SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE IN BRUNEI DARUSSALAM SPECIALTY TRAINING...
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Transcript of SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE IN BRUNEI DARUSSALAM SPECIALTY TRAINING...
SPECIALTY TRAINING AND CAREER SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE STRUCTURE FOR FAMILY MEDICINE
IN BRUNEI DARUSSALAMIN BRUNEI DARUSSALAM
SPECIALTY TRAINING AND CAREER SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE STRUCTURE FOR FAMILY MEDICINE
IN BRUNEI DARUSSALAMIN BRUNEI DARUSSALAM
OUTLINE Brunei Darussalam Background Primary Health Care System & background Outpatient Services Basic Specialty Training (Family Medicine) Career Progression Advanced Specialist Training (Family
Medicine) Challenges
BRUNEI DARUSSALAM Population 390,000 Young population – 39.2% below 19 years Malay 66.6% 4 districts – Brunei Muara District (69.3% of
population) Life expectancy 77.8 yrs female & 75.2 yrs
male Infant mortality rate 7.6 per 1000 live births
PRIMARY CARE SERVICES
BEFORE NOW
Decentralisation
PostgraduateTraining
Brunei/Muara – 7 H/Cs(June 2000- March 2001)Belait - 3 H/Cs(Oct 2002)Tutong - 4 H/Cs(Oct 2002)
RIPASHospital
IN LINE WITH MINISTRY OF HEALTH NATIONAL HEALTH CARE PLAN (2000-2010)TO PROMOTE PRIMARY HEALTH CARE
PRIMARY HEALTH CARE SYSTEM
Health centres (14) and clinics (13) providing outpatient services and maternal and child health services
Travelling health clinics (13) Flying medical services (4) School health services
MukimBerakas
MukimGadongMukim
Sengkurong
MukimSerasa
MukimMentiri
MukimKota Batu
MukimLumapas
MukimKilanas
MukimPengkalan
Batu
OTHER PHC PROVIDER 1 private hospital – Jerudong Park MC Ministry of Defence – 5 medical centres Brunei Shell Petroleum – Panaga Health
Centre Private GP clinics – 21
OUTPATIENT SERVICES First point of contact for patients Gate-keeper to secondary care
(referral rate 1-5% & admission rate <1%)
Comprehensive & holistic care Minor illnesses & chronic cases
SERVICES IN HEALTH CENTRESMEDICAL RECORD TRIAGE
LABORATORY RESULTS OPD DOCTOR CONSULTATION
SERVICES IN HEALTH CENTRESTREATMENT ROOM
DISPENSARY
PHLEBOTOMY
RADIOLOGY
SERVICES IN HEALTH CENTRES
DIETICIAN COMMUNITY PSYCHIATRY
DENTALMCH
OTHER SERVICES
Extended hours services (out of hours)
DOTS for tuberculosis treatment Smoking cessation clinic Well women clinic Weight management clinic Ophthalmology clinic
FAMILY MEDICINE TRAINING
Vocational training rotations Masters in Primary Health Care (Feb
2004) – previously Postgraduate Diploma in Primary Health Care (Feb 2000)
MRCGP [International] (Nov 2005)
VOCATIONAL ROTATIONS Rotations organised by Division of
Outpatient Services 2 years hospital rotations and 1 year GP
placement Previous clinical experience can be
accredited prior to joining the program
VOCATIONAL ROTATIONS Components of hospital training
6 months - internal medicine, paediatrics and obstetrics & gynaecology (3 months of community MCH for male doctors)
3 months – psychiatry and accident and emergency
3 months - surgery / dermatology / ENT (optional clinical placement)
PRIMARY CARE TRAINING Postgraduate Diploma in Primary Health Care -
February 2000 3 years part time academic modular
programme & vocational training 2 cohorts – 23 doctors graduated Awarded by St George’s Hospital Medical
School, London, United Kingdom
PRIMARY CARE TRAINING
Nov 2003 – RCGP examiners attended the 2nd cohort PGDipPHC exams
PGDipPHC accredited as MRCGP[INT] 1st cohort awarded MRCGP[INT] by
Accreditation by Prior Experiential Learning (APEL)
MASTERS IN PRIMARY HEALTH CARE
Masters in Primary Health Care – Feb 2004 15 modules in 3 years Awarded by Universiti Brunei Darussalam Gradual handover to local tutors from St
George’s Hospital Medical School, London 4 cohorts of doctors undergoing training –
maximum of 8 per cohort
MASTERS IN PRIMARY HEALTH CARE
