SPECIALTY TRAINING AND CAREER SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE STRUCTURE FOR FAMILY MEDICINE

IN BRUNEI DARUSSALAMIN BRUNEI DARUSSALAM

SPECIALTY TRAINING AND CAREER SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE STRUCTURE FOR FAMILY MEDICINE

IN BRUNEI DARUSSALAMIN BRUNEI DARUSSALAM

OUTLINE Brunei Darussalam Background Primary Health Care System & background Outpatient Services Basic Specialty Training (Family Medicine) Career Progression Advanced Specialist Training (Family

Medicine) Challenges

BRUNEI DARUSSALAM Population 390,000 Young population – 39.2% below 19 years Malay 66.6% 4 districts – Brunei Muara District (69.3% of

population) Life expectancy 77.8 yrs female & 75.2 yrs

male Infant mortality rate 7.6 per 1000 live births

PRIMARY CARE SERVICES

BEFORE NOW

Decentralisation

PostgraduateTraining

Brunei/Muara – 7 H/Cs(June 2000- March 2001)Belait - 3 H/Cs(Oct 2002)Tutong - 4 H/Cs(Oct 2002)

RIPASHospital

IN LINE WITH MINISTRY OF HEALTH NATIONAL HEALTH CARE PLAN (2000-2010)TO PROMOTE PRIMARY HEALTH CARE

PRIMARY HEALTH CARE SYSTEM

Health centres (14) and clinics (13) providing outpatient services and maternal and child health services

Travelling health clinics (13) Flying medical services (4) School health services

MukimBerakas

MukimGadongMukim

Sengkurong

MukimSerasa

MukimMentiri

MukimKota Batu

MukimLumapas

MukimKilanas

MukimPengkalan

Batu

OTHER PHC PROVIDER 1 private hospital – Jerudong Park MC Ministry of Defence – 5 medical centres Brunei Shell Petroleum – Panaga Health

Centre Private GP clinics – 21

OUTPATIENT SERVICES First point of contact for patients Gate-keeper to secondary care

(referral rate 1-5% & admission rate <1%)

Comprehensive & holistic care Minor illnesses & chronic cases

SERVICES IN HEALTH CENTRESMEDICAL RECORD TRIAGE

LABORATORY RESULTS OPD DOCTOR CONSULTATION

SERVICES IN HEALTH CENTRESTREATMENT ROOM

DISPENSARY

PHLEBOTOMY

RADIOLOGY

SERVICES IN HEALTH CENTRES

DIETICIAN COMMUNITY PSYCHIATRY

DENTALMCH

OTHER SERVICES

Extended hours services (out of hours)

DOTS for tuberculosis treatment Smoking cessation clinic Well women clinic Weight management clinic Ophthalmology clinic

FAMILY MEDICINE TRAINING

Vocational training rotations Masters in Primary Health Care (Feb

2004) – previously Postgraduate Diploma in Primary Health Care (Feb 2000)

MRCGP [International] (Nov 2005)

VOCATIONAL ROTATIONS Rotations organised by Division of

Outpatient Services 2 years hospital rotations and 1 year GP

placement Previous clinical experience can be

accredited prior to joining the program

VOCATIONAL ROTATIONS Components of hospital training

6 months - internal medicine, paediatrics and obstetrics & gynaecology (3 months of community MCH for male doctors)

3 months – psychiatry and accident and emergency

3 months - surgery / dermatology / ENT (optional clinical placement)

PRIMARY CARE TRAINING Postgraduate Diploma in Primary Health Care -

February 2000 3 years part time academic modular

programme & vocational training 2 cohorts – 23 doctors graduated Awarded by St George’s Hospital Medical

School, London, United Kingdom

PRIMARY CARE TRAINING

Nov 2003 – RCGP examiners attended the 2nd cohort PGDipPHC exams

PGDipPHC accredited as MRCGP[INT] 1st cohort awarded MRCGP[INT] by

Accreditation by Prior Experiential Learning (APEL)

MASTERS IN PRIMARY HEALTH CARE

Masters in Primary Health Care – Feb 2004 15 modules in 3 years Awarded by Universiti Brunei Darussalam Gradual handover to local tutors from St

