International Posters 914 – 920

International Posters 914 – 920

914 Iraqi Family Medicine training: an IRCS-RCGP Partnership

Richard Withnall

Aims/Objectives The Iraqi Red Crescent Society (IRCS)’s vision is to improve the quality of community-based Family Medicine in Iraq. In partnership with the IRCS and British Red Cross, the RCGP’s Training the Trainer (TTT) programme provided Iraqi Board-certified Family Medicine specialists with the competencies necessary to lead Iraq’s new Faculty of Family Medicine. Complementing Iraq’s Family Medicine Board, the Faculty aims to up-skill ‘Plain Doctors’ (medical graduates working as GPs but without completing higher vocational training) and enhance the quality of service delivery and GP training through an IRCS-established Family Medicine Centre of Excellence (CoE) (Al-Razi Health Centre, Baghdad).

Content of Presentation A three-module, spiral learning programme at 30 Euston Square provided five IRCS-nominated Iraqi colleagues with an advanced understanding of syllabus construction, contemporaneous methods of medical teaching, and formative and summative assessment techniques. A two-week study tour enabled delegates to visit an NHS practice led by a GP from the Iraqi diaspora.

Relevance/Impact There are 5000 ‘Plain Doctors’ in Iraq. Although these colleagues may be experienced and knowledgeable, IRCS and RCGP recognised the potential to enhance their continued professional development to benefit patient care at local, regional and ultimately national level.

Outcomes All five Iraqi colleagues successfully completed the TTT programme, receiving certificates from the RCGP President. The Iraqi Family Medicine Faculty and Al-Razi CoE have improved Family Medicine knowledge, training, governance and assurance within Baghdad.

Discussion It is hoped ongoing RCGP mentoring will support the IRCS in facilitating the continued growth of Family Medicine training networks throughout Iraq.

915 Energising medical students in India – what would make students willing to work in rural primary care

Prateek Nishant

Aim The aim of this study was to determine how barriers to medical students choosing a career in rural government primary care clinics could be overcome.

Content A written survey of medical students throughout an urban Indian medical school was undertaken. Internationally, many previous studies have attempted to determine the characteristics of students who are willing or unwilling to work in rural primary care. This study introduces a new concept – students who are “conditionally willing” provided certain criteria are met.

Relevance In India, 26% of doctors work in rural areas but 68% of the population live there. As in many other areas of the world, the majority of medical students do not wish to work in rural primary care. The concept of “conditional willingness” could usefully be applied in other contexts internationally.

Outcomes In total 394 students completed the written questionnaire (response rate 92%). The willingness of medical students to work in rural primary care declined as they progressed through professional years of medical school. However, there was a commensurate increase (p<0.0001) in conditional willingness if certain conditions were met – the most cited were housing issues (including water and electricity, 83%), facilities for doctors’ children such as a good education (69%), and an improved starting salary (66%). Absolute unwillingness to work in a rural health centre remained low; 95% of such students cited the desire to undertake postgraduate studies as a reason.

Discussion Policy makers wishing to increase the willingness of medical students to enter primary care should undertake context-relevant steps to bring about the reforms to encourage willingness.

916 GP training from Auld Reekie to The Andes

Rachael Imrie

Aims: General Practice (GP) is in its infancy in Chile: most medical graduates specialise rather than work as a generalist and it is possible to see a specialist without a primary care referral. The authors are interested to compare and contrast GP training in this environment with GP training in an established programme within South East Scotland.

Outcomes: This paper highlights some interesting contrasts between GP training in Santiago versus Edinburgh. There are discrepancies in the amount of time spent in a primary care environment, the continuity of exposure to GP work and the role of the GP trainee within the secondary care environment. In Chile, GP training is linked to universities rather than to a health board and there is a significant focus on academic development and regular examinations. When working in primary care there is emphasis on direct observation of consulting skills using parallel rooms with privacy glass.

Impact: Despite GP training being significantly better established in the UK than in Chile, there are some significant benefits of the Chilean system. We explore whether GP training within the UK could benefit from adapting to incorporate some of the Chilean training methodology.

Discussion: The small number of GP trainees in Chile allows for a more personalised training system with greater focus on learning for primary care and less requirement for service provision. Lack of relevance of work in hospital placements and lack of time in primary care are common complaints from UK GP trainees – can we learn from Chile?

917 Application of Multi Disciplinary Care for Hypertension control in a new Community Health Centre – a 4 year review

Yip Chun Kong

Objective: To review the applicability of Multi-Disciplinary Care model in treating hypertension patients in a newly establish Community Health Centre in Hong Kong which started service since February 2012.

Methods: All hypertension patients were assessed by doctors and nurses for risk stratification. They were then referred to patient empowerment program, stress management class by occupational therapist, weight reduction program by physiotherapist, nutrition counselling by dietitian and tailor made counselling by nurse specialist accordingly. High risk cases were redirected to Family Medicine specialist for further care. Satisfactory control is defined to be systolic blood pressure less than 140 mmHg and diasystolic blood pressure less than 90 mmHg. Data are reviewed monthly from 02/2012 to 02/2016 and compared with the average control among all clinics in the New Territories West Cluster.

