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Health Regulation Department

Scope of Practice for


Specialist Family Medicine

Introduction
Health Regulation department (HRD) is responsible for regulating medical practice in the
Emirate of Dubai, United Arab Emirates. Scope of Practice (SOP) refers to the activities that
licensed Medical Doctors are educated, authorized and competent to perform as well as their
decision making capacity. Such activities are established through the legislated definition of
licensed medical practice, complemented by standards, limits, conditions and education and
influenced by setting, environment and health needs of the population.
This document is the result of a collaborative effort from specialists in family medicine,
regulatory, legal experts and others from within both the public and private health care sectors
of Dubai, which has provided a broad and enabling framework which supports Medical Doctors
to make decisions about and within their scope of practice. The framework has been rigorously
benchmarked against international best practice and provides mechanisms to ensure that
specialist family medicine practitioners are competent and fit to practice their profession.
The scope of practice for the specialist in family medicine is determined by the scope of human
needs. There are, however, predictable points in the life cycle of the individual and family
where the Medical Doctor fits uniquely into the experience of health and illness. These nodal
points include pregnancy and childbirth, the newborn child, life-threatening and life-altering
illness, loss and grief, and care at the end of life.
The scope of practice for the specialist in family medicine is endorsed by HRD and should be
read in conjunction with HRD Code of Conduct for Physicians.
The American Academy of Family Physician (AAFP) defines the SPECIALIST Family
Medicine as: a physician who is educated and trained in family practice, a broadly
encompassing medical specialty. SPECIALIST Family Medicine possess unique attitudes,
skills, and knowledge which qualifies them to provide continuing and comprehensive medical
care, health maintenance, and preventive services to each member of the family regardless of
sex, age, or type of problem, be it biological, behavioral or social. The family physician, is the
best qualified to serve as the patients advocate in all health related matters, including the
appropriate use of consultant, health services and community resources.
The SPECIALIST Family Medicine must::

Provide primary, comprehensive and continuous health services to individuals, families


and communities
Provide cost effective preventive, promotive, curative and rehabilitative health services to
individuals, families and communities
Participate in improving practice management, quality of care and professional
development activities
Participate in implementing evidence based practice guidelines, audit and continuous
medical education programs

Competency Standards
This document sets out the scope of practice for Specialists in Family Medicine (SFM). SFM
have obtained a postgraduate qualification which entitles them tom practice Family Medicine
in the country of education. This additional qualification further entitles to practice as SFM in
the emirate of Dubai, United Arab Emirates.
It is recognized that the role and responsibilities of the Specialist Family Medicine are broad
and complex. The following sets out the competency framework within which Specialist in
Family Medicine must be judgment-safe and competent. The indicators are neither
comprehensive nor exhaustive but rather provide examples of evidence of competence.
The following competency framework for the SFM has been organized into seven (7)
domains of competence

Medical Expert
Communicator
Collaborator
Manager
Health Advocate
Professional Development
Professional

Domain 1 Medical Expert: A specialist Family Medicine (SFM) is a general family doctor who
integrates all roles to provide optimal, ethical and patient centered care. SFM is mandated to ensure
primary care which is comprehensive, preventive, and continuous and community based care.
Competency 1.1 Specialists in Family Medicine possess a defined body of knowledge and procedural
skills, which are used to collect and interpret data, make appropriate clinical decisions, and carry out
diagnostic and therapeutic procedures within the boundaries of their discipline and expertise. Their
care is characterized by up-to-date, ethical, and cost-effective clinical practice and effective
communication in partnership with patients, other health care providers, and the community. Such
fields require from SFMs to attain sufficient knowledge, diagnostic expertise, judgment and skills in
performing techniques and procedures to manage patients.
Indicator
1.1.1 Demonstrate
diagnostic and
therapeutic skills for
effective patient care by
using evidence based
medical practices

