Postgraduate Training In Family Medicine Research Articles

Postgraduate training for family medicine in a rural district hospital in South Africa: Appropriateness and sufficiency of theatre procedures as a sentinel indicator.

BackgroundSince 2007, the postgraduate training of family physicians for South African district hospitals has been formalised. This training differs from European and North American programmes as up to 30% of the skills needed rely on district hospital surgical, obstetrics and anaesthetics procedures, particularly in rural areas, as outlined in the national unit standards. The aim of this study was to evaluate the appropriateness and sufficiency of learning opportunities for these skills in a rural district hospital.MethodsA descriptive, cross-sectional study was undertaken of the number and type of procedures performed in theatre for a 1-year period and compared with the required procedural skills stipulated in the national unit standards. Descriptive statistical analyses were used to analyse categorical data.ResultsThree thousand seven hundred and forty-one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by Caesarean section. There were adequate opportunities for teaching most core skills.ConclusionsSufficient and appropriate learning opportunities exist for postgraduate family medicine training in all the core skills performed in a theatre according to the national unit standards.

Integrating motivational interviewing and narrative therapy to teach behavior change to family medicine resident physicians.

Motivational interviewing is a useful skill to address the common problem of patient ambivalence regarding behavior change by uncovering and strengthening a person's own motivation and commitment to change. The Family Medicine Milestones underline the need for clear teaching and monitoring of skills in communication and behavior change in Family Medicine postgraduate training settings. This article reports the integration of a motivational interviewing curriculum into an existing longitudinal narrative therapy-based curriculum on patient-centered communication. Observed structured clinical examination for six participants indicate that intern physicians are able to demonstrate moderate motivational interviewing skill after a brief 2-h workshop. Participant self-evaluations for 16 participants suggest a brief 2-h curriculum was helpful at increasing importance of learning motivational interviewing by participants, and that participants desire further training opportunities. A brief motivational interviewing curriculum can be integrated into existing communication training in a Family Medicine residency training program.

Mentoring in der Allgemeinmedizin: Beratungsbedarf von Ärzten in Weiterbildung

More than 600 trainees in family medicine (FM trainees) have participated in the Verbundweiterbildung(plus) (VWB(plus)) since this rotation network programme has been implemented in 2009. Mentoring as need-based support and counselling is an essential element of this programme. The aim of this study was to identify FM trainees' most frequent reasons for counselling in order to explore the qualifications and requirements to be a mentor. 141 e-mails written between December 2009 and July 2014 were analysed according to Mayring. This procedure generated thematic categories of common reasons for seeking counselling. 32% of all VWB(plus) participants asked mentors of the programme for advice. The most frequent questions (38%) related to job vacancies, the application process and employment contracts. The second most common inquiries (30%) referred to participation in the VWB(plus) as well as contents of education meetings within the VWB(plus). Other questions pertained to general aspects of postgraduate training in family medicine (16%), individual conflict consulting (10%) and funding applications (6%). The results of the needs assessment survey reveal that a mentoring programme needs competent advisors with experience in family medicine. While FAQ lists are helpful in answering general questions, specific requests such as, for example, a personal crisis require individual counselling provided by a mentor.

Telemedicine and E-Learning in a Primary Care Setting in Sudan: The Experience of the Gezira Family Medicine Project.

Information and communication technology (ICT) is progressively used in the health sector (e-health), to provide health care in a distance (telemedicine), facilitate medical education (e-learning), and manage patients' information (electronic medical records, EMRs). Gezira Family Medicine Project (GFMP) in Sudan provides a 2-year master's degree in family medicine, with ICT fully integrated in the project. This cross-sectional study describes ICT implementation and utilization at the GFMP for the years 2011-2012. Administrative data was used to describe ICT implementation, while questionnaire-based data was used to assess candidates' perceptions and satisfaction. In the period from April 2011 to December 2012, 3808 telemedicine online consultations were recorded and over 165000 new patients' EMRs were established by the study subjects (125 candidates enrolled in the program). Almost all respondents confirmed the importance of telemedicine. The majority appreciated also the importance of using EMRs. Online lectures were highly rated by candidates in spite of the few challenges encountered by combining service provision with learning activity. Physicians highlighted some patients' concerns about the use of telemedicine and EMRs during clinical consultations. Results from this study confirmed the suitability of ICT use in postgraduate training in family medicine and in service provision.

