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La rotación en Medicina Rural. ¿Existe? ¿Vale la pena?
 

La rotación en Medicina Rural. ¿Existe? ¿Vale la pena?

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Mesa 2. La rotación en Medicina Rural. Existe? Vale la pena?:...

Mesa 2. La rotación en Medicina Rural. Existe? Vale la pena?:
Han pasado unos 4 años desde la publicación del nuevo programa MIR para la especialidad en Medicina Familiar y Comunitaria (MFyC) en España. La principal novedad del mismo fue en su momento, la prolongación del periodo de residencia de tres a cuatro años. Al mismo tiempo, entre otras novedades destacaba la obligatoriedad de que durante este periodo los médicos de familia en formación realizaran una rotación en el medio rural de tres meses de duración.
Muchos interrogantes se abrieron en ese momento dentro y fuera de las Unidades Docentes sobre la idoneidad o no de realizar este periodo de rotación rural. Algunos de ellos fueron: ¿Va a ser atractiva esta rotación para los residentes?¿Realmente la medicina rural es tan diferente de la urbana para hacer esta rotación obligatoria? ¿Habrá algún tipo de ayuda económica para pagar los desplazamientos y la manutención de los residentes? ¿Tendremos suficientes Centros y Tutores Rurales para llevarla a cabo?
El objetivo final de la mesa “La Rotación Rural: ¿existe?, ¿vale la pena?”será el de analizar y debatir el estado actual del periodo de rotación rural que realizan los residentes en MFyC en nuestro país y en el resto de países europeos. Contaremos para ello con la experiencia, los trabajos y los diferentes puntos de vista de los ponentes de una mesa integrada básicamente por residentes, y los del público asistente, con la intención de llegar conclusiones que puedan servir como puntos de mejora para todas las partes implicadas en este periodo de formación.

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    La rotación en Medicina Rural. ¿Existe? ¿Vale la pena? La rotación en Medicina Rural. ¿Existe? ¿Vale la pena? Presentation Transcript

