POSTGRADUATE INSTITUTE OF MEDICINE

FAMILY MEDICINE & GENERAL PRACTICE

UNIVERSITY OF COLOM BO

Diploma in Family Medicine MD Family Medicine Board Certification in Family Medicine Regulations & Training Programme

REGULATIONS AND GUIDELINES

for

Diploma in Family Medicine MD Family Medicine

Postgraduate Institute of Medicine of Sri Lanka University of Colombo, Sri Lanka

Contents Page 1. 2. 3. 4. 5. Introduction Diploma in Family Medicine MD in Family Medicine General Regulations & Guidelines Interpretation and Amendments 1 1 5 11 11

In accordance with the decision of the Board of Study in Family Medicine & General Practice and the approval of the Board of Management of the PGIM, this prospectus and training programme in Family Medicine will be effective from the beginning of the DFM Course 2005/06 and the MD Course 2005.

REGULATIONS & GUIDELINES FOR FAMILY MEDICINE

1.

INTRODUCTION The Board of Study in Family Medicine & General Practice conducts the training programmes and the examinations leading to the Diploma in Family Medicine (DFM) & the MD in Family Medicine.

2.

THE DIPLOMA IN FAMILY MEDICINE 2.1 The Diploma in Family Medicine Course

a. Eligibility Applicants should have obtained a medical degree registrable with the Sri Lanka Medical Council and one year of clinical experience after internship. Entry into this course of study is based on a qualifying examination which will consist of a Multiple Choice Question paper. b. Course content The Diploma in Family Medicine (DFM) course will consist of: i. Not less than 240 teaching sessions on topics related to Family Medicine and Clinical sessions, each of at least two hours duration, in the following specialities:

ii.

Subject Family Practice General Medicine General Surgery Paediatrics Obstetrics & Gynaecology Clinical Pathology Radiology Ear, Nose & Throat (ENT) Surgery Ophthalmology

Clinical teaching sessions (30) (08) (04) (08) (08) (04) (04) (04) (04)

Dermatology Orthopaedics Accident Surgery Emergency Medicine Psychiatry Community Medicine Legal Medicine Rheumatology Rehabilitation Sexually Transmitted Diseases Neurology Cardiology Chest Medicine

(08) (04) (04) (04) (08) (08) (04) (04) (04) (04) (08) (08) (04)

The course teaching /learning activities may take the form of lectures, seminars, group discussions and clinical demonstrations. These would be conducted on three days of the week as far as possible as follows: Friday Saturday Sunday 2.00 p.m. 2.00 p.m. 8.30 a.m. 5.15 p.m. 5.15 p.m. 11.45 a.m.

The teaching sessions will be repeated annually. They could be completed by the candidate in a minimum period of one year or a maximum period of three years. Family Practice clinical sessions will be under the supervision of family physicians in at least five approved family practices in Sri Lanka. Not more than six sessions should be done in a single family practice. Approval of the teaching practices will be made by the Board of Study of the PGIM. Other clinical sessions will be held under the supervision of specialists in the relevant fields in hospitals in Sri Lanka, approved by the Board of Study. 2 A candidate has to provide evidence of attendance at the clinical sessions in the clinical appointment booklet provided by the PGIM. 2.2. The Diploma in Family Medicine (DFM) Examination a. Eligibility Satisfactory completion of the DFM course, attending at least 80% of the formal teaching sessions and all clinical sessions, as stipulated by the Board of Study.

Acquisition of competence in cardiopulmonary resuscitation and other skills stipulated by the Board from time to time, is necessary. Competence in cardiopulmonary resuscitation should be certified by trainers approved for the purpose by the Board of Study. b. The format of the examination The DFM examination will consist of three components; a written examination, a clinical / practical examination and a viva -voce based on a log diary. Components of the Examination Written examination 40% of the final marks i. MCQ 20% of the marks Total 60 questions with 50 true/false type and 10 single best type (Duration 2 hours) ii. MEQ/SEQ 20% of the marks * Two problem solving MEQ exercises * One SEQ on the principles and practice of Family Medicine (Duration 3 hours) Clinical/practical examination 50% of the final marks i. OSCE 40% of the marks There will be 8 stations (10 minutes at each station) 3 IOP/OSPE 10% of the marks There will be 12 stations (3 minutes at each station)

ii.