Developing family medicine in Zambia.

No abstract available.

Strengthening primary health care through primary care doctors: the design of a new national Postgraduate Diploma in Family Medicine

Strengthening primary health care is a national priority in South Africa, in order to improve quality of care and health outcomes, reduce inequity and to pave the way for National Health Insurance. The World Health Organization and World Health Assembly both recommend the inclusion of a primary care doctor with postgraduate training in Family Medicine in the primary healthcare team. Currently, medical practitioners without postgraduate training, and those who may need re-orientating and upskilling for the future re-engineered primary care system, are the largest pool of doctors in South Africa. Most of these doctors are of an age and at a stage in their careers where it is unlikely that they will train to be a family physician.This article reports on a national process to design a Postgraduate Diploma in Family Medicine which will meet the learning needs of primary care doctors in both the public and private sectors as they prepare for the future.A year-long process included two national stakeholder works...

The next generation of Rwandan physicians with a primary health care mindset.

No abstract available.

International primary care snapshots: Nigeria and Poland.

Doctors have been working as generalists in primary care in Africa and Nigeria, and in rural hospitals without any further training, since the start of the 19th century.1 In Nigeria, postgraduate training in family medicine (previously known as general medical practice) began in 1981,1 although the Medical and Dental Council of Nigeria recognised it as a specialty when it established postgraduate medical training in the 1970s.2 Its popularity among young medical graduates has steadily risen since then to its present status where it is now the preferred specialty of choice in postgraduate residency training in Nigeria. Its graduates, Fellows of the Specialty in Nigeria, now number 313, and hold the same status as other specialists in terms of remuneration, career path, and privileges.3 Many Nigerians also hold the West African version of the degree from the West African College of Physicians.4 These fellows are distributed in all generalist settings, serving as consultant family physicians in general hospitals, university teaching hospitals, federal medical centres (tertiary hospitals), voluntary agency (mission) hospitals, and general practices. Due to their broad training, they also fill in for surgeons, obstetricians, internal medicine specialists, and paediatricians when there are shortages in general hospitals and federal medical centres, as well as fulfilling their generalist roles.4 GPs, under the aegis of the Association of General and Private Medical Practitioners of Nigeria, are being encouraged to take the Diploma in Family Medicine course, run by the Faculty of Family Medicine (FFM) of the National Postgraduate Medical College (NPMC), so as to mainstream them into the family medicine movement.4 Although Nigeria has a strong culture of medical research in family …

Building family medicine postgraduate training in Jamaica: overcoming challenges in a resource-limited setting

This paper recounts the development of family medicine postgraduate training in Jamaica, the challenges faced and lessons learned. A self-administered questionnaire was completed by past trainees exploring the perceived usefulness, strengths and weaknesses of the programme. The results of this study helped guide the strengthening of family medicine training in a resource-limited setting.

Enuresis improvement and its associated factors among children attending enuresis clinic at Rusaifah

Background: Enuresis is a common non-lethal health problem, causing a great deal of stress, confusion, and frustration to the suffering children, parents, and physicians. Objectives: Finding and evaluating the scope of improvement and factors associated with it among children attending enuresis clinic at Rusaifah Family Medicine Postgraduate Training Center in Makkah Al-Mukarramah. Methods: The study was conducted at Rusaifah Family Medicine Postgraduate Training Center in Makkah Al-Mukarramah (June–August 2013). The targeted population was 600 patients with enuresis registered with the enuresis clinic at Al-Rusaifah Family Medicine Postgraduate Training Center. The sample size was calculated to be 150 using Epi Info, version 6. Medical records of patients with enuresis and a checklist designed by the researcher were used to obtain data covering all variables studied. Medical records were reviewed and the required information was pooled to a checklist designed to record data required for variables. Results: The response rate was 100%. A zero wetting per week improvement was found among 149 (99.3%), 54 (36%), and 9 (6%) in the first month, first 2 months, and first 3 months, respectively. The mean age of children with improved enuresis was found to be 9.38 years in the first month, 9.09 years in the first 2 months, and 11.33 years in the first 3 months, respectively, compared to that of those with non-improved enuresis (5 years, 9.51 years, and 9.23 years in the first month, first 2 months, and first 3 months). This difference was not significant except in the first 3 months (p < 0 .04). Other studied variables (age at toilet training, gender, nationality, spontaneous wakening for toilet, fear of toilet, easy access to toilet, hospitalization, parental separation, delayed milestones, fluid restriction, school/home conflict, urinary tract infection symptoms, punishment, and rewards) were not significantly associated with the degree of improvement for enuresis. Conclusion: The degree of improvement (zero wetting per week) was high in the first month then and then declined steadily in the first 2 months and in the first 3 months.

