Pc Rural Training

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“ 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 ) Wonca Europe, Istanbul 2008

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Pc Rural Training

  1. 1. “ 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 )
  2. 2. SPAIN
  3. 3. Spain has one of the oldest GP programmes in Europe... <ul><li>1978 </li></ul><ul><li>Medicine studies: 6 years </li></ul><ul><li>28 Medicine Faculties </li></ul><ul><li>MIR (exam): 250 MCQ </li></ul><ul><li>Choose Medical Speciality </li></ul><ul><li>6.388  1859 GP places </li></ul><ul><li>4 years for Family Medicine </li></ul><ul><li>1112 € + shifts = 1500-2500 € </li></ul>
  4. 4. <ul><li>1978  Health protection and care </li></ul><ul><li>(Article 43 of the Spanish Constitution) </li></ul><ul><li>Speciality of Family and Community Medicine : 3 years postgraduate training programme </li></ul><ul><li>1982  New Docent Units of Family Medicine </li></ul><ul><li>1983  Established Docent Units (structure, supports and functions). </li></ul><ul><li>1984  Basic health zones, Health center, Primary Care Team (teamwork) </li></ul>TIME LINE
  5. 5. <ul><li>1985  I GP Residency Training Programme </li></ul><ul><li>1986  General Health Care Act : </li></ul>TIME LINE “ Defines the Spanish NHS, created from the social security (SS) health services and which during the 20th century constantly widened its coverage and services, as the ensemble of “all structures and public services at the service of health”, and “the combination of state administration and autonomous communities health services”
  6. 6. <ul><li>General principles of the National Health System </li></ul><ul><li>Universal coverage with free access to health care for almost all inhabitants; </li></ul><ul><li>Public financing, mainly through general taxation; </li></ul><ul><li>Integration of different health service networks under the National Health System structure; </li></ul><ul><li>Political devolution to the autonomous communities </li></ul><ul><li>Region-based organization of health services into health areas and basic health zones </li></ul>TIME LINE
  7. 7. <ul><li>1995  II GP Residency Training Programme </li></ul><ul><li>It is compulsory in Spain to work as a GP in the public system (after the EU Directive from 1995). </li></ul><ul><li>2005  III GP Residency Training Programme (4 years). </li></ul><ul><li>The fourth year fully takes place in a teaching surgery under the supervision of an accredited tutor. </li></ul><ul><li>2010  New training programme </li></ul>TIME LINE
  8. 8. <ul><li>17 Autonomous Communities </li></ul><ul><li>93 Docent Units </li></ul><ul><li>3000 Accredited tutors </li></ul><ul><li>734 Health docent centers </li></ul><ul><li>201 Docent Hospitals </li></ul><ul><li>1859 GP places </li></ul><ul><li>42% of the NHS’ doctors are GP </li></ul><ul><li>20.000 are “MIR”- GP </li></ul>GPs in Spain...
  9. 9. GP Residency Training Programme (2005)
  10. 10. GP Residency Training Programme
  11. 11. GP Residency Training Programme It depends on the Docent Units…
  12. 12. GP Residency Training Programme <ul><li>1) First year: </li></ul><ul><li>INTERNAL MEDICINE and OTHERS SPECIALITIES : </li></ul><ul><li>5-8 months </li></ul><ul><li>EMERGENCY (Shifts, 1 month) </li></ul><ul><li>FAMILY MEDICINE : 3-6 months </li></ul><ul><li>HOLIDAYS : 1 month </li></ul>
  13. 13. <ul><li>2 - 3) Second and third year: </li></ul><ul><li>INTERNAL MEDICINE and OTHERS MEDICAL-SURGICAL SPECIALITIES : 8 months </li></ul><ul><li>EMERGENCY (Shifts) </li></ul><ul><li>PSYCHIATRY (2- 3 months) </li></ul><ul><li>PAEDIATRICS, Children´s health... ( 2 months) </li></ul><ul><li>RURAL TRAINING : 3 months (R2) </li></ul><ul><li>Women´s health (family planning, breastfeeding, high-risk pregnancy…): 2-3 months </li></ul>
  14. 14. <ul><li>2 - 3) Second and third year: </li></ul><ul><li>FAMILY MEDICINE or ELECTIVE ROTATIONS : ( 3 months) </li></ul><ul><ul><li>Rheumatology, Palliative Care, Dermatology, Geriatrics, Neumology, Surgery, Neurology, Digestive, Nefrology, Endocrinology, Radiology… </li></ul></ul><ul><li>HOLIDAYS : 2 months </li></ul>
  15. 15. <ul><li>4) Fourth year: </li></ul><ul><li>Learning in FAMILY MEDICINE ( 11 months) </li></ul><ul><li>HOLIDAYS : 1 month </li></ul><ul><li>EMERGENCY (Shifts) </li></ul><ul><li>Research project </li></ul>Common : - Self learning, - classes, - workshops, - teamwork…
  16. 16. SHIFT HOURS DISTRIBUTION DURING GP TRAINING IN DIFFERENT EMERGENCY DEPARTMENTS 100% 12,5% 12,5% 75% R4 100% 8% 12,5% 4,5% 12,5% 37,5% 25% R2 / R3 100% 75% 25% R1 TOTAL HOSPITAL EMERGENCY MED-SURGICAL TRAUMATOLOGY GYNAECOLOGY PAEDIATRICS HOSPITAL EMERGENCY PM / RURAL
