Medical education in central hospitals and health care centers Jukka Mustonen Professor, Vice Dean University of Tampere

Medical Faculty in the University of Tampere 105 new students a year Problem based learning (PBL) 1994 Clinical courses after 3.5 years Courses of Internal Medicine and Surgery (4th or 5th year) as well as General Practice (5th or 6th year) last nine weeks

Background Several educational aspects supporting decentralisation (Medical Faculty) Local interests in Seinäjoki Central Hospital and Hospital District of Southern Osthrobothina

Seinäjoki Central Hospital 170 km North from Tampere Medical education since 1991 Internal Medicine (one group of students) Surgery (one group) General Practice (one group)

Teaching staff in Seinäjoki Three clinical lecturers – General Practice – Internal Medicine – Surgery One nurse instructor (VIP)

Students in Seinäjoki All students stay 6 weeks in Seinäjoki Two weeks in Internal Medicine Two weeks in Surgery Two weeks in General Practice All groups are there at the same time All students overnight in Seinäjoki

Groups of Internal Medicine and Surgery Normal hospital learning adviced by the clinical lecturers and hospital staff in Seinäjoki central hospital Attitude of the hospital staff is positive and encouraging Students see more common illnesses

Group of General Practice Seven surrounding health care centers Local staff of health care centers Travelling from Seinäjoki and back every day (by own cars) Students examine the patients and follow other activities in health care centers ”Friday-seminar” once in two weeks in SJ

”Friday-seminar” On the last friday in Seinäjoki Integrated patient seminar Active role of the students (PBL) All three groups are present Local teaching staff Other teachers from Tampere

Patients of the seminar Patients whom the students (GP) have sent to Seinäjoki Central Hospital What has happened to these patients in the hospital (Int Med and Surgery) What happens to the patients after they leave the hospital (GP) Other intersting patients (all students)

Goals of the seminar To learn what happens to the patients in different levels of our health care system Collaboration between primary care and central hospital Ethical discussions are common

Feedback from students Very positive continuously since 1991 Attitude of the local hospital staff and the patients More time for the students This feeback irrespective of certain practical problems (travelling etc.)

Extra costs Accommondation in Seinäjoki Travelling costs between Tampere and Seinäjoki Travelling costs between Seinäjoki and heath care centers

Summary Decentralization has been succesfull Good co-operation between the university, central hospital and heath care centers Demanding process Local teaching staff is necessary Feedback from students and other partners has been very positive

Special thanks Irma Virjo, Professor of General Practice Airi Jussila, Clinical lecturer Anna-Maija Koivukoski, Clinical lecturer Heikki Lahtinen, Clinical lecturer Pauliina Suomela, Nurse instructor