PRIMARY CARE TRAINING

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SPECIALTY TRAINING AND CAREER STRUCTURE FOR
FAMILY MEDICINE IN BRUNEI DARUSSALAM
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OUTLINE

• Brunei Darussalam Background
• Primary Health Care System background
• Outpatient Services
• Basic Specialty Training (Family Medicine)
• Career Progression
• Advanced Specialist Training (Family Medicine)
• Challenges

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BRUNEI DARUSSALAM

• Population 390,000
• Young population 39.2 below 19 years
• Malay 66.6
• 4 districts Brunei Muara District (69.3 of
  population)
• Life expectancy 77.8 yrs female 75.2 yrs male
• Infant mortality rate 7.6 per 1000 live births

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PRIMARY CARE SERVICES
IN LINE WITH MINISTRY OF HEALTH NATIONAL HEALTH
CARE PLAN (2000-2010) TO PROMOTE PRIMARY HEALTH
CARE
Decentralisation
NOW
BEFORE
RIPAS Hospital
Brunei/Muara 7 H/Cs (June 2000- March
2001) Belait - 3 H/Cs (Oct
2002) Tutong - 4 H/Cs (Oct 2002)
Postgraduate Training
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PRIMARY HEALTH CARE SYSTEM

• Health centres (14) and clinics (13) providing
  outpatient services and maternal and child health
  services
• Travelling health clinics (13)
• Flying medical services (4)
• School health services

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OTHER PHC PROVIDER

• 1 private hospital Jerudong Park MC
• Ministry of Defence 5 medical centres
• Brunei Shell Petroleum Panaga Health Centre
• Private GP clinics 21

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OUTPATIENT SERVICES

• First point of contact for patients
• Gate-keeper to secondary care
  (referral rate 1-5 admission rate lt1)
• Comprehensive holistic care
• Minor illnesses chronic cases

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SERVICES IN HEALTH CENTRES
MEDICAL RECORD
TRIAGE
LABORATORY RESULTS
OPD DOCTOR CONSULTATION
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SERVICES IN HEALTH CENTRES
TREATMENT ROOM
PHLEBOTOMY
DISPENSARY
RADIOLOGY
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SERVICES IN HEALTH CENTRES
MCH
DENTAL
DIETICIAN
COMMUNITY PSYCHIATRY
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OTHER SERVICES

• Extended hours services (out of hours)
• DOTS for tuberculosis treatment
• Smoking cessation clinic
• Well women clinic
• Weight management clinic
• Ophthalmology clinic

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FAMILY MEDICINE TRAINING

• Vocational training rotations
• Masters in Primary Health Care (Feb 2004)
  previously Postgraduate Diploma in Primary Health
  Care (Feb 2000)
• MRCGP International (Nov 2005)

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VOCATIONAL ROTATIONS

• Rotations organised by Division of Outpatient
  Services
• 2 years hospital rotations and 1 year GP
  placement
• Previous clinical experience can be accredited
  prior to joining the program

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VOCATIONAL ROTATIONS

• Components of hospital training
• 6 months - internal medicine, paediatrics and
  obstetrics gynaecology (3 months of community
  MCH for male doctors)
• 3 months psychiatry and accident and emergency
• 3 months - surgery / dermatology / ENT (optional
  clinical placement)

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PRIMARY CARE TRAINING

• Postgraduate Diploma in Primary Health Care -
  February 2000
• 3 years part time academic modular programme
  vocational training
• 2 cohorts 23 doctors graduated
• Awarded by St Georges Hospital Medical School,
  London, United Kingdom

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PRIMARY CARE TRAINING

• Nov 2003 RCGP examiners attended the 2nd cohort
  PGDipPHC exams
• PGDipPHC accredited as MRCGPINT
• 1st cohort awarded MRCGPINT by Accreditation by
  Prior Experiential Learning (APEL)

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MASTERS IN PRIMARY HEALTH CARE

• Masters in Primary Health Care Feb 2004
• 15 modules in 3 years
• Awarded by Universiti Brunei Darussalam
• Gradual handover to local tutors from St Georges
  Hospital Medical School, London
• 4 cohorts of doctors undergoing training
  maximum of 8 per cohort

