Feedback of 10-year Family Medicine Training in Estonia

Heidi-Ingrid Maaroos

Department of Polyclinic and Family Medicine

University of Tartu, Estonia

Estonia

• 47000 km3

• 1.4 million inhabitants

• 32 physicians per 10000

• 1 family physician per 1900+-400

• 800-850 family physicians

are needed Lithuania

Latvia

Preconditions of high-quality family physicians' training

• competence of the teaching staff • comprehensiveness of training

programmes• the relevance of the current education• training must meet the needs of the

population• to satisfy the needs of effective health

care

Traditional university from 1632- University of Tartu

Department of family medicine from 1992.

Implementation of family medicine teaching in 1991-

1992

• the training of teachers with academic positions on international courses

• calling teachers from countries already existing family medicine system

Inside the faculty of medicine

Co-work with different specialities

• training of family physicians

• development of research in family medicine

2000-2001 the university faculty members are

• vocationally trained family physicians

• family physicians conducting their PhD in the field of family medicine.

Selection of faculty members

• the university criteria for academic posts are used

• speciality of family physician and own practice is needed

In 1991-1992

Development ofundergraduate residency retraining

programmes for family medicine;

Development

• new methods of teaching

• teaching materials

• training of preceptors

• physicianate studies and research

In 1999-2001Programmes for teachers/trainers in family medicine were developed

this experience was exported to other countries (Armenia, Turkmenistan, Uzbekistan, Tajikistan);

Basis for teaching

• Network of teaching practices with newly trained family physicians as preceptors

• New educational materials (manual in family medicine, problem-based interactive computer-based programmes)

Training of family physicians

Training in residency - 3 years at least 50% of which is family medicine practice and 10 % is theoretical part

• 1993-2003 has finished 45 family medicine residents

Certificate: family physician

Retraining of previous PHC physicians- 3 years

80% of which is independent work in practice and 20% is theoretical part (lectures and seminars)

• from 1991-2003, altogether 863 retrained physicians

Certificate: family physician

The content of the training

• population health care needs• job description of family physician in

Estonia• to local structure of population (age,

rural, urban, family structure)• to local morbidity and

epidemiological situation and health care priorities in Estonia.

Main tasks of family physician in Estonia

• curative care

• preventive care

• palliative care

• management of practice

• co-ordination between team members

New courses for family physicians supported by Estonian Health Project

• legal aspects of starting independent practice

• computer skills

• practice management

Continuous programme evaluation

• evaluation of teaching process

• evaluation of family medicine curriculum

The process evaluation: trainees` reflection on the quality of their

learning experiences

• resident/trainee-centred

• traditional rating-type questionnaires

• regular feedback meetings of teachers with resident/trainee representatives.

The indicators for curriculum quality

• Number of manuals and other teaching/learning materials

• Number of physicians completing residency training, performance data

.... indicators

• Number of trainees participating in the retraining courses,

• Number of physicians completing retraining courses, performance data

• Index: number of physicians starting work as family physician/ number of physicians finishing retraining courses (0,8-1,0)

.... indicators

Evaluation of retrained family physicians work by activity in different fields of family medicine:

• vaccination of children according to standard (% of in time vaccinated children;

• registration of pregnancies according to standard % of early registration from all pregnancies)

Conclusion

• Estonian experience shows that implementation of principles of new training of family physicians needs coherence of academic environment with practice and continuous evaluation of training process and outcome.