General and Family Medicine

Code:

MI431

Acronym:

MGF

Keywords
Classification	Keyword
OFICIAL	Medicine

Instance: 2017/2018 - 1S

Active?	Yes
Responsible unit:	Department of Community Medicine, Information and Health Decision Sciences
Course/CS Responsible:	Integrated Master in Medicine

Cycles of Study/Courses

Acronym	No. of Students	Study Plan	Curricular Years	Credits UCN	Credits ECTS	Contact hours	Total Time
MIMED	155	Mestrado Integrado em Medicina- Plano oficial 2013 (Reforma Curricular)	4	-	3	28	81

Teaching language

Suitable for English-speaking students

Objectives

This Course will consist of two main areas. One area of contact with the extra-hospital environment, where the student contact with patients and families in their homes and units in Primary Health Care and a propaedeutic area, where the student will pay attention to how it develops consultation and the relationship of the physician with the patient and his family, also in extra-hospital environment.

Thus, the learning objectives are:

1.To practice a modern concept of Health and the aspects related to it, especially the biological, psychological, familial, social and ecological.
2. To understand efforts to improve health through quality health promotion, which includes education for health, health protection and prevention of disease and its complications.
3. To know the different organizational models of health around the world, as well as their characteristics, advantages and disadvantages.
4. To know the organization of the Portuguese National Health System, including the public health services, as well as other community institutions that may be somehow related to health in Portugal.
5. To analyze the similarities and differences between state medicine, agreed, contract management and private, between Primary Care and Hospitals and between hospital doctors, public health and general practitioners.
6. To know Primary Health Care in Portugal, including the principles, the rational, physical resources, professionals, mode of operation and purpose.
7. To understand the practice of General and Family Medicine as a whole as well as its various components, especially its definition, content and nature, methods and techniques, workload, organization teams, and activities.
8. To develop skills of medical evidence focused on the person and based on scientific evidence.

9. To foster the spirit of investigation on Primary Health Care.

Learning outcomes and competences

At the end of the course, students should have knowledge and skills that enable them to go on a medical practice centered on person and oriented to the individual, their family and their community. They shall present skills on picking and recording medical history. Students must be able to identify and propose preventive measures at different life stages (primary, secondary, tertiary and quaternary), based on the best available evidence; to prioritize health problems and to guide the respective therapeutic plan. They should be able to conduct Health Education in the different age groups. Students should acquire the ability to formulate a research question in the area of primary health care and to develop a research project leading to its appropriate answer.

Working method

Presencial

Program

Definition of General and Family Medicine. The profile of the General Practitioners and Primary Health Care in Portugal. The surrounding community: determinants of health and health needs. Assessment of patient: patient-centered care. Consultation on General & Family Medicine practice. Medical history and records. Framing family and community. Doctor-patient relationship: communication as a key factor. The list of problems: prioritization of problems by the clinical and the epidemiological context. Integration and management of health promotion, prevention, cure, treatment, rehabilitation and palliative care customized to the patient at different life stages. Health Education in individual and community clinical practice. Screening in clinical practice Surveillance of vulnerable groups- Infant and juvenile Health Plan. Women's health and family planning. Maternal health. Health of older people. Surveillance of risk groups (hypertension, diabetes, respiratory diseases) Hipertension as a model of risk management, looking for primary, secondary and tertiary prevention

The decision on GFM: evidence-based medicine and the management of the uncertainty.

National health programs. Performance evaluation on GFM. Contracts. Diagnosis of organizational development and performance indicators. The International Classification of Primary Health Care.

Research on General and Family Medicine

Mandatory literature

Martins C, Azevedo LF, Santos C, Sá L, Sá L, Santos P, Couto M, Pereira A, Hespanhol A; Preventive health services implemented by family physicians in Portugal-a cross-sectional study based on two clinical scenarios, BMJ Open. 2014 May 26;4(5):e005162. Doi:10.1136 , 2014
Santos AP, Martins C, Sá L, Portinha C, Pessanha P, Ferreira-Silva A, Hespanhol A, Couto L; Health education: five years’ experience of teaching preventive medicine at the faculty of medicine of Oporto university, Educ Prim Care. 2014 Mar;25(2):103-7, 2014
Santos P., Hespanhol A., Couto L ; Accuracy of general practitioners’ readings of ECG in primary care, Central European Journal of Medicine, June 2014, Volume 9, Issue 3, pp 431-436. DOI: 10.2478/s11536-013-0288-9, 2014
Santos P, Pessanha P, Viana M, Campelo M, Nunes J, Hespanhol A, Couto L.; Accuracy ogf general practitioner’ readings of ECG in primary care, Cent Eur J Med. 2014, ; 9(3) : 431- 6 . DOI: 10.2478/s11536-013-0288-9, 2014
Neves AL, Couto L ; Cardiovascular risk in overweight/obese and lean hypertensive patients, Rev Port Cardiol. 2014 May 12. pii: S0870-2551(14)00082-1. doi: 10.1016/j.repc.2013.10.016., 2014
Muir Gray, Godfrey Fowler; Preventive medicine in general practic, Oxford University Press, 1983. ISBN: 0-19-261299-9
Daniel M. Becker and Laurence B. Gardner; Prevention in clinical practice, Plenum Medical Book, 1988. ISBN: 0-306-42624-2
Robert Silcock Downie, Carol Fyfe And Andrew Tannahill; Health promotion: models and values, Oxford University Press, 1990. ISBN: 0-19-261739-7
John M. Last and Robert B. Wallace; Public healh & preventive medicine, Prentice-Hall, 1992. ISBN: 0-8385-618-9
Steven H. Wolf; Steven Jonas; Evonne Kaplan-Liss; Health promotion and disease prevention in clinical practice, Wolters Kluer/Lippincott Williams & Wilkins, 1996. ISBN: 9780781775991
Jennifer S. Bright; Health promotion in clinical practice: targeting the health of the nation, Baillière Tindall, 1997. ISBN: 1873853416
John M. Last; Public health and human ecology, Appleton & Lange, 1987. ISBN: 0838580459
Geoffrey Rose; The strategy of preventive medicine, Oxford University Press, 1992. ISBN: 0192621254
Direção Geral da Saúde; Plano Nacional de Saúde 2012 – 2016, 2012
R. C. Wender, J.E. Nevin; Preventive medicine, Primary care: clinics in office practice, 2002

