Training of primary care physicians — II | Political economics


Educational and training institutions for primary care physicians in Pakistan are insufficient. One of the main obstacles in this regard is the lack of teaching staff. Given the serious shortage of teachers, the sustainability of this discipline depends entirely on post-graduate training.

Formal, standardized and structured training programs help participants acquire the necessary knowledge and skills (communication, interpersonal relations, patient management, research skills, administrative and managerial skills) and develop a commitment to high standards of professionalism .

An appropriate faculty development program to improve the knowledge and academic performance of family medicine faculty can help address some of these issues. Scholars trained in such programs will have an overall positive impact on undergraduate and postgraduate education and training in family medicine.

Offering master trainer courses in family medicine to address faculty shortages has its pros and cons. Most postgraduate family medicine graduates who will take such courses will have gained their qualifications through an experience-based pathway. They will need additional training in areas such as: medical education, clinical governance/audit, evidence-based medicine and clinical research.

Teaching sessions/modules to cover these areas, in addition to family medicine fundamentals, consultation skills, and clinical topics should be given special attention. Quality assurance, inspection of training sites and training standards will be required. Clinics of private GPs who become master trainers can become training venues for structured delivery programs. A master trainer program, however, may not be an alternative to a faculty development program.

The College of Physicians and Surgeons of Pakistan (CPSP) promotes postgraduate training in family medicine. It already offers membership (MCPS) and fellowship (FCPS) programs in family medicine. Membership is acquired in two ways: on the basis of five years of experience or two years of continuing education.

The World Health Organization Regional Office for the Eastern Mediterranean (WHO-EMRO) has already developed and implemented a transition program in the Eastern Mediterranean region, including Pakistan. Similar programs have been successfully carried out in other countries in the region. Course duration varies between six months and two years and includes on-the-job training and face-to-face and online teaching sessions. Saudi Arabia, Sudan, Jordan and Lebanon are among other countries in the Eastern Mediterranean region that have launched family medicine courses for primary care physicians.

Most of these courses are developed so that these physicians can obtain on-the-job training followed by certification in family medicine.

To reach the goal of three family doctors per 10,000 by 2030, we need a multimodal strategy. The target can be achieved through a bridging program for capacity building of our primary care physicians, including private GPs.

A regional professional degree program which has already been endorsed by family medicine experts in Pakistan has been started or is about to start at Khyber Medical University, Academy of Health Services, Rawalpindi Medical University, Jinnah Sindh Medical University and Lahore University of Health Sciences. The program has a blended learning approach with online sessions, face-to-face sessions, and hands-on on-site training.

To reach the goal of three family doctors per 10,000 by 2030, we need a multimodal strategy. The goal can be achieved through a bridging program for capacity building of our primary care physicians, including private GPs.

Tasks to be carried out include upgrading the skills of registered doctors, general practitioners and doctors working in primary health care centres. All stakeholders including the Pakistan Medical and Dental Council (PM&DC), medical universities and ministries of health should consider capacity building courses for practicing doctors.

These capacity building programs can be organized in the form of regular continuing medical education/continuing professional development sessions, certificate courses or professional degrees. Another approach could be to organize bridging programs that allow physicians to take qualifying exams like the MCPS or MRCGP (International). These courses can be part of a national bridging program. These courses will in no way replace a complete training of family physicians. These will, however, serve as an interim arrangement for existing GPs.

Once the transformation of the current generation of general practitioners into family physicians has taken place, all new medical graduates will need to undergo comprehensive training to become qualified family physicians.

The Islamic Republic of Iran has recognized the need for cost-effective and preventive health care and embarked on the implementation of the family medicine model. A master of public health (MPH) program in family medicine by distance education for general practitioners was set up in 2015.

In 2016, Morocco developed a bridging program where general practitioners with four years of professional experience can participate in a two-year training run by the Institute of Public Health in Rabat (diploma in family health). The two-year training course is divided into theoretical and practical phases, with the practical sessions taking place at the participants’ healthcare facilities.

We must learn from the countries of the region and benefit from their experiences. We must act. Ministries of Health must commit to making the strategy work and implementing a national transition program to move GPs to family doctors. They can encourage transformation by developing a cadre of family physicians to recognize primary care physicians with postgraduate degrees in family medicine.

In the future, a qualification in family medicine may be made compulsory for a doctor wishing to open a primary care health center that can be linked to a social health initiative/Sehat Sahulat Card programme. This will be a way to achieve universal health coverage by developing comprehensive primary care led by a family doctor.

Dr Hina Jawaid is Assistant Professor of Family Medicine at Lahore University of Health Sciences

Dr. Abdul Jalil Khan is Assistant Professor of Family Medicine at Khyber Medical University, Peshawar

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