Twenty-five years of the international Bled course for teachers of family medicine in Europe: Glancing back and looking forward

Abstract

The international Bled course for teacher training has played a central role in faculty development in family medicine for the past 25 years. The course was originally designed to promote faculty development for family medicine teachers in the new academic discipline of family medicine in Slovenia in 1990 and to introduce new topics into the family medicine curriculum. In this background paper, we perform a SCOT analysis (strengths, challenges, opportunities, and threats) of the current course, evaluating participant feedback and reviewing past topics and their impact on local and international teaching programmes. We also review the place of the course in the context of other teacher-training programmes in family medicine in Europe. We found that the structure and learning aims of the Bled course have remained stable over 25 years. It provides a safe, well-structured learning environment for the participants even though the course topic is different every year. The course has had a significant impact on curriculum development and teacher training in Slovenia as well as in many other countries in Europe and beyond. Because of the positive impact of the course and the high degree of satisfaction of the participants and course directors, it seems worthwhile to continue this endeavour. New directions for the course will depend on the learning needs of the participants and the evolving medical curricula in the countries they represent.

Keywords:

• Teaching
• physicians
• family

KEY MESSAGES:

• The international Bled course for teachers in family medicine with its stable long-term learning aims, typical course structure, and stable environment, provides a safe, well-structured learning environment for the participants from many countries.

• There are many challenges and opportunities that the course directors need to address to stimulate the evolution of the course.

Introduction

Family medicine is well recognized as an academic discipline in Europe and around the world.[1] Many factors contributed to the achievement of its present level of recognition. Education is certainly one of them.[2] The high qualitative level of education in family medicine is maintained by professional teachers with adequate preparation in the training of future family physicians.[3]

Teacher training is fundamental to the development of any academic discipline. In Europe, many countries have a well-organized system for teaching the teachers of family medicine, while some countries still struggle with problems due to lack of a critical mass of teachers.[4] So far, teaching the teachers courses have proven to be successful in terms of improving teaching skills and implementing acquired knowledge and skills in teaching after attending the course.[5,6]

The international Bled course for teacher training has played a central role in faculty development in family medicine in Europe for the past 25 years. This enterprise merits further study and reflection on reaching this milestone.

In this article, we discuss the importance of the international Bled course for teacher training for European family medicine education and suggest possible improvements for the course.

Brief history of the EURACT Bled course

The international Bled course began in 1992 and in 1995 it obtained the patronage of the European Academy for Teachers in General Practice/Family Medicine (EURACT). The course was originally designed to promote faculty development for family medicine teachers in the new academic discipline of family medicine in Slovenia in 1990. It stands alone as a separate activity, aimed at expert teachers who exchange knowledge on teaching key concepts in family medicine. The early development of the course has been described by Švab et al. [7] and a reflection on the first 16 years of the course has been published.[8]

The long-term learning aims of the Bled course have remained stable over the years. These include developing an understanding of the role of group work in enabling participants to reflect and learn about their work both as clinicians and educators. We hope the course will allow participants to:

1. Develop skills in producing an educational module, which can be used by participants in teaching activities in their home countries.

2. Promote the exchange of teaching experiences among the participants.

A variety of teaching methods is used to meet these aims. These include homework assignments, assigned readings, lectures, small-group work, fieldwork, projects, presentations, and small-group discussions.

The course lasts for five days and each day has a similar structure (Table 1). The focus is on participatory small-group work, in keeping with principles of active, adult learning. Frontal lectures are kept to a minimum.

Table 1. Structure of the five-day Bled teacher-training course.

Day 1	Day 2	Day 3	Day 4	Day 5
Introduction	Ice-breaker	Ice-breaker	Ice-breaker	Country reports
Keynote lecture 1 with discussion	Keynote lecture 2 with discussion	Keynote lecture 3 with discussion	Keynote lecture 4 with discussion	Presentation of the teaching module from small-group work
Group work 1	Group work 3	Group work 5	Group work 7	Reflection on the course
Group work 2	Group work 4	Short keynote lecture	Group work 8	Course assessment
	Fieldwork	Group work 6	Group work 9	Closure
	Reports from fieldwork and discussion

During the past 24 years, different topics were covered, reflecting current needs of family medicine teachers (Table 2). A list of past and present course directors includes Amanda Howe (UK), Gianluigi Passerini (I), Henry Finnegan (IRL), Igor Svab (SLO), Justin Allen (UK), Josephine Buchanan (UK), Jaime Correia de Sousa (P), Janko Kersnik (SLO), John Yaphe (ISR/P), Mateja Bulc (SLO), Manfred Maier (A), Marija Petek-Ster (SLO), Milica Katic (HR), and Leo Pas (B).

