General Evaluation of Postgraduate Education of Family Medicine in South-Eastern Europe Prof. Dr. Ilhami Unluoglu, M.D. Eskisehir Osmangazi University/Turkiye

Memory from Plovdiv/2006

ANTALYA CONGRESS of the AFM/GPSEE April 2010 In Antalya Congress there were two nice presentations of Dr. Lubomir Kirov. One of them is: In Antalya Congress there were two nice presentations of Dr. Lubomir Kirov. One of them is: “Current health situation and health systems in South East Europe”. “Current health situation and health systems in South East Europe”. In this presentation, Dr. Kirov also mentioned about In this presentation, Dr. Kirov also mentioned about - Speciality and CME (with a slide for each one) - Speciality and CME (with a slide for each one)

Skopje Meeting of the Association After the Antalya Congress there was a meeting of the Association in Skopje on After the Antalya Congress there was a meeting of the Association in Skopje on In Skopje it was decided that; one of the round tables of the Plovdiv Conference of AFM/GPSEE would be about “EDUCATION” and I was assigned as the moderator of this round table. In Skopje it was decided that; one of the round tables of the Plovdiv Conference of AFM/GPSEE would be about “EDUCATION” and I was assigned as the moderator of this round table. PGE is very important in FM and it is usually one of the popular topics of the activities of A GP/FM SEE. PGE is very important in FM and it is usually one of the popular topics of the activities of A GP/FM SEE.

The QUESTIONNAIRE of FAMILY MEDICINE EDUCATION IN SOUTH EASTERN EUROPE STUDY(1) Dear colleague, Dear colleague, The collected data from this questionnaire will be used to make a general evaluation about the postgraduate education of General Practice/Family Medicine in South East Europe in the IInd Conference of A GP/FM SEE in November 2011 in Bulgaria. The collected data from this questionnaire will be used to make a general evaluation about the postgraduate education of General Practice/Family Medicine in South East Europe in the IInd Conference of A GP/FM SEE in November 2011 in Bulgaria. In a panel the chairman of this panel will use these data to summarize the situation, followed by the presentations of each country about the postgraduate education of General Practice/Family Medicine in their own country. In a panel the chairman of this panel will use these data to summarize the situation, followed by the presentations of each country about the postgraduate education of General Practice/Family Medicine in their own country. Thank you very much in advance of your help Thank you very much in advance of your help Prof. Dr. Ilhami UNLUOGLU Prof. Dr. Ilhami UNLUOGLU

The QUESTIONNAIRE of FAMILY MEDICINE EDUCATION IN SOUTH EASTERN EUROPE STUDY(2) Please fill in the blancs and add your considerations for the open ended questions. Please fill in the blancs and add your considerations for the open ended questions. Member country:…… Member country:…… Name of the presenter:…… Name of the presenter:…… In which year FM was introduced in your primary care in your country?:……… In which year FM was introduced in your primary care in your country?:……… When PGE was started for FM in your country?:… When PGE was started for FM in your country?:… The duration of PGE for FM …/…… years The duration of PGE for FM …/…… years

The QUESTIONNAIRE of FAMILY MEDICINE EDUCATION IN SOUTH EASTERN EUROPE STUDY(3) The duration of PG program and where the resident spends this time? ( e.g. 6 months in field FM center, 2 months department FM, 2 months in emergency unit… etc.) The duration of PG program and where the resident spends this time? ( e.g. 6 months in field FM center, 2 months department FM, 2 months in emergency unit… etc.) The duration of work in the field ( active work in FM centers ) and total duration of PG program in FM.? The duration of work in the field ( active work in FM centers ) and total duration of PG program in FM.? What is the (approximate) number of FM specialists in your country? What is the (approximate) number of FM specialists in your country? Is the PGE for FM speciality properly fit to the needs of primary care? …… Is the PGE for FM speciality properly fit to the needs of primary care? ……

The QUESTIONNAIRE of FAMILY MEDICINE EDUCATION IN SOUTH EASTERN EUROPE STUDY(4) The QUESTIONNAIRE of FAMILY MEDICINE EDUCATION IN SOUTH EASTERN EUROPE STUDY(4) How many FM departments ( departments in universities or other sites where postgraduate education is given ) are there in your country?....../..... How many FM departments ( departments in universities or other sites where postgraduate education is given ) are there in your country?....../..... How many universities do you have and in how many of them you have departments of FM?.. How many universities do you have and in how many of them you have departments of FM?.. What are the 3 main significant problems in PGE of FM in your country? (your personal opinion) ………. What are the 3 main significant problems in PGE of FM in your country? (your personal opinion) ………. What are the 3 main problems for FM in the field in your country? ……………. What are the 3 main problems for FM in the field in your country? ……………. What can be done to improve PGE of FM in your country? What can be done to improve PGE of FM in your country?

