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Delvento G, Schindler C, Rotaru C, Curteanu A, Curochicin G, Prytherch H, Tkachenko V, Seifert B, Torzsa P, Asenova R, Busneag C, Windak A, Willems S, Van Poel E, Collins C. Follow-up of patients with chronic conditions within primary care practices during COVID-19: Results from 7 Central and Eastern-European countries from the cross-sectional PRICOV-19 study. Eur J Gen Pract 2024; 30:2391468. [PMID: 39207040 PMCID: PMC11363735 DOI: 10.1080/13814788.2024.2391468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/26/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic posed severe challenges to delivery of services at Primary Care level and for achieving follow-up of patients with chronic diseases. OBJECTIVES We analysed data from the PRICOV-19 study to explore determinants of active follow-up for chronic disease patients in seven Central and Eastern European (CEE) countries during the pandemic. METHODS Pricov-19 was a cross-sectional study conducted within PC (Primary Care) practices in 37 European countries. We analysed data from 7 CEE countries (Bulgaria, Czech Republic, Hungary, Poland, Moldova, Romania, Ukraine) collected between November 2020 and December 2021. Practices were recruited through random or convenience sampling and participation of practices was voluntary. We performed descriptive statistics to identify the level of follow-up of chronic disease and what health system and practice-specific factors were associated with better follow-up. We used logistic regression and meta-analysis techniques to explore associations and heterogeneity between countries. RESULTS 67.8% out of 978 practices reported actively following up chronic patients. Positive associations were found between active follow-up and such as having more GPs (aOR = 1.18, p-value = 0.005), an above-average chronic patient population (aOR = 3.13, p-value = 0.006), adequate government support (aOR = 2.35, p-value = 0.001), and GPs having time for guideline reading (aOR = 0.008, p-value = 1.71). CONCLUSIONS Patient follow-up, was influenced by different health system and practice-specific factors. The implications suggest the need for government support to enhance PC practice organisation during crises and solutions to decrease GP workload and provide tailored care for patients with chronic disease.
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Affiliation(s)
- Giulia Delvento
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Cristina Rotaru
- Healthy Life Project, Reducing the Burden of Non-Communicable Diseases in Moldova, Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova
| | - Ala Curteanu
- Healthy Life Project, Reducing the Burden of Non-Communicable Diseases in Moldova, Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova
- Mother and Child Institute, Chișinău, Moldova
| | | | - Helen Prytherch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Victoria Tkachenko
- Department of Family Medicine, Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Bohumil Seifert
- Institute of General Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Radost Asenova
- Department of General Medicine, Plovdiv University, Plovdiv, Bulgaria
| | - Carmen Busneag
- Department of Kinetic Therapy and Special Motricity, Spiru Haret University, Bucharest, Romania
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety, Ghent University, Ghent, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety, Ghent University, Ghent, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Irish College of General Practitioners, Dublin, Ireland
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Stepanović A, Švab I, Đukić B, Škrbić R. The Evolution and Challenges of Academic Family Medicine: Insights from the Banja Luka Declaration. Zdr Varst 2024; 63:160-163. [PMID: 39319024 PMCID: PMC11417503 DOI: 10.2478/sjph-2024-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 08/23/2024] [Indexed: 09/26/2024] Open
Abstract
Academic medicine encompasses education, research and clinical practice, and plays a crucial role in advancing medical science and training physicians. However, the field faces a crisis, with fewer graduates pursuing academic careers. Family medicine emerged as an academic discipline in the second half of the 20th century, contributing significantly to science and primary healthcare. Despite its recognised status, the World Health Organization has yet to formally define it as an academic discipline. Nevertheless, the discipline must continually update its academic dimension in order to address future challenges. The international conference in Banja Luka, attended by deans or representatives of Medical Faculties in Southeast Europe, emphasized family medicine's role in primary healthcare and academic medicine, adopting the Banja Luka Declaration to promote family medicine as an independent academic discipline. The conference aims to inspire global support for family medicine as an academic discipline.
