Khyber Medical University takes the lead by starting one year Regional Diploma in Family Medicine covering 6 Modules


An initiative by WHO EMRO to improve Primary Healthcare through training of GPs
Khyber Medical University takes the lead by
starting one year Regional Diploma in Family
Medicine covering 6 Modules
CorTeach partners with WHO EMRO to develop online
course for training modules which cover all aspects of
Family Medicine

By Shaukat Ali Jawaid

PESHAWAR: February 27th 2020 was a unique and memorable le day in the history of Khyber Medical University when it hosted the Regional Conference on Family Medicine. This initiative has been taken by the WHO Eastern Mediterranean Regional Office to improve primary healthcare in the region by training the General Practitioners. The meeting was attended by representatives of six other medical universities and institutions i.e. Jinnah Sindh Medical University from Karachi, University of Health Sciences from Lahore, Rawalpindi Medical University, University of Lahore, Commandant CMH Nowshera, Health Services Academy Islamabad besides Shifa Tameer-e-Millat University Islamabad as well who all showed interest in starting this training programme. The meeting was chaired by Prof. Arshad Javed Vice Chancellor of Khyber Medical University Peshawar.

Dr. Gohar Wajid
The moving spirit behind Regional
Diploma in Family Medicine.

Giving background of this course and highlighting its salient features, Dr. Gohar Wajid Technical Officer, Health Professional Education from WHO EMRO and the moving spirit behind this academic activity said that there are limited number of Family Medicine programmes and the total number of trained family physicians until 2016 were just 3,225 in the region which was much lower than the number of 1, 85,497 Family Physicians needed to cover the population. We need at least three Family Physicians per ten thousand population by 2030. This is a huge gap. At the same time we have large number of General Practitioners working in primary healthcare facilities in these countries in EMRO Region. Building capacity of existing practicing GPs is the best short term solution to increase the number of doctors who are proficient in Family Practice. It was in this background that during the 63rd session of the Regional Committee under the title “Scaling up Family Practice in the EMR” progressing towards Universal Health Coverage, different modalities including bridging programmes were adopted. It has been specially designed by WHO-EMRO in collaboration with American University in Beirut and WONCA-EMR to provide opportunity to the general practitioners to expose themselves to the principles and practice of family medicine. WHO-EMRO is encouraging countries to review the programme curriculum, contextualize it to the national health needs and offer it as a bridging programme to upgrade the knowledge and skills of general practitioners about the concepts and principles of family medicine. A team of family medicine experts from Jinnah Sindh Medical University, University of Health Sciences and Khyber Medical University have already contributed to contextualizing the curriculum to Pakistani health needs. This Regional Diploma in Family Medicine was planned which has been adopted by Khyber Medical University while seven other medical universities, institutions have shown interest to start it. We have prepared a team to achieve these targets. This diploma is directed at the needs of Pakistan. KMU started it in 2019 and the first batch has passed out. One of the important strength of this programme is the online system which has been designed by a team of professionals from CorTeach consisting of Prof. Rehan Ahmad Khan and Dr. Masood Jawaid.

Prof. Arshad Javed Vice Chancellor Khyber Medical University (fourth from left) alongwith
other distinguished guests presiding over the seminar on Implementation of Regional
Diploma in Family Medicine organized by WHO EMRO during the Public Health
Conference held at KMU from Feb. 26-27, 2020.

This is a twelve month Professional Diploma in Family Medicine. WHO-EMRO will own and recognize it as “WHO Fellowship”. We are collaborating with World Organization of Family Physicians known as WONCA which will pave the way to introduce this diploma in the region encouraging the educational institutes, medical syndicates in the region to adapt and create political support for its implementation, Dr. Gohar Wajid remarked.

Earlier in his introductory remarks Prof. Ziaul Haq Dean Faculty of Public Health and Pro Vice Chancellor of KMU said that in this programme medical officers working at Basic Health Units which see patients attending with diseases related to all the disciplines of medicine will be trained.

This was followed by details of the various training modules. Representatives from the JSMU Tabinda Ashfaq and Dr. Fauzia Akhtar discussed the concept of Family Medicine and practice. Family Medicine, they pointed out, can address majority of the problems of healthcare needs. It will provide skills to set up Family Medical practice, how to take comprehensive medical history, person centered care, Bio Psychosocial approach, develop disease management plans, practice cost effective healthcare, manage difficult patients, ensure patient safety while delivering healthcare. They will be able to conduct audit, recognize and manage ethical issues, obtain informed consent, demonstrate professionalism in patient care, develop critical thinking, counselling skills and have a critical approach.