1.1.2 Access and apply


relevant information to
clinical practice

1.1.3 Demonstrate
effective referral
services with respect to
patient care and
education.

Sub Indicator
1.1.1.1 Select medically appropriate investigative tools, interpret the
results of common diagnostic tests and demonstrate an
understanding of their cost effectiveness, limitations and
complications
1.1.1.2 Formulate a comprehensive patient problem list, synthesize
an effective diagnostic and therapeutic plan and establish
appropriate follow up
1.1.1.3 Generate a rational plan of diagnostic and therapeutic
measures with use of information on cost benefit ratio
1.1.2.1 Elicit, present, and document a history that is relevant,
concise, accurate and appropriate to the patient's problems
1.1.2.2 Perform, interpret the findings of present and document a
physical examination that is relevant and appropriate
1.1.2.3 Retrieve, critically appraise and apply relevant information to
clinical practice
1.1.2.4 Knowledge of normal body structure and function as
expressed in a bio psychosocial model of human
development
1.1.2.5 Knowledge of disturbed body structure and function
1.1.2.6 Be able to assess, diagnose, and manage patients with
common and uncommon diseases in the appropriate
setting.
1.1.2.7 Demonstrate an understanding of basic pharmacology
and its application to clinical practice
1.1.2.8 Appropriate application of knowledge derived from critical
appraisal of the literature
1.1.3.1 Demonstrate effective referral services in presenting welldocumented assessments and recommendations in written
and/or verbal form
1.1.3.2 Demonstrate knowledge of promotion, maintenance of
optimal functioning in biological and psychological aspects
1.1.3.3 Establish a professional relationship and interact with the
patient and parent, guardian or other caregivers in order to
obtain a history, conduct a physical examination and provide
ongoing care
1.1.3.4 Establish an atmosphere of open communication
appropriate to the situation and convey interest, sensitivity,
empathy and support
1.1.3.5 Recognize personal limitations and demonstrate a
willingness to call upon others with special expertise and

1.1.4 Demonstrate an
understanding of
medico-legal issues

make referrals where appropriate


1.1.4.1 Demonstrate an understanding of the epidemiology of such
conditions
1.1.4.2 Demonstrate sensitivity to the patient's needs, modified
according to the patient's age, gender and problem, and
record this information by regions or systems
1.1.4.3 Demonstrate the ability to correlate, evaluate, prioritise and
synthesise information, including the relevant ethical issues
1.1.4.4 Maintain confidential information as appropriate

Domain 2 Communicator: To provide humane, high-quality care, Family Medicine Specialists


establish effective relationships with patients, other physicians, and other health professionals.
Communication skills are essential to work as SFM and are necessary for obtaining information and
conveying information to patients and their families. Furthermore, these abilities are critical in eliciting
patients' beliefs, concerns, and expectations about their illnesses, and for assessing key factors
impacting on patients' health.
Competency 2.1 Specialist Family Medicine enables patient-centered therapeutic communication
through shared decision-making and effective dynamic interactions with patients, families, caregivers,
other professionals, and important other individuals. The competencies are essential for establishing
rapport and trust, formulating a diagnosis, delivering information, striving for mutual understanding,
and facilitating a shared plan of care. Poor communication can lead to undesired outcomes, and
effective communication is critical for optimal patient outcomes. SFM is also responsible to
communicate effectively to the public or media about medical issues whenever appropriate.
Indicator
2.1.1 Establish
therapeutic
relationships with
patients/families

2.1.2 Obtain and


synthesize relevant
history from
patients/families/
communities

2.1.3 Listen effectively

Sub Indicator
2.1.1.1 Recognize that being a good communicator is an essential
function of a SFM and understand that effective doctorpatient communication can foster patient satisfaction and
compliance as well as influence the manifestations and
outcome of a patient's illness
2.1.1.2 Establish relationships with the patient characterized
by understanding, trust, respect, empathy & confidentiality
2.1.1.3 Demonstrate caring and empathy for patients and their
families, & especially for those individuals who are
vulnerable
2.1.1.4 Develop strategies for managing challenging communication
issues such as obtaining informed consent, delivering bad
news, identifying situations which could lead to angry
exchanges, confusion or misunderstandings.
2.1.2.1 Interact with community care-givers and other health
resources to obtain and synthesize relevant information
about the patient
2.1.2.2 Gather information not only about the disease but also
about the patient's beliefs, concerns and expectations
about the illness, while considering the influence of factors
such as the patient's age, gender, ethnic, cultural and
socioeconomic background, & spiritual values on that illness
2.1.2.3 Provide close attention to the impact of factors such as age,
gender, disability, ethno-cultural background, social support,
and emotional influences on a patient's illness
2.1.3.1 Understand and demonstrate the importance of cooperation
and communication among health professionals involved in
the care of individual patients such that their roles are

