia. International Medical University, 2005 2. Mazza D, Womens Health in General Practice. Butterworth-Heinemann, 2004 3. Carlson KJ et al. Primary Care of Women 2nd Ed. Mosby Inc. 2002

Internet ResourcesInternet sites for Family Medicine (Organisations) 1. World Organisation of Family Doctors- WONCA Online http://www.globalfamilydoctor.com/ 2. Academy of Family Physicians of Malaysia http://www.afpm.org.my 3. Australian Family Physician (Aust Fam Physician) http://www.racgp.org.au 4. Primary Care Doctors Organisation of Malaysia http://www.pcdom.org Family Medicine Journal Websites 1. American Family Physician (Am Fam Physician) http://www.aafp.org/afp 2. Australian Family Physician ( Aust Fam Physician) http://www.racgp.org.au/publications/ 3. British Journal of General Practice (Br J Gen Pract) http://www.rcgp.org.uk/ 4. Family Medicine Journal http://stfm.org/fmhub/fmhub.html 5. Asia Pacific Journal of Family Medicine http://www.apfmj.com Websites for clinical skills: 1. A Visual Guide to Physical Examination http://www.library.mun.ca/hsl/docs/Bates.php 2. Operational Medicine; Medical Education & Training http://www.operationalmedicine.org/ 3. The Echt Center Online: Clinical Skills Exam Videos http://www.echt.chm.msu.edu/VideoLect/viewvideos.htm 4. The Connecticut Tutorials http://www.conntutorials.com/video.html 5. Physical Exam Study Guides Pelvic Exam http://medinfo.ufl.edu/year1/bcs/clist/ 6. Martindales The Virtual Medical Center http://www.martindalecenter.com/MedicalClinical_Exams.html


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Other useful internet resources 1. University Of Iowa Family Practice Handbook http://www.vh.org/adult/provider/familymedicine/FPHandbook/FPContents.html 2. Primary Care Internet Guide http://www.uib.no/isf/guide/guide.htm 3. Patient Education Website http://www.nlm.nih.gov/medlineplus/ http://familydoctor.org/ 4. National Guidelines Clearinghouse http://www.guidelines.gov 5. Primary Care Clinical Practice Guidelines http://medicine.ucsf.edu/resources/guidelines/

Further Internet Resources Are available in CUCMS Learning Management System (LMS)

OTHER LEARNING RESOURCESCourse Time-table Please use this Guidebook hand-in-hand with the time-table. This is given to you at the beginning of the course. Do scrutinise the time-table and as a group, plan your daily activities - right from beginning of the course.

Study Plan Success comes with organized planning and diligent work. To assist you in achieving the learning outcomes of this course, you are advised to plan your learning weekly. Perform a self-assessment at the end of each week and identify your weaknesses and area where you need help. The format is available in the Course Logbook (Section 12) Do show your study plan to your supervisor / mentor periodically. All the best to you! ~~~~~~~~~~~~~~~~~~~~~


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Appendix A Directory of Teaching Staff (Family Medicine) And Clinic Contact Numbers CUCMS LecturersName (Qualification/s & Designation) Dr Noor Azizah TahirMBBS(Aust), MAFP(Msia), FRACGP(Aust), PG DipRepMed(UPM),Post Grad Cert Fam Med Edu (Msia)

Hand phone

Email

013- 3383837 [email protected] .my

(Senior Lecturer and Coordinator of Family Medicine Course) Dr Hazian HamzahMBBCh. (Al-Azhar), MAFP(Mal), FRACGP (Aust)

012-7377824

[email protected] my

(Senior Lecturer and Acting Head, Family Medicine) Assoc Prof Dr Yong Rafidah A. RahmanMBBS(Malaya), FAFP(Msia), FRACGP(Australia), PG DipRepMed(UPM), PG CertMedEd(Dundee), ESME Cert in Med.Educ.