Module-II will cover Non-Communicable Diseases which form almost 70% of all disease burden. It has online contents and covers subjects like hypertension, diabetes mellitus, diabetic foot care, inhaler techniques. Time has been allotted for each topic and the participants will be provided essential reading material as well.

Representatives of various universities signing an MOU to start Regional Diploma in
Family Medicine at their respective institutions.

Representative from University of Lahore highlighted the salient features of Module-III which covers Mental Health. The participants will be trained in basic principles of mental health and practice, refer the patients in the system, they will be trained in safe medicine prescribing, there will be face to face training and clinical rotation. It also covers training through informative Videos, Discussion Boards, representative log entry and assignments.

Prof. Nasir Shah from University of Health Sciences Lahore discussed the salient features of Module-IV which covers common medical and surgical conditions. It included diagnosis and management, problems related to stress development and management, learning assessment. It also has online contents, Web Based Power Point presentations, Videos and assignments.

Dr. Kashif Ali from KMU gave details of Module V and VI. This Module covers diseases of Women, Children and Adolescents. He pointed out that more contents can be added later on keeping in view the needs. It covers Millennium Development Goals, Maternal and Child mortality, Care of the pregnant in primary care, ability to recognize warning signs. Talking about the rational of this training programme he stated that it will cove appropriate obstetric and Gynae history, how to conduct breast examination, provide pre conception advice, antenatal postnatal care, diagnose and manage common menstrual problems, identify and manage menopause, counselling about family planning, Well Baby Child and Adolescent Care. It will also cover proper physical examination of newborn, how to manage vaginal discharge, common breast disorders, early recognition of breast malignancies, pregnancy care, newborn assessment, six weeks check-up, Behavioural problems in children, disorders like Attention Deficit Hyperactivity Disorders (ADHD), bed wetting, toilet training, Autism and learning disabilities. It will have interactive discussion sessions as well as online programmes including Videos. In Module-VI diagnosis and management of common communicable diseases, infections like hepatitis, Sexually Transmitted Diseases and Immunization will be covered.

Prof. Rehan Ahmad Khan from CorTeach gave a demonstration of the Online training programme named as “Digitalizing Diploma in Family Medicine”. He was of the view that it will go a long way in improving the healthcare in Pakistan. He discussed the role of online learning in this Regional Diploma in Family Medicine, online components using LM Moodle. This, he opined, was very easy to use by the doctors as well as the facilitators. It will enable monitoring the individual student programmes. They will be provided reading material, it also has certain quiz and more can be added. Virtual patients have also been added but the participants can also develop their own virtual patients. It has individual portfolios. He however, stressed the importance of motivation which is extremely important. You can set up a Rewards Badges system and participants will be able to use it on Mobile App and download power point presentations. Feedback activity of candidates and faculty members can also be organized, he added.

The first batch who has completed the Regional Diploma in Family Medicine at Khyber
Medical University Peshawar.

Dr. Abdul Jalil Khan Associate Professor of Family Medicine at Khyber Medical University shared their experience of Family Medicine Diploma at Khyber Medical University which was stated in 2019. Their objective was transit of GPs to Family Medicine, improve their skills and knowledge, upgrade essential health services package, increase patient’s trust in view of their expectations. We also wanted to have some sort of a referral system, develop their clinical competencies, consultation and communication regarding medical family health, professionalism, ethical governance, audit, teaching and training. Some of the challenge which they had to face included training of faculty, duration of training and its recognition in view of the university rules. We had to face lot of red tap in view of various academic programmes. We needed Information Technology and administration support, lack of finances, course fee, un-paid training. There were no career pathways and after training where they will work. There were service delivery issues, commitment for various programmes, evaluation process etc. There were difficulties in monitoring the students as well.

This programme Dr. Abdul Jalil Khan said is being replicated in thirty five Basic Health Units in District Swabi. He also talked about issues like time off, course fee, problems with access to internet, lack of internet facilities and there were some other issues with the trainees. For the evaluation of the students a mixed method approach was used for Level 1-4. The results showed that satisfaction with curriculum was 94.6%, satisfaction with faculty performance was 95.84%, and satisfaction with clinical application was 96.7%. Time management and adaptation to new teaching methods were identified as some of the barriers. It also showed that after training these doctors were adopting holistic approach, there was a change in their attitude, they started using standard management guidelines, it improved patient satisfaction. They had increased future job prospects, career progress and it also increased the number of patients at their private practice. His conclusions were that it achieved the desired outcome.