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Affiliation(s)
- Aleksander Stepanović
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenija
| | - Igor Švab
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenija
| | - Biljana Đukić
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenija
| | - Ranko Škrbić
- University of Banja Luka, Faculty of Medicine, Department of Pharmacology, Toxicology and Clinical Pharmacology, Banja Luka78000, the Republic of Srpska, Bosnia and Herzegovina
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Da Fonseca Marques JP, Santiago LM, Donato H. [Evaluation of the Scientific Production in the Field of General Practice and Family Medicine in Portugal]. ACTA MEDICA PORT 2024; 37:100-109. [PMID: 38219237 DOI: 10.20344/amp.19750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/28/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION The Portuguese publications in the field of General Practice and Family Medicine have not yet been assessed in bibliometric studies. The aim of this study was to analyze that production between 2012 and 2022. METHODS The Web of Science Core Collection was used to gather the number of articles, journals and citations obtained; the Journal Citation Reports to obtain the Impact Factor and quartile of journals; and Scimago Journal & Country Rank, for the comparison of data with other European countries. The search was based on the following query: "usf OR unidade de Saude Familiar OR centro de Saude OR ACeS OR medicina geral familiar OR Gen Practice Family SAME Portugal", and a time window between 2012 and 2022 was defined. The study considered the following quantitative indicators: total number of publications, typology, language, affiliation, co-authors, geographical distribution, thematic areas, and the number of publications/inhabitant and publications/physician from European countries; the qualitative indicators selected were the Impact Factor (IF), the quartile and the number of citations. RESULTS Between 2012 and 2022, the national scientific production had an average annual growth rate of 36.6%. Of 389 publications, 73.8% were 'Articles' and 11.8% were 'Review Articles', predominantly in English (88.4%). The fields of 'General Internal Medicine' (24.7%) and 'Public Environmental Health' (14.9%) had the highest publication rates among the journals. The 389 publications received 5354 citations, for an average of 13.76 citations per article, and the average yearly citation growth was 115%. According to IF, 22.5% of the 222 journals belonged to Q4, 27.5% to Q3, 29.7% to Q2 and 20.3% to Q1, and therefore no significant bias regarding the journals where Portuguese doctors publish was observed. CONCLUSION The bibliometric analysis allowed us to examine the evolution of the scientific production in the field of Portuguese General Practice and Family Medicine by observing an increasing publication trend and with a high potential for publication growth.
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Affiliation(s)
| | - Luiz Miguel Santiago
- Faculdade de Medicina. Universidade de Coimbra. Portugal; Centro de Estudos e Investigação em Saúde. Universidade de Coimbra. Coimbra. Portugal
| | - Helena Donato
- Faculdade de Medicina. Universidade de Coimbra. Portugal; Serviço de Documentação e Informação Científica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Takahashi N, Matsuhisa T, Takahashi K, Ban N. Diversity of academic general medicine: A cross-sectional bibliometric study of original English-language research articles in general medicine and cardiology in Japan. Medicine (Baltimore) 2022; 101:e29072. [PMID: 35356933 PMCID: PMC10684137 DOI: 10.1097/md.0000000000029072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/25/2022] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Although research in general medicine is diverse, it has not been compared with research in a different medical specialty. The study aim was to understand the characteristics of research produced at Japanese university departments of general medicine and published in English-language journals, via comparison with another academic specialty, cardiology.In this cross-sectional study, a nationwide survey of the official websites of 82 university-affiliated medical schools in Japan was conducted in April 2020 to identify the heads of general medicine departments. We then surveyed the research output of these individuals in terms of original article output and research field diversity for journals listed in the Web of Science Core Collection of journals from 2010 to 2019. A similar survey of cardiology department publications was also conducted to provide a reference for intergroup comparisons and analysis of covariance.The analysis included 128 researchers from 78 general medicine departments and 96 researchers from 81 cardiology departments. The dominant research field of general medicine was general and internal medicine; that of cardiology was cardiac/cardiovascular systems. Data stratification by research field showed that general medicine researchers published significantly more articles than researchers in cardiology, a field that contains relatively few researchers. Furthermore, a comparison of individual researchers with the same number of published articles showed that researchers in general medicine departments published across a significantly wider range of fields than those in cardiology.This is the first study to describe the research characteristics of general medicine university departments in Japan through comparison with research in a different academic specialty. General medicine researchers in Japan comprise a heterogeneous group that mainly publishes research on general and internal medicine. Some general medicine researchers take a multidisciplinary approach to research and publishing.
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Affiliation(s)
- Noriyuki Takahashi
- Correspondence: Noriyuki Takahashi, Department of Education for Community Oriented Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan (e-mail: ).
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Strategies to address non-communicable diseases in the Commonwealth of Independent States countries: a scoping review. Prim Health Care Res Dev 2022; 23:e73. [DOI: 10.1017/s1463423622000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Aim:
The aim of this study is to review the literature in Commonwealth of Independent States (CIS) countries with regard to their response to non-communicable diseases (NCDs) and the implementation of the World Health Organization (WHO) Package of Essential Non-communicable (PEN) disease interventions for primary health care.
Background:
NCDs are estimated to account from 62% to 92% of total deaths in CIS countries. Current management of NCDs in CIS countries is focused on specialists and hospital care versus primary health care (PHC) as recommended by the WHO.
Methods:
This paper uses a scoping review of published and grey literature focusing on diabetes and hypertension in CIS countries. These two conditions are chosen as they represent a large burden in CIS countries and are included in the responses proposed by the WHO PEN.
Findings:
A total of 96 documents were identified and analysed with the results presented using the WHO Health System Building Blocks. Most of the publications identified focused on the service delivery (41) and human resources (20) components, while few addressed information and research (17), and only one publication was related to medical products. As for their disease of focus, most studies focused on hypertension (14) and much less on diabetes (3). The most studies came from Russia (18), followed by Ukraine (21) and then Kazakhstan (12). Only two countries Moldova and Kyrgyzstan have piloted the WHO PEN. Overall, the studies identified highlight the importance of the PHC system to better control and manage NCDs in CIS countries. However, these present only strategies versus concrete interventions. One of the main challenges is that NCD care at PHC in CIS countries continues to be predominantly provided by specialists in addition to focusing on treatment versus preventative services.
