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Primary Health Care physicians/health workers for the future

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Title: Primary Health Care physicians/health workers for the future


1
Primary Health Care physicians/health workers
for the future
Prof. Jan De Maeseneer, M.D., Ph D. 1 Chairman
European Forum for Primary Care Secretary General
The Network Towards Unity for Health Family
Physician (part-time), Community Health Center
Ledeberg Ghent Bruno Art, MD 1 1 Department of
Family Medicine and Primary Health Care, Ghent
University (Belgium)
Nicosia, 07.05.09
2
For Lou, born at home on 06.05.09
3
http//www.primarycare.ugent.be
http//www.wgcbotermarkt.be
http//www.the-networktufh.org
http//www.euprimarycare.org
4
Primary Health Care physicians/health workers for
the future
  1. The changing society
  2. Community based teaching
  3. Bridging the gap from theory to practice
  4. Towards socially accountable faculties and
    institutions for higher education
  5. International braindrain and Europe
  6. Conclusion

5
The changing society
a. Demographical and epidemiological
developments b. Scientific and technological
developments c. Cultural developments d. Socio-eco
nomical developments e. Globalisation and
glocalisation
6
The future WHO-five star doctor
THE FIVE STAR DOCTOR
  • assess and improve the quality of care
  • make optimal use of new technologies
  • promote healthy lifestyles
  • reconcile individual and community health
    requirements
  • work efficiently in teams

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Physicians competing framework 7 roles
  • Medical expert
  • Communicator
  • Collaborator
  • Manager
  • Health Advocate
  • Scholar
  • Professional

9
Introduction of a new curriculum
New curriculum
Five Star Doctor
Changing society
10
Introduction of a new curriculum
  • S tudent oriented
  • P atient based
  • E vidence based
  • C ommunity oriented

Illustration new undergraduate curriculum at
Ghent University
11
New curriculum at Ghent University
  • Units or blocks
  • Lines - Skills
  • Problem Solving
  • Personal Activity
  • Exploration and ethics
  • Studium Generale

12
The new curriculum
Start 1999
    SK Skills training Ps Problem Solving Pa
Personal activity Ex Exploration
13
Primary Health Care physicians/health workers for
the future
  1. The changing society
  2. Community based teaching
  3. Bridging the gap from theory to practice
  4. Towards socially accountable faculties and
    institutions for higher education
  5. International braindrain and Europe
  6. Conclusion

14
Community based teaching experiences at Ghent
University
  • Year 1 exploration in the health care system
  • Year 2-3 exploration with a family
  • Year 3 community oriented primary care

15
E-line Poster-presentation exploration in the
health care system
16
E-line exploration with a family (2 years)
Objectives - family-contact - child
development - communication
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Poverty index
20
Community Oriented Primary Care
  • Ghent 2002-2009

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Proces van gegevensverzameling
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3. Bevolking
  • Diverse bevolking, volks karakter
  • Kansarmoede en achterstelling
  • Dichtbevolkte stadswijk
  • 15.000 mensen, kleine oppervlakte
  • Dienst stedenbeleid en internationale
    betrekkingen

29
Mobiliteit (1)
30
Woontorens
  • Lage woonkwaliteit
  • Hoge bevolkingsdichtheid
  • Eén lift
  • Betonrot,
  • Dichtslibbende riolering,
  • Slechte vloerbekleding,
  • Enkel glas

31
Criminality figures
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Zij kunnen het en jij?
Verbondenheid, nog steeds geen feit.
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COPCen doe je niet alleen
37
Questions on community based teaching
  • What is a community?
  • What is the teaching capacity of a community?
  • How to create a win-win-partnership?
  • What about the ethics of community based teaching?

38
  • 2009 248 students 65 patients 139 health care
    professionals 8 neighbourhoods 11 tutors
  • Art B, DeRoo L, Willems S, De Maeseneer J. An
    Interdisciplinary Community Diagnosis Experience
    in an Undergraduate Medical Curriculum
    Development at Ghent University. Acad Med. 2008
    83675683

39
Input Department of Family Medicine and Primary
Health Care
Year 3
Start 2001
40
Involving the international community
  • Student exchange reciprocity
  • International programmes ERASMUS - NPHC
  • Bilateral
  • Multilateral

41
Student exchange primary health care
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Primary Health Care physicians/health workers for
the future
  1. The changing society
  2. Community based teaching
  3. Bridging the gap from theory to practice
  4. Towards socially accountable faculties and
    institutions for higher education
  5. International braindrain and Europe
  6. Conclusion

