This document outlines a 6-week primary care clinical training module for 4th year medical students. The goals are to prepare students for clerkships by teaching consultation skills, including history taking, physical examination, using medical equipment, and writing records. Students will train at primary health care centers with experienced physicians and practice these skills on real patients. They will be assessed on attendance, skills demonstrations, and completing medical records. The training uses methods like observation, independent practice, feedback, and role-playing to teach effective consultation skills.

1. 1
Primary Care Training
Module
Student’s Guide
Professor Faisal A Alnaser

2. 2
Goal:
To prepare the 4th year medical students for
the clerkship phase, with special emphasis
on the clinical skills needed for consulting
patients.

3. 3
Aims of the course:
• This module aims to give the students, clinical experience
in applying the knowledge and the skills they have learned
during their four years of medical education on real
patients.
• The aim is to expose them to the opportunity for taking
proper and relevant history, applying the learned
communication skills, performing physical examination,
using various office equipments and practicing practical
office procedures.
• This course is not intended to replace the clerkship
rotation, however during the clerkship rotation, emphasis
will be given to the management skills based on the
students sound back ground about consultation skills
learnt in this activity.
• Also please note that patients’ management, practice
management, preventive services, health education and
healthy life modification strategies will be covered during
PHC clerkship rotation.

4. 4
Duration & Place:
• This course is a 6 weeks course, one day per week for
each student, designed to be given to 4th year medical
students.
• The training will be held in Primary Health Care
centers where each student will be attached with a
Family Physician in a group of 2, either on Mondays,
Tuesdays or Wednesdays from 8:00 a.m. till 11:00 noon.
• Each family physician will provide training for a group
of students (2 student per group) for 3 days per week
for a total of 6 weeks.
• The course will start during Unit IX of the PBL which
commences in the months of March 2011 and ends by
April 2011.

5. 5
Outcome:
• This course aims to prepare the students for
the clerkship period where they will apply all
the clinical skills they have learned in this
module to help them in their hospital and
health centers attachments.

6. 6
Training and Teaching Methodology:
• The 6 weeks clinical course at P.H.C. centers will utilize
the following learning methodologies:
• Discussion on the basic principles of the consultation
skills.
• Observation of the experienced Family Physicians in
applying the skills needed for history taking, physical
examination, and management skills.
• Independent history taking.
• Performing physical examination.
• Using consultation and office equipment.
• Performing office procedures with selected and randomized
patients based on session objectives.
• Tutorials and discussion on the given tasks.
• Communication skills feedback sessions.
• Role plays on various tasks when needed.

7. 7
Learning Objectives:
• By the end of this 6 weeks of this course, the students
should be able to:
• Demonstrate effective history taking skills.
• Demonstrate skills of performing physical examination.
• Show the proper use of office medical equipments.
• Perform common office procedures.
• Know how to use Problem Oriented Medical Records.
• Identify and practice various consultation tasks and skills.
• Recognize his/her communication style and apply it in the
consultation.
• Recognize the importance of Doctor-patient relationship.
• Use hypothetico-deductive method of clinical reasoning.
• Understand and discuss the presentation of
undifferentiated problems.
• View the presentation of health problems in a holistic way.
• Communicate effectively with patients in the community
setting.

8. 8
Session 1: Theme: Setting the stage.
• This will include discussion and observation on the
following tasks:
• Introduction to consultation structures and skills.
• Understanding the importance of different that are
needed for various situations.
• Introduction to various medical equipments that are
used in the consultation room.
• Reviewing communication skills needed for a
successful consultation.
• Skills needed to open an interview and establish initial
relationship.
• Introduction to Problem Oriented Medical Records
(POMR)

9. 9
Session 2: Theme: Opening an interview & initiating
a consultation.
• This will include discussion and observation on the
following tasks:
• Structuring the consultation in terms of objectives:
• Structure: Where am I and what do I want to achieve in
this consultation?
• Skills: How do I achieve my objectives?
• Behaviors: How can I incorporate these skills into my
personality?
• Establishing initial rapport and identifying the reasons
for patient’s attendance.
• Gathering information: Exploring patient’s problems and
understanding patient’s perspective (fears, concerns,
worries and expectations).
• Building relationship: Using appropriate non-verbal
behaviour, developing rapport and demonstrating
empathy.

10. 10
Session 3: Theme: Skills of history taking (Gathering
information).
• Students will be required to demonstrate the following skills:
• Patient’s narrative: encourages patient to tell the story of the
problem(s) from when first started to the present in own
words. Question style: uses open-ended and closed questions,
moves appropriately from open to closed. Listening: listens
attentively, allowing the patient to complete statements
without interruption; leaves space for patient to think before
answering. Facilitative response: facilitates patient's responses
verbally and non–verbally e.g. use of encouragement, silence,
repetition, paraphrasing, etc. Cues: picks up verbal and non–
verbal cues (body language, speech, facial expression, affect);
checks them out and acknowledges as
appropriate. Clarification: clarifies statements which are
vague. Summary: periodically summarizes to check own
understanding of what the patient has said; allows patient an
opportunity to correct interpretation. Appropriate use of
language: uses concise, easily understood language.

