College of Medicine

The College of Medicine (CoM) was established in 1991 as a constituent college within the University of Malawi (UNIMA). It is the only medical school in Malawi. The CoM has gradually grown from a program with an intake of 10-15 students per year and a handful of Malawian faculty, to a program with a medical student intake of on average 60 per year with 110 faculty members, of whom approximately 67% are Malawians. To date the college has graduated over 250 medical doctors. The CoM recently commenced undergraduate courses in Pharmacy and Medical Laboratory Technology in 2006. Read more about CoM

University of Malawi

50 Year of Excellence in Education

Family Medicine Undergraduate (MBBS) Handbook

//Family Medicine Undergraduate (MBBS) Handbook

We wholeheartedly welcome you to the Family Medicine block, a six week rotation, starting with lectures at the main campus―compulsory― followed by four weeks spent at a clinical preceptor site and a final week at campus. The aim of the block is to expose you to the practice of family medicine and primary care in the setting of a district or rural site.

This guide has been developed to help you (the student) through the family medicine rotation. This document offers guidance on key areas for emphasis, specific skills to be learned, tasks to be completed and, in general, how to behave while at the preceptor site.

The rotation guide should be used together with the logbook in order to enable you to maximize your time at the preceptor sites. You should review the book daily to see that tasks are completed and documented in the logbook

MBBS Student sharing his Family Medicine experience during rotation at Mangochi District Hospital.

General Health

You are advised to practice universal precautions when in contact with patients. If you have an infectious condition, you should be issued a “sick” certificate and excused until non-infectious. The preceptor should ensure that you are not unduly exposed to infectious patients.

As a College of Medicine student, you have health insurance under UNIMED which may be used for hospitalisations. In case you fall sick while away from campus, inform your preceptor. They will advise you on how to get urgent care and will inform the relevant College authorities in a timely manner.

Needle Stick Injuries

In the unlikely event that you sustain a needle stick or other injury in which you may have been exposed to HIV or other blood-borne pathogens, the preceptor/other clinical staff should be notified immediately to advise on the next steps.

The program requires your full attendance for all the six weeks, all days, including weekends during the attachment. Absence from any part of the programme without prior approval and arrangement with the department will result in failing the family medicine rotation and exclusion from the end of block examination. All absences for sickness must be substantiated with a “sick” note. If you are unable to attend a session for any reason, you must inform the Family Medicine Department and the preceptor and get permission. Since you will be travelling in the community as part of the Department’s academic programme, it is important to ensure that you are accounted for at all times.

You will be required to do home visits and community surveys within normal working hours, while project work, reading and assignments are to be done after hours. Consulting time in the facilities takes priority over personal study and work.

As a student, you are expected to behave professionally. This is especially important during the four weeks that you spend on the preceptor site. You represent yourselves and the College and are expected to dress professionally and to conform to the general code of the faculty.

Improper attire: Shorts, tank-tops or bare midriffs.

Proper attire:

Male students: Clean shirt and necktie.

Female students: Appropriate dress, long skirt or trousers.

All students: A white clinical coat should be worn at all times on hospital premises. Each student should wear a name-tag. Appropriate shoes should be worn at all times for safety.

We wholeheartedly welcome you to the Family Medicine block, a six week rotation, starting with lectures at the main campus―compulsory― followed by four weeks spent at a clinical preceptor site and a final week at campus. The aim of the block is to expose you to the practice of family medicine and primary care in the setting of a district or rural site.

In this rotation, you will learn different models of consultation, communication, principles of chronic care and continuity of care, Integrated Management of Childhood Illness (IMCI), adolescent health, family health, geriatric care, palliative care, and ethics in the context of primary care.

You will notice that this block will differ from others that you have already taken. The patients you will see will be those who may not have seen a health care worker before ―i.e., they are undifferentiated. They may have no diagnosis or may be presenting with new symptoms, giving you an opportunity to make first impressions. Each of the patients you will see should be considered as an integrated whole, and all of his/her problems will have to be attended to within the context of his/her family and community.

Despite the presence of family medicine practitioners you will have to be self-directed with the bulk of your learning a result of the growth and development that comes from managing and reflecting on your patients. Take every patient encounter as a learning experience.

You will diagnose and manage patients yourself, and make decisions about them under supervision of your preceptor. Remember: ASK FOR HELP whenever you need it.

We hope that working in rural areas will be an important learning experience for you. However, you also need to make a contribution to the sites where you are working, which may not have as many resources. Become an asset to the site: work hard and willingly offer support.

Make sure you have the latest MSTG book (2009), Paediatric Handbook for Malawi (Philips, 2011), The Clinical Book (Zijlstra, 2012), the IMCI guidelines and the Handbook of Family Medicine (from the Library) with you. At the preceptor sites, there are also copies of reference books and textbooks of family medicine and general practice as well as clinical examination.

In the last week, you will be back at the campus where you will have evaluations, presentations, and end-of-block examinations.

We wish you the best of luck in this rewarding rotation.

ENJOY YOUR TIME WITH US!

