Læknaneminn - 01.04.1997, Page 16

Thord Theodorsson
India and the African continent. On the other hand
the price of rapidly achieving a highly affluent standard
of living has come to reflect itself in entities such as ‘af-
fluent malnutridon’ which along with a sedentary way
of living manifests itself in very high frequencies of
noninsulin dependent diabetes ( -10% prev. of
NIDDM) and an increasing toll of ischaemic heart
disease 6.
Old scourges such as malaria, tuberculosis and tra-
choma are rapidly on the vane due to successful public
health measures. What still remains are threats of
genetic disorders such as sickle cell disease and thalassa-
emia.
FAMCO - THE DEPARTMENT 0F FAMILY
AND COMMUNITY HEALTH
As stated above Sultan Qaboos University (SQU)
started from scratch in 1986. Luckily those who were
in charge of its planning had taken account of the
international debate regarding the need for providing
efficient primary health care on a modern basis. To that
end FAMCO was allocated a much greater share of the
clinical curriculum than traditionally has been the case
in medical schools worldwide.
After achieving a BSc degree (a four year course) the
student enters a three year clinical clerkship in which
FAMCO is seen as one of the five major specialties, in
parity with internal medicine, child health, surgery and
obstetrics and gynaecology. Furthermore FAMCO in
conjunction with the department of epidemiology and
statistics runs preclinical courses and field studies.
These address the issues of epidemiology and statistics,
nutrition and health education.
A group of students ‘adopt’ a local community (villa-
ge), identify a health problem to address and then plan
and pursue a field study. This exposure to some aspects
of community medicine as well as to a certain degree
clinical medicine enables the student to appreciate and
become aware of the potentials of primary health care.
The experience sofar has been a very positive feedback
from the students, highlighting the need for comm-
unity orientation to clinical practice.lt has demon-
strated the feasibility of integrating health care into the
undergraduate curriculum at an early stage 7.
FAMCO - THE CLINICAL CURRICULUM
During their clinical clerksip the students join
FAMCO in their 5th year for a 8 week period (junior
clerkship) and again in their 7th year (final year) for a
7 week period (senior clerkship). In the junior clerks-
hip the main emphasis is on the principles and practice
of family medicine, whereas in the senior clerkship the
focus extends more to the overall principles of primary
health care. N ow, 85-90 students rotate through
FAMCO per year, in each clerkship.
Along with their clinical clerkships the students
receive an integrated lecture and practical series cover-
ing core knowledge in the field of clinical medicine.
These are partly in a lecture format and partly in more
novel problem-oriented group tutorials. Other features
of the clinical years include an elective in which the
student travels abroad and spends 10 weeks at some
internationally recognised medical school. The ‘chart-
er class’ graduated 1993 and the fourth class is gradu-
ating 1996, numbering 60 graduates. The previous two
classes were somewhat smaller numbering around 45
each.
FAMCO runs a clinic catering for the health care
needs of the University’s employees and their families.
The clinic is fairly well equipped according to western
standards but the patient population is very heterogen-
ous reflecting the mixed ethnic background of the
employees. Affiliated with the FAMCO clinic are a
number of outlying health centres in the close vicinity
of the University whereto the students are also all-
ocated during their FAMCO clerkship. In those health
centres they are under the supervision of expatriate
doctors mainly from Egypt, India or Pakistan. These
doctors have been to some extent retrained in the
principles of family medicine by the FAMCO faculty.
In light of the highly doctor-centred health care ser-
vices provided in the many (around 45 in number)
newly established hospitals around the country as well
as the common practice among the Omani nationals of
going ‘doctor shopping’, FAMCO places great emp-
hasis on patient-centredness in its teaching. Each stu-
dent is exposed to a stay in the FAMCO health centre,
where he is supervised by a senior faculty doctor who
directs him in a patient-centred approach to all medical
problems.
During the junior clerkship each student has to
identify two patient cases to present, one orally and the
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