Feasibility of utilization of experts outside the country for education intervention on adolescent health: Case study on Macao general practitioners

Dear Sir

The health needs of adolescents would be easily under-estimated especially in countries with no structured medical education in general practice and eastern cultures putting less emphasis on the positive health development. In Macao (population around 500,000), general practitioners (GPs) are mainly graduates from mainland China without formal GP training. The health of Macao adolescents requires special attention with recent study revealing alarming high cardio-vascular risk (Lee et al. 2011).

The academic GPs of the Chinese University of Hong Kong started postgraduate GP programme in Macao including a pilot study of special designed adolescent health workshops covering management of non-specific complaints, counselling of health risk behaviours and communication skills taking reference from Sanci's study (Sanci et al. 2000). GPs were invited to join and were randomly assigned to intervention group receiving training by workshops with case discussions and the control group with lectures only. Two sets of questions were developed as pre- and post-evaluation based on format of Modified Essay Questions (MEQ) simulating adolescent consultation and was developed by one author (AL) who was the Co-ordinator of the MEQ segment of the Conjoint Fellowship examination of Royal Australian College of General Practitioner and Hong Kong College of Family Physicians, and was validated by another experienced examiner. The questions were marked by two experienced examiners averaging their marks. A third person of similar standing would mark independently for questions with discrepancy over 20% and averaged with the closer mark.

The mean scores (maximum 50) of intervention and control groups were 10.75 (95% CI 9.6, 11.9, N = 21) and 9.36 (95% CI 6.9, 11.8, N = 15) respectively with no statistical significance at level of 0.05. After completion of training workshops, the intervention group had mean score of 16.6 (95% CI 13.2, 20) with statistical significant improvement and control group was 13.73 (95% CI 10.75, 16.7) with no statistical significant improvement. No significant difference was found between two groups with regard to prior postgraduate GP education. All participants of intervention group highly rated the programme helping them consolidating their understanding of adolescent and putting the learning into practice.

Most doctors in Macao received bio-medical focused medical curriculum in acute medical setting. Adolescents are least frequent attenders of health services particularly hospital setting so GPs might have limited exposure. This study's findings demonstrate the needs and effectiveness of special designed workshops, and also the feasibility of seeking professional support from neighbouring country to supplement the gaps in medical education.