Johannesburg Health District Family Medicine Intern Orientation Overview

The orientation program for Family Medicine interns in the Johannesburg Health District covers a comprehensive agenda including teaching programs, consultation techniques, quality improvement, referrals, and community-oriented primary care. The district, serving a population of 5.5 million, faces significant healthcare challenges but boasts a dedicated team led by District Family Physician Dr. Jimmy Akii and several Family Physicians across sub-districts. Interns undergo a structured 6-month rotation across various healthcare facilities, receiving hands-on clinical experience and academic support. Supervision by experienced medical officers and nurses ensures proper training and governance.

• Johannesburg Health District
• Family Medicine
• Intern Orientation
• Clinical Governance
• Community-oriented Care

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1. Johannesburg Health District Department of Family Medicine Intern Orientation 4thJanuary 2021

2. Agenda Welcome / Introductions Jhb Health District FM Internship SOP: Do s and Don t s Teaching Programme Principles of Family Medicine Consultation QIP Referrals COPC Closure

3. JOHANNESBURG

4. Johannesburg Diepsloot Ivory Park Roodepoort Bruma Lake Protea North Mulbarton Orange Farm

5. Burden 5.5 million people 10 million visits to PHC 80 doctors (excl. interns) 400 PHC nurses Staffing >3000 Budget R3b

6. Overview District Family Physician: Dr. Jimmy Akii Family Physicians per sub-district A) Kazombia Manda B) Michelle Torlutter C) Maggie Petkova D) Shabir Moosa / Mauricio Ruiz (CMO) E) Kazombia Manda* F) Sam Ubabukoh / Gloria Malope (CMO) G) Ashraf Moti (CMO)

7. Tasks Clinical Service Provision in CHCs and after hours Supervision of Medical Officers / Interns PHC nurses Academic Support of undergraduates / postgraduate registrars Clinical Governance esp. on poorly performing indicators and integration Community-oriented primary care incl. CHW deliveries and TL case management

8. FM INTERNSHIP

9. 6mth FM rotation - CHBAH 1 mth emergency medicine (CHBAH/Bheki) 1mth district hospital Bheki Mlangeni (12-16) Lens South (4-6) 3 mths acute / chronic CHC 1 mth preventive care Mother and Child (Base CHC) Chiawelo Community Practice

10. Sites/Supervisors - CHBAH CHBAH Intern Supervisor Dr Ashraf Moti Site/s / Supervisor (Soweto-Sub D) Itereleng CHC (Dr Masiza MO2) Zola Gateway Clinic (Dr Castelvi MO3) Lillian Ngoyi CHC (Dr Ruiz MO3) Mofolo CHC (Dr Ngema MO3) Chiawelo CHC (Dr Kalula FP)

11. Sites/Supervisors - CHBAH CHBAH Intern Supervisor Dr Ashraf Moti Site/s / Supervisor (Orange Farm - Sub G) Lenz Ext Clinic (Dr Dhoodat MO2) Stretford CHC (Dr Aziza MO1)

12. 6mth FM rotation - CMJAH 1 mth emergency medicine (CMJAH) 1mth district hospital South Rand 3 mths acute / chronic (Base Site) 1 mth preventive care Mother and Child (Base Site) CHC WBOT (Base Site)

13. Sites/Supervisors - CMJAH CMJAH Intern Supervisor Dr Kazombia Manda (FP) Base Site/s / Supervisor Alex CHC (Dr Manda FP) Hillbrow CHC (Dr Malope MO3) Ivory Park Clinic (Dr Mkagamatha MO1) South Rand Hosp (Dr Letwaba MO3)

14. 6mth FM rotation - HJRMH 1mth emergency medicine (HJ) 1mth HIV in HJ/RMH (no district hosp) 1mth OPD in HJH 1mth OPD in RMH 2 mths acute / chronic CHC, community practice, preventive care

15. Sites/Supervisors - HJRMH HJRMH Intern Supervisor Dr Maggie Petkova Base Site/s / Supervisor Discoverers CHC (Dr Mahmood MO3)

