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Residency Training in Family Medicine.

OBJECTIVES OF RESIDENCY TRAINING IN FAMILY MEDICINE

The main objective of the department of Family Medicine is to train specialists in Family medicine capable of practicing as Consultant Family Physicians at various levels of the health care delivery system; Federal, State and in private practice establishments.


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The residents are expected at the end of training to be able to:

  • Provide frontline, first contact care for all category of patients, unlimited by age, gender, or body system.
  • Exhibit clinical competence over a wide range of patient problems and provide comprehensive and continuing care.
  • Be able to carry out research/ utilize research findings on relevant issues in primary care.
  • Be able to teach academic Family medicine at both the undergraduate and residency levels of education.

EDUCATIONAL OBJECTIVES OF FAMILY MEDICINE TRAINING PROGRAMME

  • Development of competences in Family Medicine through the acquisition of knowledge in various disciplines, which include Internal Medicine, Surgery, Reproductive Health, Paediatrics, Public Health, Health Policy, planning and Management, Medical Statistics, Medical Ethics, Sports Medicine, etc.
  • Capacity to develop lasting doctor- patient relationship in a family setting.
  • Ability to approach health care from the systems theory perspectives, which expresses the inter- relatedness of biological, psychological, family, occupational, social, economic, community and environmental factors on health and illness.
  • Skills in the application of person – centred clinical method (PCCM)
  • Skills necessary to provide continuity of care over long periods
  • Development of skills in the use of appropriate and efficient technology and therapeutics.
  • Skills necessary to maintain comprehensive, systematic medical records and illness registers.
  • Commitment to self motivated learning, continuing medical education and ability to conduct quality community – based researches, including research into the fundamentals of Family Medicine.
  • Development of academic leadership skills necessary to impact knowledge and skills to residents, medical undergraduates and other health workers.

STRUCTURE OF THE TRAINING PROGRAMME

The training in Family Medicine will take a minimum of four (4) years after full registration with the Nigerian medical Council (NMC) as a medical practitioner At Annunciation Specialist Hospital, vacancies in Residency positions are advertised in national dailies and subsequently interviews are conducted for short-listed candidates with the Head of the Department of Family Medicine in attendance.

The policy of the hospital is that candidates who have passed the Primary Fellowship examination in Family Medicine are given special consideration. Junior residents require at least 24 months of training before being allowed to take the Part 1 Fellowship examination.

The training must include postings and rotations through all the specialties as stipulated and approved by the Faculty of Family Medicine and the National Postgraduate Medical College of Nigeria. Newly employed residents would be made to start their postings from the Department of Family Medicine during which time they run the General Out-Patient Clinic, staff clinics, NHIS clinics. Thereafter, the residents are rotated through the various Specialties in the Hospital.


STRUCTURE OF JUNIOR RESIDENCY PROGRAMME

Programme / Posting

Duration

Consultant / Department

GOPD

3 months

Prof. G. Nnaji / Dr. Umeakunne, ASHE

Internal Medicine

3months

Dr. Nwobodo M. Prof. Ocheni S. & Dr. E. C. Offiah - ASHE

Obstetrics / Gynaecology

3months

Dr. Asimadu E. ASHE

Paediatrics

3months

Dr. Ezenwosu, ASHE

Surgery / Orthopaedics

4months

Sr. Drs. Nwankwo Elochukwu, Muobike, Dr. Nwadinigwe C. U., Dr. Ogbonnaya I. S., Dr. J. Azike, etc.

ENT

1month

Dr. Ukaegbe O.

Radiology

1month

Prof. A. Imo, Dr. S. Ezeofor ASHE

Mental Health

1month

Dr. Onyebueke, Psychiatric Hospital Enugu

Ophthalmology

1month

Dr. (Mrs.) Asimadu, ESUT

Pathology / Laboratory

1month

Dr. Nnakenyi, UNTH

Anaesthesia

1month

Drs. Ajuzieogu O., UNTH

Dr Onuora.

Accident & Emergency

1month

Dr. Umeakunne I., ASHE

Community Medicine

6weeks

Dr. Ancilla Umeobiri UNTH

Dental

1 month

Prof.  Chukwuneke

Outreach Experience

6weeks

Prof G. Nnaji/ Dr. Umeakunne

Evaluation of the Eligible Candidates on all the Part 1 Examination Areas

1week

ASHE & DDL Hospital, Eha-Alumona: Prof. Nnaji & Dr. Umeakunne



PART 1 – TRAINING PROGRAMME

DAYS

ACTIVITY

SUPERVISING CONSULTANT

1.

MONDAY

3.30PM-5PM

Group discussion

Radiology review Bed-side teaching

Drs. Umeakunne / Ihejirika/Egwu & visiting consultants

2.

TUESDAY

8AM-10.15AM

Clinical meeting / CME

Drs. Umeakunne /Ihejirika/Egwu & visiting consultants

3.

WEDNESDAY

3.30PM-5PM

Journal club

Prof G.  Nnaji & Dr. Umeakunne

4.

THURSDAY

3-6PM

Teaching, review of seminars, workshops, etc.

Prof. G Nnaji 

5.

FRIDAY

3.30PM-5PM

Mortality review

Group discussion

Drs. Umeakunne / Ihejirika/Egwu

6.

SATURDAY

8AM-1PM

MCQ and OSCE Quarterly

Drs. Umeakunne/Ijejirika/Egwu

7.