012 -6171963 [email protected] [email protected]

(Deputy Dean, Clinical Sciences & Associate Professor of Family Medicine) Dr Norlehan SamadMD (UKM), MAFP(Msia), FRACGP(Australia),

012-698 1165 [email protected] cybermed.edu.my

(Lecturer & Course Co-Coordinator 1 Skills Training and Assessment) Dr Lakhsmi SivashunmugamMBBS(IND),MAFP(Mal), FRACGP(Aust),Post Grad Diploma Rep Med (UPM)

016-6525464

[email protected]

(Senior Lecturer, General Practice Attachment Coordinator) Dr Hairel Anuar SelamatMD (UKM)

016-201 8363 [email protected]

(Assistant Lecturer) Dr Siti Norhafizah Mohamad KhapidMBBS(Western Australia),

013-224 0300 [email protected] y

(Assistant Lecturer)


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Honorary and Visiting Lecturers of Family Medicine Course, CUCMS 2010/2011 Name Dr Nor Izzati Bukhary Ismail (Family Medicine Specialist ,KK Bangi / Honorary Lecturer) Dr Haslinda Hassan (Family Medicine Specialist , KK Puchong / Honorary Lecturer) Dr Sheikh Mohd Amin Sheikh Mubarak (Family Medicine Specialist / Visiting Lecturer) Dr Zaiton Ahmad (Family Medicine Specialist,UPM / Visiting Lecturer) Dr Cheong Ai Theng (Family Medicine Specialist,UPM / Visiting Lecturer) Contact details 012-988 8667

012-2881620

019-981 1163

019-330 0458

012-456 2389


31

Contact Numbers of Klinik Kesihatan:A. Poliklinik Komuniti Bandar Baru Bangi Persiaran Pekeliling, Seksyen 3, 43650 Bandar Baru Bangi, Selangor D.E Tel No. : 03-89258707 Fax No. : 03-89267072

B. Poliklinik Komuniti Dengkil 43800 Dengkil,Sepang, Selangor D.E Tel. No. : 03-87686355 Fax No. : 03-87689190

C. Klinik Kesihatan Puchong Batu 14, Jalan Puchong, 47100 Petaling, Selangor D.E. Tel. No: 03-80611814


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Appendix BGROUPING FOR YEAR 4 ACADEMIC YEAR 2010/2011 NO GROUP 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 RUSHALIMATUN BT RUSLI NIK MARYAM BT NIK ABDUL RAHMAN AIN SYAFINAS AISHAH BT IZAHARI WAFAA BT ZULKIFLI NOOR ELYANA BT AHMAD FAWZI NUR SYAMIMI BT MOHD JANI ZA'FARAN BT HISHAM RABIATUL ADAWIYAH BT ABDUL NASER NALINI A/P MUNISAMY IFFAH BT ROSLIZAR NURUL FARHANA BT ISHAK MUMTAZAH BT MOHD ALAUDDIN FATIMAH AZ-ZAHRAH BT AHMAD LATIFF SALASIAH BT ZAINUDDIN SHAHEERA BT SHAMSUDIN INTAN KARTIINA BT A KARIM NOOR FASHAREENA BINTI ALWI DAHVINIA A/P DEVAN SHAZWI NABILA BINTI MUNAVVAR ZUBAID HARSIMRAN KAUR A/P JASMINDAR SINGH MOHD FARID MOHD FAUZI NAZIF NOR BIN RAHIM AHMAD FARID B ZULKIFLE AHMAD FIRDAUS B. HANAPAI WONG JIAN WEN AHMAD ZAWIR B. MOHD SHARIF AMIR ZULHILMI YAHAYA MUHAMMAD NAJMI B. ABD GHANI MUHD. ZUBAIR B ZAIN AL-ABIDEEN MUHAMMAD HAFIZ B. ABDUL RAHIM MOHD AFIQ SYAHMI BIN RAMLI FARID NACQIUDIN BIN ASA'AD AHMAD IBRAHIM AHMAD ZAINUDDIN ABANG MOHD MUSTAQUIM B. ABG YUSOP MOHD FAISAL FIRDAUS NORDIN MUHAMMAD FAIZ MOHD ISHAK MOHD TAUFIK RAHMAT 0708-0565 0708-0551 0708-0514 0708-0577 0708-0552 0708-0558 0708-0606 0708-0562 0708-0629 0708-0505 0708-0559 0708-0546 0708-0623 0711-0657 0708-0566 1001-1411 0910-1367 0910-1384 0910-1373 0910-1401 0708-0539 0708-0550 0708-0510 0708-0511 0708-0579 0708-0619 0708-0518 0708-0628 0709-0653 0708-0627 0708-0609 0708-0527 0708-0604 0708-0506 1001-1414 1001-1422 1001-1419 NAME MATRIC NO.


