“What Essential Competences young family doctors have to learn and practice for working in rural areas

appropriately? “

Results from 16th and 17th Wonca Europe Conferences Workshops

“ A tribute to Claudio Carosino “

Jaume Banqué Vidiella . Euripa – Semfyc – Camfic

Institut Català de la Salut. CAP Baix Ebre. Spain

jbanquev@gmail.com

Common themes in rural health…

• At the heart of the rural health education agenda is that rural people have different healthcare needs and reduced access to services….

• Rural populations tend to have different profiles to those of urban populations…

• Rural health professionals face additional isolation issues…• Isolation from professional support requires a broader scope of

practice, more training and stronger support networks…

RB Hays. School of Medicine, Keele University, Staffordshire, UKRural medical education in Europe: the relevance of the Australian experienceRural and Remote Health 7: 683. (Online), 2007

Wonca Europe Conf. Workshops

16th Conf. Málaga 17th Conf. Warsaw

10.2010 09.2011

Participants: 32(Countries: 23)

Compulsory RT period for young GP in your country ? : 5 countries

Experience in Rural Health ? : 20 partic.

(60,6%)

Results faced with Core Competences ( European Definition of GP / Family Medicine

Euract. Wonca Europe 2005 )

Results grouped into

• Abilities, training and knowledge. (42)

• Working in a rural setting (28)• Being a GP and a rural doctor

(25)• Collaborative practice (10)• Community medicine (10)• Family and home care (4)

Core Competences – Euract 2005

• Specific solving problems skills• Primary care management• Person centred care• Comprehensive approach• Community orientation• Holistic approach

Abilities, training and knowledge Specific solving problems skills

• Skills and training in emergencies• Communicational skills• Paediatrics• Geriatrics• Gynaecology and obstetrics• Palliative care. Pain Control• Up to date in technologies

Working in a rural setting Primary care management / Comprehensive approach/ Holistic approach

• Flexibility• Integration with population• Knowing the idiosyncrasy of population where you work• Commitment of at least 3 – 5 years to a rural community• Leadership • Be in touch with other colleagues. Don’t stay isolated.• Being part of your community as private person as well as

professional (How to live and work in the same and small community) • Patient guide and rural doctor´s style: going slow without stop.

Being a GP and a rural physician Primary care management / Comprehensive / Holistic approach

• Dealing with uncertainty• Holistic approach• Facing the challenges: Ability to work under stress and independently• Physician’s health • Treating all kind of people• Be closed but maintaining your doctor´s role• Greater range of skills: Procedural, diagnostic, public health...• How to prevent and treat occupational diseases • Dealing with CPD and professional development.

Collaborative practicePrimare care management

• Networking • Multidisciplinary point of view• How to work with different specialist and institutions : social services,

local politicians, veterinarians, agricultural engineers....• Collaborating with regional services

Community medicineCommunity orientation

• Working with the community • Social, demographic and epidemiologic point of view • Empowering population • Community oriented primary care • Community involvement (coherence between lifestyle

recommendations and personal choices)• Knowledge of local culture and community

Family and home carePerson centered care

• Collaboration with family to resolve problems• Home care • Long term care for chronic diseases• Traditional care in rural areas.

Rural training concepts

• Rural Doctor > Complete family doctor > Core and paradigm of the GP speciality > Model for young family doctors

• Rural Practice > Specific kind of practice > Health care for a particular community > Working with sustainability

• Rural Center > Locus for training and learning > Under and Post Graduate Doctors

• Rural Rotation > “Not a problem of contents but a problem of future life conditions”

Rural medicine values for trainees

• Getting an opportunity for working and knowing “The GP´s role” inside a defined community

• Emphasizing the holistic view in Family Medicine : “The bio-psyco-social model”

• Underlining the importance of “Equity” in health services : Equal access / Equal utilization / Equal health outcomes