    • AULA DOCENTE Mesa 2: La rotación en medicina rural Dra. Raquel Gómez Bravo Vocal JMF SoMaMFyC Miembro VdGM Recruitment
    • La rotación en Medicina Rural… ¿Existe? ¿Vale la pena? Programa formativo de la especialidad de Medicina Familiar y Comunitaria. Enero 2005. Depende. . .
    • “ El médico rural es un hombre afortunado…”
    • La experiencia nos condiciona…
      • Natural de Alhaurín el Grande, Málaga
      • Licenciada en Medicina y Cirugía
      • por la Universidad de Málaga (2004)
      • Especialista en MFYC, C. S. Barrio del Pilar
      • Área 5 de Madrid (2005-2009)
      • Guardias de SAR (R3-R4):
        • Manzanares del Real
        • Soto del Real
        • La Cabrera
      • Rotación rural (Marzo del 2009)
      • Dr. Juan Gérvas Camacho en Canencia de la Sierra, Garganta de los Montes y El Cuadrón (Madrid)
      • Miembro del Vasco da Gama Movement, sección Recruitment
      http://www.vdgm.eu/
      • VDGM:
        • Oporto, 2007
        • “ Overcoming training barriers in primary care-rural training". Wonca Europe 2008, Istanbul.
        • Amsterdam, Enero 2009.
        • "A new guidelines for GP rural training program through the diferences beetween european countries, a Vasco da Gama Movement-Euripa workshop". 9th  WONCA Rural Health World Conference, Crete 2009.
        • “ Rural practice nowadays”. 9th  WONCA Rural Health World Conference, Crete 2009.
        • “ Rural practice: present and future”. Wonca Europe 2009, Basel.
        • 2010…
      • VdGM is the WONCA Europe working group for young and future General Practitioners
      • The movement is the continuation of the work that was started during the first preconference meeting for junior doctors during the WONCA Europe conference in Amsterdam in 2004
      • OUR GOALS
      • Providing a forum, support and information for trainees and young GPs through access to WONCA Europe regional conferences and pre-conferences
      • Establishing a communication network between European trainees and young GPs and identifying their concerns, doubts and needs and helping to address them
      • Improving the quality of training programmes for general practice.
      • Istanbul 2008, Preconference:
      • The pre-conference attendants are invited from each countries scientific society´s (máximum 2 gp-trainees or young GP for country)
      • Attendants are divided into 5 groups, each one with a different arguing theme (education, exchange, research…) and, together with an Euract professor member, this issues are raised for discussion.
      • Subsequently everything debated is reported into the Wonca congress.
      • Differents GP
      • training
      • programmes
      • 2. Research
      • 3. Rural medicine
      TOPICS:
    • RURAL MEDICINE
      • Is becoming more popular nowadays
      • An attractive option for young doctors
      • Let us explore other aspects of the medical practice traditionally limited to the ones carried out in urban centers
      • It is necessary to support the development in rural areas
      • Additional benefits like:
      • Shorter fixed time, no prolongation
      • Financially more attractive
      • Get your 1st choice job or education afterwards.
      • Extra time off / study leave / to meet with other colleagues
      • International privileges (such as discounts on conferences)
      • Social life
      • Part-time schedule
      • Family friendly , Housing
    • “ OVERCOMING TRAINING BARRIERS IN PRIMARY CARE – RURAL TRAINING ” EURIPA AND VASCO DA GAMA MOVEMENT JOINT WORSHOP Dr. Raquel Gómez Bravo ( Vasco da Gama Movement – Semfyc. Spain )
    • Fernidando Petrazzuoli (EURACT) John Wynn Jones (EURIPA) Jaume Banque Vidiella (EURIPA) Raquel Gómez Bravo (VdGM) We put forward the experience of working in rural areas from different points of view: learning, teaching, feeling, working and dreaming.  WONCA EUROPE 2008, ISTANBUL
      • 1978 - 2008
      • Medicine studies: 6 years
      • 28 Medicine Faculties
      • MIR (exam): 250 MCQ
      • Choose Medical Speciality
      • 6.388  1859 GP places
      • 4 years for Family Medicine
      • 1112 € + shifts = 1500-2500 €
      Spain has one of the oldest GP programmes in Europe...
      • 17 Autonomous Communities
      • 93 Docent Units
      • 3000 Accredited tutors
      • 734 Health docent centers
      • 201 Docent Hospitals
      • 1859 GP places
      • 42% of the NHS’ doctors are GP
      • 20.000 are “MIR”- GP
    • It depends on the Docent Units…
    • SHIFT HOURS DISTRIBUTION DURING GP TRAINING IN DIFFERENT EMERGENCY DEPARTMENTS PM / RURAL HOSPITAL EMERGENCY PAEDIATRICS GYNAECOLOGY TRAUMATOLOGY MED-SURGICAL HOSPITAL EMERGENCY TOTAL R1 25% 75% 100% R2 / R3 25% 37,5% 12,5% 4,5% 12,5% 8% 100% R4 75% 12,5% 12,5% 100%
    • Rural Medicine during the postgraduate training period in our country (Spain) Valiente Hernández, S. et al. Aim: To asses the implementation of the RMPP (three-month-compulsory-stage on a national basis since 2005) and the degree of internal doctors (ID) satisfation. Aim: To asses the implementation of the RMPP (three-month-compulsory-stage on a national basis since 2005) and the degree of internal doctors (ID) satisfation. Methods: Transverse, observational study carried out in a four-month-period in 2008. Subjects of study: 154 central training units (CTU). Information sources: CTU and ID through the email surveys, supported by telephone calls and interviews. Variables: RMPP implementation (duration, training year, distance between health centre and hospitals, number of visits per day, infrastructure problems) and degree of ID satisfation.
