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!

raquelgomezbravo@gmail.comraquelgomezbravo@gmail.com