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Ma H, Cheng BR, Chang AH, Chang HT, Lin MH, Chen TJ, Hwang SJ. Internationalisation of general practice journals: a bibliometric analysis of the Science Citation Index database. Aust J Prim Health 2021; 28:76-81. [PMID: 34903327 DOI: 10.1071/py21069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/01/2021] [Indexed: 11/23/2022]
Abstract
Research plays a crucial role in the development of primary health care. Researchers in other specialities have studied the internationalisation of their journals, but no such study has been conducted for general practice. The aim of this study was to analyse the volume of publication and internationalisation of general practice journals indexed in the Science Citation Index (SCI) database in 2019. Of the total 1573 articles and reviews in 19 journals indexed under the subject category of 'primary health care' in the SCI database, 86.4% (n = 1359) were published in four English-speaking countries (32.8% in seven US journals, 34.8% in five UK journals, 12.5% in two Australian journals and 6.4% in one Canadian journal) and 40.6% (n = 639) were authored or coauthored by authors from a country other than that in which the journal was published. There was a significant (P < 0.05) relationship between the country of publication and the degree of internationalisation of the journal. The degree of internationalisation of general practice journals varied from 94.2% for family practice to 2.0% for primary care. There are wide disparities in internationalisation among different countries and general practice journals. There is much room for improvement in the internationalisation of general practice journals in the SCI database.
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Affiliation(s)
- Hsin Ma
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Bo-Ren Cheng
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - An-Hui Chang
- Department of Family Medicine, Taiwan Adventist Hospital, Taipei 10556, Taiwan
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; and School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; and School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; and School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; and Corresponding author
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; and School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
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Training Family Doctors and Primary Care Nurses in Evidence-based Prevention, Screening and Management of Cardiovascular Risks in Western Ukraine: A Longitudinal Study. Zdr Varst 2020; 59:227-235. [PMID: 33133279 PMCID: PMC7583428 DOI: 10.2478/sjph-2020-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 09/12/2020] [Indexed: 02/02/2023] Open
Abstract
Introduction The Ukrainian primary healthcare programme of preventive and screening recommendations has not been evidence-based. The traditional system of continuous medical education in Ukraine places participants in the role of passive listeners. This study explored the effects of an interactive training course on evidence-based prevention and screening of cardiovascular risks, on changes in Ukrainian family doctors' (FDs) and primary care nurses' (PCNs) knowledge and readiness to change practice over time. Methods Three hundred and seven FDs and PCNs participated in the study. Changes in participants' knowledge were assessed with 20 multiple choice questions, and their readiness to change practice with a five-item questionnaire. These were administered before, immediately after, three and twelve months after training. Results The mean pre-course knowledge score was 6.1 (SD 1.8) out of 20, increasing to 14.9 (SD 2.3) immediately afterwards (p<0.001). Three months later it was 10.2 (SD 3.2) and at one year it was 10.4 (SD 3.3), both of which were significantly higher than the pre-training level (p<0.005). The percentage of participants that were highly motivated to change their practice increased from 18.4% before the training to 62.3% immediately afterwards (p<0.001). Three months later, this fell to 40.4%. At 12 months it further reduced to 27.4%, but was still significantly higher than the baseline level (p<0.001). Conclusions The interactive training was effective in increasing both participants' knowledge and their readiness to change their clinical practice. The impact of the training diminished over time, but was still evident a year later.
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Fonken P, Bolotskikh I, Pirnazarova GF, Sulaimanova G, Talapbek kyzy S, Toktogulova A. Keys to Expanding the Rural Healthcare Workforce in Kyrgyzstan. Front Public Health 2020; 8:447. [PMID: 32984244 PMCID: PMC7484043 DOI: 10.3389/fpubh.2020.00447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022] Open
Abstract
Objective/Background: This study assessed Kyrgyzstan's progress with developing its rural primary care workforce and prioritized next steps to build on its current momentum. Kyrgyzstan has improved rural health care since 1997 through the implementation of family medicine, retraining of rural doctors and nurses, and other efforts. Attrition, emigration, urbanization, and population growth are threatening these hard-won advances. In response, Kyrgyzstan is now educating family medicine residents at rural sites and improving salaries. This study explores other steps to strengthen its rural health care, especially its rural generalists. Methods: This was an observational study using a two-phase survey process. To access the current status of Kyrgyzstan's rural health care system, we surveyed key stakeholders within that system using a draft version of the new World Health Organization Rural Pathways Checklist. To prioritize next steps, we asked rural FM residents to rank the relative importance of 31 possible future actions to support Kyrgyzstan's rural primary care workers. Results: Doctors and nurses involved in teaching rural health workers identified that Kyrgyzstan has made good progress with rural professional support and upskilling of existing health workers through education. They saw the least progress with selection of health workers and monitoring. The rural family medicine residents' top ten suggestions for rural recruitment and retention all involved improving working conditions (providing housing, internet, basic medical equipment, protected time off, better salaries, and more respect) and improving clinic efficiency (switching clinic scheduling from walk-in based to appointment based, optimizing the roles of clinical team members, and decreasing low-value clinic visits). Conclusions: The WHO Rural Pathways Checklist helped to evaluate Kyrgyzstan's current efforts to promote rural primary care. The priorities listed above from the next generation of potential rural family doctors could help guide future steps to promote rural health in Kyrgyzstan and the Former Soviet Union.
