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