Episodit
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Co-host: Dr. Chris Beavington (FMR3 in Sports and Exercise Medicine)
This week, Dr. Chris Beavington tackles the orthopedic content for the Family Medicine examination.
This week's links:
OrthobulletsAnkle FracturesDistal Radius Fractures -
Co-host: Dr. Mike Kirlew
All that wheezes is not asthma! But it's a good place to start.
This week's links:
CPS: Managing the paediatric patient with an acute asthma exacerbationCPS: Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paperMDCalc: Pediatric Respiratory Assessment Measure (PRAM) for Asthma Exacerbation Severity -
Puuttuva jakso?
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Co-host: Dr. Mike Kirlew
This week, Mike and I discuss cancer care. The best takeaway from this talk: sometimes patients can disappear into a "cancer blackhole" when they're diagnosed, where they're busy with specialist appointment after specialist appointment. Consider pre-booking appointments with these patients at regular intervals to help them navigate the process, discuss any issues that might pop up (don't forget, depression is very common), and remember: their non-cancer health continues - they still need ongoing preventative screening for other conditions!
This week's links:
What's My Risk? - Cancer Care Ontario -
Co-host: Dr. Mike Kirlew
This week, Mike and I discuss how to approach the common presenting complaint of "we've been trying, but we can't seem to get pregnant... help us!"
This week's links:
Dr. Aaron Rothstein's {GeM} Generalist Medicine PodcastSOGC - Ovulation Induction in Polycystic Ovary Syndrome -
Co-host: Dr. Mike Kirlew
Remember: H. pylori serology does not indicate current infection!
This week's links:
Choosing Wisely's "Bye Bye, PPI"Choosing Wisely - Gastroenterology Recommendations -
Co-host: Dr. Mike Kirlew
Happy Thanksgiving!
(This talk was recorded in July 2016 — it's a good one!)
Links from this week's talk:
Highly recommended: Saskatchewan Spine PathwayDr. Mike Evans - Low Back Pain -
Co-host: Dr. Mike Kirlew
Links from this week's talk:
CFP: "Update on age-appropriate preventive measures and screening for Canadian primary care providers"Canadian Task Force on Preventative Health Care (CTFPHC) guidelinesU.S. Preventative Services Task Force (USPSTF) guidelines -
Co-host: Dr. Mike Kirlew
Links from this week's talk:
Highly recommended: CCIRH's Evidence-Based Preventative Care ChecklistsCaring for a newly arrived Syrian refugee familyOntario College of Family Physicians Primary Care Interventions in Poverty -
Co-host: Dr. Mike Kirlew
This week Mike and I talk Deep Vein Thrombosis (DVT). This topic overlaps with pulmonary embolism (PE) somewhat, which we've already discussed as part of the talk on Chest Pain.
Links from this week's talk:
Venous Thromboembolism – Lecture Notes - Life in the Fast LaneWell's Criteria for DVTPadua Prediction Score for Risk of VTE -
Guest hosts: Dr. Sonali Srivastava, Dr. Mark Karanofksy — Family physician at Jewish General Hospital (McGill University training site)
This week, we have a special episode for you! A special thank you to guest hosts Dr. Srivastava and Karanofksy, who chat about Simulated Office Orals (SOOs), a core part of the CCFP examination. Bullet points are included below:
How do you think residents should prepare for the SOO? What specifically can they do to practice?Practice with staff, and practice within a study group — each prepare a different case and practice with each other.Be careful not to read all the cases beforehand.How many SOO's do you think they should do before the actual exam?No real number, until you are comfortable.Once you master the process of the exam, practice only if you need more confidence.How much before the exam should they begin practicing?It is hard to do an interview with two problems and a social context in R1. Usually we do 1-2 sessions in R1.In R2 we do 4 sessions through the residency programme, but then the residents will do a few on the side with each other. A few residents seek out staff to do other SOOs with them in the last few months. I wouldn't worry or spend too much time until 3-4 months into R2. Before then you're likely not ready.What are the common mistakes people make?Cheating on the review of systems.Time management.Not listening to the answers the patient gives.Not listening for cues.Not asking questions for all reasonable differential diagnoses (you'll never know what counts for marks and what doesn't).Forget to ask for old records.Forget to say you would perform physical exam.Forget to FIFE: but don't do it obviously / on auto-pilot!Not telling the patient what you think the diagnosis / differential is.Missing the context integration statement.Where do people often lose marks?All over the place!Usually I have seen candidates miss on the differential, review of systems, premature closure, and forgetting to ask about the social context.If someone gets stuck mid-SOO, what should they do?Summarize! "Do I understand you correctly?"In your experience, what makes someone really great at doing the SOOs?Smooth, patient-centred interviewing; not "machine gunning" yes/no questions, calm approach, interested in making the patient better and negotiating a plan – not dictating one.Do you remember any candidates that stood out for either being really great or losing steam? What did they do to get themselves in that position?Don't challenge the examiner or question the ethics of the exam!Don't try to get the examiner to tell you the second problem directly.Don't listen to the answers then just move on. Don't ask questions just to ask, theresponses should be heard and addressed if needed.Abrupt, arrogant, or condescending approach does not go over well in thisexam.Let's say it all goes wrong during the SOOs and the resident feels the actor was not being true to their part, what systems are in place for reporting this?Forget about it and move on to the next one. You'll have time after the last case is done to think about it.Address your concerns to the staff on site – there is a site coordinator. Also write it in your feedback after the exam. Speak to the on-site staff they will help direct you if you feel there was an issue.Don't forget, other candidates may get different information based on the questions they ask. Examiners don't volunteer information at times that easily if it says in the script to only answer if candidate asks specifically. You may not get information because you didn't ask the right question.Any words of wisdom would you like to impart?15 minutes: 2 problems, 1 social context. 1 context integration statement, and manage both. Check with the patient: make sure they agree with each plan.Don't leave the room early. You are allowed to, but don't. Ask more questions.Don't cheat on the review of systems or the differential diagnoses questions.With the three-minutes-left prompt, say something like "So I see you have problem A and also Problem B all in the social context C. That must be difficult and I want to help you through it".In management, remember to offer pharma and non-pharma options for treatment if applicable and to involve a support network in plan.This week's links:
Sonali's Approach to the SOO (JPG, 480KB) -
Co-host: Dr. Mike Kirlew
This week we talk about fever, which is a super common presenting complaint both in Primary Care and in the Emergency Department. Most of the CCFP exam's focus seems to be on children with fever, but we talk about a few other related conditions as well that can occur in adults.