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Affiliation(s)
- Paul Fonken
- Rural Health Project, Scientific Technology and Language Institute, Arlington, VA, United States
| | - Inna Bolotskikh
- FM Department, Kyrgyz State Medical Institute for Retraining and Continuing Education, Bishkek, Kyrgyzstan
| | | | | | | | - Aelita Toktogulova
- FM Department, Kyrgyz State Medical Institute for Retraining and Continuing Education, Bishkek, Kyrgyzstan
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Zakarija-Grković I, Cerovečki V, Vrdoljak D. Partial adoption of 'minimal core curriculum' in undergraduate teaching of family medicine: A cross-sectional study among Central and South-Eastern European medical schools. Eur J Gen Pract 2018; 24:155-159. [PMID: 29730960 PMCID: PMC5944368 DOI: 10.1080/13814788.2018.1464555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: In 2011, Tandeter et al. published a list of 15 themes, based on a Delphi survey among representatives of the European Academy of Teachers in General Practice and Family Medicine (EURACT), and suggested this be the ‘minimal core curriculum’ (MCC) for undergraduate education in family medicine. Objectives: To determine: (1) if medical schools in the former Yugoslavia region are familiar with the MCC; and (2) to what degree it is being taught to medical students. Methods: In July 2015, a questionnaire was distributed to 19 medical schools in the former Yugoslavia region. A copy of the description of the curriculum for GP/FM was requested from participants. Two researchers conducted content analysis of the curricula according to the 15 predefined MCC themes, independently. Results: Thirteen (68%) medical schools responded. Of these, 10 (77%) stated that they were familiar with the MCC. Not a single institution encompassed all 15 MCC themes. The number of themes included by individual medical schools ranged from 6/15 (40%) to 13/15 (87%).The following themes were covered by 12 of 13 (92%) medical schools: Introduction to GP/FM; communication skills; prevention and health promotion; and management of chronic diseases. The three themes most poorly covered were: consulting skills (5/13), management of diseases at an early, undifferentiated stage (2/13) and decision-making based on prevalence and incidence (1/13). Conclusion: Despite familiarity with EURACT’s MCC among medical schools in the former Yugoslavia region, significant variation in curricula content exists, and no curriculum covered all MCC themes.
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Affiliation(s)
- Irena Zakarija-Grković
- a Department of Family Medicine , University of Split School of Medicine , Split , Croatia
| | - Venija Cerovečki
- b Department of Family Medicine , University of Zagreb School of Medicine , Zagreb , Croatia
| | - Davorka Vrdoljak
- a Department of Family Medicine , University of Split School of Medicine , Split , Croatia
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Yakubu K, Colon-Gonzalez MC, Hoedebecke K, Gkarmiri V, Hegazy NN, Popoola OO. Meeting report: 'How do I incorporate research into my family practice?': Reflections on experiences of and solutions for young family doctors. Afr J Prim Health Care Fam Med 2018; 10:e1-e6. [PMID: 29781695 PMCID: PMC5913785 DOI: 10.4102/phcfm.v10i1.1640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 11/29/2022] Open
Abstract
Background Family doctors (FDs) focus on biopsychosocial components of health during consultations. However, much of the evidence employed by these doctors is produced by researchers who are not routinely involved in family practice. Family doctors competent in both clinical practice and research are essential to addressing this gap. With the growing recognition of family medicine as the specialty of choice for many young doctors, there is a scarcity of literature that describes their experiences in combining research and daily family practice. Aim Members from Young Doctor Movements (YDMs) under the auspices of the World Organisation of Family Doctors (WONCA) sought to address this knowledge gap by reflecting on their experiences towards becoming researchers. With the assistance of senior doctors, they explored solutions that can help young FDs incorporate research into their family practice. Methods Following an online YDM meeting, a summary of the experiences of young FDs as well as strategies useful for incorporating research into their everyday practice as FDs was prepared. Result Nine thematic areas were derived, including experiences and motivation towards regular research, culture and environment of practice, relevance and gains of research, teamwork and mentorship. Conclusion Family practices can incorporate research by promoting a personal and organisational research culture, highlighting gains and relevance of making it part of the profession and fostering teamwork, supportive networks and mentorship while making it enjoyable.
