PAFP INTERIM GUIDELINES FOR

FAMILY AND COMMUNITY MEDICINE RESIDENCY TRAINING PROGRAMS

AMID COVID 19 MEDICAL CRISIS

As the COVID-19 pandemic continues to evolve, the PAFP Residency Committee continues to
monitor and assess this current situation and how it affects the implementation of the activities of
the different training programs across the country. Most of the Family and Community Medicine
Departments of both government and private health institutions are at the forefront of the different
levels of care for both COVID 19 and Non-COVID 19 patients. We have taken note of how different
points of care were disrupted and restructured to the evolving needs of the COVID situation and
how difficult it is now for our patients and their families to navigate through the changes in health
care delivery system. We understand the extraordinary circumstances, the different situations and
capacities of our training institutions and training faculty.

The spirit of this interim guidelines is for programs to exercise flexibility, compassion and
understanding to residents who are already burdened with providing care for the patients and
their own families as well. However, as we have committed to train them to be Family Physicians
when they entered residency training, we want to continue to provide them with continuous
learning opportunities, especially for Family Medicine Principles and Community Oriented Primary
Care, which are both core foundation courses in our Training Curriculum.

At present, many hospital/facility-based and community activities are scaled down in different
institutions in order to prioritize the pressing need for manpower in COVID areas. Most face-to-
face activities have been suspended in accordance with the implementing rules and regulations
of Community Quarantine to contain transmission of the infection. This includes individual and
family continuity of care, family meetings, home visits, community visits and community
assemblies. Due to the dynamic nature of the current situation, we recommend continuing
suspension of teaching learning activities that involve face to face encounters as previously
stated.

DATE OF EFFECTIVITY – January 1, 2020 to February 28, 2021

I. GENERAL GUIDELINES
To guide our Training Officers, we are recommending the following steps in transitioning the
rollout of their teaching-learning activities to a format that can adapt to the current situation.

Review the Training Curriculum and the Instructional Design and determine which of the
core learning outcomes should be delivered.
a. Didactic Session. Use blended learning in your training programs. The PAFP
Primary Care training application (using MSD meetings) needs to be used as basic
resource for training particularly for quarterly examinations, self-assessment, in-
service examinations, online webinars for the foundation courses and PAFP
Residency Committee advisories for trainees and faculty. Use of available online
learning through platforms whichever is accessible to training programs such as
 PAFP INTERIM GUIDELINES FOR
FAMILY AND COMMUNITY MEDICINE RESIDENCY TRAINING PROGRAMS
AMID COVID 19 MEDICAL CRISIS

Google Classroom, Microsoft Teams or if synchronous learning can be done via

Zoom or Google hangouts.

b. Variety of cases and census requirement. The variety as well as number cases
can be reduced to what is available in the training institutions:

Clinical cases:
First year – 50%
Second year – 60%
Final year – 75%
Families handled
At least 15 families managed at the end of training.

Bridging program for skills acquisition (especially for the graduating residents)
such as in the field of Surgery and Obstetrics and Gynecology, etc will be designed
by the PAFP Residency Committee.

c. Rotations and foundation courses. Due to limitations in the outpatient clinics

and community visits across training institutions, the following can be explored to
provide practical learning opportunities for trainees:
1. If face-to-face consultation is feasible, the training programs are highly
encouraged to get support from administrators to provide the following to their
trainees:
1) Adequate physical protection when seeing COVID patients, whether
positive, probable or suspect.
2) Provide essential needs for food, lodging and financial assistance if
necessary.
3) Conduct de-briefing sessions through the mentoring program of the
Department.

For institutions with telehealth capacities: online interactions with patients and their
families. Ensure that trainees observe strict confidentiality, data privacy and ethical
considerations in using online platforms.

2. For families with internet access: online family meetings through platforms
familiar to both the trainee and the family
3. Explore the different stakeholders in the training institution where COPC may
be implemented: medical students, fellow health workers, paramedical
personnel, non-COVID 19 patient groups (ex. dialysis patients, cancer
patients), non-clinical personnel. COVID-related public health concerns and
possible interventions may be also explored in these population groups.
4. Explore the possible online data gathering for COPC activities. Trainees may
need to be provided with training on Google forms, Survey monkey and other
platforms.
 PAFP INTERIM GUIDELINES FOR
FAMILY AND COMMUNITY MEDICINE RESIDENCY TRAINING PROGRAMS
AMID COVID 19 MEDICAL CRISIS

d. Case Presentations.
1. For first year residents, focus presentations on patient-centered care. For
family-focused and community-oriented care, determine the need if learning
outcomes should be delivered at this point or can be delivered later, when the
situation is more stable.
2. For senior residents, they are expected to start initial work on their Family
Case Presentation and Community Oriented Primary Care. They should be
provided with opportunities where they could apply the principles.

e. Portfolio. Contents of portfolio can be limited to residents’ reflections of significant

experiences during training, mentoring sessions and case and procedural logs.
However, trainees can still built-up their portfolio to include others indicated in the
previously issued guidelines.