Factors associated to the career choice of family medicine among Japanese physicians: the dawn of a new era.

BackgroundDespite recent developments in post-graduate family medicine training in Japan, the numbers of junior doctors entering family medicine residencies are still limited. The objective of this qualitative study was to investigate the possible factors associated to the career choice of family medicine, especially in the context of the newly established family medicine programs in Japan.MethodsFrom December 2010 to January 2011, we distributed a semi-structured questionnaire about career choice to 58 physician members of the Japan Primary Care Association, and 41 of them responded. Four researchers used the Modified Grounded Theory Approach (Kinoshita, 2003) for three-stage conceptualization.ResultsWe extracted a conceptual model of the choice of newly established family medicine as a career in Japan, consisting of six categories and 77 subordinate concepts from 330 variations. The subcategories of personal background affecting the family-medicine career choice were characteristics (“self-reliance,” “pioneering spirit”), career direction (“community/rural-orientedness,” “multifaceted orientation”) and experience (e.g., “discomfort with fragmented care”). We divided the influencing factors that were identified for career choice into supporters (e.g., “role model”), conflict of career choice (e.g., “anxiety about diverse/broad practice”), and the dawn of a new era in family medicine in Japan (e.g., “lack of social recognition,” “concern about livelihood,” and “too few role models”).ConclusionsAlthough the dawn of a new era seemed a rather negative influencer, it was unique to our study that the dawn itself could attract those with a “pioneering spirit” and an “attitude of self-training.” Unlike previous studies, the positive factors such as lifestyle and the short residency program were not shown to be part of family medicine's attractiveness. In contrast, “concern about livelihood” was specific among our respondents and was related to career choice in the dawn period. “Community-orientedness” and “multifaceted orientation” (which have aspects in common with previous studies' findings) would appear to be universal regardless of cultural and medical system differences. In our study, these universal factors were also found to be part of the attractiveness of family medicine from the practitioners' viewpoints, and these factors may become great influencers for family medicine candidates.Electronic supplementary materialThe online version of this article (doi:10.1186/s12930-014-0011-2) contains supplementary material, which is available to authorized users.

Challenges facing postgraduate training in family medicine in Saudi Arabia: Patterns and solutions

Objective: The objective of this paper was to show the challenges that are faced by the Family Medicine Training Programmes in the Kingdom of Saudi Arabia as well as suggests appropriate and practical solutions. Materials and Methods: This study was conducted from 2010 - 2013 using a semi-structured questionnaire to achieve the objective. The questionnaire was designed and completed by the investigators during their visits to accredit the training centres all over the Kingdom. It consisted of questions concerning the trainers' and trainees' opinions regarding all the aspects of training. Another tool used was the accreditation checklist, which contained a comprehensive list of training structures and processes mandatory for any training centre. The accreditation checklist and questionnaire were reviewed by the investigators after visiting all the training centres. The challenges were then classified manually and solutions were reviewed as well as approved by the members of the Accreditation Committee. Results: Seventy-five training centres were visited and 250 trainees along with 75 trainers participated in this study. Twenty-five challenges were identified and classified under 6 major groups. The practical solutions to these challenges were discussed with participants and then approved by the investigators. Conclusion: This study showed that Family Medicine Training in the Kingdom of Saudi Arabia faces many different challenges. Early identification along with key solutions to these difficulties are extremely important in the efforts to produce a new generation of competent Saudi Family Physicians who can improve the quality of healthcare for the population of Saudi Arabia.