33

NO GROUP 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

NAME NURUL ISHANI BT MOHAMED ISAHAN NOR AZWEENA BT MOHAMAD AZAM MA FATIMA BT MIOR ISHAMUDDIN NUR SHAHADAH BT ZAKARIA AZLINA BT ABDUL RANI PARVIN A/P DEVAN NOR SHAZANA BT MOHD SHARIF NUR AIN BT ABDUL HALIM NUBLA BT NAJMUDDIN FARAH MAZIZ BAZIL BT ABD AZIZ NUR NADIA BT ABD RAHIM NUR DALILA BT NOOR AZMAN SHAH NURARNIDA BT SAID ROSMAHAIZA BT ISMAIL NOR AZIZAH MOHAMED YUSUFF RAFIZA BINTI MOHAMED NAZIR ZARINA FAZLIN MOHD FAROQUE FATIMATUZZAHRA ABDUL RAHMAN HANIS HIDAYU BINTI KASIM DARSHINI A/P BALACHANDRAN AINI NABIHAH BT ARIP TENGKU PUTRA ADREES SHAH B. TENGKU SULAIMAN JALIL SHAH MOHAMED IMRAN HJ THOULAH CHIA CHUNG HON MUHAMAD KHAIRI BIN SULAIMAN MOHD NIZAMUDIN BIN MUHAMAD WAN NAZRY HJ W. MOHAMED SHADTHARCHARAN S/O MANIAM MOHD ALIF FARHAN BIN TAHRIM JOSHUA TEO BENG CHIN MIOR MOHD KHAIRIL M.OTHMAN MOHAMAD ERHAN RAHIMI BIN AB. RAHMAN MOHD AIZUDDIN ABDUL RAHMAN WAN HISHAMUDIN WAN JAYA MOHD TAUFIQ ELIAS MUAMMAR SHAFIE BIN ROSLY KHAIRUL ANUAR ABDULLAH

MATRIC NO. 0708-0560 0708-0553 0711-0658 0708-0557 0708-0646 0708-0648 0708-0554 0711-0656 0708-0630 0708-0526 0708-0555 0708-0613 0711-0655 0708-0564 1001-1424 0910-1371 1001-1430 1001-1408 0910-1383 0910-1363 0608-0315 0708-0575 0708-0535 0708-0522 0708-0543 0711-0659 0708-0578 0708-0631 0608-0337 0708-0530 0708-0534 0910-1366 1001-1413 1001-1429 1001-1420 0910-1400 1001-1412


34

NO GROUP 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 NAJIHAH BT HAWARI KIMBERLEY SHUMIN CHAN

NAME

MATRIC NO. 0708-0549 0708-0624 0708-0576 0708-0622 0708-0529 0608-0345 0708-0610 0708-0515 0708-0611 0708-0584 0708-0605 0708-0570 0708-0642 0708-0548 0708-0617 0910-1396 0910-1370 0910-1368 1001-1425 0910-1395 1001-1409 0708-0523 0708-0545 0708-0612 0708-0524 0709-0652 0708-0640 0708-0531 0708-0632 0608-0314 0708-0533 1001-1418 0910-1397 1001-1417 1001-1415 1001-1423 1001-1421

TON SAKINAH BT WAN MOHD ZAINI ATIRAH BT MOHD AZIZUL ISHVAR KAUR GODREI NOR ANISA HANAN BINTI AYOB SHAZREEN ZUHAIRA BT MOHD ZAININ AINUN NADZURAH BT MD BAHAR AZRINA ALI BT MOHD ASHFAR AISHAH BT AZMAN BHAVANI D/O PALLANESAMY SITI MURNIRAH BT ISMAIL SHARIFAH AIN SHAMEERA BT SYED RUSLI NADRAH KHAIRUNNISA BT NASARUDDIN NOOR SYAZWANI BT REDZWAN CHE SYAZA BINTI MOHD FADZIL SHUHAIMI PATHMA A/P NADAN NORAZYLIN BINTI ROSZAINI NURHIDAYAH MOHD SALLEH KHADIJAH BINTI MUSTAFA HAZMANINA MAT HUSSIN CHITHAMBARAM A/L SETHURAMAN MUHAMMAD FAKHRUL AMMAR B.MOHAMED BAHARUM FAIZ B. RUSLI DZULFITREE B. AHMAD MUHAMMAD IRSYADUDDIN B ROSLI SYED AMIR BIN SYED AZMI JUDE CORNELIUS A/L SAVARIRAJO SYED ZAHARUDDIN HUSIN WAFA SYED ZAINAL HUSIN WAFA AHMAD SAID BIN SAADULLAH LEE YEUN SIONG MOHD SHAHRIL ANUAR ZAINAL ARRIFF MOHD IDHAM IBRAHIM MOHD RIFFI ADNAN MOHD HANAFI ABDUL HABIR MUHAMMAD FAIZ NA'AMAN MUHAMAD AMLI ABDUL RAZAK


