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Programme structure
Syllabus
Theory and practice of Family Medicine
Principles of Family Medicine
Teaching and learning skills
The Consultation

  Competencies expected of M Med graduates in Internal Medicine
  Competencies expected of M Med graduates in Emergency Medicine
  Competencies expected of M Med graduates in Obstetric and Gynecology
  Competencies expected of M Med graduates in Pediatric
  Competencies expected of M Med graduates in Community Medicine
  Competencies expected of M Med graduates in Surgery
  Competencies expected of M Med graduates in Psychiatry
  Competencies expected of M Med graduates in the use of Laboratory
  Competencies expected of M Med graduates in Radiology and Imaging
  Reference books
  Reference journals
 

Programme structure for Master in Medicine (Family Medicine)


Month Week Year 1 Year 2 Year 3 Year 4

June

July

August

2 Internal
Medicine

Surgery

Orthopaedic

Anaesthesiology

Short
Posting

Patology

Geriatric

Health
Center
4
6
8
10
12

September

October

November

14 O&G Psychiatry

Skin/STD

Radiology

Health
Center
16
18
20
22
24

December

January

February

26 Pediatric Internal
Medicine

Opthalmology

ORL&HNS

GP Posting

Health
Center

(Dissertation write up & Presentation)

28
30
32
36
38

March

April

40 A&E

Pediatric

(Basic Research
Assignment Write
Up &Presentation)

Elective

Health
Center

Health
Center
42
44
46
May 48 Revision     Revision
50
June 52 Pro.
Exam 1
    Pro.
Exam 2

N/B: Tutorial, seminar presentation and lecture will be held every Thursday
 

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Syllabus for M Med (Family Medicine) Programme

 

At the end of phase I, they are able to integrate the concept of Family Medicine and able to strengthen basic clinical skills in patient management mainly in Internal medicine, Obstetrics & Gynaecology, Paediatrics and Emergency Medicine.

At the end of phase II, they are able to further strengthen their clinical skills in all area of medicine including Surgery, Psychiatry, Orthopaedics, Anaesthesiology, Pathology Geriatric, Dermatology, Radiology, Opthalmology and ENT. The clinical skills required will enable then to make accurate diagnosis and implement relevant management including performing minor surgical procedures.

At the end of Phase III, they are able to demonstrate skills of Family Medicine Specialist in patient management at family level and able to formulate community diagnosis through research and carry out suitable intervention. They are able to manage Primary Care services.

 
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Theory and Practice Of Family Medicine
 
Principles of Family Medicine
 

The graduate should be able to demonstrate:

 
1. Ability to make diagnoses which are expressed simultaneously in physical, psychological, and social terms, using a problem-oriented approach.
   
2. Understanding of the stages of human development, in particular the different tasks and anxieties belong to each stage of life; e.g. childhood, adolescence, old age.
   
3. Understanding of normal and abnormal behaviour, in health, in sickness, in the family & co-unity and towards the health care team; e.g. be able to cope with manipulative patients.
   
4. Understanding of the at facts of culture and class among the population he/she serves; e.g. aware of traditional medicine, culture, religions proscriptions and prescriptions.
   
5. Ability to work in a health care team as a. member or leader, in a rural or urban setting, serving patients of all ages and social strata.
   
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Teaching And Learning Skills
 
1. Committed to life-long learning, and able to use a variety of media, journals, meetings, and audio-visual materials.
   
2. Able to transfer skills and knowledge about health to students, colleagues, and in the community, especially to women, children and the elderly
   
3. Able to use adult education methods in health education, including working with the media
   
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The Consultation
 
The graduate should be able to demonstrate:
 
1. Understanding of various approaches to the consultation
   
2. Understanding of the tasks of the consultation; e.g. to include opportunistic health promotion
   
3. Ability to use different styles of consulting appropriately e.g. sometimes an authoritative styles, sometimes a counseling style
   
 
Approach to clinical case. The graduate should be able to:
 
1. Recognize early, treat and, or manage emergencies, i.e. acute diseases threatening life.
   
2. Detect the early features of disease which may be aborted or of which the complications may be reduced.
   
3. Recognize and treat a wide range of common conditions.
   
4. Recognize in chronic conditions the important factors requiring continuing care.
   
In studying diseases the following aspects should be particularly considered:
 
1. Natural history and risk factors
   
2. Preventive measures
   
3. Methods of early diagnosis by history, physical examination, and appropriate, cost-effective investigations
   
4. Management options including indications for referral to specialists and/or community resources, but not including unnecessary detail of in-hospital care.
   