delineated and consistent messages are delivered to


patients and their families.
2.1.3.2 SFM demonstrates respect for individual patients, families,
colleagues and for their value systems
2.1.4.1 Deliver information to the patient and family in a humane
2.1.4 Discuss
manner and in such a way that it is understandable,
appropriate information
encourages discussion and promotes the patient's
with patients/families
participation in decision-making to a degree that is
and the health care
compatible with current surgical practice
team
2.1.4.2 Demonstrate skills in providing clear, concise and timely
verbal and written communication as applied to consultation
notes, sign over of patient care and management plans;
communication with patients and families regarding
informed consent, the medical condition, plan of treatment,
prognosis, primary and secondary prevention, adverse
events, medical uncertainty, & medical errors; and
communication with other health care professionals
regarding all aspects of patient care
2.1.4.3 Educate patients, families and health care professionals in
formal and informal educational settings
2.1.4.4 Develop a discharge plan for hospitalized patients and
learn to involve home care facility and other care-givers in
the development of long-term community health planning.
2.1.4.4 Present the patient's problem(s) clearly, concisely and
correctly, in the following ways:
2.1.4.4.1 verbally, in the clinical setting or formal
presentation
2.1.4.4.2 in a written medical record (in standard/
problem oriented form) or consultation report
2.1.4.5 SFMs demonstrate an ability to support and counsel
patients/families with chronic illness and/or impending death
and provide bereavement counselling
Domain 3 Collaborator: As Collaborators, Specialist Family Medicine effectively works within a
healthcare team to achieve optimal patient care.
Competency 3.1 A Specialist in Family Medicine works in partnership with others who are
appropriately involved in the care of individuals or specific groups of patients. It is therefore essential
for them to be able to collaborate effectively with patients and a multidisciplinary team of expert health
professionals for provision of optimal patient care, education, and research.
Indicator
3.1.1 Consult
effectively with other
specialists
and health care
professionals

3.1.2 Contribute
effectively to other
interdisciplinary team

Sub Indicator
3.1.1.1 Develop an ability to work effectively and harmoniously with
other health care workers
3.1.1.2 Participate in the interdisciplinary team meeting,
demonstrating the ability to accept, consider and respect the
opinions of other team members, while contributing
specialty-specific expertise
3.1.1.3 Function competently in the initial management of
conditions that, in major centres, fall within the Family
Medicine Specialty.
3.1.2.1 Identify and describe the role, expertise and limitations of all
members of an interdisciplinary team required to optimally
achieve a goal related to patient care, a research problem,

activities

an educational task, or an administrative responsibility


3.1.2.2 Develop a care plan for a patient they have assessed,
including investigation, treatment and continuity of care, in
collaboration with members of the interdisciplinary team, the
patient and the family
3.1.2.3 Effectively communicate with the members of an
interdisciplinary team in the resolution of conflict, provision
of feedback, and where appropriate, be able to assume a
leadership role

Domain 4 Manager: As Manager, Specialists in Family Medicine are integral participants in


healthcare organizations, organizing sustainable practices, making decisions about allocating resources,
and contributing to the effectiveness of the healthcare system.
Competency 4.1 Specialists in Family Medicine function as managers when they make everyday
practice decisions involving resources, co-workers, tasks, policies, and their personal lives. They do
this in the settings of individual patient care, practice organizations, and in the broader context of the
health care system. They also take roles of leadership within the context of professional organizations
and the health care system.
Indicator
4.1.1 Utilize resources
effectively to balance
patient care, learning
needs, and outside
activities