Satisfaction of family physicians during their training program, Jeddah, Saudi Arabia

Background: Family medicine is considered the cornerstone of health system. It's defined as medical specialty, which provides continuing and comprehensive health care for the individual and the family. The family physicians should be very well trained to be qualified for this purpose. Family medicine became a recognized specialty in our country since a proximately 30 years. Postgraduate family medicine training program established at KSA in 1981 in King Faisal University. Resident's opinion is very important as they are the target of the training process and will help a lot in future improvement. Aims & Objective: To determine the level of residents’ satisfaction about the training curriculum at different levels (R1 to R4) in the JPFCM and to predicts the factors that affecting their training. Materials and Methods: This was Cross sectional analytic study of residents and postgraduates conducted at Jeddah city, in the Joint Program of Family and Community Medicine. All the residents at different level (R1 to R4) at year 2012 and 3 years post graduates from Joint Program of Family and Community Medicine. More than 3 years Post graduates family physician were excluded from the study. Data collection was done using self-administered modified validated questionnaire of Family practice competency questionnaire (FPCQ). Results: The perception of most curriculum training items were rated as very important by the trainees. The adequacy of training was lower than trainees’ expectation especially in procedures skills. Lack of health care supporting system, quality of hospital training, lack of job description, and interruption of continuity of care among other factors were most important factors affecting the training. 48% of trainees were generally satisfied about training adequacy and 62% were satisfied of being a family physician. Conclusion: 35% of the trainees were dissatisfied about their training 89% were currently residents and 10% postgraduates. 42% of the trainees were satisfied. Satisfaction was decline during residency years but it picked up in post graduate to reach the highest during 3rd year postgraduate. This level of satisfaction could be explained by that the training provided during the residency rotations especially in non-family medicine rotations was below the expectations of the trainees. This result was cleared through the factors affecting their satisfaction about the training as we observed that Most factors affecting the training were lack of health care system supporting the specialty and the quality of the training during hospital rotations.

One program, multiple training sites: does site of family medicine training influence professional practice location?

Numerous strategies have been suggested to increase recruitment of family physicians to rural communities and smaller regional centers. One approach has been to implement distributed postgraduate education programs where trainees spend substantial time in such communities. The purpose of the current study was to compare the eventual practice location of family physicians who undertook their postgraduate training through a single university but who were based in either metropolitan or distributed, non-metropolitan communities. Since 1998, the Department of Family Practice at the University of British Columbia in Canada has conducted an annual survey of its residents at 2, 5, and 10 years after completion of training. The authors received Ethics Board approval to use this anonymized data to identify personal and educational factors that predict future practice location. The overall response rate was 45%. At 2 years (N=222), residents trained in distributed sites were 15 times more likely to enter practice in rural communities, small towns and regional centers than those who trained in metropolitan teaching centers. This was even more predictive for retention in non-urban practice sites. Among the subgroup of physicians who remained in a single practice location for more than a year preceding the survey, those who trained in smaller sites were 36 times more likely to choose a rural or regional practice setting. While the vast majority of those trained in metropolitan sites chose an urban practice location, a subgroup of those with some rural upbringing were more likely to practice in rural or regional settings. Trainees from distributed sites considered themselves more prepared for practice regardless of ultimate practice location. Participation in a distributed postgraduate family medicine training site is an important predictor of a non-urban practice location. This effect persists for 10 years after completion of training and is independent of other predictors of non-urban practice including gender, rural upbringing, and rural undergraduate training. It is hypothesized that this is due not only to a curriculum that supports preparedness for this type of practice but also to opportunities to develop personal and professional roots in these communities.

Reliability testing of a portfolio assessment tool for postgraduate family medicine training in South Africa

BackgroundCompetency-based education and the validity and reliability of workplace-based assessment of postgraduate trainees have received increasing attention worldwide. Family medicine was recognised as a speciality in South Africa six years ago and a satisfactory portfolio of learning is a prerequisite to sit the national exit exam. A massive scaling up of the number of family physicians is needed in order to meet the health needs of the country.AimThe aim of this study was to develop a reliable, robust and feasible portfolio assessment tool (PAT) for South Africa.MethodsSix raters each rated nine portfolios from the Stellenbosch University programme, using the PAT, to test for inter-rater reliability. This rating was repeated three months later to determine test–retest reliability. Following initial analysis and feedback the PAT was modified and the inter-rater reliability again assessed on nine new portfolios. An acceptable intra-class correlation was considered to be > 0.80.ResultsThe total score was found to be reliable, with a coefficient of 0.92. For test–retest reliability, the difference in mean total score was 1.7%, which was not statistically significant. Amongst the subsections, only assessment of the educational meetings and the logbook showed reliability coefficients > 0.80.ConclusionThis was the first attempt to develop a reliable, robust and feasible national portfolio assessment tool to assess postgraduate family medicine training in the South African context. The tool was reliable for the total score, but the low reliability of several sections in the PAT helped us to develop 12 recommendations regarding the use of the portfolio, the design of the PAT and the training of raters.