Study design A questionnaire presented in previous slides, had been prepared (by the help of Prof. Mumtaz Mazicioglu, Prim. Dr. Ljubin Shukriev, Prof. Murat Unalacak) and then sent to the representatives of the member countries of the Association. A questionnaire presented in previous slides, had been prepared (by the help of Prof. Mumtaz Mazicioglu, Prim. Dr. Ljubin Shukriev, Prof. Murat Unalacak) and then sent to the representatives of the member countries of the Association. Special thanks. This investigation was conducted with the kind support of the member countries of the AFM/GP SEE. This investigation was conducted with the kind support of the member countries of the AFM/GP SEE. Special thanks to the colleagues from: Special thanks to the colleagues from: Bosnia&Herzegovina Bosnia&Herzegovina Bulgaria Bulgaria Macedonia Macedonia Montenegro Montenegro Serbia Serbia Slovenia Slovenia Turkiye Turkiye

General Evaluation of PGE of FM in SEE As known; As known; South Eastern Europe(SEE) is one of the important geo-political areas of the world and also one of the important corner stones of civilization and culture. The people of Balkan countries have common culture because they had been living together for centuries. South Eastern Europe(SEE) is one of the important geo-political areas of the world and also one of the important corner stones of civilization and culture. The people of Balkan countries have common culture because they had been living together for centuries. When we look at the basic principles of FM, we can conclude that solution that we need for the problems in FM practice should also be similar in the region. When we look at the basic principles of FM, we can conclude that solution that we need for the problems in FM practice should also be similar in the region.

The limitation! There had been studies about the development of PHC in the SEE region for nearly 50 years, but; it is difficult to define a real date of acquintance with FM, because of terminological problems, of GM and FM. There had been studies about the development of PHC in the SEE region for nearly 50 years, but; it is difficult to define a real date of acquintance with FM, because of terminological problems, of GM and FM. The third question of the questionnaire: “In which year FM was introduced in your primary care in your country ?” was the limitation of the study. There must be very clear standardization in the following studies. The third question of the questionnaire: “In which year FM was introduced in your primary care in your country ?” was the limitation of the study. There must be very clear standardization in the following studies.

Introducing Family Medicine PGE for FM was firstly initiated in Serbia and Slovenia in 1960s, PGE for FM was firstly initiated in Serbia and Slovenia in 1960s, Turkiye in 1985, Turkiye in 1985, 1990s in Bosnia and Herzegovina, Bulgaria 1990s in Bosnia and Herzegovina, Bulgaria 2009 in Macedonia in Macedonia. It will start in 2012 in Montenegro. It will start in 2012 in Montenegro. (according to the replies of the questionnaires) (according to the replies of the questionnaires)

Duration of PGE Duration of PGE; Duration of PGE; 2-3 years (depending on previous working experience) in Bosnia and Herzegovina, 2-3 years (depending on previous working experience) in Bosnia and Herzegovina, 3 years in Bulgaria, Macedonia and Turkiye 3 years in Bulgaria, Macedonia and Turkiye 4 years in Serbia and Slovenia 4 years in Serbia and Slovenia

The clinical rotations and field in Bosnia&Herzegovina (questionnaire) The duration of PG program and where the resident spends this time? (e.g. 6 months in field FM center, 2 months in the department FM, 2 months in emergency unit… etc.) The duration of PG program and where the resident spends this time? (e.g. 6 months in field FM center, 2 months in the department FM, 2 months in emergency unit… etc.) Two year program- 12 months in FM Center (divided in 2 parts of 6 months), the rest clinical rotation (1 month of each clinical departments)…….. Two year program- 12 months in FM Center (divided in 2 parts of 6 months), the rest clinical rotation (1 month of each clinical departments)…….. Three year program- 12 months in FM Center (divided in 2 parts of 6 months), the rest clinical rotation (1 month of each clinical departments) Three year program- 12 months in FM Center (divided in 2 parts of 6 months), the rest clinical rotation (1 month of each clinical departments)