Viva voce examination based on the candidates Log Diary 10% of the final marks A candidate will be interviewed on the log diary submitted. The log diary should include 20 clinical records that demonstrate the following aspects of family practice

Personalized care Comprehensive care Continuity of care Co-ordination of care Family care Prevention and opportunistic health promotion (The duration of the interview will be 15 minutes.) To pass the DFM examination a candidate should score an aggregate of at least 50% whilst, scoring a minimum of 40% in the written examination, clinical and practical examinations, and the viva. If a candidate obtained the aggregate pass mark but fails because of having failed one component (written, clinical & practical, and viva) he/she will be permitted to sit only that component once within a period of three years. The gold medal for the Diploma in Family Medicine is awarded to a candidate who is successful at the first attempt and obtains a distinction mark of 65% or more whilst obtaining 60 marks or more in each component. If two or more candidates qualify, then the highest marks obtained in the clinical component will be the criterion of selection. 3. MD IN FAMILY MEDICINE This degree could be obtained either by following the training programme and examination as in 3.1 or by submitting a thesis on research done and defending it at an interview as in 3.2.

3.1

4 MD Family Medicine by Training and Examination

3.1.1 Eligibility for registration A candidate should have passed the DFM examination and have a minimum of three years active professional experience in General/Family Practice as approved by the Board of Study, during the 10 years preceding the date of application. 3.1.2 The training programme (Detail is given in the Hand book for trainees and trainers)

A trainees programme would include a minimum of 20 hours per week and will be organized by the course co-ordinator. A trainee will also be supervised by a trainer appointed for each training attachment mentioned below. i. Nine months of training in Family Practices approved by the Board of Study, which would include. * Five months in a university family practice centre. * Four months rotation in general/family practices in the community for a minimum period of 2 weeks in each. Note Training in the University practice will following - Computer skills - Research methods - Statistics - Epidemiology - Teaching ii. Fifteen months of training in hospital specialities as stipulated below in hospital units approved by the Board of Study. Medicine including Rheumatology Cardiology Paediatrics Psychiatry Accident & Emergency services Obstetrics & Gynaecology Surgery 5 Eye, Nose & Throat (ENT) Surgery Ophthalmology Dermatology Sexually Transmitted Diseases and 03 months 03 months 02 months 06 weeks 02 months 01 month 02 weeks 02 weeks 01 month 02 weeks include the

This component of the training in any hospital speciality could be modified, according to the previous experience of the trainee, with approval of the Board of Study, and he/she could be exempted from one or more of the above components of training, up to a maximum of six months. The whole training programme should be completed within a period of 3 years, and the candidate should prepare and compile a portfolio of learning, according to guidelines provided in the

Hand Book for Trainees and Trainers. 3.1.3 Research Project and submission of dissertation A proposal for research on a topic relevant to Family Medicine should be submitted within the first six months after registration, for Board approval. The research should be conducted in a General/Family Practice and should run parallel with the training programme over a minimum period of one year. The dissertation could be either on research done by the candidate as stated above or an Evidence Based Medicine Assessment task. A dissertation of about 4000 6000 words should be submitted by the candidate at least six months before the end of the training programme. The candidate could name a supervisor who would have to be approved and appointed by the Board. 3.1.4 The Examination A candidate is eligible to sit the MD (Family Medicine) examination when the components of training have been completed, and the dissertation on the research done by the candidate has been submitted, as stipulated above. The examination would have three components and will be held once a year. The written and clinical components of the examination will be held first and then followed by the research component. 6 A Board of examiners nominated by the Board of Study will be appointed by the PGIM. A candidate should pass in all components of the examination with a minimum of 50% of the marks, and one component cannot compensate for another. A candidate will be allowed a maximum of five years from the date he/she finishes the training program to complete the MD. For an award of a gold medal for the MD Family Medicine, the candidate should top the pass list at the first attempt and should have a distinction mark of 70% or more, whilst obtaining a minimum of 65% in each component . Components of the Examination

Portfolio of learning 10% of the examination marks At the end of the period of training (to be completed within 3 years) the portfolio of learning certified by the trainers must be presented for review by a panel appointed by the PGIM. This should be done 4 weeks before the date on which the examination is scheduled.

