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  1. 1. Family Medicine Training and Residency Program <ul><li>Ion Ababiy </li></ul><ul><li>Kishenev-Norfolk Partnership </li></ul>
  2. 2. Legal Foundation and the Principles It Mandates <ul><li>Shift to principles of general practice/family medicine </li></ul><ul><li>Establishment of the Department of General Medicine and Primary Medical Care, which will be responsible for residency training and the instructional methodology for other forms of training for general practitioners/family medicine physicians (GP/FMP) </li></ul><ul><li>Retraining of pediatricians, internists, and primary health care personnel in general practice </li></ul><ul><li>Training of family physicians in a three-year residency program </li></ul><ul><li>Transition to principles of general practice/family medicine </li></ul>
  3. 3. The History Of Postgraduate Training Of Physicians <ul><li>1950-1962 Primary specialization in specialized departments </li></ul><ul><li>1962 Department of Physician Training -- Primary specialization (6 months) </li></ul><ul><li>1965-1967 “Subordinancy” (1 year) </li></ul><ul><li>1968-1991 Internship (1 year) </li></ul><ul><li>1991 Residency (3 years) </li></ul>Mandatory Skills Upgrade Training (4-16 weeks) Every 3-5 years
  4. 4. Physician Qualities <ul><li>Selflessness </li></ul><ul><li>Professional Knowledge </li></ul><ul><li>Professionalism </li></ul><ul><li>Sense of responsibility </li></ul>
  5. 5. Introductory Courses <ul><li>Fundamental biomedical disciplines </li></ul><ul><li>Vertical integration </li></ul><ul><li>Horizontal integration </li></ul><ul><li>“ Reproductive” type of instruction </li></ul>
  6. 6. Advanced Courses <ul><li>Clinical disciplines </li></ul><ul><ul><li>Experiments and hands-on based type of instruction </li></ul></ul><ul><ul><li>Practical orientation </li></ul></ul><ul><ul><li>Teaching algorithms </li></ul></ul><ul><ul><li>Limited student responsibility for: </li></ul></ul><ul><ul><ul><li>Justifying a diagnosis </li></ul></ul></ul><ul><ul><ul><li>Selecting a treatment </li></ul></ul></ul><ul><ul><ul><li>Planning rehabilitation </li></ul></ul></ul>
  7. 7. Methods for Assessing Skills and Knowledge <ul><li>Fundamental disciplines </li></ul><ul><ul><li>Practical skills </li></ul></ul><ul><ul><li>Testing students’ understanding of the theory </li></ul></ul><ul><li>Clinical disciplines </li></ul><ul><ul><li>Practical skills at the patient’s bedside </li></ul></ul><ul><ul><li>Testing the students’ understanding of theory </li></ul></ul><ul><ul><li>Oral examination on a topic </li></ul></ul>
  8. 8. Change in Ratios of Hours Devoted to Different Subjects in University Programs
  9. 9. Diagram of Family Medicine Specialty Training   Post Graduate Work (3 years) Appointment as Clinical Staff Physician (2 years) Doctoral Work (2 years) RESIDENCY Specialization in Family Medicine (3 years) Specialized Middle School (Lycée) (12 years) Bachelor Degree Continuing Skills Up-Grade Training For Physicians Medical College (3 years) Bachelor’s Degree Medical Department State University Medical School “ Testemitsanu”
  10. 10. Family Physician Training Schedule Residency 3 years Specialization 6 months Continuing Education General practitioners and Pediatricians