16. SOP DOS AND DONTS

17. SOP for Drs Key bits Hours: 8-4pm punctually Keep space clean/organized incl. dispensing drugs Professional dress/name tags Professional record keeping Support guidelines Embrace teamwork

18. SOP for Drs Key bits Attend all meetings Avoid quotas and arrangements Follow leave procedures Sick leave (inform/supporting docs) Annual leave (plan) No study leave (use annual leave) Commuted overtime supervised! Communicate with Dr-in-charge / Intern Supervisor / DFP

19. TEACHING

20. Learning Programme Weekly Intern e-meetings 2.30pm Wednesdays Weekly CPD e-meetings 2.30pm Thursdays Quality Improvement Projects Intern team over six months Local weekly case/chart reviews Local arrangement

21. Learning Topics Principles of FM Clinical Audit / QIP / M&Ms Patient Rights Charter/Batho Pele principles Important health legislation in SA (p6) Navigating Guidelines (p10) Diabetes Mellitis in PHC Hypertension / CCF in PHC Routine Disease surveillance/notifiable conditions Motivational interviewing Appraise new evidence Asthma in PHC COPD in PHC HIV adults in PHC HIV OI's and prophylaxis, PEP, PREP (inc; HPCSA Guidelines on needlestick injury) HIV paeds in PHC Reporting serious adverse events HIV PMTCT HIV counselling Common neuro problems - head injury, CVA Headaches / Epilepsy in PHC Joint pains and arthritis in PHC Breaking bad news Chest pain in PHC IPV / Child Abuse Common dermatological problems in PHC Common ENT problems in PHC Common opthalmological problems in PHC Minor procedures with local anaesthetic Maternity Case Records in PHC Completion of Partogram in PHC Legalities- sick leave, death certificates, J88, Injury on Duty Forms Rational prescribing /Rational Use of investigations Palliative care Issues in PHC Contraception / Pap smear Cultural Expectations / Conflicts / Language Population-level approach to disease prevention / Promoting health in communities / Family dynamics/crises HPCSA Ethical Guidelines (Books 1-15) Ethical issues and human rights Office of Health Standards Compliance (Clinical Governance and Practice) M& Framework, Clinical governance and key health indicators in planning TB / MDR-TB in PHC Discharge Summary / Patient Referral Letter Common mental health issues in PHC Management of the aggressive patient Poisoning and overdose Substance abuse

22. Intern Allocation 2-3 interns per topic 1st session Wed 20th Jan 2021 Google doc link Presentation this week (3.30-4.30pm) Taped and available all week Identify 10 case leaders with emails Case discussion in groups of 10 next week (2.30-3.30pm)

23. PRINCIPLES

24. Role of Family Doctor

25. DHS / Family Medicine Principles FM starts with individual Subjective is important Understand context Committed to person, not disease Every contact-prevention / promotion And expands to context in some measure Share habitat Part of community-wide network Office-hosp-home Population at risk Manage resources Lifelong Learner

26. DHS / Family Medicine Principles DHS starts with the Context and System Issues Access to service Equity Integration (Overcome fragmentation) Community participation Local accountability Developmental and inter-sectoral Decentralisation Sustainable Effectiveness and efficiency With a limited focus on the individual Quality Comprehensive services

27. CONSULTATION

28. Consultation Clinical Reasoning Facilitation Collaboration Time Management

29. QIPs QIP vs Research Criteria Indicator Standards Teamwork Monthly engagement

30. Referrals Register on Vula https://vula.page.link/register Search for Dept using "Family Medicine Wish to change this setting afterwards? National>Vula Testing and Support Team Need help? Lillo +27 76 316 0190 lillo@vulamobile.com

31. COPC NHI > Capitation GP study Overview Risks/Mitigation PHC Re-engineering COPC / CCP Reduce utilization Improve quality Prevention

32. Comments/Questions shabir@profmoosa.com Resources at profmoosa.com (https://profmoosa.com/chiawelo- community-practice/ccp- resources/)