Problem based learning : Introduction to family medicine broad exam preparation

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Problem based learning Introduction to family
medicine broad exam preparation

• Patama Gomutbutra MD

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How do you feel about family medicine broad
examination?

• Surgery Swartss
• Internal medicine Harisons
• OB-Gyn Williams
• Pediatric Nelsons
• Minor etc.

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• Family medicine
• Swartss Harisons
• Williams Nelsons
  etc
• or Nothing!!

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current style of family medicine broad examination

• 1 MCQ ( one best choice)
• Thai clinical practice guidline
• AAFP online journal
• their CME quize -gt 10-40 of Broads
  exam MCQ each year

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current style of family medicine broad
examination (cont.)

• 2 Spot diagnosis 30 point
• your clinical experience!!
• should not spend time too much for review old
  examination slide
• thay are changed every year

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current style of family medicine broad
examination (cont.)

• 3 MEQ (short assay) 120 points
• the most difficult part
• Integrative
• Communication knowledge
• Clinical knowledge
• Public health knowledge

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Example MEQ ( modified from 2007 broad exam)

• The 65 year-old bussiness man with bowel habit
  change and anemia, after doing colonoscope with
  biopsy ,result was adenocarcinoma .He have a son
  40 year-old

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Question
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1 How do you tell the biopsy result to this
patient

• Breaking bad news
• SPIKES

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SPIKES key words

• S Setting
• P Perception ( how much Pt know)
• I Invitation ( how much Pt want to know)
• K Knowledge
• E Empathy
• SSummary stratergy

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2.This patients son consult you about cancer
screening and preventio,How do you suggest him

• Screening
• Genomic aspect
• Medication
• Life style education

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Thai recomodation

• Normal risk
• -gt initial screening by stool occult blood
  and/or colonoscpy when 40 year-old every 10
  years
• High risk
• first degree relative and onset lt 60 year-old
• -gt stool occult blood not nessesary
• colonoscopy when 40 year-old or earlier
• every 5 years

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• Occure in 2 generation or more -gtStrongly
  associated with genomic factor
• eg family adenomatous polyposis (FAP)
• 1choice sigmoidoscope since 12 years old
  then every year
• 2choice gene testing for APC gene
• if not detected,yearly sigmoidoscope is not
  required

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• 3.From studies in USA ,person with first degree
  relative increase risk 2 times of general
  population and colonoscopy have sensitivity 95
  specificity 98
• can you estimate positive predictive value in
  this patients son if prevalence among general
  thai male is 5.5 per 100,000

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Positive predictive value TP/ TPFP
X100
10.4 / 2010.4 X100
0.51
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3.If you are family doctor in community which
increse incident of colon cancer,how you manage
this problem

• Community oriented primary care
• COPC

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COPC keywords

• 1. Define and characterize community
• 2. Survey and identify community problem
• 3.Develope intervention
• 4. Monitor impact

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Recommended preparation

• Organized follow the three principle of Thai
  collage of family physician
• 1 Doctor-patient relationship
• Dealing with difficult patient
  Medicolegal issue
• 2 High quality health care provider
• Evidence based medicine
• Clinical practice in primary care
• 3 Community based practice
• Health care system
• International health

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Not too much Just mixing
Clinical practice
Community based practice
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Are you ready ?