The national portfolio of learning for postgraduate family medicine training in South Africa: experiences of registrars and supervisors in clinical practice

BackgroundIn South Africa the submission of a portfolio of learning has become a national requirement for assessment of family medicine training. A national portfolio has been developed, validated and implemented. The aim of this study was to explore registrars’ and supervisors’ experience regarding the portfolio’s educational impact, acceptability, and perceived usefulness for assessment of competence.MethodsSemi-structured interviews were conducted with 17 purposively selected registrars and supervisors from all eight South African training programmes.ResultsThe portfolio primarily had an educational impact through making explicit the expectations of registrars and supervisors in the workplace. This impact was tempered by a lack of engagement in the process by registrars and supervisors who also lacked essential skills in reflection, feedback and assessment. The acceptability of the portfolio was limited by service delivery demands, incongruence between the clinical context and educational requirements, design of the logbook and easy availability of the associated tools. The use of the portfolio for formative assessment was strongly supported and appreciated, but was not always happening and in some cases registrars had even organised peer assessment. Respondents were unclear as to how the portfolio would be used for summative assessment.ConclusionsThe learning portfolio had a significant educational impact in shaping work-place based supervision and training and providing formative assessment. Its acceptability and usefulness as a learning tool should increase over time as supervisors and registrars become more competent in its use. There is a need to clarify how it will be used in summative assessment.

Country Contextualization of the Mental Health Gap Action Programme Intervention Guide: A Case Study from Nigeria

The global burden of disease (GBD) study clearly brought to the fore the societal impact of mental health conditions, with the finding that neuropsychiatric conditions account for about 14% of the total disease burden [1]. The extent of this burden has been further emphasized by recent large-scale global surveys, which indicate that not only are mental disorders highly prevalent worldwide, but also that a huge treatment gap exists in both developed and developing countries [2],[3]. Furthermore, there is evidence to demonstrate that effective and affordable treatment for common mental disorders is feasible, even in low- and middle-income countries (LMICs) [4]. Several barriers and constraints in these countries have led to a situation where those with the greatest need for mental health services often lack access to these services [5]. It has therefore become imperative to seek innovative solutions to these global mental health challenges [6]–[8]. Current evidence favours innovative solutions that would result in overall health system strengthening, integrated provision of services [9], and improved access to evidence-based packages of care through task-shifting [10] As a way of confronting this global challenge, the World Health Organization (WHO) recently launched a programme of action to help countries implement activities aimed at narrowing the gap between need and available services for mental health care. This programme, the Mental Health Gap Action Programme (mhGAP), is designed to assist LMICs in their efforts to scale up the coverage of mental health services for their citizens [11]. An important component of the programme is the development of the mhGAP-Intervention Guide (mhGAP-IG), a manual designed to facilitate the recognition and management of a set of priority mental, neurological, and substance use (MNS) disorders in non-specialist settings. The manual is the product of a rigorous international expert consensus on the most burdensome MNS conditions, and describes approaches to their recognition and the provision of evidence-based interventions, both pharmacological and non-pharmacological, for alleviating these conditions. The priority conditions covered by the mhGAP-IG are depression, psychosis, dementia, bipolar disorder, epilepsy, behavioural disorders, developmental disorders, alcohol use disorders, drug use disorders, and suicide and self harm. The guide provides information on the diagnosis of each condition and the common interventions that can be offered to sufferers by non-specialists. Particular emphasis is placed on the use of commonly available non-pharmacological interventions wherever evidence exists for their efficacy. Referrals to the next level of care are suggested when such are indicated. The process of developing this tool was based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to generate an evidence-based, intervention package [12],[13]. Furthermore, the mhGAP-IG is not a stand-alone tool, but comes with a range of supporting technical tools, which includes a facilitator's guide for each module, a contextualization questionnaire, and tools for monitoring and evaluating its use. There is wide variability in local circumstances among countries, both in regard to the organization of their health systems and the availability of resources to deliver the recommended interventions. Furthermore, differences also exist in the composition and training of health care personnel, loosely referred to as “non-specialists.” For example, in some countries these may be highly skilled doctors with postgraduate training in family medicine or general practice while in some others, especially in low resource settings, such providers may be community health workers with minimal training. For these reasons, it is recommended that a process of contextualization of the generic version of the mhGAP-IG be implemented in each country setting in order to produce a fully adapted version that meets with the needs of the extant health system in which it is to be used. This paper describes the process of adaptation and contextualization of the manual for the Nigerian health system, a system with broad similarities with those of many sub-Saharan African countries.