Written examination 20% of the final marks This component will consist of four essay/structured essay questions. The questions will cover the conceptual basis, principles and core values of family practice and also aspects of practice management. Clinical examination 40% of the final marks OSCE There will be at least ten objectively structured clinical examination (OSCE) stations (10 minutes at each station) Research dissertation and the viva-voce examination 30% of the final marks This component would include the dissertation submitted by the candidate and a viva examination based on it. The viva for defense of the dissertation would be a part of the MD Family Medicine examination process. The candidates supervisor will be invited to be present as an observer at this examination. 7 The marks for the dissertation and the viva will be given at the first formal interview before the corrections recommended by the examiners are made. The trainee could make a presentation based on the dissertation to a research group of the Board of Study in Family Medicine before the formal viva. 3.2. MD Family Medicine by Thesis 3.2.1 Eligibility for registration A candidate should have passed the DFM examination and have a minimum of 5 years active professional experience in General/Family Practice as approved by the Board of Study, during the ten years preceding the date of application.

3.2.2

Research project and submission of thesis Candidates who wish to appear for the MD in Family Medicine by thesis should first submit a brief proposal including the following: The title Clear statement of the problem Rationale and objectives Method This proposal would be reviewed by the Board of Study and if approved the supervisor/s would be appointed with due consideration to the candidates choice of a supervisor. The candidate would then have to obtain the guidance of the supervisor/s and submit a detailed protocol for a research project to the Board of Study. This protocol would be reviewed by the committee appointed for review of research protocols for the MD Family Medicine and recommended for approval by the Board of Study. The protocol for a research project should include the following items:i. Title ii. Introduction iii. Hypothesis (wherever relevant) iv. Objectives of study 8 v. Review of relevant literature vi. Methods including proposed data analysis vii. Time based research plan viii. Budget ix. References x. Approval of project by a relevant ethics review committee. The research should be conducted in a General/Family Practice and the supervisor/s should be consulted and guidance obtained during the conduct of the research. The candidate must submit quarterly progress reports, through a supervisor, to the Director, PGIM. At the end of a minimum period of two years and a maximum period of three years the candidate shall submit a thesis on the research done, to the Director, PGIM. PGIM approved guidelines for the preparation and submission of

a thesis are as follows:It is recommended that the thesis should contain 15,000 to 20,000 words. It should be type-written using double-spacing on good quality A4 size paper on one side only. A margin of not less than 40 mm should be allowed on the left hand side to facilitate binding, and margins of 20 mm should be left on the top, right hand side and the bottom. Chapter headings should be capitalized and centered, whilst subdivision headings should be typed from the left hand margin in lower case type and underlined. Tables and figures should be placed as near as possible to the part of the text to which they refer. The contents of the thesis should be given under the following headings:i. Title, authors name and degrees ii. A declaration that the work presented in the thesis is the candidates own and that no part of the thesis has been submitted earlier or concurrently for any other degree iii. Summary iv. Table of contents 9 v. vi. vii. viii. ix. x. xi. xii. xiii. xiv. xv. xvi. List of tables List of figures Introduction Review of literature Methods Results Discussion Conclusions Recommendations Limitations of study Acknowledgements References (use the system laid down for the Ceylon Medical Journal)

The supervisor/s should guide the candidate in the preparation of the thesis and also approve of the final draft before the thesis is submitted. Three copies of the thesis should be submitted unbound (i.e. loose leaf form) for the examination. This will facilitate corrections which

may be recommended b y the examiners to be incorporated into the final form of the thesis to be submitted to the PGIM after the examination. The final form of the thesis should be a copy bound in a hard black cover. The front of the cover should carry the title at the top, the authors name in the centre and the year at the bottom. The authors name and degree and year should be on the spine (top to bottom). 3.2.3 Examination A Board of Examiners nominated by the Board of Study will be appointed by the PGIM, and the candidate shall defend the thesis at a viva voce examination. The candidates supervisor/s would be invited to be present as observer/s. 3.3 Board Certification A candidate will be Board Certified as a Specialist in Family Medicine when he/she

10 Has obtained the MD in Family Medicine by following a training programme and passing an examination as in 3.1 or by submitting and successfully defending a thesis as in 3.2. 4. Interpretation and Amendments In any matter relating to interpretation of the above regulations, the decision of the Board of Study duly approved by the Board of Management of the PGIM will be final. The Board of Study shall have the right to amend any provisions in the above regulations with the approval of the Board of Management of the PGIM from time to time. 5. General Regulations of the PGIM General regulations of the PGIM which are applicable to the postgraduate trainees on all courses conducted by the PGIM are in a separate booklet. All trainees are expected to buy a copy and make themselves familiar with the General Regulations in addition to the specific regulations in this booklet.

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