Developing Family Medicine through education – the next steps

I am delighted to introduce a guest editorial for this issue from Dr Jo Buchanan and Professor Jan Degryse to further strengthen the journal’s partnership with WONCA. The European Academy of Teachers of General Practice/Family Medicine [EURACT] is celebrating its 25th anniversary. As a journal we strongly support their move to develop and strengthen the academic base for primary care. We all must work together to provide a strong research evidence base not only for future health care delivery but also to provide the medical education changes needed to develop the appropriate workforce to deliver it.

Val Wass

Guest editorial: Education for Primary Care

Developing Family Medicine through education – the next steps

The last 70 years have seen the development of General Practice/Family Medicine [GP/FM] across the whole of Europe. Considerable progress has been made over the last 30 years across the countries of Central and Eastern Europe where they have been able to establish Family Medicine as a Specialty [1]. This development has been facilitated by organisations such as the European Union of General Practitioners [UEMO], the European region of the World Organisation of Family Doctors [WONCA Europe] and the European Academy of Teachers of GP/FM [EURACT].

EURACT is WONCA Europe’s medical education network and this year celebrates its 25th anniversary. It has representation from 37 different European countries and its regular meetings have, over the years, provided the opportunity for learning from one another and contributed to the development of GP/FM.

EURACT aims ‘to foster and maintain high standards of care in European GP/FM by promoting GP/FM as a discipline by learning and teaching’. The organisation has used two main strategies to realise these aims. Firstly, a coherent framework for GP/FM has been developed as demonstrated by the European Definition of Family Medicine [2] and subsequent to this the Educational and Performance Agendas. Secondly Training the Trainers courses have been developed using these documents and financed by the European Union’s Leonardo programme. These courses are now delivered in many countries in Europe and in Brazil.

Anniversaries are a good point at which to review the direction of an organisation and EURACT has been undergoing a period of reflection. Now that GP/FM is well established in many countries, it is time to consider how to promote and develop the academic aspects of the work of the General Practitioner or Family Doctor. This promotion is central to maintaining and improving the quality of the work but also to enhancing the status of Family Medicine. The latter is of great importance as many countries are experiencing significant difficulties recruiting to FM specialty training programmes. It is recognised that medical students often perceive Family Medicine as being of low interest and not intellectually stimulating [3]. Paradoxically we know from personal experience that in many medical schools all over the world GP/FM teachers have been the innovators in medical education and their work has often led to educational reform. Enthusiasm and creativity are not enough; we need to build an evidence base to support the changes that we would like to see. To this end a third strategy for EURACT is now developing – that of promoting and supporting educational research.

This article accompanies the publication, in the electronic version of this journal, of a selection of abstracts presented at EURACT’s first Educational Conference, ‘Educating Doctors for Family Medicine 2.0’, held in Dublin in 2016 in collaboration with the Irish College of General Practitioners. These can be viewed online here: [10.1080/14739879.2017.1345657, 10.1080/14739879.2017.1345656, 10.1080/14739879.2017.1345655, 10.1080/14739879.2017.1345654, 10.1080/14739879.2017.1345653, 10.1080/14739879.2017.1345652, 10.1080/14739879.2017.1345651 and 10.1080/14739879.2017.1345650]. The oral communications, workshops and posters from around the world demonstrated that education in GP/FM is alive and well and still innovating in medical education.

In 2008 Cook et al. presented a framework for classifying the purposes of research in medical education [4]. At the Dublin conference, many examples of descriptive research [What was done?] were presented, some contributions looked at clarification [why or how did it work?] and there were a few examples of well-designed justification research [Did it work?] presented.

In addition to these classic approaches to medical education research the fact that EURACT has representation from 37 different countries presents a unique opportunity for collaborative work. Countries such as Denmark and the UK have broadly similar systems of primary care, both highly regarded. However, the assessment during training is very different. In the UK, there is a three-year programme with a structured process of work place based assessment, completion of an e-portfolio requiring at least weekly entries and two end point examinations. Denmark has a five-year programme with a primary focus on formative assessment and no end point examinations. There must be much that these two countries can learn from each other from an analysis of the advantages and disadvantages of each system.

The development of research capacity continues to be a challenge, in some countries this is not helped by the clear separation of GP training and Academic Primary Care [5]. In Belgium GP specialty trainees receive a Masters Degree at the end of their training and therefore must submit a piece of research during their training. There are many examples of initiatives, from different countries, which engage all GP Specialty trainees in research.

It is important to recognise that much has been achieved in the development of FM/GP but also important to identify how to move forward. FM/GP needs to develop its academic base and clearly identify itself as the intellectually stimulating and demanding career that it is. We believe that to continue to do this we require improved collaboration between countries and specifically more justification and clarification research in education. A strong evidence base is needed to underpin the enthusiastic educational efforts of so many teachers in Europe.

The next EURACT Educational Conference will be held In Leuven, Belgium from 20th to 21st September 2018.

Jo Buchanan
President European Academy of Teachers in GP/FM, GP, Sheffield, UK
[email protected]
J. Degryse
Department of Public Health and Primary Care, Catholic University of Leuven
[email protected]