Dr J Parks

The clerkship in family medicine aims to introduce you to a thinking process that puts the family and context of a patient’s illness at the centre of his/her care. By letting the student take history from the patient or guardian, perform a physical examination, writing the findings and participating in the process of further investigations and treatment options within the limits of his competence in the care of patients assigned to him/her, family medicine allows you to learn the key principles and translate theoretical knowledge into practical skills. The module also gives you an opportunity to experience and to practise integrated primary care medicine that is responsive to patients, their families and communities.

The Family Medicine Preceptorship is offered the fourth year after attending the family medicine block of lectures. It is offered in addition to the clinical experience that you have picked up in prior clinical clerkships and is one of the field experiences. It gives students attached to any of our preceptor sites an opportunity to gain a greater understanding of how district hospitals away from the capital function.

The following boxes display the role of the different teams.

Family Medicine Faculty

  • Develop plan for clinical practice and teaching
  • Organise teams
  • Supervise students in rotation
  • Assess students and give feedback

Preceptors

  • Provide hands-on training
  • Assess students and give feedback

Students

  • Observe
  • Clinical practice
  • Self-guided learning
  • Give feedback
  • Complete assignments
  • Practice and demonstrate the primary care consultation.
  • Apply the bio-psychosocial approach to patients.
  • Appreciate the elements of primary care and their place in the health service, including disease prevention, health promotion, curative care, rehabilitation and palliation.
  • Integrate and apply skills from different disciplines.
  • Clerk and, under supervision, manage undifferentiated patients with common presenting symptoms and clinical conditions.
  • Understand the roles and functions of different members of the health care team.
  • Analyse the functioning of the health care system and the process of referral.
  • Become familiar with and use national primary care protocols and guidelines.
  • Show diligence and behave in a way that is consistent with ethical practice.
  • Conduct routine procedures.
  • Perform specific tasks as requested.
  • Present patient summaries and case studies and other assignments to clinical staff, as relevant.
  • Perform other duties as assigned by clinical staff.
  • Complete assignments and submit them to the relevant clinical staff.
  • Share clinical learning experiences through case presentations and clinical conferences.
  • Receive feedback from tutors and clinical staff on progress and discuss/ask questions.
  • Provide feedback to preceptors and family medicine coordinator on the clinical teaching and learning process.
  • Attend consulting rooms and ward rounds during the normal clinic practice hours.
  • Record (anonymously) the details of consultations on relevant forms in the Logbook.
  • Conduct consultations in preceptors’ presence.
  • Accompany patients to other health services such as X-ray departments, physiotherapists, etc., to gain an understanding of the complimentary health system and the experience of patients utilizing such services.

OBJECTIVES

By the end of this 4 week preceptorship, you should be able to:

  • Apply theoretical knowledge of family medicine into practical skills.
  • Practice family medicine/primary health care in a clinic setting.

Please review this list regularly, in order to make sure that your practical experience meets these competencies:

 

Introduction to Family Medicine
Communication
Ethics in Family Medicine
Family Health
Adolescent Health
Geriatric Care
Clinical Care
Health Promotion and Disease Prevention
Broader Biopsychosocial Approach
Health Care System
Palliative Care

 

Attendance to all 6 weeks is compulsory (including ALL lectures). Attendance of the lectures will be documented and is part of the professionalism mark in the logbook.

Your logbook accounts for 40% of your total mark. The site supervisor will mark your logbook, and the academic staff will moderate that mark. In order to pass the Family Medicine block, the logbook must receive a mark of at least 65%. The logbook must be passed in order to sit for the examination.

The written exam will make up 30% of your total mark for the Family Medicine block. Objective Structured Clinical Examination (OSCE’s) also makes up 30% of your total mark for the Family Medicine block. In order to past the examinations, a mark of at least 50% must be achieved.

Student must pass each of the three components in order to pass the course.

Component Weight in

Final Grade

Minimum

Passing Mark

Logbook 40 65
Written Exams 30 50
OSCE 30 50

 

1. Consultation of undifferentiated patients
2. Chronic Illness Consultations
3. STI consultations
4. IMCI Consults
5. Under 5 Clinic
6. Family Planning Consultations
7. VIA
9. Management of Normal Labour
10. Management of TB Patients
11. Counselling
12. Patient Education
13. Home Visit
14. Palliative Care Patients
15. Role of Other Members of the Health Care Team
16. Significant Event Analysis
17. Health Facility Profile
18. Quality Improvement Project
19. Calls
20. Chart Review
21. Weekly Reflection
22. Observed Consultations
23. Reflection on Activities
24. Self Assessment of Block
25. Ethics
ACTIVITY WHERE EXPECTED AMOUNT OF TIME HOW MANY/WHAT MUST BE RECORDED FORMAT SUPERVISION/ RESPONSIBLE PERSON
Consultation of undifferentiated patients General OPD/

casualty/ hospital ward/ health centre

At least 20 hours weekly

(80 hrs/ block)

25 undifferentiated cases, 5 hospitalization or referral cases, and reflection Logbook entries Local supervisors

