Transcript PRIMARY CARE TRAINING

SPECIALTY TRAINING AND CAREER
STRUCTURE FOR FAMILY MEDICINE
IN BRUNEI DARUSSALAM
OUTLINE
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Brunei Darussalam Background
Primary Health Care System & background
Outpatient Services
Basic Specialty Training (Family Medicine)
Career Progression
Advanced Specialist Training (Family
Medicine)
Challenges
BRUNEI DARUSSALAM
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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
IN LINE WITH MINISTRY OF HEALTH NATIONAL HEALTH CARE PLAN (2000-2010)
TO PROMOTE PRIMARY HEALTH CARE
PRIMARY CARE SERVICES
Decentralisation
NOW
BEFORE
RIPAS
Hospital
Postgraduate
Training
Brunei/Muara – 7 H/Cs
(June 2000- March 2001)
Belait
- 3 H/Cs
(Oct 2002)
Tutong
- 4 H/Cs
(Oct 2002)
PRIMARY HEALTH CARE SYSTEM
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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
Mukim
Berakas
Mukim
Sengkurong
Mukim
Gadong
Mukim
Kilanas
Mukim
Pengkalan
Batu
Mukim
Serasa
Mukim
Mentiri
Mukim
Kota Batu
Mukim
Lumapas
OTHER PHC PROVIDER
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1 private hospital – Jerudong Park MC
Ministry of Defence – 5 medical centres
Brunei Shell Petroleum – Panaga Health
Centre
Private GP clinics – 21
OUTPATIENT SERVICES
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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
SERVICES IN HEALTH CENTRES
MEDICAL RECORD
LABORATORY RESULTS
TRIAGE
OPD DOCTOR CONSULTATION
SERVICES IN HEALTH CENTRES
TREATMENT ROOM
DISPENSARY
PHLEBOTOMY
RADIOLOGY
SERVICES IN HEALTH CENTRES
MCH
DIETICIAN
DENTAL
COMMUNITY PSYCHIATRY
OTHER SERVICES
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Extended hours services (out of hours)
DOTS for tuberculosis treatment
Smoking cessation clinic
Well women clinic
Weight management clinic
Ophthalmology clinic
FAMILY MEDICINE TRAINING
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Vocational training rotations
Masters in Primary Health Care (Feb
2004) – previously Postgraduate Diploma
in Primary Health Care (Feb 2000)
MRCGP [International] (Nov 2005)
VOCATIONAL ROTATIONS
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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
VOCATIONAL ROTATIONS
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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)
PRIMARY CARE TRAINING
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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
PRIMARY CARE TRAINING
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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)
MASTERS IN PRIMARY HEALTH CARE
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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
MASTERS IN PRIMARY HEALTH CARE
DATE
FEB
YEAR 1
Critical Appraisal
Skills & Reflective
Learning
YEAR 2
YEAR 3
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
MASTERS IN PRIMARY HEALTH CARE
YR 1
MSc
YR 2
YR 3
TAUGHT MSc (6 drs)
RESEARCH – BASED MSc (2 drs)
9 X 3000 WORDS
ESSAYS
3 X 3000 WORDS
ESSAY
1 x 20000 WORDS
THESIS
MRCGP [INTERNATIONAL]
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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)
WHAT NEXT AFTER BST?
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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
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
ADVANCED SPECIALIST TRAINING
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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
ADVANCED SPECIALIST TRAINING
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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
ADVANCED SPECIALIST TRAINING
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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
ADVANCED SPECIALIST TRAINING
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Identified priority
areas
Clinical areas
Non clinical areas
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Medical education
Public health
Ethics and medical law
Healthcare quality
Health promotion and
education
E-health / Health
informatics
Research
Health management &
planning
ADVANCED SPECIALIST TRAINING
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Diabetes
Minor surgery
Endocrinology
Dermatology
Gastroenterology
Rehabilitation
Elderly health
Palliative medicine
Sports medicine
Adolescent health
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Cardiology
Men’s health
Women’s health
Child health
Mental health
Infectious disease e.g.
tuberculosis
Respiratory disease
STI
Rheumatology
ADVANCED SPECIALIST TRAINING
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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
CURRENT SITUATION
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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
CURRENT SITUATION
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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
CHALLENGES
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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
THANK YOU