Family Medicine
Family Medicine is the primary care medical specialty concerned with provision of comprehensive health care to the individual and the family regardless of sex, age or type of problem. It is the specialty of breadth that integrates the biological, clinical and behavioural sciences. Family physicians can themselves provide care for the majority of conditions encountered in the ambulatory setting and integrate all necessary health care services. They possess unique attitudes, skills, and knowledge, which qualify them to provide continuing and comprehensive medical care, health maintenance along with preventive, promotive and rehabilitative services to each member of the family. Family physicians, because of their background and interactions with the family, are best qualified to serve as each patient's advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources.
Family Medicine is emerging as a body of knowledge that is being continuously developed, researched and taught as an integrative entity. The scope of family practice covers a wide spectrum. At one end are family physicians who may be the only source of health care for their community. Besides maintaining an office practice, they can perform surgery, care for the seriously ill in hospital care units, handle trauma cases, stabilise patients for transport if necessary, staff a hospital and deliver babies, including performing cesarean sections. Family physicians with this type of practice are common in rural areas. At the other end of the spectrum are family physicians who limit their care to office practice and coordinate comprehensive care for their patients in a multi-specialty group.
AKU has the distinction of having the first organised residency-training programme in Family Medicine in Pakistan. The Family Medicine Residency Training Programme was approved by the College of Physicians and Surgeons, Pakistan (CPSP) in 1992 and initiated in 1993 by the Family Medicine Division of the Department of Community Health Sciences. CPSP re-approved the programme in 2003. In 1997, the Royal College of General Practitioners, UK, unconditionally approved the Programme for the MRCGP Examination and additionally declared it as amongst the top 10 programmes in the UK.
The programme prepares family physicians to provide broad-based health care and also contribute to the evolving knowledge base of the specialty of family medicine. In addition, it prepares them to assume leadership roles in developing and expanding Family Medicine in universities, hospitals and communities across Pakistan. The programme structure supports personal and professional growth of the residents and fosters an attitude of critical inquiry, a passion for excellence and a sense of how a family physician can integrate medicine into his or her personal life.
Objective
The goal of the programme is to train physicians to deliver high-quality, comprehensive primary medical care relevant to the health needs of individuals and families in Pakistan. The primary objective is the production of holistically minded caring, skilled, knowledgeable, and clinically competent Family Medicine physicians who are educationally well rounded in advanced medical skills and scientific principles, and who would be able to serve the health care needs of all ages and both sexes of the urban and rural populations of Pakistan providing curative, preventive, promotive and rehabilitative medical care.
Eligibility
- MBBS or equivalent degree approved by the PM&DC (preference is given to those with 60 per cent and above marks in the final professional examination)
- One-year internship with six months in Medicine and allied and six months in Surgery and allied disciplines
- FCPS Part I is not mandatory, however, preference is given to candidates with FCPS Part I (Medicine and allied only)
Candidates are required to sit for a generic residency written exam which is used as an entrance screening test. The final selection is based on interviews with the Family Medicine faculty.
Duration of training
The Family Medicine Residency is a four-year training programme.
Content
Clinical training
Year 1 (Inpatient)
During this year, the Family Medicine residents are exposed to inpatient clinical care with three monthly rotations each in the Departments of Medicine, Surgery, Paediatrics and Obstetrics and Gynaecology. They are responsible for admitting, clerking and managing patients under the supervision of senior residents and faculty team leaders of the concerned departments. During this year, they will be on-call with night duties as per rota.
The residents are required to prepare and submit their research/dissertation synopsis to the College of Physicians and Surgeons Pakistan and get their topics approved during this year, as per the requirement of CPSP.
Year 2 (Outpatient)
Second year comprises sub-specialty outpatient training, Family Medicine continuity clinics and one month of inpatient Psychiatry. Residents are encouraged to complete their data collection and analysis for their dissertation by the end of this year.
Year 3 (Off-campus)
Third year consists of rotations in the rural areas, Emergency Room, Family Medicine clinics and electives. Three months of this year are spent in a rural rotation supervised programme for increasing awareness and experiential management of health problems in rural areas at Aga Khan Health Service, Pakistan (AKHS,P), Northern Areas or AKHS,P, Chitral and Bach Christian Hospital, Abbotabad. Three months are available to be used as an elective period in specialties according to the interest of the trainee or the specific training needs of the individual. During this year, the candidates are required to complete their research/dissertation and submit it to the College of Physicians and Surgeons, Pakistan.
Year 4 (Consolidation)
In this extremely important year, the residents are required to consolidate and strengthen their Family Medicine training through Family Medicine continuity clinics and additional longitudinal experience in Paediatric and outpatient procedure clinics. One half-day per week is assigned for the fourth year residents to attend and actively participate in a preparation course for FCPS/MRCGP exams. An additional one half a day per week is allocated for teaching undergraduate medical students in order to develop the residents as future Family Medicine faculty. They are required to develop knowledge and skills in geriatrics and conduct home visits for the elderly patients.
