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AULA DOCENTE
Mesa 2: La rotación en medicina ruralDra. Raquel Gómez Bravo
Vocal JMF SoMaMFyCMiembro VdGM Recruitment
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La rotación en Medicina Rural…
¿Existe?
¿Vale la pena?
Programa formativo de la especialidad de Medicina Familiar y Comunitaria. Enero 2005.
Depende. . .
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“El médico rural es un hombre afortunado…”
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La experiencia nos condiciona…
• Natural de Alhaurín el Grande, Málaga
• Licenciada en Medicina y Cirugía
por la Universidad de Málaga (2004)
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• Especialista en MFYC, C. S. Barrio del Pilar
Área 5 de Madrid (2005-2009)
• Guardias de SAR (R3-R4):
• Manzanares del Real
• Soto del Real
• La Cabrera
• Rotación rural (Marzo del 2009)
Dr. Juan Gérvas Camacho en Canencia de la Sierra, Garganta de los Montes y El Cuadrón (Madrid)
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• Miembro del Vasco da Gama Movement, sección Recruitment
http://www.vdgm.eu/
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• VDGM:
– Oporto, 2007– “Overcoming training barriers in primary care-rural training". Wonca Europe 2008,
Istanbul.– Amsterdam, Enero 2009.– "A new guidelines for GP rural training program through the diferences beetween
european countries, a Vasco da Gama Movement-Euripa workshop". 9th WONCA Rural Health World Conference, Crete 2009.
– “Rural practice nowadays”. 9th WONCA Rural Health World Conference, Crete 2009.– “Rural practice: present and future”. Wonca Europe 2009, Basel.– 2010…
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• VdGM is the WONCA Europe working group for young and future General Practitioners
• The movement is the continuation of the work that was started during the first preconference meeting for junior doctors during the WONCA Europe conference in Amsterdam in 2004
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OUR GOALS
• Providing a forum, support and information for trainees and young GPs through access to WONCA Europe regional conferences and pre-conferences
• Establishing a communication network between European trainees and young GPs and identifying their concerns, doubts and needs and helping to address them
• Improving the quality of training programmes for general practice.
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Istanbul 2008, Preconference: The pre-conference attendants
are invited from each countries scientific society´s (máximum 2 gp-trainees or young GP for country)
Attendants are divided into 5 groups, each one with a different arguing theme (education, exchange, research…) and, together with an Euract professor member, this issues are raised for discussion.
Subsequently everything debated is reported into the Wonca congress.
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1. Differents GP training programmes
2. Research
3. Rural medicine
TOPICS:
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RURAL MEDICINE
1. Is becoming more popular nowadays
1. An attractive option for young doctors
1. Let us explore other aspects of the medical practice traditionally limited to the ones carried out in urban centers
1. It is necessary to support the development in rural areas
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Additional benefits like:
Shorter fixed time, no prolongationFinancially more attractiveGet your 1st choice job or education afterwards.Extra time off / study leave / to meet with other colleagues International privileges (such as discounts on conferences)Social lifePart-time scheduleFamily friendly, Housing
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EURIPA AND VASCO DA GAMA MOVEMENT JOINT WORSHOP
Dr. Raquel Gómez Bravo (Vasco da Gama Movement – Semfyc. Spain )
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Fernidando Petrazzuoli (EURACT) John Wynn Jones (EURIPA)Jaume Banque Vidiella (EURIPA)Raquel Gómez Bravo (VdGM)
We put forward the experience of working in rural areas from different points of view: learning, teaching, feeling, working and dreaming.
We put forward the experience of working in rural areas from different points of view: learning, teaching, feeling, working and dreaming.
WONCA EUROPE 2008, ISTANBUL
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1978 - 2008
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 €Spain has one of the oldest
GP programmes in Europe...
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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
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It depends It depends on the on the Docent Docent Units…Units…
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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 GP TRAINING IN SHIFT HOURS DISTRIBUTION DURING GP TRAINING IN DIFFERENT EMERGENCY DEPARTMENTSDIFFERENT EMERGENCY DEPARTMENTS
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Rural Medicine during the postgraduate Rural Medicine during the postgraduate training period in our country (Spain)training period in our country (Spain)
Valiente Hernández, S. et al.
Aim: To asses the implementation of the RMPP (three-month-compulsory-stage on a national basis since 2005) and the degree of internal doctors (ID) satisfation.
