General Practice II

1.Knowledge of the six core competences of family medicine 1. Primary health care organisation/management: - manage and present facts about epidemiological knowledge and about problems in primary health care, - demonstrate knowledge of regular, ongoing care of patients with chronic conditions, - demonstrate in-depth knowledge and understanding of preventive work and its organisation in general practice, - demonstrate knowledge of the work organisation of a primary health care (PHC) institution, - demonstrate an understanding of the importance of communication skills in working with patients and general practice staff, - demonstrate knowledge of the organisation of health care system and its functioning in relation to primary health care, - improve knowledge of communication skills, with special emphasis on the doctor - patient cooperation. 2. Person-centred care: - demonstrate knowledge of patient-centred care, understanding its importance in relation to the patient, their problems and living conditions, - demonstrate knowledge in understanding the processes, that are related to the growth and development of an individual, adulthood and ageing of an individual, - demonstrate knowledge and understanding of a functioning family, its role in society, the impact of social and cultural peculiarities on the family and family values, - understand the patient-centred model of GP consultation, and see the patient as an equal partner, - demonstrate knowledge in building relationships with patients, assessing priorities in the decision-making process, - demonstrate knowledge of the development of a continuous, sustained and sequential care process. 3. Specific problem-solving skills: - knowledge of specific problem solving, decision making, ability to evaluate the prevalence and incidence of disease in a given population, - ability to assess the specific characteristics, habits (age, gender distribution, prevalence of chronic diseases) of a given population, - knowledge of how to obtain and interpret information from medical history and from physical and laboratory examinations of the patient, - ability to ask specific questions related to the disease during the examination of the patient, and to use the known medical history of the patient’s family and social conditions, - knowledge of the available investigation and treatment options for a given problem, - knowledge in assessing emergency situations, decision making in emergency situations, - ability to analyse and assess the situation accurately, to decide in which case emergency care is needed, organisation of emergency therapeutic measures, and to decide in which case it is possible to carry out diagnostic and therapeutic measures in a planned manner, - ability to assess the symptoms and signs of disease, clinical findings, rapid and additional diagnostic tests in the diagnostic and therapeutic process, - the ability to understand the costs of medical and diagnostic manipulations and to assess the need for these manipulations in the given situation, and to understand the impact of specific treatment on the human body. 4. A comprehensive approach to problem solving: - understanding and knowledge of the concept of "multimorbidity", - knowledge of treatment options for multiple comorbidities, - knowledge of the use of guidelines and evidence-based research data, - knowledge of health promotion, disease prevention strategies, health concepts, - understanding of the role of the general practitioner and his/her team in promoting public health, - recognition and identification of ethnic specificities in the community, - knowledge and ability to involve members of the GP team in the individual's treatment, care process, palliative care, rehabilitation, understanding the role of each member of the GP staff in this process, being able to take an individual approach to each patient, coordinating the teamwork skilfully. 5. Community oriented health care: - coordinate individual needs with the needs of the community they live in, knowing the existing resources in the given environment, - understand the health of the community as a whole, based on the epidemiological situation of a given population, - understand the relationship between health care and social care, - understand the impact of poverty, ethnicity and epidemiological situation on health; - understand the structure of the healthcare system and its economic possibilities, - evaluate the work of other professionals and be able to find opportunities for cooperation with them, - understand how the healthcare system can be used for the benefit of the patient and the general practitioner (referral procedure, patient payments, sick leaves, legislation). 6. Holistic approach: - knowledge and understanding of the holistic care principles and their use in family medicine, - ability to perceive and work with the patient as a bio-psycho-social being, - knowledge and ability to interpret and use the information obtained in the diagnostic and treatment process, about the cultural and ethnic specificities of patients, - knowledge of how to use the patient’s experience, expectations and trust in the doctor during the healthcare process.