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Affiliation(s)
- Kenneth Yakubu
- Department of Family Medicine, University of Jos and Jos University Teaching Hospital, Nigeria; AfriWon Renaissance, WONCA, Young Doctor Movement for Africa.
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Buchanan J, Degryse J. Developing Family Medicine through education – the next steps. EDUCATION FOR PRIMARY CARE 2017; 28:253-254. [DOI: 10.1080/14739879.2017.1346485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jo Buchanan
- President European Academy of Teachers in GP/FM, GP, Sheffield, UK
| | - J. Degryse
- Department of Public Health and Primary Care, Catholic University of Leuven
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Widyahening IS, Tanoto R, Rinawan F, Setiawati EP, Leopando ZE. Does the establishment of universal health coverage drive the foundation of postgraduate education for primary care physicians? MEDICAL JOURNAL OF INDONESIA 2017. [DOI: 10.13181/mji.v26i2.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Studying the formation of postgraduate training in primary care within countries which has attained Universal Health Coverage (UHC) is important to support the development of similar training in low-and middle-income countries aiming to achieve UHC by 2030. This review aims to describe the state of postgraduate training for primary care physicians in UHC-attaining countries.Methods: A literature review of published literature and official documents from the websites of regional and global health/primary care organizations or societies such as World Health Organization (WHO), World Organization of Family Doctors (WONCA), European Forum for Primary Care, European Union of General Practitioners (GP)/Family Physicians (FP), European Academy of Teachers in GP/Family Medicine (FM), as well as the websites of GP/FP organizations in each of the respective countries. The list of UHC attained countries were identified through WHO and International Labor Organization databases.Results: A total number of 72 UHC-attained countries were identified. Postgraduate education for primary care physicians exists in 62 countries (86%). Explicit statements that establish primary care postgraduate training were corresponded with the policy on UHC is found in 11 countries (18%). The naming of the program varies, general practice and family medicine were the commonest. In 33 countries (53%), physicians are required to undertake training to practice in primary level. The program duration ranged from 2–6 years with 3 years for the majority.Conclusion: Although UHC is not the principal driving force for the establishment of postgraduate training for primary care physicians in many countries, most UHC-attaining countries make substantial endeavor to ensure its formation as a part of their health care reform to improve national health.
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Arya N, Gibson C, Ponka D, Haq C, Hansel S, Dahlman B, Rouleau K. Family medicine around the world: overview by region: The Besrour Papers: a series on the state of family medicine in the world. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:436-441. [PMID: 28615392 PMCID: PMC5471080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To demonstrate how family medicine has been recognized and integrated into primary health care systems in contrasting contexts around the world and to provide an overview of how family physicians are trained and certified. COMPOSITION OF THE COMMITTEE Since 2012, the College of Family Physicians of Canada has hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Papers Working Group, which was struck at the 2013 conference, was tasked with developing a series of papers to highlight the key issues, lessons learned, and outcomes emerging from the various activities of the Besrour collaboration. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences. METHODS An initial search was conducted in PubMed using a family medicine hedge of MeSH terms, text words, and family medicine journals, combined with text words and terms representing low- and middle-income countries and the concept of family medicine training programs. A second search was completed using only family medicine terms in the CAB Direct and World Bank databases. Subsequent PubMed searches were conducted to identify articles about specific conditions or services based on suggestions from the authors of the articles selected from the second search. Additional articles were identified through reference lists of key articles and through Google searches. We then attempted to verify and augment the information through colleagues and partners. REPORT The scope of family medicine and the nature of family medicine training vary considerably worldwide. Challenges include limited capacity, incomplete understanding of roles, and variability of standards and recognition. Opportunities for advancement might include technology, collaboration, changes in pedagogy, flexible training methods, and system-wide support.
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Affiliation(s)
- Neil Arya
- Assistant Clinical Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont, and Adjunct Professor in the Department of Family Medicine at Western University in London, Ont
| | - Christine Gibson
- Clinical Assistant Professor in the Department of Family Medicine of the Cumming School of Medicine at the University of Calgary in Alberta and Executive Director of the Global Familymed Foundation
| | - David Ponka
- Associate Professor in the Department of Family Medicine at the University of Ottawa in Ontario and Lead of the Besrour Papers Working Group.