4.1.2 Allocate finite


health care resources
wisely

4.1.3 Work effectively


and efficiently in a
health care organization

Sub Indicator
4.1.1.1 Recognizes the structure, resourcing, and operation of the
Dubai health care system, and function effectively within it,
as well as being capable of playing an active role in its
evolution
4.1.1.2 Understand knowledge of the definitions and role of audits,
quality improvement, risk management, occurrence /
incident reporting, and complaint management in a hospital
and ambulatory setting
4.1.1.3 Utilize appropriate time management for effective patient
care, administrative duties and continuous professional
development activities.
4.1.1.4 Understand population-based approaches to health care
services and recognize their implication for medical practice
4.1.2.1 Utilize resources to effectively balance patient care and health care
economics
4.1.2.2 Understand the interplay between governments & the health care
sector in allocating finite health care resources
4.1.2.3 Recognize the business and financial skills needed for a successful
medical practice and/or academic career.
Understand the advantages, disadvantages and relative costs of
preventive and therapeutic health care programs
4.1.2.4 Understand the advantages, disadvantages and relative costs of care
in different settings, including an appreciation of the various
forms of health care provision, including hospitals, ambulatory
clinics, home care, chronic care and rehabilitation facilities as
they relate to quality assurance
4.1.2.5 Avoid unnecessary investigation and/or hospitalization
4.1.3.1 Understand how to function effectively in health care
organizations, ranging from individual clinical practice to local,
regional and national associations
4.1.3.2 Demonstrate an awareness of the need to continually balance
professional, personal, institutional and social commitments
4.1.3.3 Work to develop effective and efficient patient management

4.1.4 Utilize
information technology
appropriately to
optimize patient care

strategies by avoiding duplication of services, involving other


caregivers and obtaining appropriate patient information from
other health care sources
4.1.3.4 Demonstrate conflict resolution skills and make clinical
decisions and judgments based on evidence based for the
benefit of individual patients and the population served
4.1.3.5 Delegate responsibility effectively to junior staff
4.1.4.1 Utilize appropriate use of information technology.
Understand population-based approaches to health care and their
implication for medical practice and prioritization to access for
services
4.1.4.2 Acquire the ability to access and apply a broad base of information
to the care of ambulatory patients, and those in hospitals and
other health care settings

Domain 5 Health Advocate: Specialists in Family Medicine must use their expertise and influence to
advance the health and well-being of individual patients, families, communities, and populations.
Competency 5.1 Specialists in Family Medicine recognize the importance of advocacy activities in
responding to the challenges represented by those social, environmental, and biological factors that
determine the health of patients and society. They recognize advocacy as an essential and fundamental
component of health promotion that occurs at the level of the individual patient, the practice
population, and the broader community.
Indicator
5.1.1 Identify the
important determinants
of health affecting
patients

5.1.2 Contribute
effectively to improved
health of patients and
communities

5.1.3 Recognize and


respond to those issues
where advocacy is
appropriate

Sub Indicator
5.1.1.1 Demonstrate an appreciation of health care needs.
Appreciate the existence of global health advocacy and initiatives
for elimination of poverty and disease (e.g. tuberculosis, malaria,
Acquired Immune Deficiency Syndrome)
5.1.1.2 Recognize, assess, and respond to the psychosocial, economic,
societal and biologic factors influencing the status of health
5.1.2.1 Encourage promotion of active family involvement in
decision-making & continuing patients management
5.1.2.2 Adapt management accordingly and assess the patient's ability to
access various services in the health and social system
5.1.2.3 Demonstrate the ability to contribute effectively to improved
health of patients and communities
5.1.3.1 Apply the principles of quality improvement and quality
assurance, to promote equitable health care
5.1.3.2 Educate patients and families about and promote the importance of
long-term healthy behaviours and preventive health care (e.g.
smoking cessation, screening tests, vaccinations, exercise, and
nutrition)
5.1.3.3 Be familiar with the underlying research evidence and apply this
understanding to common problems and conditions of such
specialty
5.1.3.4 Respect and empower patient autonomy
5.1.3.5 Work collaboratively with other specialty and identify current "at
risk" groups and application of available knowledge regarding
prevention to "at risk" groups
5.1.3.6 Intercede on behalf of their patients as the patient weaves his/her
way through complex health care institutions and services

