Universitat Internacional de Catalunya

Family and Community Medicine

Family and Community Medicine
3
9386
4
Second semester
OB
Main language of instruction: Catalan

Teaching staff


Students may ask lecturers questions at the end of each class. For enquiries outside of class time, students must make an appointment by email:

Dr. Emilio Gené: emgene@uic.es

Dra Maria Luz Olmedo: mlolmedo@uic.es

Dr Rafael Azagra: razagra@uic.es

Dra Marta Pascual: mpascual@uic.es

Dr Jaume Motos: jmotos@uic.es

Dra Isabel Faura: ifaura@uic.es

Dra judith Vila: 

Dra Laia Menero:

Introduction

The Alma-Ata International Conference held in Kazakhstan in 1978 defined Primary Health Care as "Essential care, based on practical, scientifically sound and socially acceptable methods and technologies, made available to all individuals and families of the community, through their full participation, and at a cost that the community and the country can bear, at each and every stage of its development, in a spirit of self-responsibility and self-determination. It represents the first level of contact of individuals, the family and the community with the National Health System, bringing health care as close as possible to the place where people live and work, and constitutes the first element of a permanent process of health care".

Thus, family medicine began in Spain as a specialty in 1978 with the aim of effectively and comprehensively addressing individual and community health problems from a biopsychosocial perspective.

Pre-course requirements

No specific requirements

Objectives

1. To know the strategies of the Family Physician to face the most prevalent and urgent health problems in Primary Care with the most practical orientation possible and bearing in mind the rational use of the available resources.

 

2. To highlight the role of Primary Care as the patient's gateway to the health system and the role of the Family Physician as the patient's responsible within the health system.

 

3. To establish a teaching and care balance between the biological model focused on the disease and based on hospital care and the biopsychosocial model focused on the patient and the family and based on Primary Health Care.

Competencies

  • 01 - Recognise the essential elements of the medical profession, including ethical principles, legal responsibilities and patient-centered professional skills.
  • 06 - Develop professional practice with other health professionals, acquiring teamwork skills.
  • 12 - Understanding the foundations for action, the indications and efficacy of therapeutic interventions, based on available scientific evidence.
  • 13 - Obtain and develop a clinical history that contains all relevant information.
  • 15 - Ability to formulate an initial diagnosis and establish a rationalised diagnostic strategy.
  • 19 - Propose preventive measures appropriate to each clinical situation.
  • 20 - Acquire adequate clinical experience in hospitals, health centers and other health institutions under supervision, as well as basic knowledge of clinical management and patient-centered proper use of tests, drugs and other health system resources.
  • 21 - Listen carefully, obtain and synthesize relevant information about the problems affecting the patient and understand the contents of this information.
  • 22 - To write and maintain medical records and other medical documents which can be understood by third parties and are adapted to the protocols and information that is required.
  • 23 - Communicate effectively and clearly, both orally and in writing with patients, family members, media and other professionals.
  • 24 - Establish good interpersonal communication skills that enables efficient and empathetic communication with patients, relatives, media and other professionals.
  • 25 - Recognize the determinants of public health; genetic and sex-dependent lifestyle, demographic, environmental, social, economic, psychological and cultural determinants.
  • 26 - Assume role in the prevention and protection from diseases, injuries or accidents and maintenance and promotion of health, both individual and at the community level.
  • 31 - Understand, critically evaluate and know how to use sources of clinical and biomedical information to obtain, organize, interpret and communicate scientific and health care information.

Learning outcomes

GENERAL LEARNING OUTCOMES

1. Is able to perform a good anamnesis of prevalent and urgent primary care pathology that allows guiding the diagnostic and therapeutic process with a rational use of available resources.

2. Is able to write a medical history or a report of care that allows communication with other professionals both health and society.

3. Is able to identify the situations that are tributary to disease prevention and health promotion, identifying the role of the individual and the family.

4. Is able to communicate effectively with the patient and family, with other professionals involved in the care process and with the Primary Care Team.

 

SPECIFIC LEARNING OUTCOMES

 

1. Identifies the role of the Family Physician and the Primary Care Team as responsible for the patient within the health system, being the closest and most trusted referents for patients at the first level of care.

 

2. Values the patient as responsible for making decisions about his/her health and about the health care received in Primary Care.

3. Knows the different professionals that make up the Primary Care Team, their functions and the relationship between them.

 

4.  Identifies the different models of relationship between primary care and specialized care and other civil society organizations (socio-health) of our country and integrates into them.

5. Knows the role of the Primary Care Team in the prevention, cure and rehabilitation of the disease both at individual and family level.

 

6. Knows the existing differences with respect to the health resources available in the different Primary Care Centers and adapts to them.

