AULA DOCENTE

Mesa 2: La rotación en medicina ruralDra. Raquel Gómez Bravo

Vocal JMF SoMaMFyCMiembro VdGM Recruitment

La rotación en Medicina Rural…

¿Existe?

¿Vale la pena?

Programa formativo de la especialidad de Medicina Familiar y Comunitaria. Enero 2005.

Depende. . .

“El médico rural es un hombre afortunado…”

La experiencia nos condiciona…

• Natural de Alhaurín el Grande, Málaga

• Licenciada en Medicina y Cirugía

por la Universidad de Málaga (2004)

• 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)

• Miembro del Vasco da Gama Movement, sección Recruitment

http://www.vdgm.eu/

• 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…

• 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

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.

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.

1. Differents GP training programmes

2. Research

3. Rural medicine

TOPICS:

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

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

EURIPA AND VASCO DA GAMA MOVEMENT JOINT WORSHOP

Dr. Raquel Gómez Bravo (Vasco da Gama Movement – Semfyc. Spain )

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

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...

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

It depends It depends on the on the Docent Docent Units…Units…

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

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.

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

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.

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

A NEW GUIDELINES FOR GP RURAL TRAINING PROGRAM THROUGH THE DIFFERENCES

BEETWEEN EUROPEAN COUNTRIES

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

• 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

Sent by email to

VdGM_Forum

Sent by email to

VdGM_Forum

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

o SPAIN

o UKo PORTUGALo GERMANYo POLANDo FRANCE

RURAL ROTATIONCOMPULSORY / ELECTIVE

TURKEY

?

?

- 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:

RESULTS: The evaluation has registered vast differences whithin compulsory GP programmes but the same

needs in each country.

> 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!

FORMACIÓN CENTRO

DE

SALUD /

ATENCIÓN

PRIMARIA

HOSPITAL:ROTACIONES /

GUARDIAS

SAR, ROTACIÓN

RURAL, GUARDIAS

ROTACIONESEXTERNAS

OTROS

MANZANARES EL REAL (MADRID)MANZANARES EL REAL (MADRID)

SOTO DEL SOTO DEL REALREAL

(MADRID)(MADRID)

LA CABRERA (MADRID)LA CABRERA (MADRID)

ROTACIÓN RURAL:

1) CARMEN

1) RAMÓN

2) JUAN

HASTINGS:-Soporte vital-Morir con dignidad

BUITRAGO DE LOZOYA, GARGANTA

DE LOS MONTES, CANENCIA DE LA

SIERRA Y EL CUADRÓN (MADRID)

80 Km

• PREPARACIÓN

• AUTOEVALUACIÓN

• PERSONALIDAD

• DESEQUILIBRIOS

• DIFERENCIAS

• El verdadero médico…

¡GRACIAS POR VUESTRA ATENCIÓN!

raquelgomezbravo@gmail.com