“What Essential Competences young family doctors have to learn and practice for working in

rural areas appropriately? “

Results from 16th and 17th Wonca Europe Conferences Workshops

“ A tribute to Claudio Carosino “

Jaume Banqué Vidiella . Euripa – Semfyc – CamficInstitut Català de la Salut. CAP Baix Ebre. Spain

jbanquev@gmail.com

Common themes in rural health…

●At the heart of the rural health education agenda is that rural people have different healthcare needs and reduced access to services….●Rural populations tend to have different profiles to those of urban populations…●Rural health professionals face additional isolation issues…●Isolation from professional support requires a broader scope of practice, more training and stronger support networks…

RB Hays. School of Medicine, Keele University, Staffordshire, UKRural medical education in Europe: the relevance of the Australian experienceRural and Remote Health 7: 683. (Online), 2007

Experience in Rural Health ? : 20 partic.

(60,6%)

Compulsory RT period for young GP in your country ? : 5 countries

Participants: 32(Countries: 23)

10.2010 09.2011

16th Conf. Málaga 17th Conf. Warsaw

Wonca Europe Conf. Workshops

Results faced with Core Competences ( European Definition of GP / Family Medicine

Euract. Wonca Europe 2005 )

Results grouped into

●Abilities, training and knowledge. (42)●Working in a rural setting (28)●Being a GP and a rural doctor (25)●Collaborative practice (10)●Community medicine (10)●Family and home care (4)

Core Competences – Euract 2005

●Specific solving problems skills●Primary care management●Person centred care●Comprehensive approach●Community orientation●Holistic approach

Abilities, training and knowledge Specific solving problems skills

●Skills and training in emergencies●Communicational skills●Paediatrics●Geriatrics●Gynaecology and obstetrics●Palliative care. Pain Control●Up to date in technologies

Working in a rural setting Primary care management / Comprehensive approach/ Holistic approach

●Flexibility●Integration with population●Knowing the idiosyncrasy of population where you work●Commitment of at least 3 – 5 years to a rural community●Leadership ●Be in touch with other colleagues. Don’t stay isolated.●Being part of your community as private person as well as professional (How to live and work in the same and small community) ● Patient guide and rural doctor´s style: going slow without stop.

Being a GP and a rural physician Primary care management / Comprehensive / Holistic approach

●Dealing with uncertainty●Holistic approach●Facing the challenges: Ability to work under stress and independently●Physician’s health ●Treating all kind of people●Be closed but maintaining your doctor´s role●Greater range of skills: Procedural, diagnostic, public health...●How to prevent and treat occupational diseases ●Dealing with CPD and professional development.

Collaborative practicePrimare care management

●Networking ●Multidisciplinary point of view●How to work with different specialist and institutions : social services, local politicians, veterinarians, agricultural engineers....●Collaborating with regional services

Community medicineCommunity orientation

●Working with the community ●Social, demographic and epidemiologic point of view ●Empowering population ●Community oriented primary care ●Community involvement (coherence between lifestyle recommendations and personal choices)●Knowledge of local culture and community

Family and home carePerson centered care

●Collaboration with family to resolve problems●Home care ●Long term care for chronic diseases●Traditional care in rural areas.

Rural training concepts

●Rural Doctor > Complete family doctor > Core and paradigm of the GP speciality > Model for young family doctors ●Rural Practice > Specific kind of practice > Health care for a particular community > Working with sustainability●Rural Center > Locus for training and learning > Under and Post Graduate Doctors●Rural Rotation > “Not a problem of contents but a problem of future life conditions”

Rural medicine values for trainees

●Getting an opportunity for working and knowing “The GP´s role” inside a defined community●Emphasizing the holistic view in Family Medicine : “The bio-psyco-social model”●Underlining the importance of “Equity” in health services : Equal access / Equal utilization / Equal health outcomes