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Competencies expected of M Med graduates in Internal Medicine
 
1. Cardiology Congenital heart disease
Valvular heart disease
Ischaemic heart disease
Heart failure
Hypertension
Bacterial endocarditis
   
2. Respiratory Upper respiratory tract infections
Asthma/COPD
Pneumonia
Tuberculosis
Lung cancer
   
3. Endocrinology &
Metabolism
Diabetes Mellitus
Thyroid disorders
Nutritional disorders
   
4. Neurology Migraine
Epilepsy
Strokes/TIA
   
5. Gastroenterology Peptic ulcer
Non-ulcer dyspepsia
Reflux oesophagitis
Dysphagia
Acute/chronic diarrhoea
Irritable bowel disease
Haemetemesis/melaena
Viral hepatitis
Obstructive jaundice
   
6. Nephrology Urinary tract infections
Acute/chronic renal failures
Acute nephritis
Nephrotic syndrome
   
7. Rheumatology Gout
Rheumatoid arthritis
Systemic lupus erythematosus
   
8. Dermatology Eczema, dermatitis
Fungal infections
Scabies
Psoriasis
Acne
Skin manifestations of systemic illness / underlying malignancies Vitiligo
Non-specific skin rash
   
9. Haematology &
Oncology
Anaemias
Bleeding disorders
Malignancies
   
10. Tropical medicine Snake bite
Malaria
Typhoid fever
Amoebiasis
Leprosy Dengue
   
11. Sexually
Transmitted
Disease
Non-specific urethritis
Gonorrhoea
Syphilis
HIV/ AIDS
   
12. Geriatrics Aging process
Drug prescription in the elderly
Special needs and psychosocial support
Epidemiology of aging
Role of other agencies
   
13. Poisoning &
Subatance abuse
Recognition, basic management and referral
   
14. Skills required

Perform and interpret ECG
Check Peak Expiratory Flow Rate
Teach inhalation technique
Use nebulizer
Diagnostic pleural aspiration
Proctoscopy
Nasogastric tube insertion
Skin scrapings/skin biopsy
Cauterization including cryotherapy and podophyllin application Glucose monitoring
Urine tests for sugar and protein
Insulin injection technique
ABO & Rh. blood grouping technique
Blood transfusion venepuncture
Urine catheterization/ Suprapubic tap
Gram staining of urethral swabs
Local injection of joints
Diagnostic aspiration of joints
Office-based physiotherapy

     
 
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Competencies expected of M Med graduates in Emergency Medicine
 
Specific emergencies for which graduates need to know which includes:
 

 

 

Cardiac arrest
Acute severe cheat pain
Acute breathlessness
Haemorrhage Shock
Unconscious patient
Convulsions Acute limb pain
Acute abdominal pain
Acute urinary retention
Head injury
Spinal injury
Multiple injury
Burns
Aberrant behaviour, e.g.. violent or suicidal.
Poisoning and substance abuse
 
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Competencies expected of M Med graduates in Obstetric and Gynecology
 
The graduate is expected to know in detail about common obstetrics and gynaecological problems seen in general practice. There are other disorders, which the candidates need only to recognise for appropriate and early referral.
 
Obstetric
 
The graduate should be able to evaluate and manage
 
  Antenatal care of a normal pregnancy
Recognition and primary-care management of high-risk pregnancy
Genetic counseling
 
Common obstetric problems:
 
  Vomiting
Anaemia
Gestational diabetes
Multiple pregnancy
General medical disease in pregnancy
Hypertensive disease
Intra-uterine growth retardation
Isoimmunisation
Antepartum haemorrhage
Premature labour
Malpresentation, including breech
Post-dates, uncertain date
 
Skills required
 
  Management of normal labour:
    Induction
Analgesia and anaesthesia
Monitoring
Indications for operative intervention
  Urine pregnancy test
Ultrasound scan of pelvis
Normal and low forceps deliveries
Repair of episiotomy and lacerations
Perineal infiltration and pudendal block
Manual removal of retained placenta
Emergency management,in the absence of specialist help, of shoulder dystocia, breech, or twins
Management of post-partum haemorrhage
Care of normal newborn
Neonatal resuscitation
Breast-feeding, promotion and support post-natal care of mother
Psychological effects of pregnancy and puerperium, on the mother and her family Epidemiology of maternal and neonatal mortality and morbidity
 
Gynaecology
 
The graduate should demonstrate knowledge of reproductive anatomy, physiology, and endocrinology at each stage of reproductive life.
 
