“Overcoming the distances” The contribution of WONCA-EU Networks Mehmet Ungan Assoc. Professor in Family Medicine METU Medical Center, Ankara, TURKEY mungan@metu.edu.tr

What is seen by the patients ? Family Physician/GP Health Care System Knowledge? Research Education Quality System FP/GP Our patients see us at the front, sometimes the politicians government see the GP/FP but can not imagine what is behind the part they see. Knowledge can be produced by good research, distributed by Education and supported by quality measures. So at the hearth of all knowledge lies good research Knowledge

At the core of all “knowledge” lies good research Gro Harlem Brundtland, WHO

WONCA-EU Process in Production of “ Knowledge” for state of art Networks Special Interest Groups Working Groups

WONCA is getting its power from “Knowledge” Netting the WONCA Networks in WONCA Congresses NETWORKS SIGS WGs WONCA is getting its power from “Knowledge” And, science is searching for the “Truth” The pain of dyspepsia overlaps with that of GORD and irritable bowel syndrome (IBS). Functional dyspepsia is a diagnosis that can only be made after investigation to exclude an organic cause. It is not necessary to investigate all patients with dyspepsia. Use of the term ‘non-ulcer’ dyspepsia is now discouraged. Talley et al., Gut 1999; 45(Suppl II): II37–42.

Turkey today (physician workforce) 70,586,000 population 108,000 physicians (61,000 working in MoH) 47,000 specialists (including 1900 FPs) 15,000 trainees in various specialities 35,000 practitioners (w/o vocational training after completion of medical school) (25,000 medical students...)

Specialization in Family Medicine 1983 Regulation basis completed... 1985 Training began in 9 teaching MoH hospitals, A 3-year-all-hospital-rotation programme (9 months internal disease, 9 months paediatrics, 8 months obstetrics & gynaecology, 6 months general surgery and 4 months psychiatry)

TAHUD Turkish Association of Family Physicians established in 1990 ; four years before the ONTARIO declaration of WONCA-WHO Joint Meeting: “Each country should establish an independent National Association of Family Medicine”

Some milestones... FM Departments in Universities (1993) 1st National Congress of Family Medicine by TAHUD (İstanbul, 1993) 1st attendance to WONCA-Europe Meeting (1995, Prague)

Some milestones... Turkish Journal of Family Practice (1997) Decision to join WONCA (1998) Attendance to EGPRW (1998, Crete) Turkish Board of Family Medicine -TAHYK, (1998 ) Joined to WONCA (2003)

Where is Turkey in Research 91 Professors in Family Medicine Medical Schools (Full& Associate+Assistant) 41 Medical Schools have Academic departments of Family Medicine EGPRN WONCA World and WONCA-EU High impact & indexed International journals, (> 500 publication) Modules in 1st Phase Training Almost 1900 Specialist Family Physicians Web of MoH, May 2008&Topalli UP-05,WONCA2008, TAHYK Aug 2008 11

Where is Turkey in EGRPN Meetings (2002-2007 abstract numbers) Gathered from EGPRN Abstract books Unpublished Data 12

The total numbers of abstract sent in sorted by country of first / presenting researcher: Frequency Percent Germany 68 12,9 Turkey Netherlands 60 11,4 France 44 8,4 UK 40 7,6 Belgium 37 7,0 Italy 31 5,9 Greece 25 4,8 Bulgaria 18 3,4 Slovenia 14 2,7 Spain Israel 13 2,5 Denmark 11 2,1 Ireland 10 1,9 Croatia 9 1,7 Malta Country Frequency Percent Hungary 6 1,1 Finland 5 1,0 Poland Portugal Romania Switzerland Lithuania 4 0,8 Sweden Austria 3 0,6 Estonia Norway Serbia Bosnia and Herzegovina 2 0,4 Canada 1 0,2 USA Total 526 100 Unpublished Data, Topsever P 13

Wonca Europe 2005 to 2007: WONCA Congresses Abstract Books & Duhot D; OP280, WONCA-2008, Istanbul

Wonca Europe 2005 (GREECE, FIRST 5 COUNTRIES) Duhot D; OP280, WONCA-2008, Istanbul

Wonca Europe 2006 ( ITALY) FIRST 5 COUNTRIES) Duhot D; OP280, WONCA-2008, Istanbul

WONCA Congresses abstarct books &Duhot D; OP280, WONCA-2008, Istanbul

Distribution of Turkish family medicine articles printed in international peer-reviewed publications ( % vs Year) Yaman & Kara, Med Sci Monit, 2007; 13(9): SR24-27

Topics of Turkish family medicine articles printed in international peer-reviewed publications Yaman & Kara, Med Sci Monit, 2007; 13(9): SR24-27

Where is Turkey in Education 41 Academic departments of Family Medicine, first one established 15 years ago 91 Professors in Family Medicine Medical Schools (Full& Associate+Assistant) Almost 1900 Specialist Family Physicians 21000 Re-trained Family Doctors By MoH Web of MoH, May 2008&Topalli UP-05,WONCA2008, TAHYK Aug 2008 20

The Pathway in Training Medical School Graduate (already practicing) may choose to start to training program in order to work as a Family Doctor in the system 1st Phase Training (on site, intensive, 10 days) Basic principles and approach of FM/GP, self learning skills, Communication, Patient Doctor Relationship, Research, Basic Epidemiology, Med. Records,... Has the right to practice as a Family Doctor + May be selected as an associate Trainer + Needs to have 2nd Phase training in order to continue to practice Temporary certificated &Must attend to 2nd phase for permanent certif. 2nd Phase (1 year) Mainly clinical Modules and Mainly distant learning ( 70% e-learning, 30% clinical skills lab training ), Not like a specialist program training, May choose to go specialization in FM by TUS Specialization Program (3 years, needs a central specialization entrance examination “TUS” like the other clinical specialization branches Or a Medical School Graduate May directly choose to enter specialization program in FM

Family Medicine model for PHC; The cities in which the implementation has already Started : 22 provinces, 15.5 million population

THOSE 38 NEW CITIES ARE STARTING TO THE IMPLEMENTATION

Re-training: Phase 1 Up to now 59 cities among 81, More than 21 000 medical graduates were trained

Retraining of Practicing Medical Graduates: Phase 1 and Phase 2 in Family Medicine EURACT (Prior courses, basic experience ) SIGS (PCD Europe...) EGRPN Modules: Why to make Research and Applied Statistics Euripa Europrev EQUIP (QUALITY measures in Training and Medical Records and Classification) ESPCG Clinical Modules

Core Curricullum of Specialization in Family Medicine New program prepared by Turkish Board of Family Medicine in terms of aims and objectives of knowledge, skills and attitude in 2006. It contains training in primary care setting in addition to hospital rotations as in WONCA suggestion. The duration of primary care rotation is 1 year.

Where is Turkey in Quality Europep ICPC2 Europep Translation and Validation and Distribution, Has been cited many times ICPC 2 Training Workshops for practice, ICPC2 will be put in to practice in 2009 (Translated by TAHUD) Records in FM/Primary Care Chapter in Phase 1 Module in Re-training 1st Phase ? FM specialists and those re-trained medical doctors (Phase 1 training) practicing as Family Doctor in the health system; how can be the quality reassued? 28

Mustafa Kemal Atatürk -------------------------------------------- Biz daima hakikat arayan ve onu buldukça ve bulduğumuza kani oldukça ifadeye cüret gösteren adamlar olmalıyız. -------------------------------------------- We should be individuals who keep searching the truth and when we find the truth we should dare to present it without hesitation. Mustafa Kemal Atatürk