Curriculum for General Practice - The Royal New Zealand College ...

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C Cardiovascular Cardiovascular Cardiovascular disease (CVD), defined as angina, myocardial infarction (MI), ischaemic stroke, transient ischaemic attack (TIA) and peripheral vascular disease, is responsible for over 40 percent of deaths in New Zealand. 1 Ischaemic heart disease was responsible for 131 deaths per 100,000 population in 2009, one of the highest rates in the OECD countries. 2 While there has been significant reduction in the incidence of CVD over the past several years, our aging population and increasing prevalence of risk factors, including obesity and diabetes, have kept absolute numbers high. The rate of decline in CVD in Māori has been substantially lower than in Pacific and non-Māori people, 3 and still represents a considerable discrepancy in health equity. Total cardiovascular disease mortality was two and a half times higher for Māori than for non-Māori between 2004 and 2006. 4 The prevalence of risk factors for cardiovascular disease varies by ethnicity. 5,6 There is also evidence of lower rates of interventions promoting revascularisation in Māori. 7 Screening for CVD must be started 10 years earlier in Māori patients than non-Māori, 8 and those involved must have an understanding of cultural, whānau and life view differences that will have an impact on the success of any health interventions. PHARMAC’s One Heart Many Lives programme, encouraging Māori and Pacific men to get a heart check, is one of the interventions that endeavours to address this disparity. 9 Primary prevention of CVD with education, lifestyle and pharmaceutical intervention is a major factor in preventing early death and suffering in our patients, and in reducing the costs and resources used in caring for affected people. Appropriate and timely investigation, diagnosis and management of established CVD is vital to optimising outcomes and reducing subsequent disability, and management pathways will vary with where a doctor practices. 1 http://www.heartfoundation.org.nz/know-the-facts/statistics Accessed 26/4/12 2 http://www.oecd-ilibrary.org/sites/health_glance-2011-en/01/03/index.html?contentType=/ns/Chapter,/ns/StatisticalPublication&itemId=/content/chapter/health_glance- 2011-6-en&containerItemId=/content/serial/19991312&accessItemIds=&mimeType=text/html Accessed 26/4/12 3 http://journal.nzma.org.nz/journal/117-1199/995/content.pdf Accessed 26/4/12 4 http://www.maorihealth.govt.nz/moh.nsf/indexma/cardiovascular-disease Accessed 26/4/12 5 A Portrait of Health: Key results of the 2006/07 New Zealand Health Survey http://www.health.govt.nz/publication/portrait-health-key-results-2006-07-new-zealandhealth-survey Accessed 26/4/12 6 http://www.health.govt.nz/publication/tobacco-use-new-zealand-key-findings-2009-nz-tobacco-use-survey Accessed 26/4/12 7 Ethnic and gender differences in the use of coronary artery revascularisation procedures in New Zealand http://journal.nzma.org.nz/journal/115-1152/2230/content.pdf 8 New Zealand primary care handbook 2012 http://www.health.govt.nz/publication/new-zealand-primary-care-handbook-2012 Accessed 26/4/12 9 http://www.hiirc.org.nz/page/17701/one-heart-many-lives/?tab=2614&section=8959 10 http://www.health.govt.nz/our-work/diseases-and-conditions/rheumatic-fever Accessed 26/4/12 11 http://journal.nzma.org.nz/journal/124-1329/4530/content.pdf Accessed 26/4/12 12 http://www.beehive.govt.nz/release/12m-boost-reduce-rheumatic-fever Accessed 26/4/12 42 Curriculum for General Practice
Cardiovascular C We know that after a CVD event patients are at increased risk for progressive disease so secondary prevention, using all the same interventions as above, is vital. This must not be overlooked. It does not take long in practice to realise that atrial fibrillation is extremely common and a significant risk factor for embolic stroke, so optimal management of this is very important to our patients. As our population ages, increasingly more patients present with heart failure but, fortunately, the ability to manage this more competently in the community has advanced enormously over the past few decades. Finally for this topic, acute rheumatic fever (ARF) is a disease that is endemic in some North Island areas of Aotearoa, particularly in the Northland, Counties Manukau, Hawke’s Bay and Capital and Coast District Health Board areas. 10 It is almost exclusively a disease of Māori and Pacific people, who respectively have a 23-fold and 50- fold increase in risk of ARF over all other ethnicities. 11 ARF rates in New Zealand are markedly elevated compared to other developed countries. In recognition of this, in 2011 the Government began funding a range of programmes to combat rheumatic fever. 12 Cardiovascular disease – largely preventable, diagnosable and treatable – is still a huge burden on our society and highlights inequity in Māori and Pacific health and is a central focus of general practice in New Zealand. Communication The GP will demonstrate the ability to: • communicate information about the screening process and risk factors in a relevant and clear way to patients, such that they can understand their chance of developing CVD, and how modification of risk factors will benefit them and their family/whānau • apply knowledge and confidently undertake brief intervention and motivational interviewing techniques to address modifiable lifestyle risk factors • develop a non-judgmental relationship and rapport with their patient, enhancing their ability to facilitate change, and recognise other life events and factors that may be influencing