35

NO GROUP 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

NAME SUMAYYAH BT MOHAMAD FARIDZ NURUL AZIDAH BT ABD AZIZ ALLIAH BT MUSA SITI FATIMAH AZ-ZAHRA BT MOHD HAMDAN ZUBALQIAH BT ZULKIFLI ANEESAH BT ZAHARI SARA BT IDRIS RANPREET KAUR D/O RANJIT SINGH NABILA BT MOHD AZIZAN SHAHIRAH BT HJ SHUAIB ENGKU HAMIDAH BT ENGKU MUHAMMAD AZMI HASRINA BT HUSSIN AISHAH HARIZAH BT ABDULLAH ALWI AMIRAH NABIHAH BT BAZLAN RAJA HAZWANI AIMI BT RAJA MUKHTAR NURUL HIDAYAH HASHIM INTAN FATTIYAH ZAMRI NUR SUZANA ZAINAL DILPREET KAUR A/P GURMEET SINGH AKMAR FARIZA AHMAD TERMIZI TEE SHAO PENG AHMAD ILYAS DZULKAMAL ANIS ANWAR BIN ZAHARI AHMAD FAIDHI MOHD ZAINI TENGKU AKMAL FARIS TENGKU AHMAD ZULASRI AZAN BIN MD ZAIN ABDUL HALIM B. MAT DAUD SYED FAREEZ BIN SYED NASIR OMAR B. S. MASOHOOD MOHD NIZA ZAKARIA ZAIZUL AMRI ZAMAN MOHD FAKHRUL RAZI B. MANSOR MUHAMAD HASIF B. HANAFI SHAH FIZZAN ROSLI MANMEET RAI SINGH THIND A/L BHAJAN SINGH NURUL AZAM MOHAMAD SALIM MOHD NAJMUDDIN HISAMUDDIN

MATRIC NO. 0708-0572 0708-0602 0708-0517 0708-0569 0708-0614 0708-0520 0708-0639 0708-0647 0708-0547 0708-0567 0708-0525 0708-0528 0708-0516 0708-0620 0708-0563 1001-1427 1001-1410 0910-1369 0910-1364 1001-1407 0708-0615 0708-0513 0708-0621 0708-0509 0708-0633 0708-0582 0708-0507 0708-0573 0708-0561 0708-0541 0708-0581 0708-0538 0708-0542 1001-1428 0910-1365 1001-1426 1001-1416


36

**************************** Through measures preventive, curative, and educative, with their primary care team and in co-operation with specialist colleagues where appropriate, family physicians seek to promote the health of the individual and family.

So how have you been since your discharge from hospital?

One of the essential qualities of the clinician is interest in humanity, For the secret in care of the patient is in caring for the patient. FW Peabody, MD ****************************

**************************** With purity and holiness I will live my life and practise my art. Into whatever houses I go, I will enter them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption. Whatsoever I see or hear in the life of men which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret Hippocratic Oath 460-377 BC

****************************


37


38

Editorial Board Advisors: Prof Dr Mohd Hatta Shaharom (Dean, Faculty of Medicine) Assoc Prof Dr Yong Rafidah A Rahman (Deputy Dean, Clinical Sciences) Coordinator Assoc Prof Dr Muhammad Najib Mohamad Alwi (Year 4 Coordinator) Family Medicine Course Coordinator: Dr Noor Azizah Tahir Members: Dr Hazian Hamzah Dr Norlehan A Samad Dr Lakshmi Sivashunmugam Dr Hairel Anuar Selamat Dr Siti Norhafizah Md Khapid Puan Zaiful Liza Kassim (Secretariat) Cik Daliena Laily (Secretariat)

If found, please return to: Faculty of Medicine Cyberjaya University College of Medical Sciences Main Campus No. 3410, Jalan Teknokrat 3 Cyber 4, 63000 Cyberjaya Selangor Darul Ehsan Tel : 603 8313 7000


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