Table 2. Topics of the Bled teacher-training course 1992–2016.

Location (Slovenia)	Year	Topic
Bovec	1992	Practice organization
Bovec	1993	Medical record-keeping
Gozd Martuljek	1994	Quality assurance
Gozd Martuljek	1995	Doctor–patient communication
Bled	1996	Prevention
Bled	1997	The family
Bled	1998	Prescribing
Bled	1999	Management of chronic diseases
Bled	2000	Evidence based medicine
Bled	2001	Out-of-office medicine
Bled	2002	Medical errors
Bled	2003	Ethical problems
Kranjska Gora	2004	Patient-centred care in modern cross-cultural communities
Kranjska Gora	2005	Co-morbidity
Bled	2006	Community orientation
Bled	2007	Patient empowerment
Bled	2008	Self-medication
Bled	2009	Impact of medicalization
Bled	2010	Impact of new information technologies
Bled	2011	Professionalism
Bled	2012	Managing difficult relationship with patients
Bled	2013	Doctors’ wellbeing
Bled	2014	Scope and limits of general practice/family medicine
Bled	2015	Managing multimorbidity in aging populations
Bled	2016	Future developments in family medicine (refugees and migrants, the role of the family, new technologies)

Since 1992, 920 participants from more than 20 countries in Europe, and outside Europe including Turkey, New Zealand, Canada and Israel, have attended the course.

An analysis of participant feedback showed that participants valued a hard-working, friendly, positive atmosphere in the ‘Bled course family.’ They enjoyed practical work, excellent group leaders and the variety of teaching techniques used.

Impact of the EURACT Bled course

During the last 24 years, the course has acquired a reputation as one of the longest running international courses for teachers of family medicine.[8] With its stable long-term learning aims, typical course structure, and supportive environment it provided a safe, well-structured learning experience for participants from many countries.

A series of workshops were organized annually in Slovenia on the same topic as the Bled course of that year for Slovenian teachers and trainers in family medicine. The workshops were shorter in duration than the Bled course, but provided the material covered by the courses in a more concentrated way, in Slovenian, organized by the Slovenian participants of the course. Attendance at these courses is a prerequisite for recognition as a tutor of family medicine in Slovenia.

Serbia has also been successful in adapting the Bled course locally, with more than 15 national courses presented. Topics from the Bled course were eventually incorporated into specialist training in general practice at the School of Medicine of the University of Belgrade.

In Israel, the Bled course materials have been used in many different settings, from seminars for GP teachers to courses for teachers of family medicine at Tel Aviv University. New topics that were introduced in the curriculum as a result of the Bled course include medical anthropology and medical error.

Adaptation of material from Bled courses to teaching settings in northern Portugal began in 1994, in the vocational training scheme, in CME activities, and in 2004 in the family medicine undergraduate programme and clerkships in the medical school in Minho University (School of Health Sciences). The medical school course on medical sociology called Family, Society and Health includes material from Bled courses on culture and health, family structure and function, professionalism, doctors’ wellbeing, and end of life issues. The final year rotation for medical students in family medicine includes workshops on medical error, ethics, medicalization, empowerment, and self-medication, using material from Bled courses.

In Austria, there is a yearly report on the Bled course in lecture format to teachers from all teaching practices.