Educational activities
Core curriculum
The core curriculum is a mandatory training criterion. It provides a forum for the residents to gain structural knowledge and skills regarding the essentials of Family Medicine. It is organised by the Family Medicine faculty and is designed to highlight relevant and important Family Medicine aspects in health care. It is mandatory for all residents to attend and actively participate in the half-day per week core curriculum sessions on Thursday afternoons throughout the four-year residency programme. This is the time when all residents gather to touch base with Family Medicine and participate in a structured teaching-learning programme, and learn consultation/clinical skills and office practice skills relevant to family medicine.
Additional educational activities
Journal Club, Patient Oriented Evidence that Matters (POEM's) sessions and Continuing Medical Education (CME) Updates:
These sessions are resident centered. The residents are required to participate in, lead the journal club and the POEM's sessions and duly attend all CME sessions.
The objectives of these sessions are:
- Develop lifelong learning skills and presentation skills
- Accrue knowledge and skills relevant to the practice of family medicine through article presentations and case discussions
- Critically appraise the literature in order to develop the skills to find and make sense of research evidence, helping them to put knowledge into practice
- Exchange evidence-based ideas about the practice of family medicine, with faculty
Mandatory workshops and courses
The residents are required to attend and actively participate in the courses and workshops mandated by CPSP and those arranged by the PGME and Family Medicine.
Assessment and evaluation
Continuous assessment and feedback between residents and the faculty is an essential feature of this training programme. The Family Medicine Residency Coordinator obtains assessment of residents from other specialty departments at the end of each rotation. Feedback is bi-directional, from resident to faculty and vice versa on a six-monthly and annual basis, taking into account resident performance, faculty performance, continuous assessment and in-house annual exam. Promotion to the next level is based on fulfilling established criteria.
Additional highlights of the programme
- Provision of protected time for education, and research
- Community based clinical exposure and supervised teaching of undergraduate medical students in final year
- Weekly preparatory sessions for FCPS II examination built in the final year of residency
- Ample opportunity for research and scholarly activities under guidance of Family Medicine and Research faculty
- Opportunity to avail the international travel scholarship awarded bi-annually by the Royal College of General Practitioner, UK
- Administrative opportunities to residents
- Chief resident
- Academic coordinator
Positions available
Six positions of first year residents are available on open merit basis from January 1 of each year. One (l) position is available for candidates on deputation from Aga Khan Health Service, Pakistan , and other governmental and non-governmental organisations.
Administrative set-up
The residency is overseen by the Departmental Residency Committee comprising Dr Marie Andrades, Associate Professor and Residency Programme Director; Dr Samreen Kausar, Senior Instructor and Residency Coordinator; Dr Swaleha Tariq Bhombal, Senior Instructor and Core Curriculum Coordinator; the Chief Resident and the Academic Coordinator. The programme is assisted by Mr Jahangir Alam, Adminstrative Officer.
Full-time faculty
Chairman
Department of Family Medicine
Dr Waris Qidwai
MBBS; MCPS; FCPS Pakistan
Professor and Associate Dean, Education
Dr Rukhsana W Zuberi
MBBS; FCPS Pakistan ; MPHE Chicago
Associate Professor
Dr Niloufer Sultan Ali
MBBS; DCH Pakistan ; FCPS Pakistan
Dr Marie Andrades
MBBS; FCPSPakistan, Adv.Dip.HPE
Programme Director Family Medciine Residency
Assistant Professors
Dr Aziz Abdul Rehman Jiwani
MBBS; FCPS Pakistan
Dr Saniya Sabzwari
MBBS Pakistan
Diplomate American Board of Family Medicine
Dr Sameena Shah
MBBS; MCPS; FCPS Pakistan
Dr Seema Bhanji
MBBS; FCPS Pakistan, Dip. Clinical Epidemiology
Senior Instructors
Dr Samreen Kausar
MBBS; FCPS Pakistan, MRCGP Int.
Family Medicine Residency Programme Coordinator
Dr Swaleha Tariq Bhombal
MBBS; FCPS Pakistan; MRCGP Int.
Family Medicine Core Coordinator
Dr Tabinda Ashfaq
MBBS; FCPS Pakistan, MRCGP Int.
Ms. Mashmire Nanji
BScN, MSc Epi
Part-time faculty
Professor
Dr Riaz Qureshi
MBBS Pakistan; DCH DTM&H London; MRCGP, FRCGP UK
Lecturers
Dr Asma Usman
MBBS; FCPS Pakistan
Dr Badar Sabir Ali
MBBS; FCPS Pakistan
Dr Nausheen Ahmed
MBBS Pakistan
Diplomate American Board of Internal Medicine; ECFMG, USMLE Step III
Dr Samar Zaki
MBBS; FCPS Pakistan
Core Curriculum Coordinator
Dr Faisal Ahmed
MBBS,MRCP,MRCGP(UK),D.P.Derm