7. Recognizes the role of the physician as manager of the consultation and consumption of health resources.

 

8. Recognizes, appreciates and accepts that clinical decision making is done in a probabilistic and uncertain context.

Syllabus


  1. Presentación. Medicina Familiar y Comunitaria en el grado de Medicina en España. Medicina Familiar y Comunitaria en la UIC: Objetivos, competencias y resultados de aprendizaje. Aspectos organizativos y logísticos de la asignatura de Medicina Familiar y Comunitaria. Evaluación final.


  1. Antecedentes y desarrollo histórico. Modelo bio-psico-social. Perfil del médico de familia. Concepto de salud y enfermedad.

  1. Composición, funciones, actividades y organización. Capacidad resolutiva de cada tipo de profesional. Elementos de incentivación, motivación y crecimiento personal. Historia clínica informatizada (e-CAP) e Historia Clínica Compartida en Catalunya (HC3). El papel de la enfermera en el equipo. Protocolos del ICS para la resolución de las visitas de demanda espontanea por parte de enfermería. Unidades docentes multiprofesionales: Enfermería Familiar y Comunitaria. Calidad y seguridad clínica en Atención Primaria.

  1. Atención a la patología prevalente en atención primaria. Del signo y/o síntoma al juicio diagnóstico inicial, al diagnóstico diferencial, a la estrategia diagnóstica razonada y al pronóstico. Prescripción del tratamiento más adecuado, valorando el potencial beneficio y los posibles efectos secundarios asumidos.

  1. Atención a la patología crónica prevalente atendida en atención primaria. Prescripción farmacológica, exploraciones complementarias y control por el equipo de atención primaria.

  1. Identificación de personas en riesgo de exclusión social y de distocia familiar. Atención al paciente discapacitado y al paciente inmigrante.

  1. Características de la comunicación oral y escrita en ámbito científico y clínico. Particularidades frente a los medios de comunicación.

  1. Técnicas de entrevista clínica. Recomendaciones para la entrevista clínica. Comunicación con el paciente y la familia.

  1. Actividades de prevención y de promoción de la salud en Atención primaria: Medidas farmacológicas y medidas que favorezcan un cambio en el estilo de vida.Factores de riesgo cardiovascular: Hipertensión arterial, Diabetes mellitus, dislipemia, obesidad, tabaco.

  1. Actividades de prevención y de promoción de la salud en Atención primaria: Medidas farmacológicas y medidas que favorezcan un cambio en el estilo de vida. Métodos de cribaje de cáncer en Atención primaria: Mama, colon, próstata, cuello útero. Alcoholismo y drogodependencias. Vacunaciones.

  1. Incapacidad Laboral Transitoria. Cobertura socio-laboral en enfermedades crónicas: invalidez permanente y minusvalías.


  1. Gestión del tiempo y de la agenda del médico de familia. El Equipo de Atención Primaria como puerta de entrada al sistema sanitario. El médico de familia como gestor de los recursos sanitarios disponibles. Información al paciente y seguimiento en la atención de patologías infrecuentes, asesoramiento ante la demanda de intervención estética. Sistemas de información. Registro y evaluación. Protocolos, guías clínicas y trayectorias.

  1. El proceso de envejecimiento. La decisión de limitación del esfuerzo terapéutico. El paciente terminal médico y oncológico. Morir en domicilio y acompañar a la familia en el proceso de muerte. Certificado de defunción.

  1. Uso de fármacos en Atención primaria. Farmacología y riesgo terapéutico. Uso racional del medicamento. Control de tratamientos prolongados y cumplimiento prolongado. Relación con la industria farmacéutica.

  1. Importancia y particularidades de la investigación en Atención primaria. Comités de ética e investigación clínica. Normativa de los estudios observacionales. Ley orgánica de protección de datos aplicada a la investigación clínica en Atención primaria.

Teaching and learning activities

In person



 The master class is the stage in which a teacher transmits knowledge in a classroom to the whole group of students. The format, however, allows the introduction of activities in small groups in the classroom and the deployment of strategies that encourage the active participation of students. 

The case method consists of the process of solving clinical cases or those specific to the profession. These are group activities that are solved with the active participation of the teacher after the deliberation of the students. The methods of the case will be face-to-face.

The skills lab is an area in which the student can basically develop communication and physical exploration skills based on mannequins, robots and also simulated patients and real patients. They are performed in small groups. Skills labs will be face-to-face.

Evaluation systems and criteria

In person



a) Attendance: Class attendance is recommended and attendance to the two skills laboratories will be essential to pass the course.

 

b) Multiple-choice exam: There will be a multiple-choice exam. Multiple choice questions with four possible answers and only one correct answer. Wrong answers will be penalized (35%).

c) Short questions: There will be an exam of short questions on the content of the subject (30%).

d) Oral and written communication: Students will present a written work and will make an oral defense of their work. They will work in groups of 6-7 students. The oral presentation will be made by a representative of the group. The grade will be the same for the whole group (25%).

 e) Continuous evaluation: partial exams will be carried out during the classes of the course.

