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General Practice Attachments in the IMU Medical Program

Introduction to the General Practice (GP) Postings In Phase 1
At the International Medical University (IMU), family medicine (FM) is one of the essential components of the undergraduate medical program. FM is introduced early in the Medical Sciences (Phase 1) phase of the medical curriculum as we believe learning aspects of FM from the early years of undergraduate medical training will enhance the students' knowledge, attitude and skill about the holistic model of Health Care as well as the importance of a whole-person approach to medical practice.

Moreover, as a large proportion of the medical students eventually become family doctors; an early introduction maximising their learning opportunities in FM is essential. As a continuum, further experience and in-depth learning in FM is provided during the clinical years.


How long is a GP posting in Phase 1?
The student is expected to observe activities at the assigned General Practice (GP) clinic over a one-week (minimum 5 working days, 2 sessions a day or equivalent) period at the end of Semester 4 under the supervision of their FM Teacher (GP tutor). The students have the opportunity to learn in public (health clinics) and private (GP clinic) in more depth during their clinical years.


When is the students' GP posting in Phase 1?
This posting will be at the end of Semester 4 (of a 10-semester medical program). Students from East Malaysia and abroad mostly will remain in Kuala Lumpur and choose to do their attachment with GPs in the Klang Valley.


What are the advantages of this early introduction to Family Medicine?
The students will have an opportunity:
  • To experience how the holistic model of health care is delivered.
  • To complement their formal learning of communication skills.
  • To gain insight into what the work of a general practitioner is like.
  • To detect whether they possess those personal capabilities and characteristics desirable for a profession in medicine.
  • To take responsibility for their own learning and encourage self-directed learning.


How do the teaching-learning activities occur in this posting?
The posting in Phase 1 is based on enhancing the students self-learning capabilities under the supervision of a FM Teacher (GP tutor) as well as guidance from the faculty members of the Department of Family Medicine. The FM teachers are provided with guidelines (FM Teacher Guide) regarding the posting as well as a summary of what studies the students' have undertaken prior to the posting.

Before staring the posting, students are provided with Briefing lectures and a Student Handbook (practical exercises and guidelines are provided to encourage learning at the site). A debriefing session is conducted at the end of the posting were students share their experiences via presentations.

What are the overall outcomes expected of the IMU undergraduate medical graduate?

The Eight IMU Outcomes

The educational strategies adopted at the International Medical University (IMU) include elements of community-based approaches to learning and teaching to complement hospital-based learning. This is emphasised in one of the eight educational outcomes of the IMU i.e. "The family and community context of health care". During the rotation, we expect our students to:
  • Appreciate the effects of illness on patients and their families.
  • Observe what action/s individuals take during illness.
  • Develop awareness of the family structure and the home environment.
  • Observe the cultural practices that are relevant to illness.
  • Observe the role of complementary medicine.
  • Become aware of the range of resources available in the community.


What we hope the students would have gained during their attachment to your practice?
In the IMU undergraduate medical program, the students have the opportunity to have at least two (2) GP postings and achieve the following objectives:
    By the end of Semester 4 the student should be able to:
  • Briefly describe the role of the general practitioner/ primary care doctor in providing health care to his/her community.
  • Describe briefly the types of illness that present in general practice/ health clinics (e.g. by documenting the health problems that brought the patients to see the primary care doctor).
  • Begin to appreciate and develop appropriate communication skills important in health professionals.
  • Have the opportunity to improve their communication and clinical skills, as well as obtaining the family history and constructing a family genogram.
  • Have a better understanding of patients from different cultures (interview patients from different ethnic groups).
  • Recognise the role of multi-disciplinary approach to health care in a general practice setting i.e. observe and assist team members other than the doctor in the clinic e.g. dispenser, nurses or nurse assistants at work.
  • Assume more responsibility for own learning.
  • Appreciate and begin to develop the desirable attitudes important in a health care professional.


    By the end of Semester 8 the student should be able to:
  • Enumerate the roles of the general practitioner/ primary care doctor and other health professional in providing health care to his/her community.
  • Enumerate the types of illness that present in general practice/ health clinics.
  • Demonstrate the appropriate communication skills important in a health professional.
  • Show increasing confidence in clinical skills, diagnosis and management of common medical conditions.
  • Handle with increasing confidence patients from different cultural background.
  • Enumerate the role of multi-disciplinary approach to health care in a primary care setting i.e. observe and assist team members other than the doctor in the clinic e.g. dispenser, nurses, pharmacy assistants at work.
  • Undertake readily self-directed learning.
  • Continue to develop the desirable attitudes important in a healthcare professional.


By the end of the undergraduate medical program we hope each student should have achieved all the 8 IMU outcomes. In addition to the general IMU outcomes (stated above) expected of each medical student, below are areas or topics where Family Medicine has greater emphasis:

OUTCOMES IN FAMILY MEDICINE POSTINGS

Application of basic sciences in the practice of medicine.
The student should achieve good understanding of the current scientific knowledge of common symptoms and diseases, including the behavioral aspect.

Communication skills
The student should communicate effectively with patients, not only for gathering relevant medical history, but also in patient education. The student should strive to develop the patient-centered communication skills of a competent family doctor that you have observed during your attachment in the health clinics (Klinik Kesihatan) and the general practice clinics.

Clinical skills
The student should be able to achieve the following:
  • Diagnose clinical problems in primary care using an efficient diagnostic strategy. The student should be able to identify the patient’s ideas, concerns and expectations (“Is there a hidden agenda?”). The student should be able to make a Whole Person Diagnosis.
  • Provide an investigation and management plan for common symptoms (the “undifferentiated illness”) and diseases in primary care. The student should manage not only patient’s presenting problem but also his continuing problems, and make use of the opportunity to promote health and modify his health-seeking behaviour. (In primary care, time may be the best diagnostic and management tool.)


In general, a hypothetical-deductive diagnostic approach is preferred. The student clinical decision should be scientific and evidence-based. The student should identify relevant literature to assist in your decision making.

Disease prevention and health promotion.
The student should consider how the three levels of prevention in every patient that you come across. Furthermore, the student should be able to discuss with the patients the pros and cons of screening methods that are available.

Family and community issues in health care.
The student should be able to
  • Identify the differences in the illness pattern in community and hospital practice and recognise their impact on clinical diagnosis in the ambulatory setting.
  • Have observed referral from primary care to secondary care (and vice versa) and determine the reasons for the referral.
  • Describe the essential role played by family physician and other primary care workers in health care delivery.
  • Describe the organisation of health services in both the urban and rural * areas.
  • Compare the primary care services available in the government sector (e.g. Health Clinic) and private sector (general practice).


(The Community and Family Case Study (CFCS) Guide lists the additional outcomes)

Professionalism, ethics, and personal development.
The student should be aware of the prevailing moral and ethical standards expected of doctors. You should be able to distinguish between rights of the individual and public and be constantly aware of the medico-legal and ethical dimension of doctor-patient contact.

The student should be able to assess your personal strengths and weaknesses as a human being and accommodate patient's wishes and frailty.

Self-directed life-long learning & information management.
The student should learn to evaluate your own strength and weakness in your personal arena and clinical skills. The student should also strive to identify effective strategy to manage the ever increasing amount of medical information.

Critical thinking & research.
    The student should be able to achieve the following:
  • Understand the principles of evaluating the validity and applicability of diagnostic tests and therapies encountered in family practice.
  • Conduct clinical audit and simple research projects.