Basic Medical Education
More steps for basic medical education are now organised in Italy. After the first agreement signed between University of Modena and Italian College of General Practitioners, now we have various kind of experiences in Bari, Genova, Pavia, Udine, Bologna, Rome, Milan, with courses and lessons and tutorships (even if usually not in a really structured module) for students on fifth and sixth year.
A course is organised for Tutors specifically for an unique aim: the post-graduating national exams to get professional license. These ones are really Tutors for the University, working in every town where an University of Medicine is seated, and in charge to deeply exam the new doctors giving a structured scheme of scores, in this way judging what these students learned during six years in University, usually not been prepared at all on Primary Care specific competences.
The problems are “political “, and there are still many difficulties, because the academic body is still not agreeing in its majority ( but consensus is growing), and because all European WONCA Networks are out of the political decisional arena (now EURACT National Representative is trying to be always there, active and super-parts in a national context really divided in Societies and Trust Associations. The success could be facilitated if enough supported by a strong EURACT position).
Postgraduate specialist training
VT is not yet changed into a real specialist certificate, with a three year course, one year in the practices. This schedule (not as specialty) is managed only in some Regions, more able to use money; others are still at two years or stopped at all.
The VT School in Trento prepared a paper on total organisation based on EURACT Educational Agenda and core competences. The National Task Force on Undergraduate and VT met twice in Treviso and in Rome and two big mail- lists work strongly all the time, exchanging and developing ideas in progress.
The EURACT National Representative presented everywhere the Educational Agenda and launched and proposed realistically an Italian version of it.
( see in other paragraphs what were the developments).
Continuing medical education
It is obligatory for National Contract with NHS, to take 40 hours of CME, (20 with Health Local Authorities, 20 with Scientific Societies or in other places of choice).
Now, we are managing a national CME system, with an accreditation of events, by credits and points attributed to events, 150 credits to collect in five years.
Many colleagues involved in teaching and research are not satisfied and they are studying to arrive to a system accrediting also curricula, active participation at congresses, and distance learning systems ( more difficult to organise and value). Italian College is trying to realise this, having changed its bylaws with a system based on membership and fellowship.
Generally, there is a fighting about “who” has to accreditate “ whom”: Government, General Medical Council, Local Medical Councils, Scientific Societies, a National College or Academy, Trust Doctors’ Organisations.
After strong fighting, Scientific Societies are taken again in discussion, but, really, CME by Internet accreditation is not working well and points are attributed automatically not with real verification, with problems on getting real control on providers, different credit – points just attributed to the same event in different cities, no real consideration about professional quality. … Debate is spreading and CME is in difficulties, with Italian College of GPs trying to put on the table his point of view, very similar to EURACT's point of view. Now, e-learning and distance education systems are on debate and development and they could be a real big choice for the future.
Health Care
The National Health System is getting one of the worst period in its life with cuttings, inquiries, conflicts, problems. So, GPs are on the highest level of frustration and burn out since years. As example, also with WONCA Europe Congress for the first time in Italy, sponsorships were not allowed for Family Medicine, companies involvement is disincentived and everything for Family Medicine is considered of second level, but at first level as control for finances and for controls from guards and magistrates.
Life as Council Member
The National Representative translated the EURACT Statement on Selection for Teachers and Tutors. Now this Statement is consulted and used for selection in VT in two Regions, for national exams in some Universities, and we hope to get a national use.
Also, he pressed and convinced that EURACT Educational Agenda needed a national translation, and in short time, with nine colleagues, all EURACT members, one colleague in charge for print, with Nat. Rep. supervising and managing and enrolling five male as well as four female EURACT members, divided as working in North, in Central and in South Italy, members for at least four different Italian Societies... we have many paper copies of Italian EURACT Educational Agenda to be used according to necessities, and with versions on different web, owners Regional Schools and Societies.
The official presentation was made in Florence during WONCA Europe Congress at EURACT Workshop on E.E.A.
Nat. Rep. got other papers of his published on the European Journal of General Practice, on British Journal General Practice ( also as Editorial), on Family Practice, on Slovenian Journal of Family Medicine and on weekly Italian magazines ( just every time with themes concerning EURACT, three expressly only on EURACT).
So EURACT persists to be known, as it was in all these long years in Council.
The National Representative was appointed also for this year as Professor for General Practice at University of Milan for students at 5th and 6th year ( winner all chairs) and for specializing doctors in Internal medicine with enlargement of duties; the Dean charged him to open with a lecture on dyspepsia in the GP setting the academic year.
The National Representative, was charged to organize the international side for a National High Level Meeting in Como ( organized by the national trust GP organisation called SNAMI) where EURACT's leader role was finally accepted and was put into the philosophy of the meeting.
New members for EURACT are still coming, all from different geographic areas and from different GPs Societies ( Csermeg, Snamid, SIMG, SNAMI, FIMMG, local P.C. schools), so EURACT – Italy persists as absolutely the biggest international society in Italy and the most visible on journals and on internet. Now, as we have lost some members really convinced not to receive enough feedback, and because of reception of some membership applications not really as educational or bypassing the rules of application, just only to “ create internal problems “, the operative members met to discuss how to manage this situation at the best as soon as possible. It was decided to present an official proposal to the next Council Meeting in Prague.
A colleague is still taking an office as secretary, looking at managing internal relationships and feedback.; another one is in charge for all concerning translations; another one for managing all concerning possible meetings.
About WONCA in Florence, the National Representative was in the International Advisory Board, and in charge as reviewer and as chairman, and to give feedback about all EURACT workshops. The personal presentations were fifteen as presentations, workshops or symposia. The Italian participation was the biggest till now … but not so much as it could have been expected because of the bad situation indicated in the paragraph “ health care “ and the lack of real political willing towards GP in Italy.
Many of EURACT Italy members were directly or indirectly, more or less involved (I thank so many doctors: Valle, Di Marco, Rieve, Nati, Bruschelli, Calzini, Stimamiglio, Petrazzuoli, Buono, Sauro, Parisi, Carosino, Valcanover, Colorio, Sartori, Gorini, Lieto, Zizzo, Piccoliori, Rivolta, Bagnoli, Valenti, Assorgi, Cacici, Migliavacca, Sorghi).
The leaders have to fight for this: Florence style and time have to be utilized to push finally Italian GP to the European level as specialist academic teaching and research discipline. They have to be successful, because they can, as the WONCA Europe President said clearly and strongly at the symposium on “ the Academic level: when, who, where, how “, Italian Nat. Rep. organised inviting also, with other leaders, the World WONCA Elected President.
Francesco Carelli
EURACT Council Nat. Rep. and Director of Communications Professor University of Milan
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