Teaching methods and learning activities

The teaching activity consists in seminars, for a structured deepening of knowledge, complemented by training periods, with theoretical and practice approach, in which students are asked to analyze pedagogical clinical cases (in role-playing sessions, simulated patients or case reports prepared for discussion) and consultation of real patients collecting their medical history and evaluating the quality parameters of visits.

Using different approaches, students will be able to describe patients' medical history, drawing up the list of health problems, active, passive and inactive, hierarchically presented taking into account the whole person, and structuring a preventive and therapeutic plan.

Students will visit a Family Health Unit, to contact with the multidisciplinary team, prospecting for the operation of the institution in the preventive and curative aspects.

 To get approval in this course, the student must meet a minimum of 2/3 of the proposed activities. A minimum of 10 points is required in each of the 3 components of assessment:

1. Continuous assessment, taking into account the participation in teaching activities and the demonstration of the skills’ acquisition in General & Family Medicine (10% of the final classification).
2. Evaluation of the knowledge integration capacity based on the construction of a structured medical report, including the list of health problems, the family assessment, and the therapeutic plan for the patient (20% of the final classification).
3. Knowledge evaluation through a written test of multiple choice (70% of the final classification)

The final grade will be distributed by the weighted average of the three components of evaluation in a numerical scale of 0-20 values.

Evaluation Type

Distributed evaluation with final exam

Assessment Components

Designation	Weight (%)
Exame	70,00
Participação presencial	10,00
Trabalho prático ou de projeto	20,00
Total:	100,00

Eligibility for exams

To get aproved in this curricular unit, the student must actively participate in at least 2/3 of the proposed teaching activities of this discipline, and he/she must obtain a minimum of 10 out of 20 points in all the evaluation components.

The final knowledge assessment test (during 60 minuts) consists of a total of 50 multiple-choice questions (with 4 options, each) in which several options can correctly answer the utterance. Within each question, each option of answer will be pointed with 1 point that will count positive if correctly marked or negative if it is wrong.
The final classification of the test results from the total sum (up to 200 points) divided by 10.

Calculation formula of final grade

The final classification of the curricular unit, translated into a numerical scale of 0-20 points, is given by the weighted average of the assessment components:

1. Continuous assessment, taking into account participation in school activities and demonstration of the acquisition of competences (10% of the final grade, the responsibility of the teacher responsible for the class).


2. Knowledge integration capacity based on the construction and structuring of a clinical history, including the list of problems and the therapeutic plan of the user (20% of the final classification).


3. Assessment of knowledge through multiple choice written test (70% of final grade)

Examinations or Special Assignments

The practical test of 4th curricular year of Faculty of Medicine of University of Porto (corresponding to the intermedial stage of education of the future doctor) aims to verify the aquisition of the basic skills, crucial to the balanced exercise of medicine, by an independent and accurate way. The performance of the students will be evaluated by the capacity to integrate the relational, cognitive, psycho-motor and knowledge dimensions.
This test is conducted by General and Family Medicine curricular unit together with Endocrine Diseases, Nutrition and Metabolism, and Cardiovascular Diseases Units.

The conduction of this test will be homogenized according to:

1. Each test will last 20-30 minutes


2. In this test will be simultaneously involved 2 examiners,


3. Taking into account that students are still involved in an early stage of formation, this test will have a focus on the simplicity of gestures and concepts to be addressed.


4. During the test the student will be asked to:




1. Make a short story - duration: 10-15 minutes


2. Perform simple physical examination gestures (selected from those included in the program) and / or comment on the patient's basic subsidiary exams - duration: 5-10 minutes


3. Establish a diagnostic hypothesis and possible differential diagnoses and indicate a simple plan of diagnostic and therapeutic approach - duration: 5 minutes




5. Students will be ranked in order to 5 parameters:




1. Contact with the patient (attitude, respect, empathy): 1 to 4 values


2. Structuring of history: 1 to 4 values


3. Physical examination: 1 to 4 values ​​/


4. Basic complementary examinations: 1 to 4 values


5. Structuring of diagnostic and plan synthesis and prognosis: 1 to 4 values

The sum of the points assigned in the evaluation parameters will be the final rating of each evaluator.
The student's final grade in this exam will be the arithmetic mean of the grade given by each of the evaluators.

Classification improvement

To improve the classification in this curricular unit the student will have to repeat the knowledge assessment test and the practical test, maintaining the evaluation related to the participation in the academic activities.