1. SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE
IN BRUNEI DARUSSALAM

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

3. 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
Information from ‘Health Information Booklet 2007’

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

5. 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

6. Mukim Berakas Gadong Sengkurong Serasa Mentiri Kota Batu Lumapas
Kilanas
Pengkalan
Batu
Sengkurong H/C is the oldest health centre – opened in Oct 1992
PAPHRSB Sg Asam H/C – started 1996
Each health centre has smaller catchment area and closer to the community

7. 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

8. OUTPATIENT SERVICES First point of contact for patients
Gate-keeper to secondary care (referral rate 1-5% & admission rate <1%)
Comprehensive & holistic care
Minor illnesses & chronic cases
Provide comprehensive services
Holistic care – continuity of care to the patient, getting to know patient and family
Health screening eg pap smear, checking for risk factors of IHD etc.

9. SERVICES IN HEALTH CENTRES
MEDICAL RECORD
TRIAGE
LABORATORY RESULTS
OPD DOCTOR CONSULTATION

10. SERVICES IN HEALTH CENTRES
TREATMENT ROOM
PHLEBOTOMY
DISPENSARY
RADIOLOGY

11. SERVICES IN HEALTH CENTRES
MCH
DENTAL
DIETICIAN
COMMUNITY PSYCHIATRY

12. OTHER SERVICES Extended hours services (out of hours)
DOTS for tuberculosis treatment
Smoking cessation clinic
Well women clinic
Weight management clinic
Ophthalmology clinic

14. 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)

15. 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

16. 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)

17. 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 George’s Hospital Medical School, London, United Kingdom
23 doctors have graduated including local, expatriate and doctors from Royal Brunei Armed Forces

18. PRIMARY CARE TRAINING
Nov 2003 – RCGP examiners attended the 2nd cohort PGDipPHC exams
PGDipPHC accredited as MRCGP[INT]
1st cohort awarded MRCGP[INT] by Accreditation by Prior Experiential Learning (APEL)

19. 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 George’s Hospital Medical School, London
4 cohorts of doctors undergoing training – maximum of 8 per cohort
We trained 2 of our 1st cohort local doctors to do Masters in Medical Education in Cardiff and currently we have completely take over the Masters in Primary Health Care programme from SGHMS.

20. 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
Women’s Health
Family Practice as a Profession

21. MASTERS IN PRIMARY HEALTH CARE
YR 1
YR 2
YR 3
MSc
9 X 3000 WORDS
ESSAYS
TAUGHT MSc (6 drs)
3 X 3000 WORDS
ESSAY
1 x WORDS
THESIS
RESEARCH – BASED MSc (2 drs)

22. 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)
So far we have candidates from saudi arabia, pakistan, australia and malaysia.

23. 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

24. Senior Medical Officer
CAREER PROGRESSION
Salary Scale
Position
Qualifications
M16 - M16A
Medical Officer
MBBS
MBChB
M17 – M17A
Senior Medical Officer
MSc PHC
MRCGP[INT]
M18 – M21
Specialist
AST Family Medicine

25. 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

26. 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

27. 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

28. 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

29. ADVANCED SPECIALIST TRAINING
Diabetes
Minor surgery
Endocrinology
Dermatology
Gastroenterology
Rehabilitation
Elderly health
Palliative medicine
Sports medicine
Adolescent health
Cardiology
Men’s health
Women’s health
Child health
Mental health
Infectious disease e.g. tuberculosis
Respiratory disease
STI
Rheumatology

30. 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

31. 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

32. 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

33. 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

34. THANK YOU