Outcomes: In February 2012, there are 143 patients with hypertension and only 24% are with satisfactory control. The number of patients increased to more than 1400 on 02/2016. However the proportion of patient reached satisfactory level raised from 24% to 75% despite the growing number of patients. The standard of care in TSW CHC reaches cluster average after 18 months of intervention and its effect can be maintained after 4 years of services.

Discussion: Multi-Disciplinary Care model is applicable even in a new clinic which start with poorly controlled cases and with growing numbers of patients. It is effective to improve the control of hypertensive patients significantly and efficient in improving the control in a short period of intervention.

918 Lost in Prescription- Establishing Primary Care in a land of soaring life expectancy, geological fragility and timeless tradition

Emily Clark

Aims To present the experience of 5 UK GP trainees/first-five GPs who took part in a reciprocal exchange programme to Japan. The aim of this collaboration is to encourage mutual development and mobility among junior GPs, thus providing a broader perspective to the concepts of Family Medicine at systemic, professional and personal levels.

Content Five UK junior GPs attended 7th Japanese Primary Care Association (JPCA) annual conference in Asakusa, Tokyo 11th-12th June and underwent a one-week exchange in a range of urban and rural primary care practices in Japan. They presented posters comparing UK and Japanese systems. This was the 4th year of reciprocal exchanges that have occurred between the RCGP and the JPCA, organised by the RCGP Junior International Committee.

Relevance/ impact Aware of the impending chronic disease and dementia burden, the primary care system in Japan is flourishing with widespread plans to increase formal recruitment and investment. Facing these same burdens in the UK, we may have some lessons to learn at systemic, professional and personal levels.

Outcomes Delegate satisfaction and reflections are included. Among other lessons, at a systems level, reflections about holistic elderly care in the community were considered; at a professional level, they were inspired towards professional development for lifelong learning; at the individual, delegates reflected on values and created new friendships.

Discussion The exchange has gone from strength to strength and has promoted on-going mutual development of Primary Care, fostered a strong UK-Japan link, and provided an opportunity for a unique exchange experience.

919 The benefits and challenges of primary care exchanges: a systematic review

Eugene Tang

Aims/Objectives: The aim of this systematic review is to bring together the available evidence on primary care exchanges to better understand the process, challenges and benefits of such an experience.

Content of Presentation: We present findings from a systematic review of the available literature. We searched MEDLINE, Embase, PsycINFO, EBM reviews, CAB abstracts and PubMED using the following search terms: exchange, general practitioners/physicians, family physician, primary care, general practice, GP, family medicine, family practi*, primary health care, primary care physician, family doctor, primary medical care. We searched from inception to the 4th March 2016. Articles were included if they a) discussed participant exchanges in primary care b) associated outcome data – this includes i) individual/group experience of exchange ii) mechanism of exchange iii) observations during exchange. We identified 2094 articles (after duplicate removal). There were 28 eligible studies.

Relevance/Impact: There has been increasing recognition to modernise family medicine training to reflect the culturally diverse healthcare environment that General Practitioners (GPs) face daily. This has mainly been facilitated through international exchanges between healthcare systems in primary care. Although there is anecdotal evidence into the value of such experiences, there has not been a systematic synthesis of the available literature on primary care exchange experiences.

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920 Think global, act local: The Story of the Grantham-KNUST primary care partnership and the concept of general practice twinning

Rakesh Modi

Aims/Objectives To describe a twinning-relationship between a General Practice in South London (Grantham Practice) and a Family Doctor in Ghana (KNUST, Kumasi); their achievements in two years; goals for the future; and in doing so, to promote the twinning of general practices as promoted by the Junior International Committee(JIC) of the RCGP.

Content of Presentation We present the steps taken to develop this twinning-relationship, their outcomes over the initial two years, lessons they have learnt professionally and personally and their future plans.

Relevance/Impact Twinning relationships generate a sense of community and mutual development. However, despite being the centre of many communities, the twinning of general practices has not yet been developed. Learning lessons from the Grantham-KNUST project, the JIC have been promoting the widespread use of twinning general practices between the UK and low-/middle-income countries. Costs and admin are minimal, development is organic, learning and problem-solving is mutual and community-spirit is encouraged. This, along with the increasing need to understand health-framings from diverse ethnicities, creates perfect environment for twinning of general practices.

Outcomes Through e-communication and exchange visits, a personal relationship was developed. Subsequent outcomes included infrastructure development, including a document of goals and a social media platform; improvements in practice with donated computers and application for grants; and academic achievements such as international workshops.

Discussion In a time of globalisation and pressures on primary care, twinning offers a morale-boosting and community-building relationship. The Grantham-KNUST relationship is an excellent example of this and shows exciting promise for the future.