In Ireland, the small group learning (SGL) model of CME has been successfully used as the most popular method of keeping GPs up to date with topics relevant to the specialty of GP/FM and it has been shown that attendance at CME SGL meetings improved clinical practice, including prescribing, use of investigations and application of guidelines.[9]

The International Primary Care Respiratory Group designed a ‘teach-the-teacher’ programme template inspired by concepts and structure from the Bled course. This programme has been adapted to national or regional needs and includes identification of a work-based educational project that then provides the material for the programme.[10]

The place of the EURACT Bled course among other teacher training courses in Europe

Many teacher training courses exist in family medicine throughout Europe.[5,6,11–14] They are mainly designed to meet local educational needs and their content is usually oriented towards the theory and practice of pedagogy. These courses also have a stable curriculum, which allows new teachers to acquire necessary knowledge and skills.

In the past years, EURACT produced several international courses for teachers of family medicine. Within the Leonardo da Vinci project, it has developed and launched a comprehensive programme with courses at three levels of participant expertise, to address the personal learning needs of GP educators.[15,16] A course on assessment was also developed and has been implemented several times.[17]

These EURACT courses and local courses in many countries are designed to cover the educational needs of teachers and have a stable structure. Teachers can attend them individually to gain sufficient knowledge on the topic presented.

Compared to the courses described above, the EURACT Bled course offers a different approach to teacher training. It has a stable environment, an international nature, and possibilities for local implementation of the course. To our knowledge, this is the only course for teachers of family medicine, which has existed continuously for 25 years with a duration of five days. The duration of this course is a possible key to its success. Participants are involved actively in course work and the small groups develop healthy group dynamics. Participants can put aside daily professional concerns and focus only on learning and on interactions with other participants. With a large variety of countries participating, there is a stimulating exchange of contrasts and comparisons of healthcare systems and teaching methods between countries.

The course continues to enjoy the patronage of the European Academy of Teachers in Family Medicine. EURACT provides course faculty and participants as well as material support in the form of scholarships to allow deserving teachers to attend the course at a reduced fee.

Other external opportunities provide continuing support for the course. The Department of Family Medicine at Tel Aviv University rewards one outstanding teacher each year with participation in the Bled course.

Unique teaching methods including home visits to patients cared for by the local community health centre and offer excellent opportunities to learn from practice.

Future of EURACT Bled course

In recent years, participants and faculty have looked critically at past courses. Controversial points include the length of the course, financial resources, future themes of the course, and the need for new faculty members.

The course suffered a severe challenge with the sudden death of Janko Kersnik in May 2015. Janko Kersnik was one of the Bled course directors for many years. Between 2008 and 2015, he was president of EURACT. He was a respected professor of family medicine nationally and internationally.[18] It was natural that the Bled course changed its name to the Janko Kersnik International Bled Course for Teachers in Family Medicine to honour all his efforts for European family medicine and the Bled course. The Council of EURACT approved the proposition in the autumn of 2015.

The need for new course directors with fresh ideas was stressed at the conclusion of the 2015 course. New teachers will be introduced to the course in the coming year and will be offered the opportunity to establish themselves as course directors. It will provide an opportunity for several long-time participants to take over as small group leaders.

The course must cope with external threats including economic crises facing many countries in Europe. The course must find new sources of financial support, to allow participants with limited financial resources to attend. One opportunity is to invite other academic institutions abroad to act as co-organizers. Obtaining European Union funding and national funding are also possibilities.

The Bled course should serve as a springboard for young, enthusiastic future teachers of family medicine in Europe. Topics of future courses should be adapted to reflect that. A needs-assessment of young teachers should be conducted which will enable the faculty to prepare a course attractive for young teachers. The length and structure of the course will not be changed. Adaptations to the programme including more activities that are social are possible.

Conclusion

The Bled course has a solid reputation on the international teacher-training scene in family medicine. The success of the course can be measured in the growing number of first-time participants who have become regular attenders. It can also be measured in the spread of ideas from the course into family medicine curricula in undergraduate and postgraduate courses around the world. Teaching modules from the course have been presented at workshops at national and international meetings like Wonca conferences and have appeared in several publications. The course had also had a role to play in developing strong international friendships and academic partnerships. The course has become a trademark for active learning at the highest level. It continues to grow because it continues to meet the needs of the participants. By remaining attentive to the needs of teachers of family medicine in Europe and beyond, the course would appear to have a bright future for many years to come.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.