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MASTERS IN PRIMARY HEALTH CARE
DATE YEAR 1 YEAR 2 YEAR 3
FEB Critical Appraisal Skills Reflective Learning Mental Health Child Health
APRIL Hypertension / Ischaemic Heart Disease Minor Illness Respiratory Medicine
JULY Teaching Learning Communication, Counseling Consultation Skills Registrar Led Hot Topics
SEPT Diabetes Infectious Disease Care of the Elderly / Palliative Care
NOV Research Skills Methods Womens Health Family Practice as a Profession
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MASTERS IN PRIMARY HEALTH CARE
YR 1
YR 2
YR 3
9 X 3000 WORDS ESSAYS
MSc
TAUGHT MSc (6 drs)
3 X 3000 WORDS ESSAY 1 x 20000 WORDS THESIS
RESEARCH BASED MSc (2 drs)
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MRCGP INTERNATIONAL

• Brunei Darussalam accredited as centre for MRCGP
  International examinations
• 2nd site to Oman - November 2005
• Exam based qualification open to local and
  overseas doctors
• 2 components
• a) OSCE (12 stations)
• b) MCP (Multiple Choice Paper)

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WHAT NEXT AFTER BST?

• After completion of their GP training some
  general practitioners have been given expanded
  roles such as in MCH services, school health
  services, HPEU, district health officer, KBS,
  KBM, TB, academic/medical education, e-health and
  administration

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CAREER PROGRESSION
Salary Scale Position Qualifications
M16 - M16A Medical Officer MBBS MBChB
M17 M17A Senior Medical Officer MSc PHC MRCGPINT
M18 M21 Specialist AST Family Medicine
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ADVANCED SPECIALIST TRAINING

• New concept and development for family medicine
  specialty
• Progression and expanded role of general
  practitioners
• GP with special interest/subspecialty
• Improve quality of care given to patients
• To provide equivalent quality specialist care in
  primary care setting

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ADVANCED SPECIALIST TRAINING

• Increase accessibility of specialist care to the
  community
• Recognition of general practitioners as a
  specialist care provider
• Wider scope of recognition as an area of
  specialty
• In line with proposed new scheme of service

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ADVANCED SPECIALIST TRAINING

• Increase workload of general practitioners for
  chronic care management
• Reduce referral to hospital
• Reduce workload and waiting time of hospital
  specialists
• Able to prescribe certain restricted specialist
  drugs

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ADVANCED SPECIALIST TRAINING

• Medical education
• Public health
• Ethics and medical law
• Healthcare quality
• Health promotion and education
• E-health / Health informatics
• Research
• Health management planning

• Identified priority areas
• Clinical areas
• Non clinical areas

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ADVANCED SPECIALIST TRAINING

• Diabetes
• Minor surgery
• Endocrinology
• Dermatology
• Gastroenterology
• Rehabilitation
• Elderly health
• Palliative medicine
• Sports medicine
• Adolescent health

• Cardiology
• Mens health
• Womens health
• Child health
• Mental health
• Infectious disease e.g. tuberculosis
• Respiratory disease
• STI
• Rheumatology

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ADVANCED SPECIALIST TRAINING

• 3 years (2 years 1 year elective)
• Collaboration with RCGP for clinical placements
  and fellowship portfolio assessments MOU signed
  May 2009
• Postgraduate Dip/MSc (GP with special interest)
  Clinical placement /- FRCGP
• Starting September 2009

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CURRENT SITUATION

• New recruitment for GPs emphasis on training and
  postgraduate qualifications
• All local Bruneian doctors wishing to pursue
  career in GP have to go through mandatory
  vocational training rotations and MSc PHC

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CURRENT SITUATION

• MRCGP International is a required qualification
  to enter Advanced Specialist Training program (in
  collaboration with RCGP)
• 38 (30 out of 78) have vocational training /
  postgraduate qualifications in family medicine

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CHALLENGES

• Continuing battle for family medicine to be
  recognized as a specialty
• Increasing demand and expectation from patients
  and colleagues
• Recruitment and retaining problems for trained
  family medicine doctors

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THANK YOU