  11. 11. STRUCTURE OF THE PRIMARY SPECIALIZATION CYCLE <ul><li>INTERNAL DISEASES </li></ul><ul><li>PEDIATRICS </li></ul><ul><li>FAMILY MEDICINE </li></ul><ul><li>CARDIOLOGY </li></ul><ul><li>OBSTETRICS AND GYNECOLOGY </li></ul><ul><li>SURGERY </li></ul><ul><li>EMERGENCY MEDICINE </li></ul><ul><li>INFECTIOUS DISEASES </li></ul><ul><li>TUBERCULOSIS </li></ul><ul><li>ONCOLOGY </li></ul><ul><li>TRAUMATOLOGY AND ORTHOPEDICS </li></ul><ul><li>OTORHINOLARYNGOLOGY </li></ul><ul><li>OPHTHALMOLOGY </li></ul><ul><li>DERMATOLOGY AND VENEREOLOGY </li></ul><ul><li>PSYCHOLOGY AND DRUG ADDICTION TREATMENT </li></ul><ul><li>NEUROLOGY, INCLUDING PEDIATRIC NEUROLOGY </li></ul>
  12. 12. Medical Specialties in Residency <ul><li>1992 Surgery. Obstetrics and gynecology </li></ul><ul><li>1993 Traumatology and orthopedics </li></ul><ul><li>1994 Otorhinolaryngology. Ophthalmology </li></ul><ul><li>Pediatrics, Neurology, Neurosurgery Pediatric surgery, Internal diseases </li></ul><ul><li>Dermatology and veneral diseases, Traditional medicine, Pediatric Traumatology </li></ul><ul><li>1997 FAMILY MEDICINE </li></ul><ul><li>Microbiology, Analysis of drugs, Radiology, </li></ul><ul><li>Abnormal morphology, Oncology, Infectious diseases, Psychiatry, </li></ul><ul><li>Emergency Medicine, Neonatology, Pediatric hygiene, Epidemiology, </li></ul><ul><li>Tuberculosis and diseases of the lungs, </li></ul><ul><li>Clinical pharmacology, </li></ul><ul><li>Pharmacological management </li></ul>
  13. 13. Curriculum for Training General Practice (Family) Physicians During Their Residency Fam. Med. Internal diseases Pediatrics Obstetrics & gynecology General surgery Surgical Sp. Medical sp. Neuro- psych. Infectious dis. Oth. Family medicine (urban) Family medicine (rural) Others Social medicine . 0 10 20 30 40 50 Year I Year II Year III
  14. 14. Structure of the Continuing Medical Education Curriculum <ul><li>Mandatory cycles </li></ul><ul><li>Family medicine </li></ul><ul><li>Emergency medicine </li></ul><ul><li>Internal diseases </li></ul><ul><ul><li>(selected issues) </li></ul></ul><ul><li>Pediatrics </li></ul><ul><ul><li>(selected issues) </li></ul></ul><ul><li>Optional cycles </li></ul><ul><li>Surgery </li></ul><ul><li>Hematology </li></ul><ul><li>Infectious diseases </li></ul><ul><li>Neurology </li></ul><ul><li>Psychiatry </li></ul><ul><li>Tuberculosis </li></ul><ul><li>Obstetrics and gynecology </li></ul><ul><li>ENT-diseases </li></ul><ul><li>Ophthalmology </li></ul><ul><li>Oncology </li></ul><ul><li>Endocrinology </li></ul><ul><li>Epidemiology </li></ul>
  15. 15. Ways to Evaluate Knowledge and Practical Skills <ul><li>Written evaluation of theoretical knowledge using standardized tests </li></ul><ul><li>Colloquia on sections of the training program </li></ul><ul><li>Evaluation of practical skills at the patient’s bedside </li></ul><ul><li>Oral examination on a subject </li></ul>
  16. 16. Main Problems <ul><li>Establishment of model family medicine centers equipped with advanced medical and instructional equipment </li></ul><ul><li>Improvement of the programs for training family physicians, performing expert evaluation of them, and bringing them up to modern standards </li></ul><ul><li>Training and improvement of instructors on family medicine </li></ul><ul><li>Instructional material (textbooks, manuals, anatomical atlases, models, etc.) </li></ul><ul><li>Continuous development and implementation of information systems </li></ul>