  17. 17. EVALUATION <ul><li>Submit a Learning Portfolio (LEAP) </li></ul><ul><li>Obligatory courses of continuous training </li></ul><ul><li>Shifts (5-6 per month) </li></ul><ul><li>Evaluation of each rotation by acredited tutors </li></ul><ul><li>Congress, workshops, oral communications or </li></ul><ul><li>posters, self learning… </li></ul><ul><li>Research project in the last year </li></ul>Marks: 0-3 points Annual
  18. 18. PRIORITY and RESPONSABILITY LEVELS
  19. 19. PRIMARY CARE RURAL TRAINING in SPAIN
  20. 20. <ul><li>- Compulsory rotation since 2005 </li></ul><ul><li>2 months / shifts </li></ul><ul><li>Diversity between different rural communities </li></ul><ul><li>No docent rural centers in all of them or accredited tutors </li></ul><ul><li>Elective rotation in another docent unit / country </li></ul><ul><li>Environmental barriers: </li></ul><ul><li>The rural/remote location of practice </li></ul><ul><li>Isolation from colleagues, </li></ul><ul><li>Transport: timetables, own car... </li></ul><ul><li>Lack of resources and staff sometimes... </li></ul>BARRIERS IN RURAL GENERAL PRACTICE
  21. 21. SOTO DEL REAL (MADRID)
  22. 22. <ul><li>3 MONTHS OF RURAL TRAINING </li></ul><ul><li>RURAL SHIFTS (1-2 per month) </li></ul>SOTO DEL REAL (MADRID)
  23. 23. Very good: 155/400. Good: 161/400. Bad: 80/400. Very bad: 4/400. Rural Medicine during the postgraduate training period in our country (Spain) Rate of participation Rate of ID satisfation Valiente Hernández, S. et al. <ul><li>RESULTS </li></ul><ul><li>RMPP implementation : 29/34 </li></ul><ul><li>Average duration : 2 months (and shifts) </li></ul><ul><li>Mean number of visits/day : 25 patients </li></ul><ul><li>Mean distance to hospital : 50 km; (25-80) </li></ul><ul><li>Infraestructure problems : </li></ul><ul><ul><li>Lack of official training </li></ul></ul><ul><ul><li>responsibles for CTU, </li></ul></ul><ul><ul><li>Need of a private mean of </li></ul></ul><ul><ul><li>transport and extra expenses for ID. </li></ul></ul>
  24. 24. MANZANARES EL REAL (MADRID)
  25. 25.   <ul><li>PATIENTS </li></ul><ul><li>Patients' expectations and behaviour </li></ul><ul><li>Necessary patient education about the evidence base of treatments, antibiotics, consultations, moves... </li></ul><ul><li>Patients may prefer to see their regular GP </li></ul><ul><li>Patients not wanting to see someone with less experience </li></ul><ul><li>Not hurry </li></ul><ul><li>More sincerelly grateful, presents... </li></ul><ul><li>Differences whithin population: </li></ul><ul><ul><li>Residents (elderly people) </li></ul></ul><ul><ul><li>Temporary residents </li></ul></ul>
  26. 26.     LA CABRERA (MADRID)
  27. 27.     <ul><li>The workload in rural general practice </li></ul><ul><li>Isolation experienced in rural practice </li></ul><ul><li>Limited time in attending </li></ul><ul><li>Inadequate computer system </li></ul><ul><li>and d ifficult internet access </li></ul><ul><li>Difficulty in attending continuing medical education events </li></ul><ul><li>Not available treatments or tests </li></ul><ul><li>Lack or poor resources to encourage GP </li></ul><ul><li>research, for continued medical education, </li></ul><ul><li>difficulty in accesing practical workshop </li></ul><ul><li>- Quality of Life / Funny experience </li></ul>GP TRAINEES / TRAINER
  28. 28.     CARDONA Montmaneu Cataluña
  29. 29.     <ul><li>No preparation at Medical School </li></ul><ul><li>Coordinating different organisations </li></ul><ul><li>The continuity of care in the community </li></ul><ul><li>Chronic disease management </li></ul><ul><li>Dermatological conditions </li></ul><ul><li>Minor surgery </li></ul><ul><li>Preventive health </li></ul><ul><li>Unsupervised decisions </li></ul><ul><li>A great spectrum of illness </li></ul><ul><li>Holistic approach to health, person and family </li></ul><ul><li>Conflicts with the placement of GP trainees </li></ul><ul><li>(between hospital and rural areas) </li></ul>
  30. 32.     At hospital, You have everything… Specialist, training and support, staff, adequate computer system and internet access, friends… Different sort of medicine No possibility of continuity of care in the community, chronic disease management, dermatological conditions, minor surgery... Consultation just for one person not the whole family But…
  31. 33.     We consider being rural GP as a career possibility...
  32. 34. Thanks for your attention! It was a pleasure! Please don’t hesitate in contacting me! [email_address]

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