| | - Cynthia Haq
- Professor of Family Medicine and Community Health in the School of Medicine and Public Health at the University of Wisconsin in Madison
| | - Stephanie Hansel
- Technical Specialist at Juzoor for Health and Social Development in Ramallah, Palestine, at the time of the study
| | - Bruce Dahlman
- Head of the Department of Family Medicine and Community Care in the School of Medicine and Health Sciences at Kabarak University in Kenya
| | - Katherine Rouleau
- Associate Professor and Director of the Global Health Program in the Department of Family and Community Medicine at St Michael's Hospital and the University of Toronto in Ontario, and Director of the Besrour Centre at the College of Family Physicians of Canada
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Scherz N, Markun S, Aemissegger V, Rosemann T, Tandjung R. Internists' career choice towards primary care: a cross-sectional survey. BMC FAMILY PRACTICE 2017; 18:52. [PMID: 28381243 PMCID: PMC5382387 DOI: 10.1186/s12875-017-0624-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022]
Abstract
Background Swiss primary care (PC) is facing workforce shortage. Up to 2011 this workforce was supplied by two board certifications: general medicine and internal medicine. To strengthen them against subspecialties, they were unified into one: general internal medicine. However, since unification general practitioners’ career options are no longer restrained by early commitment to PC. This may lead to a decrease of future primary care physicians (PCPs). Methods To gain insights in timing and factors influencing career choice of internists, we addressed a cross sectional survey to all board certified internists in the years 2000–2010 (n = 1462). Main measures were: final career choice (PCPs, hospital internists or subspecialists), timing and factors influencing career choice, and attractiveness of PCP career during medical school and residency. Results Response rate was 53.2%, 44.8% were female and median age was 45 years old. Final career choice was PCP for 39.1% of participants, 15.0% chose to become hospital internists, 41.8% became subspecialists and 4.0% other. Timing of career choice significantly differed between groups. Most of the subspecialists have chosen their career during residency (65.3%), while only 21.9% of the PCPs chose during residency. Work experience in an academic hospital was negatively associated with becoming PCP (P < 0.001). Family influence on career choice was more frequently reported among PCPs and chiefs’ influence more reported among non-PCPs (P < 0.001). Fifty-nine percent of the participants considered a career as PCP to be attractive during medical school, this proportion decreased over time. Conclusions Timing of career choice of PCPs and subspecialists strongly differed. PCPs opted late for their career and potentially modifiable external factors seem to contribute to their decision. This stresses the importance of fostering attractiveness of PC during medical school as well as during and after residency and of tailored residency positions for future PCPs in the hospital-dominated new general internal medicine training. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0624-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathalie Scherz
- Institute of Primary Care, University Hospital of Zurich, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland. .,Arud Centres for Addiction Medicine, Zurich, Switzerland.
| | - Stefan Markun
- Institute of Primary Care, University Hospital of Zurich, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Vera Aemissegger
- Institute of Primary Care, University Hospital of Zurich, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital of Zurich, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Ryan Tandjung
- Institute of Primary Care, University Hospital of Zurich, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.,Federal Office of Public Health, Bern, Switzerland
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16
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Klemenc Ketiš Z, Švab I. Using movies in family medicine teaching: A reference to EURACT Educational Agenda. Zdr Varst 2017; 56:99-106. [PMID: 28289469 PMCID: PMC5329773 DOI: 10.1515/sjph-2017-0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/13/2016] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians' competencies as listed in the Educational Agenda produced by the European Academy of Teachers in General Practice/Family Medicine (EURACT) can be found in movies, and to propose a template for teaching by these movies. METHODS A group of family medicine teachers provided a list of movies that they would use in cinemeducation. The movies were categorised according to the key family medicine competencies, thus creating a framework of competences, covered by different movies. These key competencies are Primary care management, Personcentred care, Specific problem-solving skills, Comprehensive approach, Community orientation, and Holistic approach. RESULTS The list consisted of 17 movies. Nine covered primary care management. Person-centred care was covered in 13 movies. Eight movies covered specific problem-solving skills. Comprehensive approach was covered in five movies. Five movies covered community orientation. Holistic approach was covered in five movies. CONCLUSIONS All key family medicine competencies listed in the Educational Agenda can be taught using movies. Our results can serve as a template for teachers on how to use any appropriate movies in family medicine education.
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Affiliation(s)
- Zalika Klemenc Ketiš
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000 Maribor, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
- Community Health Centre Ljubljana, Metelkova 9, 1000 Ljubljana, Slovenia
| | - Igor Švab
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
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Holecki T, Romaniuk P, Woźniak-Holecka J. The Systemic Changes to Improve Efficiency in Polish Primary Health Care. Front Pharmacol 2016; 7:209. [PMID: 27468269 PMCID: PMC4943038 DOI: 10.3389/fphar.2016.00209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/30/2016] [Indexed: 11/13/2022] Open
Abstract
Primary health care is an important part of any health care system. In highly developed countries it secures the population's most elementary health needs, with particular emphasis on preventive care and early intervention. Polish PHC model is currently undergoing a thorough transformation, associated with the need to adapt to standards designated based on the WHO's criteria, and with reference to the experience of other European countries. The paper describes the process of changes being carried out, in the context of previous experiences of reform relating to the sphere of organization, processes and efficiency. A review and systematization has been made, with regard to the undertaken activities in the field of deregulation and change of legal provisions, which are aimed at achieving the improvement of the efficiency of treatment and resource allocation. A set of recommendations based on expert's discourse have also been provided, with respect to future directions of Polish PHC transformation.