The clinical rotations and field in Bulgaria (questionnaire) The duration of post graduate program and where the resident spends this time? (e.g. 6 months in field FM center, 2 months FM, 2 months in emergency unit… etc.) The duration of post graduate program and where the resident spends this time? (e.g. 6 months in field FM center, 2 months FM, 2 months in emergency unit… etc.) 4 weeks dept. FM weeks dept. FM weeks dept. Internal medicine 10 weeks dept. Internal medicine 10 weeks dept. Pediatrics………… 10 weeks dept. Pediatrics………… 6 weeks dept. Surgery…………… 6 weeks dept. Surgery…………… 6 weeks dept. Obstetrics and Gynaecology… 6 weeks dept. Obstetrics and Gynaecology… 4 weeks dept. Neurology… 4 weeks dept. Neurology… 4 weeks dept. Psychiatry… 4 weeks dept. Psychiatry… 2 weeks dept. ENT … 2 weeks dept. ENT … 2 weeks dept. Ophthalmology … 2 weeks dept. Ophthalmology … 2 weeks dept. Dermatology… 2 weeks dept. Dermatology… 2 weeks dept. Infectious diseases 2 weeks dept. Infectious diseases 1 week dept. Physical therapy and rehabilitation 1 week dept. Physical therapy and rehabilitation 6 months in a Training practice 6 months in a Training practice 18 months in GP practice 18 months in GP practice

The clinical rotations and field in Makedonia (questionnaire) The duration of post graduate program and where the resident spends this time? (e.g. 6 months in field FM centre, 2 months in the department FM, 2 months in emergency unit… etc.) The duration of post graduate program and where the resident spends this time? (e.g. 6 months in field FM centre, 2 months in the department FM, 2 months in emergency unit… etc.) 3 months KME Centre 3 months KME Centre 6 months FM practice 6 months FM practice 6 months hospital 6 months hospital 3 months surgery and emergency unit 3 months surgery and emergency unit 6 months FM practice 6 months FM practice 6 months hospital 6 months hospital 3 months FM practice 3 months FM practice

The clinical rotations and field in Serbia (questionnaire) The duration of post graduate program and where the resident spends this time? The duration of post graduate program and where the resident spends this time? (e.g. 6 months in field FM center, 2 months in the department FM, 2 months in emergency unit… etc.) (e.g. 6 months in field FM center, 2 months in the department FM, 2 months in emergency unit… etc.) Internal medicine 6 months, Internal medicine 6 months, Oncology 1 month Surgery 3 months Oncology 1 month Surgery 3 months Orthopedics 1 month Orthopedics 1 month Gynacology 3 months Gynacology 3 months ORL 1 month Pediatrics 3 months ORL 1 month Pediatrics 3 months Ophthalmology 1 month Infectious Diseases 2 months Ophthalmology 1 month Infectious Diseases 2 months Dermatology 1 month Neurology 1 month Dermatology 1 month Neurology 1 month Psychiatry 1 month Psychiatry 1 month General medicine 24 months General medicine 24 months

The clinical rotations and field in Slovenia (questionnaire) The duration of post graduate program and where the resident spends this time? (e.g. 6 months in field FM center, 2 months in the department FM, 2 months in emergency unit… etc.) The duration of post graduate program and where the resident spends this time? (e.g. 6 months in field FM center, 2 months in the department FM, 2 months in emergency unit… etc.) 2 years hospitals – clinical specialties...… 2 years hospitals – clinical specialties...… 2 years FP (2 days a month workshop at the FM department)…… 2 years FP (2 days a month workshop at the FM department)……

The clinical rotations and field in Turkiye (questionnaire) The duration of post graduate program and where the resident spends this time? (e.g. 6 months in field FM center, 2 months in the department FM, 2 months in emergency unit… etc.) The duration of post graduate program and where the resident spends this time? (e.g. 6 months in field FM center, 2 months in the department FM, 2 months in emergency unit… etc.) 18 months hospital–clinics 18 months hospital–clinics - Internal Medicine (4 months), - Internal Medicine (4 months), - Pediatrics (5 months) - Pediatrics (5 months) - Gyneacology and Obst.(4 months) - Gyneacology and Obst.(4 months) - Psychiatrics (2 months) - Psychiatrics (2 months) - Pulmology (1 month) - Pulmology (1 month) - Cardiology (1 month) - Cardiology (1 month) - Surgery (1 month) - Surgery (1 month) - 18 months Family Practice (field) - 18 months Family Practice (field)

The ratio of the clinical rotations and field When we look at the ratio of the clinical (hospital) rotations and field (practice, FM center/training practice…) When we look at the ratio of the clinical (hospital) rotations and field (practice, FM center/training practice…) the ratio is generally 50%, the ratio is generally 50%, in Bulgaria field duration is more than 50% of total. in Bulgaria field duration is more than 50% of total. but, field rotation is less than 50% only in Macedonia and 3-years-group in Bosnia and Herzegovina. but, field rotation is less than 50% only in Macedonia and 3-years-group in Bosnia and Herzegovina.

