Developing learning objectives in postgraduate medical education for family medicine (Tunisia).


Asma Belguith Sriha
Rim Klii
Hela Abroug
Walid Bouali
Jihen Chelly
Sondes Arfa
Chokri Chouchen
Mehdi Hasnaoui
Imen Chaabane
Yosra Soua
Soumaya Bouchareb
Mohamed Amine Mosrati
Maroua Bousaid
Nader Slama
Rania Kaddoussi
Hassen Ibn Hadj Amor
Maher Tka
Hajer Ben Brahim
Afifa Abdelkefi
Olfa Harzallah
Sourour Ncibi
Samia Grira
Jnaina Kooli
Mouna Ouaz
Maha Ben Mansour
Sonia Zaied
Mejdi Ben Massoud
Ikram Chamtouri
Tarak Kellil
Mohamed Ben Khalifa
Ghassen Belkahla
Nabil Dammak
Hazem Ben Ghozlen
Rachida Laamiri
Aymen Manser
Yassine Binous
Fadia Boubaker
Wafa Ben Alaya
Bilel Ben Amor
Arwa Gueddiche
Mohamed Hichem Loghmari
Haifa Bouchahda
Khouloud Marzouk
Wafa Marrakchi
Adel Sekma
Sarra Sassi
Emira Sghaier
Ines Rassas
Marouane Hayouni
Asma Khedher
Dorra Oualha
Amina Kalai
Houda Migaou
Aymen Haj Salah
Mouna Sghir
Hayet Ben Hmida
Mouna Hamouda
Kais Maamri
Mouna Aissi
Amel Korbi
Sameh Mbarek
Imen Khairallah
Amina Wardani
Nesrine Jammali
Zohra Chadli
Asma Guedria
Jamel Saad
Amina Ben Salem
Hayfa Hachfi
Mahbouba Jguirim
Oussama Jaoued
Souheil Elatrous
Manel Lahmar
Lamia Besbes Wannes
Ahmed Zrig
Charfeddine Amri


Introduction-Aim: The third cycle of medical studies (TCMS) lasts 3 years for the specialty of family medicine (FM) in Tunisia. The members of the FM committee of the Faculty of Medicine of Monastir (FMM) aimed to detail the learning objectives (LO) of residents in FM.

Method: We used the Delphi method in 2 rounds including a group of experts called FM Learning Objectives Writing Group (FMLOWG) at the FMM. The FMLOWG included 74 university hospital physicians and FM internship supervisors. These members actively participated in the 10 meetings held during the month of March 2022. Three points were discussed: the identification of LOs; the development of training titles and the proposal of the teaching methods to be adopted. The writing was subdivided into 5 domains of LO: transversal, public health, typical population and by system.

Results: We identified 1359 LOs for FM residency, for which 552 were LOs per system (40.5%). The learning included 618 training session titles. Residents will have an academic training day every 3 weeks during 9 months for each TCMS year.

Conclusion: A detailed, MF-specific consensus has been developed by majority of medical specialties. It will be a learning base for learners, a reference for supervisors and TCMS teachers.


Family Practice, Goals, Learning, Education, Medical, Graduate, Aptitude, Professional competence, communication, leadership, Professional Role, Tunisia