      • RESULTS:
      • RMPP implementation : 29/34
      • Average duration :
      • 2 months (and shifts)
      • Mean number of visits/day :
      • 25 patients
      • Mean distance to hospital : 50 km; (25-80)
      • Infraestructure problems :
        • Lack of official training responsibles for CTU,
        • Need of a private mean of transport and extra expenses
        • for ID.
      CCAA: CTU: VARIABLES IMPLEMENTATION TIME OF RURAL PRACTICAL ATTENDED VISITS/DAY RATE OF INTERNAL DOCTORS SATISFATION INCONVENIENTS
      • Conclusions:
      • The level of replay is acceptabled and
      • new technologies have contributed to this fact.
      • The implementation of the RMPP gives different
      • training opportunities depending on the CTU.
      • The lack of official training responsible limits
      • the degree of implementation.
      • Due to the high level of satisfaction
      • we encourage the NHS to provide CTU with resources.
      • These kind of studies are necessary to asses national training programmes.
    •  
      • To study the differences between GP rural training programs
      •  
      • 2. To redesign and implement a new training guide for rural practice including the main objective to draw a program that provides the infrastructure for a remote learning experience.
      RECRUITMENT
    • A NEW GUIDELINES FOR GP RURAL TRAINING PROGRAM THROUGH THE DIFFERENCES BEETWEEN EUROPEAN COUNTRIES
    • METHODS: Through a cross-sectional study, we compare the structure and quality of the GP vocational training schemes in the rural areas among VdGM countries.   
      • SPAIN - UK
      • FRANCE - ROMANIA
      • PORTUGAL - GERMANY
      • POLAND - HOLLAND
      • ITALY - TURKEY
      • CROATIA - AUSTRIA
      • CZECH REPUBLIC
      • Rural exposure from an attachment in medical school and through residency training programs may have a significant impact on recruitment and retention of rural physicians.
      • • Exposure to a rural curriculum has been shown to produce attitude changes in students, while rural primary care clerkships positively influence students’ perceptions of rural primary care.
      • • The WONCA Rural Working Party recomm all medical students should have an opportunity for rural exposure, and that medical schools should ensure that support and encouragement is given to students prior to embarking on a career in rural practice ends that
      Lionis C, Wynn-Jones J. Establishing academic rural practice: a future and challenging target. Rural and Remote Health 7 (online), 2007: 727. Available from: http://www.rrh.org.au
    • Sent by email to VdGM_Forum
      • 6 years for Medical degree
      • Most of them have PC studies at University, GP exposure, lectures on GP or teaching by a GP.
      • Poor rural practice and learning at med school
      • GP training:
      • - 5 years in Germany / UK
      • - 4 years : Spain, Czech Republic, Poland and recently Portugal
      • - 3 years : them of all!
      • 50% postgraduate exam
      • SPAIN
      • UK
      • PORTUGAL
      • GERMANY
      • POLAND
      • FRANCE
      RURAL ROTATION COMPULSORY / ELECTIVE
      • TURKEY
      ?
    • ? - Training for emergencies, chronic disease management with limited human and material resources, cardiovascular and skill disease, mother and child health, contraception, vaccination programmes, obstetrics problems, home care for elderlies, minor surgery, palliative care, poisonings - Become conscious about oneself - Difficult communication between hospital and GPs - Isolation, less social life, more distances, difficult access… - More heavy, technology and financial problems,working longer… - Lacks of…
      • MAIN ISSUES,
      • common to all countries :
    • RESULTS: The evaluation has registered vast differences whithin compulsory GP programmes but the same needs in each country.
    • > 50% ? CONCLUSIONS: GP Education must include a special practice training based in rural settings, because remote medicine is another way to feel what kind of doctor you are!
    •  
    •  
      • FORMACIÓN
      CENTRO DE SALUD / ATENCIÓN PRIMARIA HOSPITAL: ROTACIONES / GUARDIAS SAR, ROTACIÓN RURAL, GUARDIAS ROTACIONES EXTERNAS OTROS
    •  
    • MANZANARES EL REAL (MADRID)
    • SOTO DEL REAL (MADRID)
    • LA CABRERA (MADRID)
      • ROTACIÓN RURAL:
      • CARMEN
      • RAMÓN
      • JUAN
      • HASTINGS:
        • Soporte vital
        • Morir con dignidad
    • BUITRAGO DE LOZOYA, GARGANTA DE LOS MONTES, CANENCIA DE LA SIERRA Y EL CUADRÓN (MADRID) 80 Km
      • PREPARACIÓN
      • AUTOEVALUACIÓN
      • PERSONALIDAD
      • DESEQUILIBRIOS
      • DIFERENCIAS
      • El verdadero médico…
    •  
    •  
    •  
    •  
    • ¡GRACIAS POR VUESTRA ATENCIÓN! [email_address]