1.Skills in the six core competences of family medicine. The ability to apply theory, methods and problem-solving skills independently to carry out highly skilled professional functions or research activities. The skills acquired are: 1. Primary health care organisation/management: - ability to apply knowledge, when organising and carrying out preventive work, - ability to examine and take care for a patient with multiple, yet undifferentiated health problems, - ability to provide emergency medical care and to organise care for patients with acute and chronic illnesses, - ability to carry out and organise palliative health care, - skills in the diagnostic process: obtaining a medical history, physical examination of a patient, doing additional diagnostic tests, - therapeutic skills, including knowledge of both pharmacological and non-pharmacological therapy, - ability to prioritise problems, - good communication skills with the patient, the staff of the primary health care institution, and other primary health care doctors and specialists, - ability to organise the work of a primary healthcare team, - communication skills, ability to educate patients and their family members in the examination and treatment process, - ability to organise the correct entry of patient data in outpatient medical history, to process the information, - management skills, ability to audit the quality of the work performance in GP practice, - ability to act in the interests of a patient, - negotiation skills with the patient in finding a compromise, - ability to evaluate primary health care from the point of view of a general practitioner, ability to understand the uncertainty of a patient, their peculiarities, curiosity; ability to be caring and diligent. 2. Person-centred care: - assessment skills, insight into the patient's illness, - ability to organise patient-centred consultation, starting with listening to the patient's complaints (ideas, concerns, hopes), integrating them into the doctor's proposals, future decisions by finding a common solution to the problem when drawing up the examination and care plan for the future, - ability to analyse and present the results of examinations in a way that the patient understands, including explaining further solutions to the patient, drawing up a future treatment plan in collaboration with the patient, - ability to take any further decisions respecting the patient's interests and autonomy, - ability to avoid subjectivity in medical decision-making, - skills and abilities in developing the "doctor - patient" relationship, - skills and abilities to establish a balanced (close and distant at the same time) relationship with the patient, - ability to understand and put into practice the three key principles of continuity: 1) continuity of the doctor-patient relationship throughout the treatment process, 2) regular treatment episodes, provision and explanation of medical information to the patient, 3) regular availability of family medicine services, Specific problem-solving skills: - specific decision-making skills (using tools such as the clinical approach, decision-making algorithms), - ability to take a medical history, perform physical examination and interpret the data, - willingness and ability to involve the patient in the decision-making process, - general practice skills such as understanding, empathy and caring, - ability to use diagnostic and therapeutic tools such as "time", the "patient-doctor" relationship in the decision-making process, - ability to assess and understand the presence of inevitability and doubt in the process of solving primary health care problems and the ability to tolerate it, - ability to make a decision, to provide assistance in an emergency situation, - ability to counsel "seriously-ill" patients with serious health problems, - familiarity with the costs of medical and diagnostic manipulations, to assess the need for these manipulations in a given situation. 4. A comprehensive approach to problem solving: - knowledge of a number of simultaneously existing health problems, ability to prioritise, understand the interactions between these conditions, and select appropriate treatment tactics, - ability to work with medical records and to use of electronic information, - ability to apply the latest scientific achievements and research data in practice, - health promotion through prevention and health promotion programmes in primary care, - ability to coordinate and organise the work of the members of the general practitioner’s team in both curative and preventive measures, as well as in palliative care and organisation of rehabilitation measures. 5. Community-oriented health care: - ability to assess health problems in a given community, taking into account the specific epidemiological situation, - ability to collaborate with other professionals working in the community, to understand their role, - ability to understand and use the healthcare system for the benefit of the patient and doctor, organising their work skilfully, - ability to avoid shortcomings in the healthcare system. 6. Holistic approach: - ability to work with the patient as a bio-psycho-social being, - ability to apply the holistic care principles in practical work with patients, - ability to use the patient's experience, expectations, trust in the doctor during the healthcare process. Skills to be strengthened during the family medicine education programme. Skills to be strengthened during the family medicine curriculum: examination skills, treatment methods, disease prevention and health promotion measures: 1. Emergency medical care: - ABC of resuscitation, - airway clearance, - patient positioning, - intubation in adults and children, - prevention of pneumothorax, - stopping bleeding (including posterior packing), - gastric lavage, - enema, - cavity punctures (ascites, pleural cavity), - cricothyroidotomy, - infusion therapy. 2. Surgical manipulations: - minor outpatient surgery (wound suturing, opening of abscesses, removal of foreign bodies, excision of warts, nail avulsion), - local anaesthesia, - wound management, - fracture immobilisation, splinting. 3. Gynaecological procedures: - gynaecological examination, - breast examination, palpation, - bacteriological and cytological smears of the vagina, cervix, - explanation of hormonal contraception, - insertion and removal of intrauterine devices (IUD), - advice on inserting a contraceptive vaginal ring, - determining the time of pregnancy, - deliveries. 