45
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46
The social accountability rhomb
COPC Community Oriented Primary Care CBPR
Community Based Participatory Research
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An example
The university centre for primary health care
Nieuw Gent,a COPC-practice
  • An underserved multiproblem area, not much
    community
  • A partnership University Family Physicians
    City of Ghent
  • A building Local Welfare Centre (restaurant
    social service child health service community
    workers primary health care centre)

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Nieuw Gent community diagnosis
  • 6.400 people on 0,6 km2
  • 18 migrants, 68 nationalities
  • Problems isolation, poverty, alcohol abuse,
    unemployment, psychiatric problems

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Service
integrated multidisciplinary primary health care
team,with focus on accessibility (capitation
no cost share)
  • Family physicians
  • Nurses
  • Dieticians
  • Partnership with social service

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58

THE NETWORK TOWARDS UNITY FOR HEALTH (The
Network TUFH)
  • A global association of individuals, groups,
    institutions and organizations committed to
    improving and maintaining health in the
    communities they have a mandate to serve

59
Membership
  • Over 218 member institutions and individuals
    (worldwide)
  • Academic health professionals and teachers
  • Multiprofessional health providers and
    stakeholders

60
Global Map Pinpointing Members
61
Mission
  • To promote equity in health through
    community-oriented education, research and
    service

62
Strategies
  • Create partnerships between academic health
    professions institutions and with stakeholders
    (communities, health services, health care
    providers, professional organizations)
  • Act locally and internationally
  • Share expertise to
  • promote change and
  • change processes

63
The Partnership Pentagram
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So, what is Inter-professional Education?
Inter-professional Education is those occasions
when members (or students) of two or more
professions learn with, from and about one
another to improve collaboration and the quality
of care. CAIPE (2002)
66
International Policy WHO paper
  • World Health Organisation (1988) Learning
    together to work together for health. Report of
    a WHO Study Group on Multi-professional Education
    for Health Personnel. The Team Approach
    Technical Report Series 769. Geneva WHO

67
Health 21
  • is littered with references to the need for
    collaborative frameworks integrated approach
    co-operation common approaches pooling of
    resources common values and, furthermore, it
    signals the need to strengthen, adapt and
    reconfigure models of health service delivery
    based on evidence of best practice and
    sustainable strategies
  • Tope (2007).

68
This Framework is a call for action to
policymakers, decision-makers, educators, health
workers, community leaders and global health
advocates to move towards embedding
inter-professional education and collaborative
practice in all of the services they deliver.
WHO (2008) Framework for Action on
Inter-professional Education andCollaborative
Practice
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Leicester Model
  • Adult learning
  • Interactive, team facilitation, reflection
  • The Leicester Model of Inter-professional
    Education
  • Immersion into practice
  • Patient-led
  • Potential to challenge, change and improve
    quality of care

72
Students interview a patient in her home
73
The University of Leicester Model
immersion into patient carer professional
experiences
analysis relating professional perspectives,
theory policies
become change agents through feedback
consider solutions to problems identified
74
Learning, especially inter-professionally,
is risky and brings us close to the boundaries of
our comfort zone
(Sills 2005)
75
A IPE module INTERPROFESSIONAL COLLABORATION IN
HEALTH CARE (IPCHC)
  • Educational module of one week
  • 3 plenary sessions
  • Groups of 12 to 14 students from 10 different
    education programs medicine, nursing, social
    work, psychology, speech therapy, physiotherapy,
    occupational therapy, dietitics , midwifery
  • Each group guided by a well trained tutor

76
IPCHC
  • Interprofessional
  • Different disciplines in the groups
  • In interaction with each other
  • Collaboration
  • Work on assignments
  • Work on own development of competences
  • Help the other with their development of
    competences
  • In Health Care
  • Patient seen as member of the team
  • Patient-centred
  • What you learn today , do it tomorrow
  • And keep doing it .

77
EDUCATIONAL STRATEGY
  • From
  • Learning to know each other / professions
  • To
  • Collaboration in patient-centred care
  • Teamwork (relational- en task-directed)developing
    a care plan, discussing ethical issues, taking
    up different roles in a team,

78
ASSESSMENT of the COMPETENCE
79
IPCHC
80
Primary Health Care physicians/health workers for
the future
  1. The changing society
  2. Community based teaching
  3. Bridging the gap from theory to practice
  4. Towards socially accountable faculties and
    institutions for higher education
  5. International braindrain and Europe
  6. Conclusion

81
Brain drain
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Towards socially accountable faculties
ACTION IS NEEDED!
ACTION IS NEEDED!
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