Domain 6 Professional Development: This domain assumes primary responsibility for maintaining
competence and fitness to practice as a Specialist in Family Medicine (self regulation). It includes a
commitment of life long learning, as well as the creation, dissemination, application and translation of
medical knowledge.
Competency 6.1 Specialists in Family Medicine engage in a lifelong pursuit of mastery of their
domain of professional expertise. They recognize the need for continuous professional development
(CPD) activities and set example for others. Through CPD activities, they contribute to the appraisal,
collection, and understanding of health care knowledge, and facilitate the education of their, patients,
students and others.
Indicator
6.1.1 Develop,
implement and monitor
a personal continuing
professional
development strategy

6.1.2 Facilitate learning


of patients, residents/
students and other
health professionals

6.1.3 Contribute to
development of new
knowledge

Sub Indicator
6.1.1.1 Recognize the importance of self-assessment of
professional competence and acceptance of the
responsibility for self-directed learning as a life long goal, to
develop, implement and monitor a personal CPD strategy
6.1.1.2 Identify clinical problems and practice areas for research
6.1.1.3 Recognize and identify gaps in knowledge and expertise
6.1.1.4 Monitor the outcome of professional development
6.1.2.1 Demonstrate the ability to teach medical students, residents,
patients, colleagues and other health care professionals
6.1.2.2 Demonstrate an understanding of, and the ability to apply
the principles of adult learning, with respect to oneself and
others
6.1.2.3 Demonstrate an understanding of preferred learning
methods in dealing with students, residents, and colleagues
6.1.2.4 Facilitate teaching of patients about their health problems
directly or through the involvement of other professionals
6.1.3.1 Specialists in Family Medicine will maintain a questioning
and inquisitive attitude towards medical information and an
appreciation of the necessity for ongoing research to
develop new knowledge
6.1.3.2 Attend academic day to develop learning skills in evidencebased medicine, medical ethics, physical examination skills,
acquisition of medical knowledge, etc.
6.1.3.3 Attend other available rounds to enhance learning

Domain 7 Professional: As a Professional, Specialist in Family Medicine is committed to the health


and well-being of individuals and society through ethical practice, profession-led regulation, and high
personal standards of behavior.
Competency 7.1 Specialists in Family Medicine have unique societal role with a distinct body of
knowledge, skills, and attitudes dedicated to improving the health and well being of others. They are
also committed to the highest standards of excellence in clinical care and ethical conduct, and to
continually perfecting mastery of their discipline.
Indicator
7.1.1 Deliver highest
quality care with
integrity, honesty and
compassion

Sub Indicator
7.1.1.1 Display attitudes commonly accepted as essential to
professionalism.
7.1.1.2 Evaluate one's abilities, knowledge and skills, recognize one's
limitations and use appropriate strategies to maintain and advance
professional competence
7.1.1.3 Acquire the training and experience to maintain competence as a
Specialist in Family Medicine.

7.1.2 Exhibit
appropriate personal
and interpersonal
professional behaviours

7.1.3 Practice as
specialist ethically with
consistency

7.1.2.1 Strive to heighten personal and professional awareness and


explore and resolve interpersonal difficulties in professional
relationships
7.1.2.2 Strive to balance personal and professional roles and
responsibilities
7.1.2.3 Demonstrate ways of attempting to resolve conflict and role strain
7.1.2.4 Demonstrate a willingness to accept peer and supervisor reviews
of professional competence
7.1.3.1 Know and understand the professional, legal and ethical codes to
practice
7.1.3.2 Recognize, analyze and attempt to resolve in clinical practice
ethical issues such as truth telling, consent, advanced directives,
confidentiality, end-of-life care, conflict of interest, resource
allocation, research ethics, interactions with the pharmaceutical
industry
7.1.3.3 Understand and apply relevant legislation that relates to the health
care system in order to guide one's clinical practice
7.1.3.4 Recognize and know how to deal with unprofessional behaviours
in medical practice, taking into account local and provincial
regulations
7.1.3.5 Know the basics of the principles of medical ethics including:
"best interest" of the child, autonomy, beneficence and nonmalfeasance, confidentiality, truth-telling, justice, respect for
persons, conflict of interest, advanced directives and end-of-life
care, and resource allocation
7.1.3.6 Know and be able to obtain informed consent
7.1.3.7 Know the ethical decision-making process and legal and
ethical codes of professional behaviour
7.1.3.8 Demonstrate tolerance for ambiguity and uncertainty & the
possibility of error in ethical decision-making; flexibility
& willingness to adjust appropriately to changing
circumstances

