Primary Care Education for Doctors
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This presentation is aimed at giving an overview of the primary care medical education at both undergraduate and postgraduate education followed by suggestions for improvement.
![SRI LANKAN
DOCTORS'
EXPERIENCE
IN FAMILY MEDICINE / GENERAL PRACTICE EDUCATION
CHAMATH FERNANDO
MBBS, DFM, DipPallMed (UK), MRCGP [INT],
PhD Student in Palliative Care (Lancaster University, UK)
Lecturer/ Family Physician, Faculty of Medical Sciences,
Coordinator, National Centre for Primary Care and Allergy Research
University of Sri Jayewardenepura, Sri Lanka.](https://image.slidesharecdn.com/ylnfamilymedicineeducation-190314042847/85/Primary-Care-Education-for-Doctors-1-320.jpg)
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Primary Care Education for Doctors
- 1. SRI LANKAN DOCTORS' EXPERIENCE IN FAMILY MEDICINE / GENERAL PRACTICE EDUCATION CHAMATH FERNANDO MBBS, DFM, DipPallMed (UK), MRCGP [INT], PhD Student in Palliative Care (Lancaster University, UK) Lecturer/ Family Physician, Faculty of Medical Sciences, Coordinator, National Centre for Primary Care and Allergy Research University of Sri Jayewardenepura, Sri Lanka.
- 2. MY OBJECTIVES OF THIS PRESENTATION • To give an overview of Sri Lanka and its health system. • To brief the evidence from studies published on Sri Lankan Family Medicine Education. • To outline the structure of primary care in undergraduate education. • To enumerate the acceptable qualifications to practice as a GP in Sri Lanka • To give first hand experience of the barriers faced by doctors’ who wish to pursue primary care as their carrier.
- 3. SRI LANKA
- 4. (“Nepal’s HDI ranking improves moderately to 145: UN - The Himalayan Times,” n.d.) (“(15) (PDF) Human development and South East Asian countries,” n.d.)
- 5. STUDIES RELEVANT TO GP/FM EDUCATION • PubMed: 4 published articles in relation to the topic. • Evaluation of Undergraduate Family Medicine Curriculum. Ramanayake, R. P. J. C., De Silva, A. H. W., Perera, D. P., Sumanasekara, R. D. N., Gunasekara, R., & Chandrasiri, P. (2015). Evaluation of Teaching and Learning in Family Medicine by Students: A Sri Lankan Experience. Journal of Family Medicine and Primary Care, 4(1), 3–8. https://doi.org/10.4103/2249-4863.152236 • In 1983: 1/3 of doctors were identified to be practicing in primary care, who had neither undergraduate or postgraduate training in the discipline. Fernando, J. (1983). Training doctors for family practice in primary health care work in Sri Lanka. Social Science & Medicine (1982), 17(19), 1457–1461.
- 6. • In 2008, Online programme: Postgraduate Diploma in Family Medicine (15) (PDF) Student Perceptions of an Online Post Graduate Course in Family in Sri Lanka. (n.d.) • Ramanayake, R. P. J. C. (2013). Historical Evolution and Present Status of Family Family Medicine in Sri Lanka. Journal of Family Medicine and Primary Care, 2(2), 131–134. https://doi.org/10.4103/2249-4863.117401
- 7. UNDERGRADUATE EDUCATION Faculty Teaching Family Medicine Clinical Exposure Dedicated Family Medicine Department Professorial Clinical Department Sri Jayewardenepura Yes Yes Yes Yes Ragama Yes Yes Yes No Jaffna Yes Yes Yes No Eastern Yes Yes Yes No Colombo Yes Yes No No KDU Yes Yes No No Rajarata Yes No No No Peradeniya No No No No Karapitiya No No No No Wayamba* (Being est.) No No No No
- 8. POSTGRADUATE EDUCATION AND BARRIERS FOR GPS TO DEVELOP THEIR CAREERS
- 9. ACCEPTABLE QUALIFICATIONS TO PRACTICE FAMILY MEDICINE Postgraduate Qualification Conducted by Minimum duration to complete since internship Minimum duration of the degree proper Status Career prospects None -- 0 -- GP No position in the state sector. Able to practice as a private GP (mostly after duty hours) PG Diploma in Family Medicine (DFM) Postgraduate Institute of Medicine (PGIM – Colombo) 7 years 1 year GP No position in the state sector. Able to practice as a private GP (mostly after duty hours) Member of College of GPs Examination (MCGP) College of General Practitioners of Sri Lanka 7 – 8 years 2 years GP No position in the state sector. Able to practice as a private GP (mostly after duty hours) Member of Royal College of General Practitioners Examination (MRCGP [INT]) Royal College of General Practitioners, UK 6 years Experience based assessment GP No position in the state sector. Able to practice as a private GP (mostly after duty hours) MD in Family Medicine (by clinicals) PGIM - Colombo 12 – 13 years 7 – 8 years Specialist Family Physician Posted to the OPD of a hospital as a primary care specialist MD in Family Medicine (by thesis) PGIM - Colombo 12 – 13 years 7 –8 years Specialist Family Physician Posted to the OPD of a hospital as a primary care specialist
- 11. • Lack of credibility of the Board of Studies in Family Medicine at Postgraduate Institute of Medicine. • Resistance from specialists.
