Welcome to the MDR3208 Senior Family Medicine Posting.

This 4-week clinical rotation is designed to transition you from theoretical knowledge to high-level clinical application within the primary care setting.

The Learning Objectives

CLINICAL SESSIONS

1. Rotation Blocks: Students are divided into three groups (Group 1, 2, and 3). You will have a total of 23 clinical sessions and will be on a rotation to 

• General Practitioners (GPs),  

• Klinik Kesihatan (KKs) and 

• Family Medicine Specialist Clinic (FMC), HSAAS

2. For KK Seri Kembangan, you will need to collect an access pass from PKD Petaling prior to starting the attachment at KK (person to contact Dr. Sazalina 016-311 6096). RM10/pass deposit is needed for this. Kindly wear the access pass all times. Please return back to PIC at PKD Petaling on the last day of your attachment.

3. Inform the doctor in charge of the clinic and the coordinator about those who are absent. MC/ time slip (from PKU, FMC, or the government's health care facility) should be submitted through the Medical Certificate Report.

4.  Please be punctual and introduce yourselves to the Family Medicine Specialist (FMS) of the KKs, the lecturer in charge of the FMC, and the doctor of the GPs.

5. Students must get their attendance signed by the Person in Charge (PIC) or the FMS at the end of each clinical session.

6. Please bring back the claim forms from the KKs and GPs in the first week.

Things to do during clinical session

During the clinical attachments, you are expected to observe and adhere to professionalism, clinical engagement, and administrative compliance.

1. Professionalism and Conduct

• Dress Code: Students must adhere to the clinical dress code. This usually means smart professional attire (no jeans, no open-toed shoes). A clean short white coat (if required by the specific site) and your university name tag must be visible at all times.

• Punctuality: You are expected to arrive at the KK or GP clinic at least 10–15 minutes before the session begins. If you are going to be late or absent due to illness, you must inform both the Clinic Supervisor and the Course Coordinator immediately.

• Confidentiality: Strict adherence to patient privacy is mandatory. Do not discuss patient details in public areas (elevators, cafeterias) and ensure all patient identifiers are removed from your case write-ups or logbooks.

2. Clinical Engagement (The "Proactive" Student)

• At the KK, please tag with the Medical Officer if the FMS is not around, a maximum of 2 students per room.

• Active Observation: Don't just stand in the corner. Position yourself so you can see the patient-doctor interaction, but ensure you are not blocking the doctor’s access to the patient or the computer.

• Patient Interaction: With the supervisor's permission, take the lead in history taking or performing physical examinations. Primary care is the best time to practice communication skills and "ICE" (Ideas, Concerns, and Expectations).

• Ask Questions (At the right time): Save your questions for the gaps between patients or at the end of the session. Avoid questioning the doctor’s decision in front of the patient.

• Understand the System: Use the attachment to learn not just about diseases, but how the healthcare system works (e.g., referrals, chronic disease management programs).

3. Documentation and Logbooks

• Daily Logbooks: Ensure your clinical logbooks are updated daily. Do not leave them until the end of the week, as details are easily forgotten.

• Sign-offs: It is your responsibility to get your attendance and completed tasks signed off by the supervising doctor before you leave the clinic for the day. It is often very difficult to get these signed retrospectively.

• Case Studies: Identify interesting cases early in the attachment for your required case reports or presentations. Ask the supervisor if you can follow up on a specific patient's results.

4. Safety and Ethics

• Scope of Practice: Never perform a procedure (even a simple one like a blood draw) without direct supervision, even if you feel confident.

• Infection Control: Adhere strictly to the clinic’s hand hygiene protocols. This may require properly fitted N95 mask or follow the required PPE protocol.

• Patient Consent: Whenever it is appropriate, always introduce yourself as a medical student and ask the patient for permission to be present or further engage during the consultation. Respect their right to refuse.

5. Specific Advice for the Different Clinics

• KK Health Clinics vs. GP Clinics: 

  • In KKs, the pace is fast. Be prepared for high patient volume and focus on how doctors manage time while maintaining quality.

  • In GP Clinics, you may see more "family" dynamics. Pay attention to the long-term relationships the GP has with the community.

Summary Checklist:

• Before you go: Confirm the clinic location and the name of your preceptor. Bring an extra face mask and wear your student ID all the time. Please bring along your stethoscope and other necessary equipment. 

• During the shift: Be helpful, stay curious, and keep your logbook handy.

• Before you leave: Get your signatures and thank the nursing and administrative staff (they are vital to your learning environment).