The national portfolio for postgraduate family medicine training in South Africa: a descriptive study of acceptability, educational impact, and usefulness for assessment.

BackgroundSince 2007 a portfolio of learning has become a requirement for assessment of postgraduate family medicine training by the Colleges of Medicine of South Africa. A uniform portfolio of learning has been developed and content validity established among the eight postgraduate programmes. The aim of this study was to investigate the portfolio’s acceptability, educational impact, and perceived usefulness for assessment of competence.MethodsTwo structured questionnaires of 35 closed and open-ended questions were delivered to 53 family physician supervisors and 48 registrars who had used the portfolio. Categorical and nominal/ordinal data were analysed using simple descriptive statistics. The open-ended questions were analysed with ATLAS.ti software.ResultsHalf of registrars did not find the portfolio clear, practical or feasible. Workshops on portfolio use, learning, and supervision were supported, and brief dedicated time daily for reflection and writing. Most supervisors felt the portfolio reflected an accurate picture of learning, but just over half of registrars agreed. While the portfolio helped with reflection on learning, participants were less convinced about how it helped them plan further learning. Supervisors graded most rotations, suggesting understanding the summative aspect, while only 61% of registrars reflected on rotations, suggesting the formative aspects are not yet optimally utilised. Poor feedback, the need for protected academic time, and pressure of service delivery impacting negatively on learning.ConclusionThis first introduction of a national portfolio for postgraduate training in family medicine in South Africa faces challenges similar to those in other countries. Acceptability of the portfolio relates to a clear purpose and guide, flexible format with tools available in the workplace, and appreciating the changing educational environment from university-based to national assessments. The role of the supervisor in direct observations of the registrar and dedicated educational meetings, giving feedback and support, cannot be overemphasized.

Rifat Atun: looking at the bigger picture

Rifat Atun: looking at the bigger picture

Las características familiares y la salud percibida en médicas y médicos de familia de Andalucía

ObjectiveTo determine the relationships between a group of professional and family characteristics and the components of physical and mental health in female and male primary care physicians working in health centers in Andalusia (Spain). MethodsA descriptive, cross-sectional, multicenter study was performed. The population consisted of urban health centers in Andalusia and their physicians. The sample comprised 88 health centers and 500 physicians. Measurements consisted of sex, age, professional characteristics (postgraduate training in family medicine, position of health center manager, accreditation as a residents’ tutor, and workload based on patient quota and the mean number of patients/day); family responsibilities, defined by two dimensions of the family-work relationship (support overload-family support deficit and family-work conflict); and perceived physical and mental health. The data source was a self-administered questionnaire sent by surface mail. Multiple regression analyses were performed for physical and mental health for the whole sample and by gender. ResultsResponses were obtained from 368 physicians (73.6%). Mental health was worse in female physicians than in male physicians; no differences were found between genders in physical health. The family-work conflict was associated with physical and mental health in physicians of both genders. Physical health deteriorated with increasing age in both genders, improved in the female tutors of residents, and decreased with increasing family-work conflict in male physicians. Mental health decreased with increasing housework on the weekends and with family-work conflict in both genders. In male physicians, mental health deteriorated with postgraduate training in family medicine and improved if they were health center managers. ConclusionsWorkload and professional characteristics have little relationship with the health of primary care physicians. Family characteristics play a greater role.