He should be able to evaluate and manage:
  Menstrual disorders
Disorders of early pregnancy, e.g.. abortion, ectopic
Fertility control
Unwanted pregnancy
Infertility Infections of reproductive tract
Congenital anomalies and paediatric gynaecological problems
Sexuality problems
Genital tract neoplasia
Menopausal problems
Incontinence and prolapse
Ethical and legal aspects. e.g.- sexual assault
 
Skills required:
 
  Vaginal examination
PAP smear
Counseling about family spacing, and methods available
IUCD insertion
Evacuation of incomplete abortion
Cervical punch biopsy and polypectomy
Endometrial biopsy
Cautery of condylomata acuminata M
arsupialisation of Bartholin's abscess
 
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Competencies expected of M Med graduates in Pediatric
 
The graduate is expected to know in detail about common problems seen in general practice. There are other disorders, which the candidates need only to recognise for appropriate and early referral. In Paediatrics, even more than other area prevention should be emphasised.
 
The graduate should be able to provide primary care management of:
 
  Well baby care
Neonatal care, resuscitation, stabilisation. and transport
Feeding and nutrition of infants Breast feeding, promotion and support
Assessment of growth and development
Failure to thrive
Immunisation
Disorders of fluid and electrolyte balance
Common genetic disorder
Handicaps, cerebral palsy, mental retardation, blindness, deafness, physical handicap Gastrointestinal problems, e.g.. diarrhoea, vomiting
Cardiovascular problems, e.g.. congenital heart disease, cardiac failure, rheumatic fever Respiratory problems, e.g.. upper and lower respiratory tract infections, asthma Neurological problems, e.g. febrile fits, epilepsy, head injury
Genitourinary problems, e.g.. urinary tract infection, reflux
Haematological problems, e.g.. anaemia, leukaemia
Endocrine and metabolic problems, e.g.. diabetes, hypothyroidism, nutritional disorders Dermatological problems, e.g.. eczema, impetigo, scabies
Orthopaedic problems, e.g.. congenital hip disease, limp
Common infections and parasitic infestations
Common paediatric malignancies
Common paediatric surgical problems
Accidents, non-accidental injury
Poisoning
Emotional and behaviour disorders, e.g.. school problems
Adolescent problems
 
The graduate should also demonstrate an understanding of the epidemiology of paediatric problems in Malaysia, and the various health care services available in the community
 
Skills required:
 
  Measuring and charting height and weight, and interpreting changes
Developmental assessment Resuscitation, including intubation of the newborn Venepuncture
Providing intravenous fluids
Lumbar puncture
Passing nasogastric tube
Inserting chest tubes
Counseling children and families
Communication skills for health education
 
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Competencies expected of M Med graduates in Community Medicine
 
  Epidemiology/ Statistics/ Health Information Data
 
  Skills required:
 
  Ability to use epidemiological data in primary care diagnosis, and community care Ability to plan and carry out both audit and research statistical skills for planning research, in selecting and interpreting tests critical appraisal of other people's research, and its application to clinical work use of a computer for word processing and communication by modern use of software for data processing, including Epi-Info, SPSS and STATA
 
  Maternal and Child Health
 
  The graduate will demonstrate:
 
  Understanding at the causes of morbidity and mortality of mothers and children in Malaysia. The ability to use this knowledge to identify the health and nutritional needs of mothers and children in Malaysia. Understanding of the MCH delivery systems, and of his/her role in improving the care of mothers and children in the local area
 
  Nutrition
 
  The graduate should be able to evaluate and manage:
 
  Nutritional problems of all age-groups, including children and the elderly
Eating disorders, e.g. obesity
Nutritional aspects of clinical conditions e.g. diabetes mellitus
 
  The graduate should be able to provide health education for healthy eating for all age groups
 
  Breast feeding promotion and support
Weaning practices
 
  Skills required:
 
  Office-based anthropometric measurements
Interpretation of a nutritional survey
 
  Occupational Health/Environmental Health
 
  The graduate must be able to demonstrate understanding of how occupational and environmental factors affect clinical practice, e.g.
 