  1. Journal Officiel de la République Tunisienne. Décret gouvernemental n° 2019-341 du 10 avril 2019. 2019.
  2. Ben Abdelaziz A, Nouira S, Chebil D, Azzaza M, Barhoumi T, Ben Salem K. La Médecine de Famille (Mé-decine Générale): Quelles spécificités académiques et professionnelles? Tunis Médicale. 2021 Jan;99(1):29–37.
  3. MacCarthy D, Kallstrom L, Kadlec H, Hollander M. Improving primary care in British Columbia, Canada: evaluation of a peer-to-peer continuing education program for family physicians. BMC Med Educ. 2012 Nov 9;12:110.
  4. Rothlind E, Fors U, Salminen H, Wändell P, Ekblad S. The informal curriculum of family medicine - what does it entail and how is it taught to residents? A systematic review. BMC Fam Pract [Internet]. 2020 Nov 3 [cited 2022 Nov 1];21(1). Available from:
  5. Textes juridiques et réglementaires - Ministère de la santé publique. [cited 2022 Nov 11]. Available from:
  6. Shaughnessy AF, Allen L, Duggan A. Attention without intention: explicit processing and implicit goal-setting in family medicine residents’ written reflections. Educ Prim Care Off Publ Assoc Course Organ Natl Assoc GP Tutors World Organ Fam Dr. 2017 May;28(3):150–6.
  7. Brody DS, Ryan K, Kuzma MA. Promoting the development of doctoring competencies in clinical settings. Fam Med. 2004 Jan;36 Suppl:S105-109.
  8. Araújo HPA, Santos LCD, Domingos T da S, Alencar RA. Multiprofessional family health residency as a setting for education and interprofessional practices. Rev Lat Am Enfermagem. 2021;29:e3450.
  9. Hansen SE, Mathieu SS, Biery N, Dostal J. The Emergence of Family Medicine Identity Among First-Year Residents: A Qualitative Study. Fam Med. 2019 May;51(5):412–9.
  10. Besigye IK, Onyango J, Ndoboli F, Hunt V, Haq C, Namatovu J. Roles and challenges of family physicians in Uganda: A qualitative study. Afr J Prim Health Care Fam Med. 2019 Oct 29;11(1):e1–9.
  11. Castro D, Yang J, Greer ML, Kwan B, Sauerbrei E, Hopman W, et al. Competency Based Medical Educa-tion—Towards the Development of a Standardized Pediatric Radiology Testing Module. Acad Radiol. 2020 Nov 1;27(11):1622–32.
  12. McPherson S, Reese C, Wendler MC. Methodology Update: Delphi Studies. Nurs Res. 2018 Oct;67(5):404–10.
  13. EQUATOR Network | Enhancing the QUAlity and Transparency Of Health Research [Internet]. [cited 2022 Nov 12]. Available from:
  14. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for Reporting Qualitative Research: A Synthesis of Recommendations. Acad Med. 2014 Sep;89(9):1245–51.
  15. Monteiro BR. Monitoring and performance indicators in family health units and the objectives of Sustainable Development Goals (SDG 3) in health: a comparative analysis in Portugal in the 2013-2018 period. Cienc Saude Coletiva. 2020 Mar;25(4):1221–32.
  16. Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, et al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. The Lancet. 2020 Dec;396(10267):2019–82.
  17. LETAIEF M, Hirschhorn LR, Leatherman S, Sayed AA, Sheikh A, Siddiqi S. Implementation research on measuring quality in primary care: balancing national needs with learning from the Eastern Mediterranean Region. Int J Qual Health Care. 2021 Jul 1;33(3):mzab119.
  18. Lubetkin EI, Krackov SK, Storey-Johnson C. The use of questionnaires to assess achievement of course goals in medical students’ longitudinal community-based clinical experiences. Acad Med J Assoc Am Med Coll. 1999 Dec;74(12):1316–9.
  19. Babenko O, Szafran O, Koppula S, Au L. Motivations for learning of family medicine residents trained in competency-based education. Educ Prim Care Off Publ Assoc Course Organ Natl Assoc GP Tutors World Organ Fam Dr. 2018 Mar;29(2):86–93.
  20. Gardiner P, Filippelli AC, Lebensohn P, Bonakdar R. Family medicine residency program directors attitudes and knowledge of family medicine CAM competencies. Explore N Y N. 2013 Oct;9(5):299–307.
  21. Nothnagle M, Reis S, Goldman RE, Anandarajah G. Fostering professional formation in residency: develop-ment and evaluation of the “forum” seminar series. Teach Learn Med. 2014;26(3):230–8.
  22. Mlika M, Ben Hassine L, Charfi R, Mezni F, Jouini M. Teaching of evidence-based medicine principles in Family medicine curriculum: a descriptive study. Tunis Med. 2019 Dec;97(12):1332–7.
  23. Little P, Hayes S. Continuing professional development (CPD): GPs’ perceptions of post-graduate education-approved (PGEA) meetings and personal professional development plans (PDPs). Fam Pract. 2003 Apr 1;20(2):192–8.
  24. Antit S, Zairi I, Bellakhal S, Mzoughi K, Ouali S, Mghaieth F, et al. Evaluation of students’ motivation during the gamification of electrocardiogram interpretation learning. Tunis Med. 2020 Nov;98(11):776–82.
  25. Boughzala W, Hariz A, Badri T, Ben Hassine L, Azzabi S, Khalfallah N. Family medicine: attractiveness, constraints and prospects as perceived by residents of the specialty. Tunis Med. 2019 Jul;97(7):904–9.
  26. Bohle LF, Valencia E, Ross G, Dzhabarovna DD, Yarbaeva SN, Kasymova ZA, et al. Medical education reform in Tajikistan: comparison of the conventional one-year family medicine residency program and the new two-year residency program for postgraduate medical education. BMC Med Educ. 2021 May 28;21(1):306.
  27. Neutze D, Hodge B, Steinbacher E, Carter C, Donahue KE, Carek PJ. The Practice Is the Curriculum. Fam Med. 2021 Jul 7;53(7):567–73.
  28. Jenkins LS, Von Pressentin K. Family medicine training in Africa: Views of clinical trainers and trainees. Afr J Prim Health Care Fam Med. 2018 Apr 12;10(1):e1–4.