- 12. REQUESTS FROM “WORLD HEALTH ORGANIZATION”
Hinweis der Redaktion
- Hi everyone, I am Chamath; a GP and a Lecturer in Family Medicine from Sri Lanka. I wish to share the Family Medicine or General Practice Education in the Sri Lankan DOCTORS’ context.
- My objectives of this presentation are to To give an overview of Sri Lanka and its health system. To brief the evidence from studies published on Sri Lankan Family Medicine Education. To outline the structure of primary care in undergraduate education. To enumerate the acceptable qualifications to practice as a GP in Sri Lanka and To give first-hand experience of the barriers faced by doctors’ who wish to pursue primary care as their carrier.
- Sri Lanka…… is an island nation located in the Indian Ocean with 21 million population. Click An additional tip would be that it has been rated by the Lonely Planet, Fox News and many other travel guides as the best destination for 2019.
- On the bright side, Sri Lanka boasts for the best health indices in the South Asian region. Although they are quantitative figures, that is ‘really something’. The preventive aspects of medicine undertaken by the community health services is commendable. e.g. immunization coverage in the country is almost 100% and the maternal mortality rate is 30 per 100,000 live births. However, the qualitative evaluations in terms of patients’ satisfaction about the healthcare they receive are lacking at the national level. There is an obvious discrepancy in healthcare facilities between the urban and rural sectors. New domains of primary healthcare such as palliative care, which could potentially be delivered in a cost-effective manner by a GP, are still thriving in the infantile stage.
- A PubMed search only identified 4 published articles on this topic. One of the two Sri Lankan medical faculties with clinical Family Medicine Departments, evaluated the undergraduate students’ perspectives on the Family Medicine teaching programme. The students believed that the programme was instrumental to develop their clinical problem-solving skills, communication skills and so on.; especially where active student participation was involved in teaching. In 1983: 1/3 of doctors were identified to be practicing in primary care, who had neither undergraduate nor postgraduate training in the discipline. A postgraduate family practice programme was initiated back then by the University of Colombo which was one year in duration. However, it was not made compulsory to practice as a private sector GP.
- In 2008, this programme also boasted the launch of an online programme which was open for foreign graduates from the fellow countries of South Asian region. In an evaluation carried out in 2010 it was identified that 88% of the trainees felt themselves to have gained much clinical competency with it. However, this has been suspended within the subsequent couple of years without an apparent reason. The current status of Family Medicine in Sri Lanka was explored in a recent study where the stratification of postgraduate qualifications was pointed out. The author recommended that the doctors practicing Primary Care held either of these qualifications. He also stated that by the year 2013, there were only 20 fully qualified Family Physicians in Sri Lanka.
- Moving on to undergraduate exposure to Family Medicine…. Currently, Sri Lanka produces medical graduates through 9 state operated Medical Schools. Family Medicine was introduced to the Undergraduate medical curricula of two Medical Faculties in 1980. As of today, only four medical colleges have clinical departments of Family Medicine equipped with trainers. Family Medicine lecturers met around the end of last year to develop a standard core curriculum to be introduced to all medical faculties in the Island. This is currently in progress.
- Next, we will explore the Postgraduate education and the barriers faced by doctors who wish to practice as General Practitioners. Although there is not much published literature for many of the barriers, the following facts are based on the experiences of myself and my colleagues while in training.
- A major perceived problem is that there are 6 strata of GPs in the island. The fact that a doctor could practice as a GP right after the internship makes the discipline looked down upon by other specialists also leading to poor rates of back-referrals from specialists to the GPs. Then there are Diploma in Family Medicine, MCGP, MCRGP, MD by clinicals and MD by thesis. The extensive durations consumed for the postgraduate programmes and the fact that one would still be no more than a GP having spent 12 – 13 years in training. Completion of these exhaustive programmes is not rewarding in a financial, professional or a career sense to the doctors. For the 21 million population in Sri Lanka, only 4 – 5 specialist Family Physicians are being produced per year when compared to nearly 150 internal medicine physicians produced. There is lack of consistency in conducting the examinations by the postgraduate institution. For instance, the selection examination may not be held in certain years at all. Lack of a quality assurance of the course structure and examinations is another discouraging fact.
- Over to some serious concerns now. The current academic prospectuses for the DFM and MD programmes for instance, are poorly constructed with erroneous under-calculation of credit hours. The document has a similarity index of 55% on turnitin software, that raises the suspicion of plagiarism.
- The ‘Board of Studies’ in Family Medicine at PGIM is not responsive to the trainees’ requests. The students also convicted the board in the courts in a few instances. On the other hand, most students do not make any complaints regarding the course fearing the consequences. Since the patients’ appointments to the specialists are not regulated through GPs, the patients consult specialists in the private sector right away. For instance, a patient could see an ENT surgeon right on the first day of a sore throat which may amount to unjust utilization of resources. Owing to the same reason, there is a resistance from the specialists from general practice being established at all.
- We will present our recommendations later on in the presentation. We seek advocacy from the part of the WHO in order to mitigate these serious problems.