Upload
raquel-gomez-bravo
View
1.551
Download
2
Tags:
Embed Size (px)
DESCRIPTION
“ 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
Citation preview
EURIPA AND VASCO DA GAMA MOVEMENT JOINT WORSHOP
Dr. Raquel Gómez Bravo (Vasco da Gama Movement – Semfyc. Spain )
Spain has one of the oldest GP programmes in Europe...
1978
Medicine studies: 6 years
28 Medicine Faculties
MIR (exam): 250 MCQ
Choose Medical Speciality
6.388 1859 GP places
4 years for Family Medicine
1112 € + shifts = 1500-2500 €
1978 Health protection and care
(Article 43 of the Spanish Constitution)
Speciality of Family and Community Medicine: 3 years
postgraduate training programme
1982 New Docent Units of Family Medicine
1983 Established Docent Units (structure, supports and
functions).
1984 Basic health zones, Health center, Primary Care
Team (teamwork)
1985 I GP Residency Training Programme
1986 General Health Care Act:
“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”
General principles of the National Health SystemGeneral principles of the National Health System
- Universal coverage with free access to health care for
almost all inhabitants;
- Public financing, mainly through general taxation;
- Integration of different health service networks under the
National Health System structure;
- Political devolution to the autonomous communities
- Region-based organization of health services into health
areas and basic health zones
1995 II GP Residency Training Programme
It is compulsory in Spain to work as a GP in the public
system (after the EU Directive from 1995).
2005 III GP Residency Training Programme (4 years).
The fourth year fully takes place in a teaching surgery
under the supervision of an accredited tutor.
2010 New training programme
17 Autonomous Communities
93 Docent Units
3000 Accredited tutors
734 Health docent centers
201 Docent Hospitals
1859 GP places
42% of the NHS’ doctors are GP
20.000 are “MIR”- GP
It depends on It depends on the Docent the Docent
Units…Units…
1) 1) First year:First year:
• INTERNAL MEDICINE and OTHERS SPECIALITIES:
5-8 months
• EMERGENCY (Shifts, 1 month)
• FAMILY MEDICINE: 3-6 months
• HOLIDAYS: 1 month
2 - 3) 2 - 3) Second and third year:Second and third year:
• INTERNAL MEDICINE and OTHERS MEDICAL-
SURGICAL SPECIALITIES : 8 months
• EMERGENCY (Shifts)
• PSYCHIATRY (2-3 months)
• PAEDIATRICS, Children´s health...(2 months)
• RURAL TRAINING: 3 months (R2)
• Women´s health (family planning, breastfeeding, high-risk
pregnancy…): 2-3 months
2 - 3) 2 - 3) Second and third year:Second and third year:
•FAMILY MEDICINE or ELECTIVE ROTATIONS: (3 months)
Rheumatology, Palliative Care, Dermatology, Geriatrics,
Neumology, Surgery, Neurology, Digestive, Nefrology,
Endocrinology, Radiology…
• HOLIDAYS: 2 months
4) 4) Fourth year:Fourth year:
• Learning in FAMILY MEDICINE (11 months)
• HOLIDAYS: 1 month
• EMERGENCY (Shifts)
• Research project
Common: - Self learning,
- classes,
- workshops,
- teamwork…
PM / RURALPM / RURAL HOSPITAL HOSPITAL EMERGENCYEMERGENCY
PAEDIATRICSPAEDIATRICS GYNAECOLOGYGYNAECOLOGY TRAUMATOLOGYTRAUMATOLOGY MED-MED-SURGICALSURGICAL
HOSPITAL HOSPITAL EMERGENCYEMERGENCY
TOTALTOTAL
R1 25% 75% 100%
R2 / R3 25% 37,5% 12,5% 4,5% 12,5% 8% 100%
R4 75% 12,5% 12,5% 100%
SHIFT HOURS DISTRIBUTION DURING SHIFT HOURS DISTRIBUTION DURING GP TRAINING IN DIFFERENT GP TRAINING IN DIFFERENT
EMERGENCY DEPARTMENTSEMERGENCY DEPARTMENTS
• Submit a Learning Portfolio (LEAP)
• Obligatory courses of continuous training
• Shifts (5-6 per month)
• Evaluation of each rotation by acredited tutors
• Congress, workshops, oral communications or
posters, self learning…
• Research project in the last year
Marks: 0-3 points
Annual
- Compulsory rotation since 2005
- 2 months / shifts
- Diversity between different rural communities
- No docent rural centers in all of them or accredited tutors
- Elective rotation in another docent unit / country
- Environmental barriers:
The rural/remote location of practice
Isolation from colleagues,
- Transport: timetables, own car...
- Lack of resources and staff sometimes...
BARRIERS IN RURAL GENERAL BARRIERS IN RURAL GENERAL PRACTICEPRACTICE
SOTO DEL REAL (MADRID)SOTO DEL REAL (MADRID)
- 3 MONTHS OF RURAL TRAINING3 MONTHS OF RURAL TRAINING
- RURAL SHIFTS (1-2 per month)RURAL SHIFTS (1-2 per month)
SOTO SOTO DEL REALDEL REAL
(MADRID)(MADRID)
Very good: 155/400.
Good: 161/400.
Bad: 80/400.
Very bad: 4/400.
Rural Medicine Rural Medicine during during
the postgraduate the postgraduate training period training period
in our country (Spain)in our country (Spain)Rate of participation
Rate of ID satisfation
Valiente Hernández, S. et al.
RESULTS
• RMPP implementation: 29/34• Average duration: 2 months (and shifts)• Mean number of visits/day: 25 patients• Mean distance to hospital: 50 km; (25-80)• Infraestructure problems:
-Lack of official training responsibles for CTU,- Need of a private mean of transport and extra expenses for ID.
MANZANARES EL REAL (MADRID)MANZANARES EL REAL (MADRID)
PATIENTSPATIENTS • Patients' expectations and behaviour
• Necessary patient education about the evidence base of treatments, antibiotics, consultations, moves...
• Patients may prefer to see their regular GP
• Patients not wanting to see someone with less experience
• Not hurry
• More sincerelly grateful, presents...
• Differences whithin population:
• Residents (elderly people)
• Temporary residents
LA CABRERA (MADRID)LA CABRERA (MADRID)
- The workload in rural general practice
- Isolation experienced in rural practice
- Limited time in attending
- Inadequate computer system
and difficult internet access
- Difficulty in attending continuing medical education events
- Not available treatments or tests
- Lack or poor resources to encourage GP
research, for continued medical education,
difficulty in accesing practical workshop
- Quality of Life / Funny experience
GP TRAINEES / TRAINERGP TRAINEES / TRAINER
CARDONACARDONAMontmaneuMontmaneu CataluñaCataluña
•No preparation at Medical School
•Coordinating different organisations
•The continuity of care in the community
•Chronic disease management
•Dermatological conditions
•Minor surgery
• Preventive health
• Unsupervised decisions
• A great spectrum of illness
• Holistic approach to health, person and family
• Conflicts with the placement of GP trainees
(between hospital and rural areas)
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…
Please don’t hesitate in contacting me!Please don’t hesitate in contacting me!
[email protected]@gmail.com