APPENDIX 1
PRIMARY CARE SERVICES
General Health Services Across the Life Span
1. The provision of continuity of care: the Doctor Patient Relationship.
2. The appropriate assessment and management of all acute physical or psychological
symptoms.
3. The management of chronic diseases: heart disease, diabetes, asthma, COPD,
epilepsy, Thalassaemia, sickle cell, G6PD Deficiency.
4. Screening for cancers: breast, cervical, bowel, prostate.
5. Screening for chronic diseases for example - diabetes, hypertension, G6PD,
dysliepedemia.
6. Health Education and Health Promotion. (the science and art of helping people
change their lifestyle to move toward a state of optimal health)
7. Provision of all adult vaccinations.
8. The assessment and management of Mental Health Disorders.
9. Continual liaison with other medical Professionals.
10. A Family Medicine Specialist with a Special Interest and relevant further
qualifications may also be involved in the delivery of more specialist medical care,
for example Care of the Elderly, Pain Management, Sports, Sleep and Hospice
Medicine.

Childs Health services


1. Assess, identify, treat and refer appropriately newborns with Infections or congenital
abnormalities
2. Screen for congenital diseases in new born
3. Monitoring of growth, nutrition assessment and development during regular pediatric
wellness visits
4. Administer/ provide immunizations in accordance with most current guidelines
5. Assess and treat common childhood illness e.g. acute respiratory infection, otitis
media, skin rashes
6. Screen for chronic diseases and make appropriate referrals

Women's Health Services


1. Antenatal Care
Antenatal clinic booking
Referral of high risk pregnancy to Obs/Gyn physician
Initial antenatal investigations
Monitoring fetal growth and wellbeing
Provide anti-D for Rh negative mothers
Vaginal screening for group B beta haemolytic streptococcus
Education of nutrition and breast feeding

10

Supplementation of vitamins/folic acid

2. Delivery Care
Referral of pregnancies to hospital for delivery
3. Cancer Screening
Breast
Breast assessment - Mammography for those 40-69 years every 1 - 2 yearly
Referral of suspected cases
Cervix
Cervix assessment - Pap smear for those women within 3 years of onset of
sexual activity or age 21 then every 3 years
Referral of suspected cases

A Specialist in Family medicine should be competent to use the followings


appropriately:
1. Laboratory tests:
Hematological test:
Microbiological test
Biochemical test
Serological and viralogical test:
All other diagnostic tests
2. Radio Diagnostic Services:
X-ray, Ultrasound, MRI and CT scan.
3. Therapeutic and relevant Equipment:
Nebulizer and Oxygen Therapy
Suction therapy and ear wash
Defibrillation therapy
Nasogastric intubation and Urinary catheterization
Expression of breast milk
Stitching and ENT packs
4. Other services:
ECG, Fluorescein eye stain, and PE FR
Fundoscopy, Proctoscopy, etc.

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References
1. Royal College of Physician and Surgeon of Canada, Can MEDS 2005 framework,
http://meds.queensu.ca/medicine/obgyn/pdf/CanMEDS_2005_Framework.pdf
2. Department of Health and Medical Services, Dubai (2007); Dubai Residency
Program.
3. Department of health and medical services, Dubai, UAE: Job description card of
General Practitioner.
4. Department of Health and Medical Services, Dubai (2007); Senior House Officer Job
Description.
5. Victoria, Queensland, Australia: World Organization of National Colleges,
Academies, and Academic Associations of General Practitioners/ Family physicians
(1991); WONCA: the role of the general practitioner/ family physician in health care
systems.
6. General Medical Council (1999): Management in health care: the role of doctors.
7. Good Medical Practice. RCGP Curriculum Statement 1 (2005); Being a General
Practitioner,
8. Dubai Health Authority (2008); Scope of Practice for Registered Nurse.
9.

Web definition for Medical Doctor; http://en.wikipedia.org/wiki/Medical_doctor,


accessed on 28/03/2010.