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  • 1. Feedback of 10-year Family Medicine Training in Estonia Heidi-Ingrid Maaroos Department of Polyclinic and Family Medicine University of Tartu, Estonia
  • 2. Estonia
    • 47000 km 3
    • 1.4 million inhabitants
    • 32 physicians per 10000
    • 1 family physician per 1900+-400
    • 800-850 family physicians
    • are needed
  • 3. Preconditions of high-quality family physicians' training
    • competence of the teaching staff
    • comprehensiveness of training programmes
    • the relevance of the current education
    • training must meet the needs of the population
    • to satisfy the needs of effective health care
  • 4. Traditional university from 1632- University of Tartu
    • D epartment of family medicine from 1992.
  • 5. I mplementation of family medicine teaching in 1991-1992
    • the training of teachers with academic positions o n international courses
    • calling teachers from countries already existing family medicine system
  • 6. Inside the faculty of medicine
    • Co-work with different specialities
    • training of family physicians
    • development of research in family medicine
  • 7. 2000-2001 the university faculty members are
    • vocationally trained family physicians
    • family physicians conducting their PhD in the field of family medicine.
  • 8. S election of faculty members
    • the university criteria for academic posts are used
    • speciality of family physician and own practice is needed
  • 9. In 1991-1992
        • Development of
        • undergraduate
        • r esidency
        • retraining
        • programmes for family medicine;
  • 10. Development
    • new methods of teaching
    • teaching materials
    • training of preceptors
    • physicianate studies and research
  • 11. In 1999-2001
        • Programmes
        • for teachers/trainers in family medicine were developed
        • this experience was exported to other countries (Armenia, Turkmenistan, Uzbekistan, Tajikistan);
  • 12. Basis for teaching
    • Network of teaching practices with newly trained family physicians as preceptors
    • New educational materials (manual in family medicine, problem-based interactive computer-based programmes)
  • 13. Training of family physicians
    • Training in residency - 3 years at least 50% of which is family medicine practice and 10 % is theoretical part
    • 1993-2003 has finished 45 family medicine residents
    • Certificate: family physician
  • 14. Retraining of previous PHC physicians- 3 years
    • 80% of which is independent work in practice and 20% is theoretical part (lectures and seminars)
    • from 1991-2003, altogether 863 retrained physicians
    • Certificate: family physician
  • 15. T he content of the training
    • population health care needs
    • job description of family physician in Estonia
    • to local structure of population (age, rural, urban, family structure)
    • to local morbidity and epidemiological situation and health care priorities in Estonia .
  • 16. Main tasks of family physician in Estonia
    • curative care
    • preventive care
    • palliative care
    • management of practice
    • co-ordination between team members
  • 17. New courses for family physicians supported by Estonian Health Project
    • legal aspects of starting independent practice
    • computer skills
    • practice management
  • 18. Continuous programme e valuation
    • evaluation of teaching process
    • evaluation of family medicine curriculum
  • 19. The process evaluation: trainees` reflection on the quality of their learning experiences
    • resident/trainee-centred
    • traditional rating-type questionnaires
    • regular feedback meetings of teachers with resident/trainee representatives .
  • 20. The indicators for curriculum quality
    • Number of manuals and other teaching/learning materials
    • Number of physicians completing residency training, performance data
  • 21. .... indicators
    • Number of trainees participating in the retraining courses,
    • Number of physicians completing retraining courses, performance data
    • Index: number of physicians starting work as family physician/ number of physicians finishing retraining courses (0,8-1,0)
  • 22. .... indicators
    • Evaluation of retrained family physicians work by activity in different fields of family medicine:
    • vaccination of children according to standard (% of in time vaccinated children;
    • registration of pregnancies according to standard % of early registration from all pregnancies)
  • 23. Conclusion
    • Estonian experience shows that implementation of principles of new training of family physicians needs coherence of academic environment with practice and continuous evaluation of training process and outcome.