Site icon 99 Topics for the CCFP

Cancer

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:


New Study Note: Dementia

A new study note has been published on Dementia, contributed by Dr. Romesa Khalid, a resident in Family Medicine at McMaster University, and kindly reviewed by Dr. Fabian Schwarz. We welcome contributions from all residents and Family Physicians — if you would like to contribute to a topic, please drop us a line.

Special: A Simplified SOO Approach

To supplement Sonali and Mark's excellent talk about an approach for SOOs, I thought I would share the simplified, 3 step approach for the SOOs that I used during the examination.

There are lots of other ways to prepare for the SOOs, and this is just one more added into the fray: I would encourage you to try a few out as mental models while you're doing your practice, and use what works best for you. For myself, I found that I really can't keep that much in my head, especially when I'm nervous for an exam, and so I worked to simplify the SOO content into 3 short prompts that I could use to keep organized and make sure that I touched on all the relevant information during the exam. A PDF of the approach is included below for your use, feel free to share if you find it helpful!

3 Step Approach to the SOO


This week's links:

Kirlew Telling It Like It Is

Dr. Mike Kirlew speaking

Our very own regular co-host Dr. Michael Kirlew is much too modest to mention it himself, but here at the 99 Topics we felt like giving him a special shout-out for standing up and telling it like it is in Ottawa in front of the Indigenous Affairs Committee.

"In my 10 years, I can say that First Nations individuals who live on reserves receive a level of health care that's far inferior to what other people get, not just a little inferior, far inferior."

Keep fighting the good fight, Dr. Kirlew. To see video of him speaking before the committee, hop on over to the CBC article.

Special: Practicing for the SOOs

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, the responses should be heard and addressed if needed.
  • Abrupt, arrogant, or condescending approach does not go over well in this exam.

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:


Hypertension

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 one-page summary.


Hyperlipidemia

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:


Diabetes (Part 2)

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.


Depression

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:


Chest Pain

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.

Anaphylaxis

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.


Epistaxis

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!


Anemia

This week, we talk anemia — a fairly big topic!

As an aside, another great study resource for you: Dr. Mike Kirlew’s CCFP podcasts, from Sioux Lookout, Ontario. His lectures are focused on OSCE content rather than the 99 Topics, which I think complements this podcast nicely. I find his lecture style a bit too energetic for me, but the content is fantastic, and he has a knack for simplifying complex content.

This week's links:


Allergy

This week, we talk about allergy and anaphylaxis.

"The key to treating patients with anaphylaxis is to have a low threshold to treat. The most important point out of this whole podcast is that epinephrine, given IM at anaphylaxis doses, is essentially without serious sequelae. If you think of anaphylaxis, you should probably give it!"

This week's links:


ACLS

The second of the 99 topics, Advanced Cardiac Life Support (ACLS). A much more manageable topic this week, thank goodness!

As we're just getting started, feedback (and corrections) are greatly appreciated. Please do get in touch via email or twitter.

This week's links:


Study Resources

Here are some resources I have used and would recommend for your study for the CCFP Exam, roughly in order of how effective I feel they are:

  1. Swanson's Family Medicine Review — My favourite study resource bar none! An American textbook (although I've been told Swanson himself was Canadian) focused on the AAFP examinations, but nonetheless broad enough in scope to touch on most if not all of what we need to know for the CCFP exam.

    Why do I love it? It's case-based: it holds my attention as I work through a presenting complaint, differential, management, and then I come out on the other side knowing more about a particular condition. Highly recommended, and a good resource that can hold your attention when you're burnt out from learning "bullet point medicine".

  2. The Practice Based Small Group (PBSG) Learning Program (a.k.a. "The McMaster PBLs") — The McMaster PBLs are a good resource for the CCFP, and useful for Mainpro credit once you're out into solo practice. If your Department doesn't provide you access, then beg them to get it. The University of Saskatchewan academic half-days usually include at least one of these. Each PBL works through a topic in great detail, with 2-3 cases, questions to prompt learning, as well as thoroughly-referenced and researched explanations.

  3. Dr. Mike Kirlew’s CCFP podcasts (iTunes) — Dr. Mike Kirlew practices in Sioux Lookout, Ontario, and his lectures are mostly focused on OSCE content rather than the 99 Topics, which I think complements this podcast nicely. I find his lecture style a tad scattered, and unfortunately the lectures don't have an accompanying description at this time (to match up to particular topics), but the content is fantastic, and he has a knack for simplifying complex content. Highly recommended.

  4. The Guide to the Canadian Family Medicine Examination — Published in 2013, it was created as an initiative of the University of Saskatchewan Family Medicine Residents at the time, along with faculty support. I think this book is great, although it's getting a bit out of date. It is brief but thorough — if you read through it from cover to cover, which won't take you very long, you'll have a great idea of what you know and what you don't, and where you need to focus your studies.

  5. Family Medicine Notes by Dr. Danielle O'Toole — These are compiled study notes from Dr. Danielle O'Toole, a former Family Medicine Resident, now practicing in Academic Family Medicine at McMaster. They are updated yearly, and comprehensive in scope. These study notes are quite condensed, but fairly comprehensively cover the topics. She has sample pages available on her website — have a look and see what you think.

  6. Bates' Guide to Physical Examination and History-Taking — Last but not least, if you need to brush up on your physical examination skills, which are a core component of both the MCCQE2 and CCFP examinations (but are generally considered prior knowledge from medical school), this is the book for you. Everything you need to know, with lots of pictures.

Do you have study resources that I haven't covered here that you think are awesome? Let me know via email or Twitter.