 Criteria for passing the course:

 * Attendance to the two skills laboratories. Signature control.

 * Passing separately the test exam, the development of a topic and the presentation of papers in order to average the three grades.

 

Area of evaluated knowledge

%

Minimum %

1. Theoretical knowledge evaluation:

Multiple-choice exam

35%

17,5%

Short answers

30%

15%

2. Oral and written communication.

Report’s presentation in groups of six students.

25%

12,5%

3. Continuous evaluation

Mid-term exams

10%

 

 

Additional considerations for the 2022_2023 academic year

1. In case of non-attendance to any of the mandatory activities to the subject due to confinement or infection by SARS COV-2 or due to a cause of force majeure, it will be the subject coordinator who will agree with the students involved the suitable activities for the achievement of the competences.

 2. The exams of the subject will have the duration stipulated by the subject coordinator. For the good development of the test, it will not be possible to leave the classroom before the time has finished. If a student finishes before the established time, he/she must remain seated until the end of the time allotted for the exam.

3. The partial exam will consist of two parts: multiple-choice questions and short questions. Each part will be evaluated separately and will be worth 5% of the final grade.

 4. In case a student is unable to take the partial exam due to confinement or SARS COV-2 infection, the exam cannot be taken at home. The percentage of the final grade attributable to the partial exam (10%) will be divided proportionally between the value of the final exam of short questions and multiple-choice questions.

5. The final exams, both in first and second call, will begin at the established time. In case a student arrives once the exam has already started, he/she will not be able to take the exam unless the subject coordinator considers the reason as a force majeure. In no case will the student have more time to take the exam.

 

Second call:

In case the student does not pass the course in the first call, depending on the reasons for the failure, the attitude will be one or the other.

 

In case of failing one of the evaluations that make up the final grade, the student will have to repeat only that test and the evaluation obtained in the other tests will be kept.

 

The maximum grade in the second call will be of 7.5 (except in cases of justified illness in which it will be possible to reach the Excellent 9).

 

Bibliography and resources

Bibliography

1. Martín Zurro A, Cano Pérez JF. Atención Primaria. Concepto, organización y práctica clínica. 6ª edición. Madrid: Elsevier; 2008.

2. ALMA-ATA. Atención Primaria de Salud. 1978.[en línea]. [consultado 14-08-2011]. Disponible en:  http://whqlibdoc.who.int/publications/9243541358.pdf

3. Borrell F. Entrevista clínica. Manual de estrategias prácticas. Barcelona: semFYC; 2004.

4. Santos Suárez J, Santiago Àlvarez M, Alonso Hernandez PM, Alonso Llamas MA, Merladet Artiach E, Corrales Fernández E. Medicina de familia: ¿la cenicienta del pregrado? Estudio de la opinión de los estudiantes de medicina sobre la especialidad de medicina familiar y comunitaria. Atención primaria. 2001;27 (5): 324-330.

5. Borrell F, Bonal P. Adaptación de la asignatura de Medicina de Familia al Plan Bolonia. FMC 2010; 17 (7): 445-4448.

6. Littlewood S, Ypinazar V, Margolis SA, Scherpbier A, Spencer J, Dornan T. Early practical experience and the social responsiveness of clinical education: systematic review. BMJ. 2005; 331: 387-91.

7. Pascual M, Gené E, Arnau R, Pelegrí M, Pineda M, Azagra R. Evaluación de la eficacia de enfermería de atención primaria en la resolución de las visita urgentes. Emergencias 2011 (en prensa)

8. Gené E, García-Bayo I, Barenys M, Abad A, Azagra R, Calvet X. La coordinación entre atención primaria y especializada de digestivo es insuficiente. Resultados de una encuesta realizada a gastroenterólogos y médicos de familia. Gastroenterologia y Hepatologia. 2010; 33(8): 555-62

9. Castillejo J, Vicente R; Dolz M; Prats M; Ramos E. Reflexiones sobre los sistemas sanitarios del Municipio de São Paulo y de Cataluña. Programa Salud y Familia São Paulo. Elementos clave comunes de ambos sistemas sanitarios. Atención Primaria. 2008; 40(12): 633-7 y  Atención Primaria. 2009; 41 (01):49-54.

 

10. Motos J, Calvet X. Cobertura socio laboral en enfermedades crónicas: invalidez permanente y minusvalía. Medicina Clinica. 2007;128 (20):780-5.

 

Resources:

1. Societat Catalana de Medicina Familiar y Comunitària

http://www.camfic.org

2. Sociedad Española de Medicina de Família y Comunitaria.

http://www.semfyc.es