11. 11
Session 4: Theme: Skills of performing physical
examination & appropriate use of consultation medical
equipments.
• Students will learn and practice the following skills:
• Opening an interview and gathering information.
• Performing focused physical examination. This will
include assessing vital signs and doing relevant physical
examination based on patient’s complaints.
• Introducing screening examination based on patient’s
gender and age.
• Using consultation equipments for the followings:
• Measuring blood pressure
• Performing fundoscopic examination
• Conducting ear examination
• Measuring height and weight and calculating BMI.

12. 12
Session 5: Theme: Making Diagnosis and Planning
Explanation
• This will include further exploration of the disease and illness
framework.
• Balance between open ended and closed questions: asks
appropriate questions to explore facts of the history that have
not emerged from the patient’s problem. Symptom analysis:
site, radiation, character, severity, duration, frequency,
aggravating factors, relieving factors and associated
phenomena. Ideas and concerns: determines patient's ideas,
believes, concerns and worries regarding each problem. Effects:
determines the effects on the patient’s life of each
problem. Expectations: determines what help the patient had
expected regarding each problem. Feelings and thoughts:
encourages the expression of the patient’s feelings. Apply
hypothetico-deductive approach to reach probable diagnoses.
• Provide the correct amount and type of information to the
patient.
• Aid accurate recall and understanding of the problem for which
the patient has come to-day and arranging follow-up.

13. 13
Session 6: Theme: Skills of closing the session &
writing medical record.
• This will include:
• Confirming the established plan of care.
• Clarifying next steps for both doctor and the patient.
• Making efficient use of time in the consultation.
• Continuing to allow the patient to feel part of a
collaborative process and to build the doctor-patient
relationship for the future.
• Encouraging an environment that maximizes accurate
and efficient initiation of the consultation, information
gathering and explanation and planning.
• Involving the patient in the process of the consultation
so that he/she understands what is happening and
eventually develop self reliance.
• Writing medical history by using SOAP system.

14. 14
Assessment
• Assessment will be done through the following
means:
• Assessment of student’s attendance, punctuality,
attitude, appearance, and relationships with staff
and patients. (Form A) (50%)
• Demonstrating the learned skills on real patients.
(Form B) (50%)

15. 15
Form A
Ongoing Activities Assessment
Student Name:________________________ I.D. No. _______________
Evaluator:___________________________ Date: __________________
Evaluating Parameters
1 - 2 3 4 - 5
1. Attendance
2. Punctuality
3. Demonstrating respect to the tutor and
peers
4. Active participation in the group activities
5. Seeking feedback from the tutor
6. Dressing professionally
7. Maintaining professional relations with
patients
8. Showing interest towards learning
9. Fulfilling assignments
10. Overall performance
Please use the following scale Poor Good V. Good

16. 16
Form B
Ongoing Activities Assessment
Student Name:________________________ I.D. No. _______________
Evaluator:___________________________ Date: __________________
Patient's Problem/s Weak
< 5
Average
5 - 6
Good
7
V. Good
8 - 9
Excellent
> 9
1- Defines patient’s specific
reason for consultation.
2- Defines specific nature of the
problem/s through appropriate
information gathering.
3- Explores patient’s ideas,
expectations, fears, feelings,
and impacts on life.
4- Conducts physical exam that
is appropriate, relevant, and
carried in a sensitive manner.
5- Establishes diagnoses,
considering physical, social
and psychological dimensions.
6- Formulates management plan appropriate to
the findings and patient's circumstances.
7- Considers other problems &
health issues including
preventive measures.
8- Shares management decision
with the patient, & provide
proper explanation / education
9- Shows appropriate/ required
communication skills that
include empathy and caring
10- Completes medical record
using the system in a
logical, and coherent fashion.

17. 17
Arabian Gulf University
College of Medicine & Medical Sciences
Tutor Evaluation Form (Primary Health Care Clinical Training)
To be completed by each student
Student’s name: _________________________ I. D. No: _______________ Date: ___________
Tutor name: ______________________________ Place of work: ___________________
Use the following scale: 1 = Poor 2 = Average 3 = Good 4 = Very good 5 = Excellent
To what extent was your Tutor helpful in completing the programme tasks, by preparing you for the
Task and following up on experience? (Tick One)
1.Demonstrating effective history taking skills. 1 2 3 4 5
2.Demonstrating skills of performing physical examination. 1 2 3 4 5
3.Showing the proper use of office medical equipments. 1 2 3 4 5
4.Performing common office and diagnostic procedures. 1 2 3 4 5
5.Properly using Problem Oriented Medical Records. 1 2 3 4 5
6.Practicing various consultation styles based on clinical situations. 1 2 3 4 5
7.Applying different communication style in the consultation. 1 2 3 4 5
8.Emphasizing the importance of Doctor-patient relationship. 1 2 3 4 5
9.Using hypothetico-deductive method of clinical reasoning. 1 2 3 4 5
10.Discussing the presentation of undifferentiated problems. 1 2 3 4 5
11.Viewing the presentation of health problems in a holistic way. 1 2 3 4 5
12.Summarizing and arranging proper follow-ups. 1 2 3 4 5
13.Showing enthusiasm about the course. 1 2 3 4 5
14.Adopting challenging, supportive and constructive behavior. 1 2 3 4 5
Comments & Recommendations: __________________________________________________