  Smoking
Water supply and sanitation
Occupational lung disease
Industrial injury and accidents
Substance abuse, e.g. glue-sniffing, alcohol, opiates
Food quality Pesticides
 
  The graduate will understand the role of the District Health officer, and will make appropriate referral of problems related to occupational and environmental health hazards
 
  Health Care Management
 
  The graduate should be able to show knowledge of:
 
  1. The concept of Health Systems, specifically as applied to Malaysia
     
  2. The variety of Systems in Malaysia, e.g. government, private, traditional, and other community health services
     
  3. The health programmes in Malaysia, e.g. family planning, applied nutrition, vector control
     
  4. The legal aspects of community medicine, e.g.. Factories and Machinery Act, 1967
     
  The graduate should also be able to show how he/she applies principles of medical ethics to his/her work.
 
  Practice management
 
  The graduate needs to demonstrate knowledge of:
 
  1. Setting up and managing a practice: finance, organization selection and training of personnel, legal aspects
     
  2. Medical records and appointment systems
     
  3. Use of age, sex and disease register
     
  4. Use of the computer in family medicine
     
 
  Medical Sociology and Anthropology
 
  The graduate needs to demonstrate knowledge of:
 
  1. Health care systems in general, with reference to system (medical pluralism)
     
  2. Health seeking behaviour of communities in the quest for better health or therapy
     
  3. Structure and function of health care providers in the community including alternative health care providers (Homeopathy, traditional Malay, Chinese and Indian medicine)
     
  4. Islamic medicine: concepts, practices & ethics
     
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Competencies expected of M Med graduates in Surgery
 
The range of surgical conditions are very wide, and for many of them the graduate only needs to be ab1e to recognise them, arrange preliminary investigations, and make appropriate referral. There are certain common conditions, which the graduate should be able to evaluate more fully:
 
General Surgery
 
  Inguino-scrotal swelling
Breast lump and breast pain
Varicose vein
Prostatism
Ureteric calculus
 
  Skills required

  Toilet and suturing
Wound debridement and desloughing
Management of minor burns
Excision of small lumps
Incision and drainage of abscess
Circumcision
Proctoscopy
Banding procedure for haemorrhoids
Stoma care
Avulsion of toe nails
Insertion of chest drain
 
The graduate should also be able to assess fitness for surgery, and to manage common post-operative complication
 
Orthopaedic
 
  The graduate should be able to evaluate and manage
 
  Soft tissue injuries
Sports injuries
Dislocations of limb joints
Simple fractures requiring closed reduction and plaster immobilisation
Inflammatory conditions requiring injection
Acute and chronic back pain
 
Anaesthesiology
 
  The graduate should acquire the following skills:
 
  Cardiopulmonary resuscitation, basic and advanced
Endotracheal intubation for all age groups
Emergency cricothyroidotomy
Local anaesthesia for simple procedures
 
 
ORL & HNS
 
  The graduate should be able to evaluate and manage
 
  Otitis media
Otitis externa
Loss of hearing
Foreign body or wax in external auditory meatus
Vertigo
Tinnitus
Facial palsy
Epistaxis
Seasonal and perennial rhinitis
Sinusitis
Foreign body in nose or throat
Hoarseness
Dysphagia
Mouth ulcers
Dental abscess
 
  Skills required:
 
  Ear syringing and toilet
Nasal packing
Cauterisation of nasal polyp
 
Opthalmology
 
  The graduate should be able to evaluate and manage
 
  Conjunctivitis
Keratitis
Iritis
Acute glaucoma
Foreign body
Dry eye
Blepharitis, pterygium, chalazion, hordeolum
Loss of vision, acute and gradual
Floaters and flashes
 
  Skills required:
 
  Testing visual acuity and colour vision
Fluorescein staining
Eye lid eversion
Perimetry
Tonometry
Slit lamp examination
Curettage of chalazion
Flushing of naso-lacrimal duct
 
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Competencies expected of M Med graduates in Psychiatry
 
The graduate is expected to know in detail about common psychiatric problems seen in general practice. There are other disorders, which the candidates need only to recognise for appropriate and early referral.
 
The graduate should demonstrate skill at interviewing and mental status examination.
 