the patient’s ability to make lifestyle change • discuss pharmaceutical interventions, including benefits and side effects, for cardiovascular disease, atrial fibrillation, TIA and diabetes • confidently use consultation screening methods and tools for opportunistic screening and brief intervention • understand the need, willingness and ability to involve family/whānau when addressing risk factors in Māori patients. Specific to rural general practice The GP will demonstrate the ability to: • communicate the benefits and risks of pre-hospital thrombolysis to a patient, and the patient’s family/ whānau, experiencing an acute MI in a rural setting • communicate clearly the results of any assessments in a way that makes sense to patients, recognising their level of health literacy, and adjust explanations accordingly. • communicate the risks and benefits of staying in rural hospital versus transfer to a base hospital to an elderly patient, and the patient’s family/whānau, experiencing a stroke in a rural setting www.rnzcgp.org.nz Curriculum for General Practice 43
Page 1 and 2: Curriculum for General Practice www
Page 3 and 4: Mihi E ngā mana, e ngā reo, e ng
Page 5 and 6: Acknowledgements Acknowledgements A
Page 7 and 8: Overarching Curriculum Curriculum S
Page 9 and 10: Part 2 - General practice in New Ze
Page 11 and 12: Improving Māori access to primary
Page 13 and 14: Part 4 - Delivering the curriculum
Page 15 and 16: Part 5 - Curriculum domains Part 5
Page 17 and 18: Core competencies Fellows of The Ro
Page 23 and 24: Further competencies As further exp
Page 29 and 30: Curriculum statements Curriculum st
Page 31 and 32: Acute Care A Communication The GP w
Page 33 and 34: Acute Care A Clinical Expertise Neu
Page 35 and 36: Acute Care A Management The GP will
Page 37 and 38: Addictions A Communication The GP w
Page 39 and 40: Addictions A Management The GP will
Page 41 and 42: Adolescent/Rangatahi/Youth Health A
Page 43: Adolescent/Rangatahi/Youth Health A
Page 47 and 48: Cardiovascular C Specific to rural
Page 49 and 50: Dermatology D Dermatology The skin
Page 51 and 52: Dermatology D Professionalism The G
Page 53 and 54: e-health E e-health The World Healt
Page 55 and 56: e-health E Professionalism The GP w
Page 57 and 58: End-of-life Care E End-of-life Care
Page 59 and 60: End-of-life Care E Clinical Experti
Page 61 and 62: Endocrinology E Endocrinology A wid
Page 63 and 64: Endocrinology E Clinical Expertise
Page 65 and 66: Ear, Nose and Throat E Ear, Nose an
Page 67 and 68: Ear, Nose and Throat E Professional
Page 69 and 70: Eyes E Communication The GP will de
Page 71 and 72: Family Violence F Family Violence F
Page 73 and 74: Family Violence F Professionalism T
Page 75 and 76: Gastroenterology G Gastroenterology
Page 77 and 78: Gastroenterology G Professionalism
Page 79 and 80: Genetics G Genetics With the mappin
Page 81 and 82: Genetics G Professionalism The GP w
Page 83 and 84: Health and Work H Inequality persis
Page 85 and 86: Health and Work H Scholarship The G
Page 87 and 88: Long-term Conditions L Long-term Co
Page 89 and 90: Long-term Conditions L Clinical Exp
Page 91 and 92: Māori Health M Māori Health The T
Page 93 and 94: Māori Health M Clinical Expertise
Page 95 and 96:
Māori Health M Context of General
Page 97 and 98:
Men’s Health M However, in the sa
Page 99 and 100:
Mental Health M Mental Health In 20
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Mental Health M The following subto
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Mental Health M Professionalism The
Page 105 and 106:
Musculoskeletal M Musculoskeletal M
Page 107 and 108:
Musculoskeletal M Professionalism T
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Neurology N Neurology Neurological
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Neurology N Professionalism The GP
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Older People O Older People General
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Older People O Professionalism The
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Oncology O Oncology Cancer is one o
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Oncology O Professionalism The GP w
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Paediatrics and Immunisations P Pae
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Paediatrics and Immunisations P Com
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Paediatrics and Immunisations P Man
Page 127 and 128:
Population and Public Health P Comm
Page 129 and 130:
Population and Public Health P Mana
Page 131 and 132:
Renal and Urology R Communication T
Page 133 and 134:
Respiratory Medicine R Respiratory
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Respiratory Medicine R Clinical Exp
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Rheumatology R Rheumatology Rheumat
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Rheumatology R Professionalism The
Page 141 and 142:
Rural R Many rural general practiti
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Rural R Professionalism The GP will
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Sexual Health S Sexual Health ‘Se
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Sexual Health S Clinical Expertise
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Travel Medicine T Travel Medicine N
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Travel Medicine T Scholarship The G
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Women’s Health W Before 2007, gen
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Women’s Health W Context of Gener
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