Basic Medical Education and Vocational Training for Regional Health Care – Family Medicine at the University of Regensburg

Summary: At its conference in June 2013, the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physi-cians (WONCA) agreed on standards for postgraduate family medicine education. These standards are organized in nine areas: mission and outcomes, training process, assessment, trainees, staffing, training settings and educational resources, evaluation of training process, gover-nance and administration and continuous development. Main points are that responsibilities, structures and processes of training have to be clearly defined; trainees must be supervised and coached continously; and the focus of the training must be on family medicine. Postgraduate training in family medicine in Germany fulfills these standards only in part. Compared to WONCA standards, training in Germany focuses too much on learning by doing and too little on training and personal and professional development.

Survey on Doctors in Speciality Training for Family Practice and Family Practice / Internal Medicine Compared to Other Specialities in Westfalen-Lippe, GermanyBackground: This study deals with the situation of physicians of all fields in vocational training in Westfalen-Lippe, Germany. We focussed on physicians’ personal situation, motivation, evaluation of clinical rotations, theoretical courses as well as experiences, impressions and ideas for improvement. 2 different forms of training for family practice were compared to other specialities.Methods: Postal questionnaire to 438 physicians in vocational training with 35 items.Results: 123 physicians in speciality training answered (45 family practice, 48 family practice & internal medicine; 29 other). Mean total time between licensure and final examination of the 5-year speciality training is 9.5 years (median 8 years). 2 out of 3 trainees of family medicine choose their field after licensure. Reasons for family medicine are content, family friendliness, relation to patients and lack of hierarchy; doubts are mainly political or economical. Critique is focussed in salary, lack of training program structure and missing of preparedness of the supervisors. 51 % of future family practitioners prefer fixed rotations for their training, 73 % wish short-time rotations in different medical fields. Critique on courses include fees and lack of regular local training with relevance for family practice. An accompanying training for future FPs during working hours and an established mentor system would be favourable.Conclusion: To improve the quality of postgraduate training different aspects are highlighted. On a curricular level, an optimised structure, integration of other subjects and longitudinal mentoring is needed. University departments for family medicine should be involved.

A Qualitative StudyBackground: Germany has to face the unresolved problem of an impending striking shortage of family practitioners. Too few medical students are currently interested in a training as a medical specialist in the area of family medicine. There is disagreement about their motives. In this article, the factors that made fourth and fifth year medical students develop a career aspiration in the area of family medicine will be illustrated.Methods: In a qualitative study 14 medical students of the Otto-von-Guericke-University Magdeburg with a mentioned career aspiration in the area of family medicine were interviewed using guideline interviews. The guideline included the following aspects: The process of dealing with different career aspirations, the beginning of an interest for specialist training in family medicine and the influence of the university curriculum. The interviews were transcribed and analyzed using the Global analysis and grounded theory methodology.Results: The categories of the analysis process show the correlation of the career aspiration in the area of family medicine with the students’ rejection to be part of a perceived professional socialization in hospital. In addition, the different views of the students before beginning their studies are illuminated, that show their opinions about what it means to be a family practitioner. During the studies, an incompatibility of own values, norms, life and work planning and views of a good doctor -patient relationship is perceived with conditions of daily hospital routine. Positive and unique specialist experiences in the area of family medicine and thus the opportunity to maintain the own views and dispositions in this field contribute significantly to the formation of this career aspiration and to an alternative image of family medicine.Conclusions: The results presented here provide an insight into the complex issues of the career aspiration in the area of family medicine. Since the students have very heterogeneous images about being a family practioner before beginning their studies, an early and continuous contact with the discipline is crucial. There the differences from the other disciplines must be pointed out. This could be ensured by solid electives within the university curriculum. Overcoming anxiety and prejudices of students in relation to the work of a family practitioner by such information events is also important.