Participating in the discussion Brig. Saeed Afsar Director Medical Service’s 11-Corp said that army started family physicians training programme in 1991 but later on in 1997 it was stopped. The objective was that we wanted to have good physicians, I was a member of the last batch trained in 1997. We are thinking to build on that but load on the faculty needs to be reduced. They can filter patients and it was a good effort in primary health care as they can take care of 70-80% of patients.

Prof. Nasir Shah alongwith other experts who prepared the different
modules for the Regional Diploma in Family Medicine.

Dr. Ayaz, Prof. Zafar Iqbal, Dr. Fayaz Bukhari and a representative of nursing profession pointed out that nurses and paramedics have an important role in primary healthcare which also needs to be looked into. Dr. Gohar Wajid responded by saying that they were already working on nurses training programme and at present their curriculum was under preparation.

Prof. Nasir Shah from UHS said that CPSP had started MCPS and later FCPS in Family Medicine. Many universities at Karachi as well as UHS have started Family Medicine programmes. Rawalpindi Medical University is starting training programme in Family Medicine. Dr. Ejaz Khan from Health Services Academy and Dr. Samina Iqbal from Shifa International Hospital sated that they are considering starting this programme but we need more faculty members for this. Brig. Ziaullah Commandant CMH Nowshera said that the importance of Family Medicine has now been realized.

Mr. Shaukat Ali Jawaid Chief Editor Pakistan Journal of Medical Sciences congratulated Khyber Medical University and its Vice Chancellor for hosting such an important conference. They are fortunate to have built a good combination in Dr. Gohar Wajid and Prof. Arshad Javed VC KMU and then they have built a team and acquired the services of professionals in E learning like Prof. Rehan Ahmad Khan and Dr. Masood Jawaid which all augers well and ensures the success of this programme. He particularly appreciated the inclusion of subjects like ethics, patient safety, cost effective healthcare. Issues like ADHD, Autism, Learning disabilities were also very important which are often neglected and recognized at a much later stage. However, there will be some teething troubles to the start of this programme for which they must be ready to face, have arrangements for trouble shooting while it will also require a strong IT support.

Prof. Arshad Javed, he further stated is a multifaceted personality who has enormous accomplishments to his credit. He and Prof. Major Gen. M. Aslam at present Pro VC of NUMS Rawalpindi are the two persons which they can identify who have contributed a great deal to the development of discipline of Medical Journalism in Pakistan. It was in recognition of this that they in PAME have invited Prof. Arshad Javed to be the Chief Guest at their 5th Biennial conference scheduled to be held at JSMU at Karachi on April 11th 2020.

Monograms of the Universities, Institutions who have agreed to start Regional Diploma in
Family Medicine being displayed during the conference.

Prof. Shahid Mahmood Malik Rector Health Sciences at University of Lahore commended organizers by bringing everybody together. House job, he opined, does not solve our issues. At present there is disconnect between service providers and establishment but let us do whatever we can do. Rest will follow. We need to connect it with tertiary care. It will require training of GPs in Information Technology. One can develop a database and we plan to start this programme at UOL, he remarked.

Dr. Asad Zaheer Registrar UHS said that they will support this programme. It can be further improved. Representative of WHO Dr. Jamal Nashar said that family health care demands consistent quality healthcare in which nurses, Lady Health Workers and Allied Health Workers also play an important role besides family physicians.

Prof. Arshad Javed Vice Chancellor of Khyber Medical University in his concluding address said that he was glad to have a team which is devoted, dedicated and capable of delivering. We have a whole hearted support for the programme. Khyber Medical University is moving forward. Family Medicine is an important discipline and we aim to take it to greater heights in Pakistan an in the region.

Competencies of
Family Physicians

WONCA, it may be mentioned here has defined six main competences that a GP/Family Physician has to master and they include Primary care management, person-centered care, specific problem solving skills, comprehensive approach, community-orientation and holistic approach. This Regional Diploma in Family Medicine covers the following:

  • Maintain health and wellbeing of the population they serve.
  • Provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health in different settings.
  • Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
  • Exhibit the ability to investigate and evaluate the care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on continuous self-evaluation and life-long learning.
  • Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
  • Show a commitment to carrying out professional responsibilities and an adherence to ethical principles.
  • Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
  • The student’s assessment will include Mini Clinical Exercises, Directly Observed Procedural Skills, Case Based Discussions and Consultation Observation Tools. There will be a Mid Term Exam (Written) and Mid Term Clinical Exam. Exit Exam will consist of one hundred MCQs, Summative OSCE on twelve stations and pass marks in each assessment will be 60%.
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