SATURDAY

9AM-12Noon

Bed-side teaching 2nd and4th Saturdays

Dr. Umeakunne /visiting



SENIOR RESIDENCY

The senior residents will be allowed to take the Part II Fellowship examination after at least two years of passing the Part 1 Fellowship examination.

TRAINING ACTIVITIES

Departmental Activities during Postings: Residents are expected to fully participate in the departmental activities of the specialty / subspecialty where they are posted. However, they are also expected to participate in the Family Medicine departmental activities (clinical, workshop / seminars, tutorials, demonstrations, etc) during their specialty and sub-specialty postings within the Hospital except in special circumstances where they are exempted.

Monitoring and Evaluation of Training Activities during Postings: A close monitoring of the training activities of each resident during posting is carried out by the Co-ordinator of Training. The residents write up and present cases they managed during each posting. They are evaluated for examination (Mock Part 1 and II examinations) based on the cases presented during the weekly clinical case presentation meetings in the Department.

Authentication of Cases seen during Postings: Residents must have their Log books filled-out and signed by the consultants during their postings.

Workshops/ Seminars/ Revision Courses: Residents must attend the required number of workshops and seminars and revision courses before they are signed up for the final (Part 1 & II examination). Failure to meet the Departmental requirement for signing – up would lead to non-presentation for examinations.


PART 2 (SENIOR RESIDENCY TRAINING) 2 YEARS

DAYS

ACTIVITY

SUPERVISING CONSULTANT

1.

MONDAY

3.30PM-5PM

Group discussion

Radiology review Bed-side teaching

Drs. Umeakunne / Ihejirika/Egwu & visiting consultants

2.

TUESDAY

8AM-10.15AM

Clinical meeting / CME

Drs. Umeakunne /Ihejirika/Egwu & visiting consultants

3.

WEDNESDAY

3.30PM-5PM

Journal club

Prof G.  Nnaji & Dr. Umeakunne

4.

THURSDAY

3-6PM

Teaching, review of seminars, workshops, etc.

Prof. G Nnaji 

5.

FRIDAY

3.30PM-5PM

Mortality review

Group discussion

Drs. Umeakunne / Ihejirika/Egwu

6.

SATURDAY

8AM-1PM

MCQ and OSCE Quarterly

Drs. Umeakunne/Ijejirika/Egwu

7.

SATURDAY

9AM-12Noon

Bed-side teaching 2nd and4th Saturdays

Dr. Umeakunne /visiting


Resident to work on proposal, his/her approved topic,Attend Revision course, I update course, Research methodology, Human Resources.


SENIOR RESIDENCY PROGRAMMES (2 YEARS)

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  • Part II Training: Residents for the Part II Fellowship examination are stationed in the department where there are expected to sharpen their skills in the core areas of Family Medicine.

  • Tutelage: Residents for the Part II examination shall be expected to proceed on a 3 months Tutelage in approved centre, where they are expected to participate in both the clinical and administrative activities in the hospital.

  • Casebook Dissertation for Part II Examination: Residents for the Part II examination are required to submit topics for case books and Dissertation for discussion and approval before being sent to the college.

Clinical and Bedside Experience for Residents.

Residents on rotation are expected to gain their bedside experience while on their postings in the clinical specialty and sub-specialty departments; this is added to their clinical exposure in the General Out-Patient Clinics. Senior residents are expected to spend much of their time at the clinics where daily ward rounds/ bedside teaching and other clinical activities take place.


RESIDENCY TRAINING ACTIVITIES

  • General Out-Patient Clinics: Daily clinic from 8.00 am to 4.00 pm daily. Residents are also programmed in the monthly duty roster to manage emergencies under supervision of consultant family physician – GOPD and other consultants.

  • Case Reviews/ Clinical Case Audit: reviews of cases seen by the residents are carried out at the close of consultations usually on Thursdays and Fridays (2.00pm). Interesting cases are discussed while paying attention to the communication skills exhibited by the residents, their approach to consultations e.g. PCCM, diagnostic skills and holistic approach to the management of the cases. Clinical approach to patients’ management is evaluated and suggestions proffered. Revision courses / workshops are reviewed.

  • Journal Critique Meeting: Residents choose journal topics of relevance to Family Medicine for extensive review by consulting recent local and foreign journals.

  • Lecture on Topics: (CME/Scientific Session) Lecture Topics of interest shall be listed for a period; residents shall be expected to search and update their knowledge through a lead discussant. A moderator directs the discussion while all residents participate during the debates, CME points are usually obtained too.

  • Case Presentation: Cases of interest that have been managed by residents are presented for discussion, and input by all participants. The cases should be capable of providing lessons/opportunity to learn. Group discussion encouraged and radiological reviews including CT Scan, MRI done.

  • Departmental Library Books Usage: Residents are allowed to borrow some of the text books while the core reference books are to be consulted and not to be removed from the Department except in special cases when an assignment is given to a resident.

  • Senior Residents are expected to attend twice weekly consultants’ ward round on Mondays and Wednesdays. The consultant would observe the following clinical skills; history taking, patient presentation, General examination, systemic examination, communication of diagnostic information to patients, counseling and other approach to the management of patients in the family context, community health problems / management, Health systems Management, fundamentals in operational research and biostatistics, choice of research topics, planning of research project, writing of research proposals, data presentation, data analysis and writing of research reports.