George’s Hospital Medical School, London 4 cohorts of doctors undergoing training –

maximum of 8 per cohort

MASTERS IN PRIMARY HEALTH CARE

DATE YEAR 1 YEAR 2 YEAR 3FEB Critical Appraisal

Skills & Reflective Learning

Mental Health Child Health

APRIL Hypertension / Ischaemic Heart Disease

Minor Illness Respiratory Medicine

JULY Teaching & Learning Communication, Counseling & Consultation Skills

Registrar Led Hot Topics

SEPT Diabetes Infectious Disease Care of the Elderly / Palliative Care

NOV Research Skills & Methods

Women’s Health Family Practice as a Profession

MASTERS IN PRIMARY HEALTH CARE

9 X 3000 WORDSESSAYS

MSc

YR 1 YR 2 YR 3

TAUGHT MSc (6 drs)

RESEARCH – BASED MSc (2 drs)

3 X 3000 WORDS ESSAY

1 x 20000 WORDSTHESIS

MRCGP [INTERNATIONAL] Brunei Darussalam accredited as centre for

MRCGP [International] examinations 2nd site to Oman - November 2005 Exam based qualification – open to local and

overseas doctors 2 components

a) OSCE (12 stations) b) MCP (Multiple Choice Paper)

WHAT NEXT AFTER BST?

After completion of their GP training – some general practitioners have been given expanded roles such as in MCH services, school health services, HPEU, district health officer, KBS, KBM, TB, academic/medical education, e-health and administration

CAREER PROGRESSIONSalary Scale Position Qualifications

M16 - M16A Medical Officer MBBS

MBChB

M17 – M17A Senior Medical Officer

MSc PHC

MRCGP[INT]

M18 – M21 Specialist AST Family Medicine

ADVANCED SPECIALIST TRAINING

New concept and development for family medicine specialty

Progression and expanded role of general practitioners

GP with special interest/subspecialty Improve quality of care given to patients To provide equivalent quality specialist care in

primary care setting

ADVANCED SPECIALIST TRAINING

Increase accessibility of specialist care to the community

Recognition of general practitioners as a specialist care provider

Wider scope of recognition as an area of specialty

In line with proposed new scheme of service

ADVANCED SPECIALIST TRAINING

Increase workload of general practitioners for chronic care management

Reduce referral to hospital Reduce workload and waiting time of hospital

specialists Able to prescribe certain restricted specialist

drugs

ADVANCED SPECIALIST TRAINING

Identified priority areas

Clinical areas Non clinical areas

Medical education Public health Ethics and medical law Healthcare quality Health promotion and

education E-health / Health

informatics Research Health management &

planning

ADVANCED SPECIALIST TRAINING Diabetes Minor surgery Endocrinology Dermatology Gastroenterology Rehabilitation Elderly health Palliative medicine Sports medicine Adolescent health

Cardiology Men’s health Women’s health Child health Mental health Infectious disease e.g.

tuberculosis Respiratory disease STI Rheumatology

ADVANCED SPECIALIST TRAINING

3 years (2 years + 1 year elective)3 years (2 years + 1 year elective) Collaboration with RCGP for clinical Collaboration with RCGP for clinical

placements and fellowship portfolio placements and fellowship portfolio assessments – MOU signed May 2009assessments – MOU signed May 2009

Postgraduate Dip/MSc (GP with special Postgraduate Dip/MSc (GP with special interest) + Clinical placement +/- FRCGPinterest) + Clinical placement +/- FRCGP

Starting September 2009Starting September 2009

CURRENT SITUATION

New recruitment for GPs– emphasis on training and postgraduate qualifications

All local Bruneian doctors wishing to pursue career in GP have to go through mandatory vocational training rotations and MSc PHC

CURRENT SITUATION

MRCGP [International] is a required qualification to enter Advanced Specialist Training program (in collaboration with RCGP)

38% (30 out of 78) have vocational training / postgraduate qualifications in family medicine

CHALLENGES Continuing battle for family medicine to

be recognized as a specialty Increasing demand and expectation from

patients and colleagues Recruitment and retaining problems for

trained family medicine doctors

THANK YOU