DATE YEAR 1 YEAR 2 YEAR 3FEB Critical Appraisal
Skills & Reflective Learning
Mental Health Child Health
APRIL Hypertension / Ischaemic Heart Disease
Minor Illness Respiratory Medicine
JULY Teaching & Learning Communication, Counseling & Consultation Skills
Registrar Led Hot Topics
SEPT Diabetes Infectious Disease Care of the Elderly / Palliative Care
NOV Research Skills & Methods
Women’s Health Family Practice as a Profession
MASTERS IN PRIMARY HEALTH CARE
9 X 3000 WORDSESSAYS
MSc
YR 1 YR 2 YR 3
TAUGHT MSc (6 drs)
RESEARCH – BASED MSc (2 drs)
3 X 3000 WORDS ESSAY
1 x 20000 WORDSTHESIS
MRCGP [INTERNATIONAL] Brunei Darussalam accredited as centre for
MRCGP [International] examinations 2nd site to Oman - November 2005 Exam based qualification – open to local and
overseas doctors 2 components
a) OSCE (12 stations) b) MCP (Multiple Choice Paper)
WHAT NEXT AFTER BST?
After completion of their GP training – some general practitioners have been given expanded roles such as in MCH services, school health services, HPEU, district health officer, KBS, KBM, TB, academic/medical education, e-health and administration
CAREER PROGRESSIONSalary Scale Position Qualifications
M16 - M16A Medical Officer MBBS
MBChB
M17 – M17A Senior Medical Officer
MSc PHC
MRCGP[INT]
M18 – M21 Specialist AST Family Medicine
ADVANCED SPECIALIST TRAINING
New concept and development for family medicine specialty
Progression and expanded role of general practitioners
GP with special interest/subspecialty Improve quality of care given to patients To provide equivalent quality specialist care in
primary care setting
ADVANCED SPECIALIST TRAINING
Increase accessibility of specialist care to the community
Recognition of general practitioners as a specialist care provider
Wider scope of recognition as an area of specialty
In line with proposed new scheme of service
ADVANCED SPECIALIST TRAINING
Increase workload of general practitioners for chronic care management
Reduce referral to hospital Reduce workload and waiting time of hospital
specialists Able to prescribe certain restricted specialist
drugs
ADVANCED SPECIALIST TRAINING
Identified priority areas
Clinical areas Non clinical areas
Medical education Public health Ethics and medical law Healthcare quality Health promotion and
education E-health / Health
informatics Research Health management &
planning
ADVANCED SPECIALIST TRAINING Diabetes Minor surgery Endocrinology Dermatology Gastroenterology Rehabilitation Elderly health Palliative medicine Sports medicine Adolescent health
Cardiology Men’s health Women’s health Child health Mental health Infectious disease e.g.
tuberculosis Respiratory disease STI Rheumatology
ADVANCED SPECIALIST TRAINING
3 years (2 years + 1 year elective)3 years (2 years + 1 year elective) Collaboration with RCGP for clinical Collaboration with RCGP for clinical
placements and fellowship portfolio placements and fellowship portfolio assessments – MOU signed May 2009assessments – MOU signed May 2009
Postgraduate Dip/MSc (GP with special Postgraduate Dip/MSc (GP with special interest) + Clinical placement +/- FRCGPinterest) + Clinical placement +/- FRCGP
Starting September 2009Starting September 2009
CURRENT SITUATION
New recruitment for GPs– emphasis on training and postgraduate qualifications
All local Bruneian doctors wishing to pursue career in GP have to go through mandatory vocational training rotations and MSc PHC
CURRENT SITUATION
MRCGP [International] is a required qualification to enter Advanced Specialist Training program (in collaboration with RCGP)
38% (30 out of 78) have vocational training / postgraduate qualifications in family medicine
CHALLENGES Continuing battle for family medicine to
be recognized as a specialty Increasing demand and expectation from
patients and colleagues Recruitment and retaining problems for
trained family medicine doctors
THANK YOU