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