Middle-sized primary health centre as an optimal environment for learning medicine?

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Middle-sized primary health centre as an optimal
environment for learning medicine?
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Historical background

• Primary Health Centres were founded in early
  sixties of the 20th century in all Slovenian
  communities. Their basic purpose was to enable
  and practice comprehensive and quality health
  care adjusted to real needs of each communities
  population.
• These Centres incorporated dentistry services,
  general practices and different medical
  specialities in (so called) dispensary
  departments
• Private practices either solo or group, were
  replaced completely, and health planning and
  managing have been put in local authorities
  hands.
• Nowadays, Slovenian primary care is a bit
  fragmented among different specialities as well
  between public sector and private health
  care providers.

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More about our community

• PHCC is located in commune on the south
  Slovenian border with population of approximately
  25 thousand inhabitants.
• The biggest Slovenian SPA is 5 kilometre far
  away.
• Important highway and railway are passing
  through.
• Tourism, trading, farming and vine producing are
  traditional business in our region

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More about our PHCC

• Employed staf7 specialists in general medicine,
  paediatrician, psychiatrist, gynaecologist,
  internist, two specialist in labour medicine and
  four dental doctors. Each primary care doctor
  worked together in team with a nurse. She is
  dealing preferably with office administration.
• There are surgeries of three private
  practitioners, well equipped laboratory, urgent
  service with our own ambulance cars, pharmacy,
  home nursing service and centre for treatment and
  prevention of illicit drug addiction all in
  the same building.

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Teaching stuff and trainees

• Two lady-physicians are tutors for postgraduates
  and two younger physicians are tutors for medical
  students
• An average of three or four students and one or
  two residents each year
• An average number of consultations is over 50 per
  working day.

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Teaching methods (1)

• All teaching methods are adopted to Medical
  Faculty curriculum. The most frequently used
  are
• Reading
• Observations
• Office demonstration and office practice
• Case discussion, case presentation
• One to one teaching

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Teaching methods (2)

• Problem based learning
• Reflection on consultation
• Case simulation
• Emergency service attachment
• A problem list construction
• Lecturing
• Preparing a project or material
• Field work

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Tutors opinions

• Main advantages and opportunities for learners
• - well organized urgent service (4/4)
• - well equipped laboratory (3/4)
• - interdisciplinary collaboration (2/4)
• -satisfactory level of informatics support
  (1/4)
• Main barriers for more efficacious education
• work overload
• shortage of time

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Tutors self-evaluation

• The effects of teaching
• Explaining issues to students helps me
  re-evaluate my practice.
• Students participation strongly influenced my
  approach to managing chronic illnesses.
• Frequently, J am afraid that it couldnt be
  possible to fulfil some expectations of trainee.
  The cooperation with other colleagues and
  experienced medical stuff were crucial when J
  was trying to meet the most of learners needs.
• It helps me to renew my knowledge and clinical
  skills.

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Learners attitudes and comments (1)

• A( female student) Work in urgent ambulant is
  very useful and dynamic. J needed more time for
  history taking and examination. Administrative
  overload had a strong influence on my working
  motivation.
• B (male student) There are too much paper work
  in GPs office. Some of these administrative
  tasks seems to be completely unnecessary.
  Otherwise, it is could be a very dynamic work.
• C (female student) It is very interesting and
  very stressful work, especially when you are
  urgent doctor at the same time.

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Learners attitudes and comments (2)

• D (male- resident)
• J am very satisfied with working environment
  and possibilities for professional development
  within this Centre. Access to internet and
  informatics support, including electronic patient
  records could be of ultimate importance for a
  young physicians in primary care. However, J have
  missed some learning methods video recording
  and self-evaluation in small groups

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Instead of conclusion

• Typical Slovenian middle-sized Primary health
  centre complies with the majority of conditions
  that are list in 6 chapters of EURACTs most
  recent educational agenda (2004).
• Successful implementation of teaching process
  into family practice settings depends on variety
  of factors which could be anticipated and
  measured.
• Additional tools and procedures for evaluation of
  efficiency of teaching processes should be
  developed and applied in primary care settings.
  

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The word doctor literally means teacher good
teachers are those who can inspire, guide,
educate, lead, and bring out the best in others
Brennan MG, Lancet 2003