II. EXAMINATIONS
In support to the plight of the training programs, the minimum learning assessments will be the
self-assessment test, quarterly examinations and in-service examinations using the PAFP
Primary Care Training App. The MPL that will be set for these examinations will be set by the
PAFP Residency Committee, but the training programs are given the discretion to set their own
MPL as deemed appropriate.

III. RESEARCH
Based from the October 2019 National Board Meeting, the research requirements for residency
training will include any of the following types of research:
a. Descriptive study (case study, naturalistic observation, survey)
b. Correlational (case-control study, observational study)
c. Experimental (filed experiment, controlled experiment, quasi-experiment)
d. Systematic review
e. Meta-analysis
For those residents graduating in 2020 and probably up to first quarter of 2021, the following are
their options:
Option 1: Join any national research projects spearheaded by the PAFP National
Committees, as such the resident’s participation shall follow the guidelines set by the
PAFP Research Committee.

Option 2: Group research output that is completed and publishable. Active participation
each resident needs to be ensured and vetted by the Department’s research coordinator
and the training officer.
 PAFP INTERIM GUIDELINES FOR
FAMILY AND COMMUNITY MEDICINE RESIDENCY TRAINING PROGRAMS
AMID COVID 19 MEDICAL CRISIS

Option 3: Completed individual research output that does not necessarily involve patient
interaction and full-scale ERB (expedited or exempted according to institutional
requirements).
a. Exempted from review (for negligible risk protocols).
1) Research about public behavior (voting trends, opinion surveys, etc)
2) Evaluation of programs (internal or external to the institution)
3) Quality control studies
4) Standard educational tests & curriculum development
5) Surveillance functions the organization/institution
6) Historical & cultural events
7) Research involving large statistical data without identifiers
8) Research not involving humans or human data
b. Expedited review (for minimal/low risk health research that requires personal
information)
1) About a topic that should result in causing social stigma
2) Does not involve vulnerable populations
3) Retrospective studies using anonymized data from medical records
4) Studies using simple questionnaires without identifiers
5) Laboratory research that uses anonymized human tissue/specimen

IV. ACCREDITATION
The onsite accreditation visits will be suspended. The Sub-committee on Accreditation will issue
revisions of the guidelines based on the scenarios brought by COVID 19 crisis as we move
forward. The training programs due for accreditation for 2020 need to follow these guidelines:
a. Initial evaluation of the training program implementation will be done using desk
review by assigned accreditation team based on the following reportorial
requirements:
1) Self-assessment using the updated accreditation tool
2) Annual reports that reflects the quality of training implemented
3) Updated training manual
b. Virtual assessment using online platforms shall be done for training programs
needing validation of findings from the desk review.
c. Previous accreditation level will be valid for another year until onsite visit is
feasible except for those programs accessed as Level 3 which can be afforded
validity of 4 years.
d. Application for new programs shall follow the same process. Documentary
requirements include the following:
1) Letter of intention addressed to the President through the Residency
Committee Chair
2) Training manual that reflects the intended quality of training to be
implemented
3) Manual/booklet of facilities and resources that are present to support
the training program.
 PAFP INTERIM GUIDELINES FOR
FAMILY AND COMMUNITY MEDICINE RESIDENCY TRAINING PROGRAMS
AMID COVID 19 MEDICAL CRISIS

e. Pro-rated discounted rate as approved by the board shall be enforced.

1) Program for re-visit after 6 months – waived
2) New program – P3,000
3) Level 1 & Level 2 – P5,000
4) Level 3 – P8,000

V. FACULTY DEVELOPMENT
The committee will collaborate with the Foundation for Family Medicine Educators, Inc in
providing sessions necessary for the cope with skills in developing blended learning strategies.
1. Google classroom and other google utilities
2. Microsoft teams
3. Telemedicine: teaching and evaluation
4. Others

The Residency Committee will continuously monitor status of the medical crisis and shall issue
advisories to assist training programs in providing required standards of residency training amidst
the challenges posed.

Based from Consensus Meeting

Residency Committee Members
May 4, 2020