Links from this week's talk:
CFPC's Fever in Infants and Children [pdf]UpToDate's Patient Information: Fever in Children (Beyond the Basics) -
Co-host: Dr. Mike Kirlew
Arguably, the last of the "core" chronic disease topics this week: Hypertension! The 2015 Canadian Hypertension Education Program (CHEP) has everything you need to know for the exam and for practice; guidelines published alongside the paper are a fairly short and recommended read, or even shorter, their highlights.
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Co-host: Dr. Mike Kirlew
Yet another core Family Medicine topic this week, hyperlipidemia. The best reading you can do for the exam around this topic is to read through Dr. Michael Allan et al.'s recent article in the CFP titled Simplified lipid guidelines: prevention and management of cardiovascular disease in primary care, but of course we'll have a "summary of the summary" up in the study notes very soon!
Links from this week's talk:
2013 Cochrane Review, Statins for the primary prevention of cardiovascular diseaseiCCS Mobile App from the Canadian Cardiovascular Society -
Co-host: Dr. Mike Kirlew
And the second part of our two-parter discussion of Diabetes.
Thanks to Dr. Alain-Philip Gendron (FMR1) for help in developing the study notes for this topic.
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Co-host: Dr. Mike Kirlew
The first part of our two part discussion of Diabetes (what a huge topic!), certainly one of the most prevalent diseases in Family Medicine.
Links from this week's talk:
CANRISK Diabetes Risk Assessment ToolThe excellent Canadian Diabetes Association Guidelines in full.Thanks to Dr. Alain-Philip Gendron (FMR1) for help in developing the study notes for this topic.
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Co-host: Dr. Mike Kirlew
This week, we discuss depression: one of the most common presentations in Family Medicine. I managed to not record my chat with Mike this time around, so you'll need to take our word for it that it was excellent and highly entertaining.
Some points from our chat:
Brief, office-based CBT is a great skill to have to help your depressed patients. An example guide is available at A Therapist's Guide to Brief Cognitive Behavioral Therapy. The University of Calgary also offers a distance-learning certificate in CBT.
The RXFiles offers a very comprehensive comparison of antidepressant medications.
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Co-host: Dr. Mike Kirlew
Another week, another topic! A favourite topic for GP/Emerg docs everywhere, and Dr. Mike Kirlew is back to talk Chest Pain. The study notes to accompany will be up shortly, and I would highly recommend them: this topic is so large that covering it in one podcast episode is a hopeless task (although we tried our best!). Be sure to look up the new and upcoming chest pain / ACS scoring tools and rule out algorithms (HEART score, TIMI score, etc.), as most Emergency departments are moving to a 1- or 2-hour rule-out for low risk ACS patients.
Erratum:
We mentioned the ADJUST-PE for age-adjusted D-dimer as being completed in 2012: it's newer than that, completed in 2014. -
Co-host: Dr. Mike Kirlew
We have a special treat this week - Dr. Mike Kirlew, of the famous (infamous?) Dr. Mike Kirlew's CCFP Podcasts has joined us for a special episode on Anaphylaxis!
The study notes have been published alongside the podcast this week - we're still looking for interested residents who would like to work on one of the 99 Topics, if that sounds like you please get in touch with us, we'd love to have you.
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And we're back, but dammit, we have a nosebleed this week. Blame it on the dry northern Saskatchewan air.
Key points this week:
These patients are commonly anxious, which makes everything worse: work on reducing their level of anxiety in the office/ED.90% of nosebleeds will resolve with basic first aid: start with basic first aid when you first see them, and teach it to them to save them the trip in the next time it happens.If it's recurrent or you can't get it to stop, consider a posterior bleed: these will usually need help from ENT.Thanks to FMR2 Dr. Isa Saidu for help in developing this topic!
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Exams are over, time to celebrate!
This week, we talk antibiotics.
Probably the most important thing know about antibiotics is having a first-line and second-line antibiotic (and dosing) in mind for common infections.
Two great resources for this:
RXFiles (the "Common Infections" page)MUMS Health’s "Anti-infective Guidelines for Community Acquired Infections" (commonly known as the "Orange Book") - Näytä enemmän