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Affiliation(s)
- Tomasz Holecki
- Department of Health Economics and Health Management, School of Public Health in Bytom, Medical University of Silesia in Katowice Bytom, Poland
| | - Piotr Romaniuk
- Department of Health Policy, School of Public Health in Bytom, Medical University of Silesia in Katowice Bytom, Poland
| | - Joanna Woźniak-Holecka
- Department of Health Promotion, School of Public Health in Bytom, Medical University of Silesia in Katowice Poland
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Turkeshi E, Michels NR, Hendrickx K, Remmen R. Impact of family medicine clerkships in undergraduate medical education: a systematic review. BMJ Open 2015; 5:e008265. [PMID: 26243553 PMCID: PMC4538263 DOI: 10.1136/bmjopen-2015-008265] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Synthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients. DATA SOURCES Medline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian. REVIEW METHODS Independent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick's levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings' grades. Descriptive narrative synthesis applied. RESULTS Sixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME's grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students' attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student's presence and participation did not have a negative impact on patients. CONCLUSIONS Research quality on the impact of FM clerkships is still limited, yet across different settings and countries, positive impact is reported on students, FPs and patients. Future studies should involve different stakeholders, medical schools and countries, and use standardised and validated evaluation tools.
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Affiliation(s)
- Eralda Turkeshi
- Faculty of Medicine, Department of Family Medicine,University of Medicine in Tirana, Tirana, Albania
| | - Nele R Michels
- Faculty of Medicine and Health Sciences, Department of General Practice, University of Antwerp, Antwerp, Belgium
| | - Kristin Hendrickx
- Faculty of Medicine and Health Sciences, Department of General Practice, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Faculty of Medicine and Health Sciences, Department of General Practice, University of Antwerp, Antwerp, Belgium
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19
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International primary care snapshots: Nigeria and Poland. Br J Gen Pract 2015; 65:84-5. [PMID: 25624291 DOI: 10.3399/bjgp15x683677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Klemenc-Ketis Z, Kersnik J. Deficiency areas in decision making in undergraduate medical students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2014; 5:223-7. [PMID: 25053897 PMCID: PMC4105214 DOI: 10.2147/amep.s64920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND In family medicine, decisions can be difficult due to the early presentation of often poorly developed symptoms or the presentation of undifferentiated conditions that require competencies unique to family medicine, such as; primary care management, specific problem-solving skills, and a comprehensive and holistic approach to be taught to medical students. PURPOSE The aim of this study was to assess the decision-making process covering all theoretical aspects of family practice consultation and to recognize possible areas of deficiency in undergraduate medical students. MATERIALS AND METHODS This was a cross-sectional, observational study performed at the Medical School of the University of Maribor in Slovenia. The study population consisted of 159 fourth-year medical students attending a family medicine class. The main outcome measure was the scores of the students' written reports on solving the virtual clinical case. An assessment tool consisted of ten items that could be graded on a 5-point Likert scale. RESULTS The final sample consisted of 147 (92.5%) student reports. There were 95 (64.6%) female students in the sample. The mean total score on the assessment scale was 35.1±7.0 points of a maximum 50 points. Students scored higher in the initial assessment items and lower in the patient education/involvement items. Female students scored significantly higher in terms of total assessment score and in terms of initial assessment and patient education/involvement. CONCLUSION Undergraduate medical education should devote more time to teaching a comprehensive approach to consultation, especially modification of the health behavior of patients and opportunistic health promotion to patients. Possible sex differences in students' performance should be further evaluated.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Department of Family Medicine, Maribor Medical School, Maribor, Slovenia
- Department of Family Medicine, Ljubljana Medical School, Ljubljana, Slovenia
| | - Janko Kersnik
- Department of Family Medicine, Maribor Medical School, Maribor, Slovenia
- Department of Family Medicine, Ljubljana Medical School, Ljubljana, Slovenia
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Tandjung R, Ritter C, Haller DM, Tschudi P, Schaufelberger M, Bischoff T, Herzig L, Rosemann T, Sommer J. Primary care at Swiss universities--current state and perspective. BMC Res Notes 2014; 7:308. [PMID: 24885148 PMCID: PMC4037554 DOI: 10.1186/1756-0500-7-308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/16/2014] [Indexed: 11/17/2022] Open
Abstract
Background There is increasing evidence that a strong primary care is a cornerstone of an efficient health care system. But Switzerland is facing a shortage of primary care physicians (PCPs). This pushed the Federal Council of Switzerland to introduce a multifaceted political programme to strengthen the position of primary care, including its academic role. The aim of this paper is to provide a comprehensive overview of the situation of academic primary care at the five Swiss universities by the end of year 2012. Results Although primary care teaching activities have a long tradition at the five Swiss universities with activities starting in the beginning of the 1980ies; the academic institutes of primary care were only established in recent years (2005 – 2009). Only one of them has an established chair. Human and financial resources vary substantially. At all universities a broad variety of courses and lectures are offered, including teaching in private primary care practices with 1331 PCPs involved. Regarding research, differences among the institutes are tremendous, mainly caused by entirely different human resources and skills. Conclusion So far, the activities of the existing institutes at the Swiss Universities are mainly focused on teaching. However, for a complete academic institutionalization as well as an increased acceptance and attractiveness, more research activities are needed. In addition to an adequate basic funding of research positions, competitive research grants have to be created to establish a specialty-specific research culture.
