Middle-sized primary health centre as an optimal environment for learning
medicine?
Historical background
Primary Health Centres were founded in early sixties of the 20th century in all Slovenian communities. Their basic
purpose was to enable and practice comprehensive and quality health care adjusted to real needs of each
communitie’s population.These Centres incorporated dentistry services, general
practices and different medical specialities in (so called) dispensary departments
Private practices either solo or group, were replaced completely, and health planning and managing have been
put in local authorities’ hands.
Nowadays, Slovenian primary care is a bit fragmented among different specialities as well between public sector
and »private« health care providers.
More about our community
PHCC is located in commune on the south Slovenian
border with population of approximately 25 thousand
inhabitants.
The biggest Slovenian SPA is 5 kilometre far away.
Important highway and railway are passing through.
Tourism, trading, farming and vine producing are
traditional business in our region
More about our PHCC
Employed staf:7 specialists in general medicine, paediatrician,
psychiatrist, gynaecologist, internist, two specialist in labour
medicine and four dental doctors. Each primary care doctor
worked together in team with a nurse. She is dealing preferably
with office administration.
There are surgeries of three private practitioners, well equipped
laboratory, urgent service with our own ambulance cars,
pharmacy, home nursing service and centre for treatment and
prevention of illicit drug addiction – all in the same building.
Teaching stuff and trainees
Two lady-physicians are tutors for postgraduates and two younger physicians
are tutors for medical students
An average of three or four students and one or two residents each year
An average number of consultations is over 50 per working day.
Teaching methods (1)
All teaching methods are adopted to Medical Faculty curriculum. The most frequently used are:
Reading
Observations
Office demonstration and office practice
Case discussion, case presentation
One to one teaching
Teaching methods (2)
Problem based learning
Reflection on consultation
Case simulation
Emergency service attachment
A problem list construction
Lecturing
Preparing a project or material
Field work
Tutors’ opinions
Main advantages and opportunities for learners: - well organized urgent service (4/4)
- well equipped laboratory (3/4)
- interdisciplinary collaboration (2/4)
-satisfactory level of informatics support (1/4)
Main barriers for more efficacious education:- work overload
- shortage of time
Tutors’ self-evaluation
The effects of teaching: “Explaining issues to students helps me re-evaluate my
practice”.
“Students’ participation strongly influenced my approach to managing chronic illnesses.”
“Frequently, J am afraid that it couldn’t be possible to fulfil some expectations of trainee. The cooperation with other colleagues and experienced medical stuff were crucial when J was trying to meet the most of learners needs.”
“It helps me to renew my knowledge and clinical skills.”
Learners’ attitudes and comments (1)
A( female student): ”Work in urgent ambulant is very useful and
dynamic. J needed more time for history taking and examination.
Administrative overload had a strong influence on my working
motivation”.
B (male student): “There are too much paper work in GPs’
office. Some of these administrative tasks seems to be completely
unnecessary. Otherwise, it is could be a very dynamic work.
C (female student): “It is very interesting and very stressful
work, especially when you are “urgent doctor” at the same time.”
Learners’ attitudes and comments (2)
D (male- resident):
“J am very satisfied with working environment and possibilities for professional development within this Centre. Access to internet and informatics support, including electronic patient records could be of ultimate importance for a young physicians in primary care. However, J have missed some learning methods video recording and self-evaluation in small groups”
Instead of conclusion
Typical Slovenian middle-sized Primary health centre complies with the majority of conditions that are list in 6 chapters of EURACT’s most recent educational agenda (2004).
Successful implementation of teaching process into family
practice settings depends on variety of factors which
could be anticipated and measured.
Additional tools and procedures for evaluation of efficiency of teaching processes should be developed and
applied in primary care settings.
The word doctor literally means teacher; good teachers are those who can inspire, guide,
educate, lead, and bring out the best in others Brennan MG, Lancet 2003
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