EURACT EDUCATIONAL AGENDA FOR GENERAL PRACTICE

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EURACT EDUCATIONAL AGENDA FOR GENERAL PRACTICE
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OVERVIEW OF PRESENTATION

• Background of the agenda development
• The process of its development
• The agenda itself
• Consequences

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BACKGROUNDEUROPEAN HARMONISATION

• Academic context
• Bologna 1999 creation of European Higher
  Education Area 2010
• European Credit Transfer system 1988

• Professional context
• Free movement of doctors 1993
• Title III or title IV

Harmonisation finding points of convergence and
common understanding and defining a set of
competencies desired learning outcomes 
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PROCESSDEFINING THE DISCIPLINE

• European definition of general practice
• Adopted in London 2002
• At least two years of work towards reaching a
  consensus
• A basis for research, quality and educational
  agendas

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OVERVIEW OF THE DEFINITION

• 6 Core Competencies
• 1. Primary Care Management
• 2. Person Centred Care
• 3.Specific Problem Solving
• 4. Comprehensive approach
• 5.Community Orientation
• 6. Holistic Modelling

• 11 Characteristics
• a. First contact / all health problems
• b. Care co-ordinator advocacy
• c. Person centred approach
• d. Doctor-patient relationship
• e. Longitudinal continuity
• f. Decision making f.o prevalence
• g. Acute Chronic management
• h. Early undifferentiated stages
• i. Health Wellbeing
• j. Health in the community
• k. Bio-Psycho-Social culture and existential

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PROCESSDEFINING AIMS AND SCOPE OF THE AGENDA

• Focus on the 6 competencies, specific for GP/FM
• 1. Primary Care Management
• 2. Person Centred Care
• 3. Specific Problem Solving
• 4. Comprehensive approach
• 5. Community Orientation
• 6. Holistic Modelling
• Focus on learning outcomes
• Lead to European recommendations
• A 2 years process, involving all EURACT council
  members

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THEORY
17 ICPC chapters 6 components All
patients at all age groups From Health
promotion, prevention, cure care,
to palliation
Performance DOES Competence SHOWS
HOW Skills KNOWS HOW Knowledge KNOWS
Contextual basis Attitudinal basis Scientific
basis
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PRACTICE

• You encounter a 75-year old elderly man who has
  not been in practice for more than two years.
  During the last visit, his blood pressure was
  190/100 mm Hg.
• Today he is complaining abou headache. He says
  that he has lost some weight. He is also
  coughing. His blood pressure today is 190/110 mm
  Hg. He is dirty.

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THE AGENDAELEMENTS

• Intoduction to the agenda
• 6 chapters with the same structure
• Educational aims
• Consequences to teaching methods
• Consequences for assessment
• Consequences to setting and timeframe
• Literature

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PRIMARY CARE MANAGEMENT

• Objectives
• Primary care epidemiology
• Management of unselected problems
• Organization of primary care clinic

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COMPETENCES 1

• Epidemiology of resopiratory illnesses in your
  practice
• Reasons for weight loss in general practice?
• Reasons for headache?
• Potential diagnoses in primary care?
• Epidemiology of respiratory diseases in your
  practice?

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METHODS 1

• With a teacher, who is an excellent practitioners
• During GP attachment
• Assessment of performance in practice

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PATIENT CENTEREDNESS

• Objectives
• Always as a  person  in  context 
• continuity personal / episodic / discipline
• Also the doctor as a person in his/her context

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COMPETENCES 2

• Establishing a patients agenda
• Negotiating his needs and wants
• Reason for encounter
• Ensuring continuity for this episode/disease/docto
  r
• Managing negative emotions and maintaining
  professionalism

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METHODS 2

• A place for narratives and patient stories
• Negotiation training
• Assessment
• Direct observation
• Indirect methods

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SPECIFIC PROBLEM SOLVING SKILLS

• Objectives
• Hypothetico deductive / Learning scripts
• Use of time
• Incremental investigation,
• Coping with uncertainty
• Communicate on strategies

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COMPETENCES 3

• Diagnostic procedure
• Reaching diagnosis
• Stepwise approach
• Reasons for referral
• Communicating diagnosis
• Communicating risk factors
• Negotiating disease management strategy

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METHODS 3

• Role modelling
• Case reflection and supervision
• Simulation and case discussions
• Assessment
• Checklists
• Case - based orals

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COMPETENCE 4 Comprehensive Approach

• Objectives
• Multiple complaints and co-morbidity
• Aim on health promotion and well being

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COMPETENCES 4

• Prioritising health problems
• Needs and wants
• Health promotion in an elderly patient

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METHODS 4

• Assignements in healthcare settings
• Case descriptions and small group discussions
• Assessment
• Patient should be the starting point
• Individual consultation review

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COMMUNITY ORIENTATION

• Objectives
• Understand health needs of the communities
• Understand impact of poverty, ethnicity,
  inequality
• Reconcile health needs of individual with
  community

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COMPETENCES 5

• Involving family in the management of the
  condition
• Arranging for financial benefits?
• Managing communicable diseases in a community
  setting
• Ethical impications ?

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METHODS

• Structured reflection on work-based experience
• Conventional classroom methods
• Practice audit / practice studies
• Assessment
• Report / discussion with work based teacher

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HOLISTIC MODELLING

• Objectives
• Whole person in the context of values, beliefs,
  culture
• Biopsychosocial model as the basis for cure and
  care
• From holistic understanding into practical
  measures

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COMPETENCES 6

• Developing management strategy
• Medicines
• Psychological and emotional support
• Social support
• Family interventions

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METHODS

• Patient-case studies
• Single case descriptions
• Video analysis of clinical encounters
• Assessment
• Written reports, essays on specific aspects

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SUMMARY METHODS

• Work in practice should be a cornerstone of
  learning experiential
• Observation of others, or by others
• Indirect (video, notes review) or direct (sitting
  in)
• Records review random case analysis, audits
• Population based health needs assessments
• Learning in small groups peers,
  multiprofessional
• Planned patient encounters for specific
  conditions, technical practice, balanced caseload
• Tutorials
• Reflection

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SUMMARY ASSESSMENT

• The patient should be the starting point in
  assessment
• Patient feedback
• Staff feedback
• Tutor feedback
• Learner self assessment
• Written evidence of performance (from practice or
  under exam conditions)
• Assessment of performance (from practice or under
  exam conditions)
• Prepared work portfolio, project, papers,
  dissertation
• Reflective log

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SUMMARY TIMEFRAME

• basic medical education the student should know
  the theoretical background and application in
  simple cases.
• vocational training the doctor should be
  competent
• continuous professional development the doctor
  should demonstrate adequate performance in this
  area.

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Consequences

• An on-going process
• Distribuition
• To universities and teaching organisations
• To curriculum responsibles
• To policy makers
• To WONCA network organisations
• Adaptation in local situations
• Curriculum development at various levels
• Discussions with policymakers
• Other