Methods: Transverse, observational study carried out in a four-month-period in 2008. Subjects of study: 154 central training units (CTU). Information sources: CTU and ID through the email surveys, supported by telephone calls and interviews. Variables: RMPP implementation (duration, training year, distance between health centre and hospitals, number of visits per day, infrastructure problems) and degree of ID satisfation.
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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.
CCAA:CTU:VARIABLES IMPLEMENTATION
TIME OF RURAL PRACTICAL
ATTENDED VISITS/DAY
RATE OF INTERNAL DOCTORS SATISFATION
INCONVENIENTS
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Conclusions:
• The level of replay is acceptabled and new technologies have contributed to this fact.
• The implementation of the RMPP gives different training opportunities depending on the CTU.
• The lack of official training responsible limits the degree of implementation. • Due to the high level of satisfaction we encourage the NHS to provide CTU with resources.
• These kind of studies are necessary to asses national training programmes.
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1. To study the differences between GP rural training programs
2. To redesign and
implement a new training guide for rural practice including the main objective to draw a program that provides the infrastructure for a remote learning experience.
RECRUITMENT
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A NEW GUIDELINES FOR GP RURAL TRAINING PROGRAM THROUGH THE DIFFERENCES
BEETWEEN EUROPEAN COUNTRIES
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METHODS: Through a cross-sectional study, we compare the structure and quality of the GP vocational training schemes in the rural areas among VdGM countries.
-SPAIN - UK
-FRANCE - ROMANIA
-PORTUGAL - GERMANY
-POLAND - HOLLAND
- ITALY - TURKEY
-CROATIA - AUSTRIA -CZECH REPUBLIC
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• Rural exposure from an attachment in medical school and through residency training programs may have a significant impact on recruitment and retention of rural physicians.
• Exposure to a rural curriculum has been shown to produce attitude changes in students, while rural primary care clerkships positively influence students’ perceptions of rural primary care.
• The WONCA Rural Working Party recommall medical students should have an opportunity for rural exposure, and that medical schools should ensure that support and encouragement is given to students prior to embarking on a career in rural practice ends that
Lionis C, Wynn-Jones J. Establishing academic rural practice: a future and challenging target.Rural and Remote Health 7 (online), 2007: 727. Available from: http://www.rrh.org.au
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Sent by email to
VdGM_Forum
Sent by email to
VdGM_Forum
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6 years for Medical degree
Most of them have PC studies at University, GP exposure, lectures on GP or teaching by a GP.
Poor rural practice and learning at med school GP training: - 5 years in Germany / UK - 4 years: Spain, Czech Republic, Poland and recently Portugal - 3 years: them of all!
50% postgraduate exam
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o SPAIN
o UKo PORTUGALo GERMANYo POLANDo FRANCE
RURAL ROTATIONCOMPULSORY / ELECTIVE
TURKEY
?
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?
- Training for emergencies, chronic disease management with limited human and material resources, cardiovascular and skill disease, mother and child health, contraception, vaccination programmes, obstetrics problems, home care for elderlies, minor surgery, palliative care, poisonings
- Become conscious about oneself- Difficult communication between hospital and GPs- Isolation, less social life, more distances, difficult access…- More heavy, technology and financial problems,working longer…
- Lacks of…
MAIN ISSUES, common to all countries:
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RESULTS: The evaluation has registered vast differences whithin compulsory GP programmes but the same
needs in each country.
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> 50%> 50% ?
CONCLUSIONS: GP Education must include a special practice training based in rural settings, because remote medicine is another way to feel what kind of doctor you are!
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FORMACIÓN CENTRO
DE
SALUD /
ATENCIÓN
PRIMARIA
HOSPITAL:ROTACIONES /
GUARDIAS
SAR, ROTACIÓN
RURAL, GUARDIAS
ROTACIONESEXTERNAS
OTROS
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MANZANARES EL REAL (MADRID)MANZANARES EL REAL (MADRID)
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SOTO DEL SOTO DEL REALREAL
(MADRID)(MADRID)
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LA CABRERA (MADRID)LA CABRERA (MADRID)
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ROTACIÓN RURAL:
1) CARMEN
1) RAMÓN
2) JUAN
HASTINGS:-Soporte vital-Morir con dignidad
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BUITRAGO DE LOZOYA, GARGANTA
DE LOS MONTES, CANENCIA DE LA
SIERRA Y EL CUADRÓN (MADRID)
80 Km
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• PREPARACIÓN
• AUTOEVALUACIÓN
• PERSONALIDAD
• DESEQUILIBRIOS
• DIFERENCIAS
• El verdadero médico…
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