Site coordinator

Chronic illness consultations General OPD clinic/ chronic illness clinic Part of general consults; Aim for 3 hours per week (15hrs/block) 10 patients and reflection Logbook entries Local supervisor

Site coordinator

STI consultations General OPD clinic/STI clinic 1 hour 5 patients and reflection Logbook entries Local supervisor
IMCI consultations General OPD Clinic/Under 5 clinic/casualty Part of general consults; Aim for 3 hours per week (12 hrs/block) 5 patients: 3 entries plus 2 detailed cases. Logbook entries

Presentation of detailed cases

Local supervisor (Logbook entries)

Site coordinator (Detailed record)

Under 5 clinic Under 5 clinic 3 hours/block 10 patients Logbook entries Site coordinator
Family Planning consultations General OPD clinic/Family planning clinic 3 hours/block 6 patients Logbook entries Local supervisor
VIA VIA clinic 3 hours/block 1 patient Logbook entries Local supervisor
Antenatal consultations Antenatal clinic 6 hours/block 10 patients: 9 entries plus 1 case study Logbook entries Local supervisor (Logbook entries)

Site coordinator (report)

Deliveries Hospital/ Health centre As long as needed 5 patients: 4 entries plus 1 case study Logbook entries Midwife/ Local supervisor (Deliveries)

Site coordinator (Report)

TB management Clinic/hospital ward 3 hours per block 1 suspected and 2 diagnosed TB patients with contact tracing Logbook entries Site coordinator
Counselling Clinic 2.5 hours/block 5 patients Logbook reports Site coordinator (Detailed record)
Patient education Clinic/ community 20 mins/block, plus two colleague observations 3 sessions Logbook report Peer assessment
Home visit Community 5 hours/block 1 patient Logbook report

Presentation

Site coordinator
Palliative care patients Hospital/ health centre 2 hours/block 3 patients and reflection Logbook entries Site coordinator
Health Team Interview Clinic/ hospital 3 hours/block 1 interview Logbook report Site coordinator
Significant Event Analysis Clinic/hospital 1 hour/block Reflection Logbook report Site coordinator
Health facility profile Clinic/ Community 4 hours 1 audit Group presentation Present to staff at facility/site coordinator
Mini QI Project Clinic 3 hrs weekly

(12 hrs per block)

1 project Presentation

Written report

Present to staff at facility/site coordinator
Calls Hospital/health centre Weekly

 

1 weeknight per week (4 nights) and 2 full weekend days Logbook entries Doctor-on-call/site coordinator
Chart review Clinic 1 hour weekly as group Each student presents 1 chart/week (4/block) Logbook entries Logbook
Weekly Reflection on consultation Any meeting venue 1 hour per week 4 sessions Logbook entries Student directed
Observed consultations Clinic 1.5 hours (30 mins each) 3 patients Logbook entry Site coordinator

As you can see, your days will be very busy completing all of the tasks of the logbook. It may be helpful to divide up the tasks by week. A sample schedule is below.

Week 1

 

By the end of week 1, you will be able to:

·      Utilise principles of family medicine in patient management.

·      Apply basic clinical and diagnostic laboratory procedures in management of patients.

·      Apply basic communication principles with patients.

Tasks to be completed by preceptor/clinical staff

Orientation to clinical areas

Demonstrate clinical care

Brief teaching as necessary

Tasks to be completed by students

Take patients history

Conduct physical exam

Perform simple procedures

Start Health Facility Audit

Clinical Areas

All clinical areas

 

Week 2

 

By the end of week 2, you will be able to:

·      Apply basic principles of clinical examination and diagnostic procedures to reach proper diagnosis.

·      Use principles of family medicine to manage patients.

·      Apply principles of clinical medicine and pathology in management of patients.

·      Apply basic principles of immunization, health education and nutrition to promote health.

Tasks to be completed by preceptor/clinical staff

Demonstrate signs and symptoms and general clinical skills

Model professional behaviour

 

 

 

 

Tasks to be completed by students

Take history independently

Present cases to preceptor and other staff

Continue with tasks and learning competencies in family medicine.

Clinical Area

Outpatient clinic

Specialized clinics

Inpatient male and

female wards

Paediatric clinics

Antenatal care

Community

Week 3

 

By the end of week 3, you will be able to:

·      Conduct clinical procedures and laboratory findings to arrive at a proper diagnosis.

·      Manage patients with simple medical and surgical conditions.

·      Employ effective health promotion and counselling techniques to patients, clients and families at the facility and in hospital.

Tasks to be completed by preceptor/clinical staff

Teach skills

 

Tasks to be completed by students

Record histories accurately

Communicate with patients

Fill patient files

Prescribe under supervision

Clinical Area

All Areas, including Community

Week 4 By the end of week 4, you will be able to:
Tasks to be completed by preceptor/clinical staff

Provide guidance home visit

Provide guidance on facility assessment

Tasks to be completed by students

Health Facility audit and Quality improvement projects

Conduct home visit

Conduct facility assessment

Clinical Area

All areas, including community

Week 1: Classroom Based Learning
Week 2 - 5: Preceptorship
Week 6: Assessment