4. Examination of children: - techniques for examination of the new-born, infant, toddler, preschool age, junior school age and senior school age child, - primary care of the new-born, - growth and development assessment, - breastfeeding counselling, breastfeeding techniques, - vaccination technique, immunisation, - tuberculin test; - first aid in life-threatening situations (choking, drowning, burns, trauma), - building rapport with parents, taking a medical history, - basic knowledge of rehabilitation methods. 5. Skills in working with adolescents: - specific counselling skills, establishing rapport, - objective examination (gynaecological, andrological), sexual maturity assessment, - confidentiality, - knowledge of legislation related to adolescence, - ability to advise on issues of contraception, sexual behaviour, addictions (alcohol, nicotine, drugs). 6. Skills in women's care: - counselling on issues related to birth control, - insertion and removal of IUD, insertion and removal of the vaginal ring, - urinary catheterisation, - oncocytology smear, - breast palpation, - advising pregnant women, - diagnosis and management of normal pregnancy, - postnatal care. 7. Skills in men’s care: - prostate palpation, - urinary catheterisation. 8. Skills in elderly care: - obtaining adequate information from people with memory, hearing and visual impairment, - examination of patients with reduced mobility, - assessing the extent of examinations required in an elderly person (assessing information productivity, possible complications of examinations). - ability to assess the possibilities of examinations and therapeutic measures. - communication skills with patients with chronic and terminal illnesses. - skills in advising on health care, social rehabilitation options for the elderly, - knowledge of rehabilitation options for the elderly and the disabled. 9. Skills to treat people with mental and behavioural disorders: - history taking skills, - delirium, withdrawal treatment, - family therapy, - counselling on alcohol, medication and drug dependence, - treatment tactics and referral to a specialist. 10. Ear - throat - nose examination: - otorhinolaryngoscopy, - audiometry, - radiodiagnostic examination of sinus diseases, - ear rinsing, - removal of foreign bodies, - application of drops, ointments and rinses in treatment. 11. Eye examination: - examination of the external parts of the eye, - ophthalmoscopy, - visual acuity, - testing colour vision, - visual field testing, - measuring intraocular pressure, - emergency care for eye injuries and acute glaucoma, - removal of superficial foreign bodies. 12. Other manipulations: - injections (into muscle, vein), - ECG, - spirometry, - cycloergometry, - urinary catheterisation, medication administration, - indwelling catheter insertion, replacement, - digital rectal examination and prostate palpation, - rectoscopy, - blocks, - skin biopsy, - taking bacteriological material in case of urogenital infections. 13. Health check-up and related consultations: - knowledge of diagnostic methods, - physical ability assessment, - explaining the dangers of tobacco, - sexual education, - counselling on psychological problems, stress management, - education on hormone replacement therapy for women during menopause. 14. Laboratory tests: - blood: haemoglobin, erythrocytes, leukocytes, ESR, - leucogram, blood sugar, CRP, - evaluation of urinalysis (specific gravity, pH, colour, sugar, protein, bilirubin, ketones, acetone, nitrites, sediment), - faeces (parasites, blood), - sputum (bacterioscopic examination), - gynaecological smear analysis: the purity of the vagina (vaginosis, trichomonas vaginalis, gonorrhoea, candida).

1.Competences of the general practitioner. Able to independently formulate and critically analyse complex scientific and professional problems. The knowledge and skills of the general practitioner are seen in six core competences: 1. Organisation/management of primary health care, 2. Person-centred care, 3.: Specific problem-solving skills, 4. A comprehensive approach to problem solving, 5. Community-oriented health care, 6. Holistic approach: The competences acquired allow to justify decisions and, where necessary, do additional test: - Ability to explain the impact of environmental changes on the prevalence of diseases in a population, and understanding of the use of preventive, diagnostic and therapeutic methods in this context. - Ability to assess patient complaints, their relationship to the patient's state of health. Has a broad understanding of diseases and their risk factors, the most common diseases in the population, the care of chronic diseases, diseases causing disability, conditions requiring emergency care. - Understanding of the use of preventive and diagnostic manipulations in primary health care, covering virtually all specialties (i.e. paediatrics, gynaecology, surgery, ear-neck-nose diseases, dermatovenerology, ophthalmology, neurology, psychiatry, cardiology). - Ability to provide treatment at primary care level, to organise rehabilitation, if necessary. - Understanding of diagnostic possibilities at primary and secondary care level, understanding of the possibility of referring the patient to a specialist, if necessary. - Ability to organise and conduct consultations on matters related to the organisation of health care, particularly maternal and child health care an, family planning. - Understanding of the public health issues. - Ability to understand the importance of a positive doctor-patient relationship, to teach patients to understand their complaints and to learn to cope with them. - Ability to work as part of a team with other members of the primary health care team and other professionals. Able to integrate knowledge from different fields: - Understanding of the issues of the organisation of health care in general and particularly of the organisation of primary health care. - Knowledge of legislation and directives in health care, ability to participate in their development. - Knowledge and understanding of specialised disciplines: clinical chemistry, physiology, microbiology, pharmacology, acute care, basic principles of family medicine, ethical issues, psychology, epidemiology, statistics, use of research methods in family medicine, preventive work, and other disciplines. Able to contribute to the creation of new knowledge, research or the development of professional methods: - Knowledge of the basic principles of research methods. Able to apply the methods and principles of research to their work, and understands the nature of epidemiological research. - Ability and willingness to carry out independent research. Able to demonstrate an understanding of and ethical responsibility for the potential impact of scientific results or professional activities on the environment and society: - Ability to organise research independently, analyse its results, compare with research data from other countries. - Ability to use research data in practical work.