Number of FM specialists Turkiye has nearly 2500 FM specialists, Turkiye has nearly 2500 FM specialists, Bulgaria : 1739, Bulgaria : 1739, Serbia : 1516, Serbia : 1516, Slovenia : 600, Slovenia : 600, Bosnia and Herzegovina: 533( ) and Bosnia and Herzegovina: 533( ) and Macedonia: 30. Macedonia: 30.

Comparing theFM specialists numbers according to the population If we compare these numbers according to the population; If we compare these numbers according to the population; (FM specialist/ population): (FM specialist/ population): Slovenia 300 specialists/ population, Slovenia 300 specialists/ population, Bulgaria 217 specialists/ population Bulgaria 217 specialists/ population Serbia 207 specialists/ population Serbia 207 specialists/ population Bosnia&Herzegovina 124 specialists/ population Bosnia&Herzegovina 124 specialists/ population Turkiye 34 specialists/ population Turkiye 34 specialists/ population Macedonia 15 specialists/ population Macedonia 15 specialists/ population

Is the speciality properly fit to needs of primary care? In Bosnia&Herzegovina, Macedonia and Slovenia PGE for FM speciality is properly fit to needs of primary care, In Bosnia&Herzegovina, Macedonia and Slovenia PGE for FM speciality is properly fit to needs of primary care, but; in Bulgaria, Serbia and Turkiye there are some points that can be developed in education. but; in Bulgaria, Serbia and Turkiye there are some points that can be developed in education. (according to the replies of the questionnaires) (according to the replies of the questionnaires)

Family Medicine Departments In Turkiye there are 71 medical faculties in nearly 160 universities and there are 45 FM departments. (+ MoH education hospitals nearly 20) In Turkiye there are 71 medical faculties in nearly 160 universities and there are 45 FM departments. (+ MoH education hospitals nearly 20) In other countries there are 2-5 universities and all the universities have FM departments in the region In other countries there are 2-5 universities and all the universities have FM departments in the region Except Macedonia ( which has one FM department in 3 universities). Except Macedonia ( which has one FM department in 3 universities).

The main significant problems in PGE Three main significant problems in PGE in the regio:(at least 4 countries) have; Three main significant problems in PGE in the regio:(at least 4 countries) have; Insufficient number of residents, lack of motivation to enter speciality, Insufficient number of residents, lack of motivation to enter speciality, Insufficient education, inadequate regulation, unadjusted education program, lack of elaborated program, Insufficient education, inadequate regulation, unadjusted education program, lack of elaborated program, Financial problems and support during the speciality education. Financial problems and support during the speciality education.

The most common problem of the FM in the field The most commonly encountered problem of the FM in the field is “financial income/support” in the region. The most commonly encountered problem of the FM in the field is “financial income/support” in the region. It is followed by “insuffient number of trained mentors/academical staff, insuffiency in education and problems with Health Insurance System” (at least 2 countries) It is followed by “insuffient number of trained mentors/academical staff, insuffiency in education and problems with Health Insurance System” (at least 2 countries)

The proposals for improving PGE Most common proposals to be done to improve PGE were as follows: Most common proposals to be done to improve PGE were as follows: Development of training program according to needs, re- organization of clinical rotations, e-learning, Development of training program according to needs, re- organization of clinical rotations, e-learning, Better financial support, Better financial support, Regulation of program for creating education time for mentors, and continuing education of educators and mentors, Regulation of program for creating education time for mentors, and continuing education of educators and mentors, Enough FM residents and supporting of them, Enough FM residents and supporting of them, Collaboration between Ministries (Health-Education), associations, decision makers…. Collaboration between Ministries (Health-Education), associations, decision makers….

One of the important solution of the common problems of FM in the region We can see there are many common problems in PGE of FM in the region and we can solve them with developing collaboration and sharing the experiences. We can see there are many common problems in PGE of FM in the region and we can solve them with developing collaboration and sharing the experiences.

THANKS FOR ATTENTION