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Affiliation(s)
- Ryan Tandjung
- Institute for Primary Care and Health Services Research, University of Zurich, Zurich, Switzerland.
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Klemenc-Ketis Z, Kersnik J. New virtual case-based assessment method for decision making in undergraduate students: a scale development and validation. BMC MEDICAL EDUCATION 2013; 13:160. [PMID: 24295091 PMCID: PMC4220563 DOI: 10.1186/1472-6920-13-160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 11/28/2013] [Indexed: 05/29/2023]
Abstract
BACKGROUND There are many Internet forums where patients can ask medical question and get an answer from doctors. The aim of this study was to develop and validate the rating scale for the assessment of decision-making skills in undergraduate medical students based on such Internet questions. METHODS This cross-sectional observational study carried out in Medical School of University of Maribor in Slovenia during the family medicine teaching course in the fourth study year. The sample consisted of 159 students. The source of data were the scoring sheets of the students' reports, assesses by two independent researchers. The assessment tool consisted of 10 items on a five-point Likert scale. RESULTS Our final sample consisted of 147 (92.5%) students' reports. The ICC for matching of the final total scores on assessment tool of both assessors was 0.742. Cronbach's alpha of the assessment scale was 0.848. Factor analysis revealed four factors: initial assessment, physical examination planning, planning patient management and patient education/involvement. CONCLUSIONS This assessment tool can be used for assessing undergraduate students' decision-making based on medical questions asked by real patients in a virtual setting.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Department of Family Medicine, Maribor Medical School, Taborska ulica 8, 2000 Maribor, Slovenia
- Department of Family Medicine, Ljubljana Medical School, Poljanski nasip 58, 1000 Ljubljana, Slovenia
| | - Janko Kersnik
- Department of Family Medicine, Maribor Medical School, Taborska ulica 8, 2000 Maribor, Slovenia
- Department of Family Medicine, Ljubljana Medical School, Poljanski nasip 58, 1000 Ljubljana, Slovenia
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Brekke M, Carelli F, Zarbailov N, Javashvili G, Wilm S, Timonen M, Tandeter H. Undergraduate medical education in general practice/family medicine throughout Europe - a descriptive study. BMC MEDICAL EDUCATION 2013; 13:157. [PMID: 24289459 PMCID: PMC4220558 DOI: 10.1186/1472-6920-13-157] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 11/25/2013] [Indexed: 05/15/2023]
Abstract
BACKGROUND It is increasingly becoming evident that a strong primary health care system is more likely to provide better population health, more equity in health throughout the population, and better use of economic resources, compared to systems that are oriented towards specialty care. Developing and maintaining a strong and sustainable primary health care requires that a substantial part of graduating doctors go into primary care. This in turn requires that general practice/family medicine (GP/FM) strongly influences the curricula in medical schools. In the present paper we aim at describing the extent of GP/FM teaching in medical schools throughout Europe, checking for the presence of GP/FM curricula and clinical teaching in GP offices. METHODS A brief questionnaire was e-mailed to GP/FM or other professors at European medical universities. RESULTS 259 out of 400 existing universities in 39 European countries responded to our questionnaire. Out of these, 35 (13.5%) reported to have no GP/FM curriculum. These 35 medical faculties were located in 12 different European countries. In addition, 15 of the medical schools where a GP/FM curriculum did exist, reported that this curriculum did not include any clinical component (n = 5), or that the clinical part of the course was very brief - less than one week, mostly only a few hours (n = 10). In total, 50 universities (19%) thus had no or a very brief GP/FM curriculum. These were mainly located in the Eastern or Southern European regions. CONCLUSION It is still possible to graduate from European medical universities without having been exposed to a GP/FM curriculum. The European Academy of Teachers in General Practice (EURACT) will launch efforts to change this situation.
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Affiliation(s)
- Mette Brekke
- Department of General Practice, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, 0318 Oslo, Norway
| | - Francesco Carelli
- University of Milan, Milan, Italy
- University Campus BioMedico in Rome, Rome, Italy
| | - Natalia Zarbailov
- Department of Family Medicine, State Medical and Pharmaceutical University “Nicolae Testemitanu”, 165 bd. Stefan Cel Mare si Sfint, 2004 Chisinau, Moldova
| | - Givi Javashvili
- Department of Family Medicine, Tbilisi State Medical University, 33 Vazha-Phshavela Avenue, Tbilisi 0177 Georgia
| | - Stefan Wilm
- Institute of General Practice, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Markku Timonen
- Institute of Health Sciences, University of Oulu, P.O. Box 5000, FIN-90014 Oulu, Finland
| | - Howard Tandeter
- Department of Family Medicine, Ben Gurion University, P.O. Box 653, 84105 Beer Sheva, Israel
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