He must know the presentation and primary care management of:
 
  Anxiety
Depression
Schizophrenia
Substance abuse
Personality disorder
Insomnia
Phobias
Bereavement
Somatising disorder
Psychosexual problems
Emotional disorders of childhood and adolescence
Mental retardation
Organic mental disorder
Psychiatric disorders of old age
Culturally determined syndrome in Malaysia Psychiatric emergencies, e.g.. violent or suicidal patient
 
Skills required:
 
  Supportive psychotherapy
Counseling for individuals, couples, and families
Simple behaviour therapy
Crisis intervention
Use of neuroleptics, antidepressants, and Benzodiazepines
 
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Competencies expected of M Med graduates in the use of Laboratory

 
The graduate is expected to know in detail about common tests used in general practice.
 
Skills required:
 
  Cost-effective selection of tests
Interpretation of test results
Specimen collection, including blood culture
Examination of blood film, urine, and stool
Interpretation of cytology and serology results
Office-based laboratory tests
 
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Competencies expected of M Med graduates in Radiology and Imaging

 
The graduate should know the indications and interpretation for:
 
  Chest XR
Skull XR
XR nasal sinuses and mastoid
XR of bones and joints
 
The graduate should also know the indication for and preparations required for:
 
  Ultrasound scan
Contrast studies
CT scan
MRI
Radionuclide scan
 
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Reference books

 

Teaching General Practice Ed Cormack, Marinker, Morrell, Kluwer, Medical 1981 W18 T253

Clinical Methods, A General Practice Approach, Robin Fraser, Butterworths 1987. WB 110 C641

Towards Earlier Diignosi5 in Primary Care, Keith Hodgkin, Churchill Livingstone, 1978 W13141 H689

The Consultation: An approach to Learning and Teaching, Pendleton, Schofield, Tate, Havelock, Oxford University Press I 984. W62

The Doctor-Patient Relationship, Freeling and Harris, Churchill Livingstone, 1984. W62 F854

Doctor-Patient Communication Pendleton, Hasler, Academic Press, 1983. W62 D637

Six Minutes for the Patient, Balint and Norell. Tavistock Press. 1973. W62 625

Talking with Patients, Nuffield Working Party. (1972) W62 T146

Transcultural Medicine, Bashir Qureshi, Kluwer Academic Publ, 1989. W84 FAIQ9

The Future General Practitioner, Learning and Teaching working Party of the Royal college of General Practitioners, 1972.

Practical General Practice - Guidelines for Logical Management, Khot and Polmear, Butterworths, 1988,2nd ed. 1992

Practical Prescribing; Brodie and Harrison, Churchill Livingstone, 1986.

Emergencies in General Practice, Moulds, Martin, Bouchier-Hayes, Update Publication, MT Press, 983.

Obstetrics and Gynaecology in General Practice, Eddy and Owen, Churchill Livingstone, 1987.

Oxford General Practice Series, oxford University Press.

Geriatric Problems in General Practice, wilcock, Gray Pritchard 1982

Preventive Medicine in General Practice, Cray and Fowler 1983

Modern Obstetrics in General Practice, Marsh, 1998.

Essentials of Family Medicine, Sloane, Slat and Baker, William and Wilkins 1988

Essential Primary Care Street, Birch, Blackwell 1987 (W. B4.6)

Primary Care Medicine. Gorall, May, Mulley 2nd. Ed.. Lippincott (1987)

Textbook of Family Medicine, Rakel 3rd. Ed. (1987) Saunders (WIB 110 Tex)

Scientific Foundations of Family Medicine, Cornmack et. al Ed. (1978) Heinemenn (WB110) Sci

Specialization in Primary Health Care; College of General Practitioners in Malaysia 1979

Essentials of family Practice, Rakel 1993 WB11 E78

Textbook of family Practice, Rakel 1990 4th. Ed. WBl10 T35s

Books on MRCGP 28. Lecture Motes on Medical Sociology, D.R. Harray 1988 WA3O U243

 
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Reference journals

 

Update Medicine Journal

The British Journal of General Practice.

The Journal of the Royal College of General Practitioners.

Family Doctor - The Journal of College of Family Practice, Canada

Current Therapy in Emergency Medicine

The Family Physician (Malaysia college of General Practitioners)

Australian Family Physician

Singapore Family Physician UPDATE

The Journal of Continuing Education for General Practitioners

 
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