Public Health Clinics (The Klinik Kesihatan)

Private Clinics (the General Practice)

ASSESSMENT

Components

To pass the Family Medicine posting, students MUST obtain a minimum of 50% in the overall components of the posting, which includes the end-of-posting (EOP) exam. The components of the posting comprise:

1. Student's presentation - 20%

2. Precepting - 20%

3. Case write-up - 20% (an average of the three cases)

4. Practice attachment (KK 25% and GP 25%) - 20% (KK + GP x 0.4)

5. EOP of 30 single best answer questions - 20%

The EOP examination is to assess the students’ overall knowledge of family medicine and its related topics. This assessment will include all the topics from the central teaching and the topics discussed in the students’ presentation, as well as any aspects of the practice attachments. 

Prerequisites for obtaining a PASS

1. Attendance of NOT less than 100%

2. SATISFACTORY completion of tasks in the logbook 

Students who fail will be required to complete remedial coursework or retake the entire posting.

If I have passed this posting before, do I have to go for the assessment again?

Students who have passed the Family Medicine posting previously do not need to sit for the EOP examination.

However, you need to follow the attachment and participate in all other teachings as scheduled.

END OF POSTING EXAMINATION

Date: The last Friday (or sometime Thursday) morning of the posting (Week 4)

Time: 9.00-10.00 am (1 hour)

Venue: Dewan Peperiksaan 4, FPSK, UPM (may depend on availability)

Remember to bring along your student's ID.

Learning Resources

Recommended textbook

1. Chew, B.H., Cheong, A.T. & Ghazali, S.S. (2015). An Introduction to Family Medicine and Its Essential Skills in Primary Medical Care. Serdang: UPM Press.

2. Murtagh, J. Rosenblatt, J., Coleman, J. & Murtagh, C. (2022). John Murtagh’s General Practice (8th Edition). North Ryde: McGraw-Hill

3. David, J.A. (2021). CURRENT Practice Guidelines in Primary Care 2021-2022 (19th Edition). New York: McGraw Hill.

4. Goroll, A.H. & Mulley, A.G. (2020). Primary Care Medicine (8th Edition). Philadelphia: Lippincott Williams & Wilkins.

5. Rackel, E.R. & Rakel, D. (2015). Textbook of Family Medicine (9th Edition). Philadelphia: Saunders Elsevier.

Local websites

• Clinical Practise Guidelines (CPGs) at the Academy of Medicine Malaysia [https://www.acadmed.org.my/index.cfm?&menuid=67]

• MIMS Malaysia | Drug Website, Directory & Medical Information  [https://www.mims.com/malaysia]

• Malaysian Family Medicine Specialists' Association [https://fms-malaysia.org/] 

• Academy of Family Physicians of Malaysia or AFPM (known also as Akademi Kedoktoran Keluarga Malaysia, AKKM in Bahasa Malaysia) [https://www.afpm.org.my/] 

• Digital resources of UPM's library [https://lib.upm.edu.my/sumber_digital-1791]

• Infosihat by the Bahagian Pendidikan Kesihatan, Kementerian Kesihatan Malaysia [https://infosihat.moh.gov.my/] 

• NGO Kesihatan [https://infosihat.moh.gov.my/direktori-pegawai-1/ngo-kesihatan.html?utm_source=chatgpt.com]

• Malaysian Support Groups & Foundations [https://new.medicine.com.my/public-info/support-groups/?utm_source=chatgpt.com&customize_changeset_uuid=] 

International websites

• GP notebook [http://www.gpnotebook.co.uk] 

• American Family Physician- Patient Care [https://www.aafp.org/family-physician/patient-care.html]; and the journal of the American Family Physician [https://www.aafp.org/pubs/afp.html] 

• The Royal Australian College of General Practitioners [https://www.racgp.org.au/]; and the Australian Journal of General Practice (AJGP) [https://www1.racgp.org.au/ajgp/home] 

• BMJ Rapid Recommendations [https://www.bmj.com/rapid-recommendations]; and the BMJ Infographics [https://www.bmj.com/infographics] 

• Clinical Guidelines and Recommendations by the Agency for Healthcare Research and Quality, Rockville, MD. [https://www.ahrq.gov/prevention/guidelines/index.html] 

• The Lancet's Seminars of core clinical topics [https://www.thelancet.com/clinical/core-clinical-topics]

• The  JAMA Network YouTube [https://www.youtube.com/@JAMANetwork] 

• Videos in Clinical Medicine by the New England Journal of Medicine [https://www.nejm.org/browse/nejm-media-type/videos-in-clinical-medicine] 

• World Organisation of Family Doctors [https://www.globalfamilydoctor.com/], or WONCA (World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians)

• World Health Organisation [http://www.who.int] 

• Centre of Disease Control  (CDC, USA) [http://www.cdc.gov] 

• The Cochrane Library [https://www.cochranelibrary.com/] 

• Patient Information from the JAMA Network [https://jamanetwork.com/collections/6258/patient-information]