Poster Presentation 6th Euripa Rural Forum. Marseille 09/2016

1. Improving Rural Rotation in Spain. Medical Training
Based on Competences
Authors: Jaume Banqué-Vidiella, Josep Vidal-Alaball, Miguel Angel Maria-Tablado, Maria del Portal Lorenzo-Gonzalez.
semFYC Working Group in Rural Medicine (Spanish Family Doctors Association)
Introduction
In 2015 a new training program for the specialty of Family and
Community Medicine started in Spain. For the first time a training
period in rural areas, called rural rotation was introduced. This new
mandatory rotation was suggested to have a duration of three months
approximately and to be done during the second year of training. With
this decision numerous rural health centres were incorporated as
educational. Rural centres in Spain provide health care to 21% of the
Spanish population.
It has been some time since the implementation of the rural rotation
in our country. During this time has been some changes in the needs
of patients, in the way of delivering health care and in the training
environment for residents with the increasing importance of “the
learning based on competencies”.
Reflecting about all this new reality has led us to ask the next
question:
At the present and responding to the specific nature of medical
practice in rural areas, what specific competences need to be
acquired by residents in Family and Community Medicine that
could define the training program in the rural rotation?
Goals
To answer this question we present a survey performed using a
Delphi methodology. This technique is based on the search for
consensus on the views within a selected group of experts in a
particular topic. It´s important to remember that when using Delphi
methodology and during the discussion, it is not necessary to agree
with the results shown or proposed by participants.
Methodology and Development Process
This project was set up during the first quarter of 2016 with the
constitution of the Research Committee formed by various members of
the semFYC working group in Rural Medicine. The proposals and
selection of the expert group to participate in the study was carried out
by the members of the working group. These experts came from
different levels of care and had extensive experience in rural medicine.
All the experts selected were invited to participate to participate via a
private and personalized email where the main lines of the project
were described. Those who finally agreed to participate, received all
the information needed in a second shipment with three documents
attached: work objectives, a summary of Delphi methodology and a
questionnaire where competences chosen for evaluation were listed.
In a second phase after analysing the answers received a final
delivery with theses analysis and the same questionnaire were send to
the same experts in order to continue and complete the discussion
The 22 competences selected and included in the questionnaire for its
evaluation and discussion, were taken from the document “Learning
based on competences for medical specialists” edited by Hospital of
Cruces in Bilbao, one of the most qualified centres in our country on
this subject. The skills were presented in the questionnaire in different
panels and were grouped in 6 blocks.
A Likert scale was used to determine the degree of agreement or
disagreement on the questions raised. The graduation of this scale in
the consensus statements, was performed as follows: Strongly agree:
5, Agree: 4, I don´t know: 3 Disagree: 2 and Totally disagree: 1. A free
text was included in case other contributions by participants were
done.
Results
Conclusions
Professional Attitudes Comunication Knowledge
Values Clinical Interview Clinical Knowledge
Disposition Relations with
patients
Clinical Reasoning
Behaviours Relations with
relatives
Decision making
Ethics Working as a team
Specific Clinical Skills Health services
relationship
Information
Management
Clinical Exploration Using Resources Applying EBMedicine
Technical procedures Patient Safety Collaboration in training
Diagnostic and therapeutic
interventions
Clinical Guidelines
and EBMedicine
Self – learning and self-
evaluation
Global strategy Scientific and clinical
judgement
Finally 42 experts in rural health were invited to participate in the
survey: 97.61% of them accepted. Of these 41, 23 (56.09%)
responded to both questionnaires. The average age for the
participants was 48.8 years (SD: 11.56). 56.1% were women and
73.2% were trained as specialists in Family and Community
Medicine thought the official program. In relation to years of
expertise, the average was 22.20 years (SD: 11.88).
With all the information gathered from both shipments, we could
affirm that any of the specific competences evaluated obtained an
average lower than 3. Half of these competences (11) got an
average lover than 4, and the other half (11) achieved a value of 4 or
above. All these data indicates that experts recognized on an equal
value the importance of all competences proposed for evaluation.
A second aspect to remark is that if we analyse the information
using the grouped block competences, we can affirm that clinical and
communication skills were the most valued skills.
We can conclude that there is a high degree of consensus among
experts consulted in relation to competencies needed to learn by
residents in Family and Community Medicine during the rural rotation
in Spain. This study confirms the versatility of the training model used
in Hospital de Cruces in Bilbao, a model that as the authors suggest
can be used in any medical specialty. Other results suggest that
residents could reinforce their competences in clinical and
communication skills during the rural rotation. New studies may be
necessary to know whether future rural doctors need to acquire other
competences not evaluated in this work.
Poster awarded with Special Mention in the category of "Teacher
Experiences" in semFYC XXXVI Congress. La Coruña - Spain
2016.06.
With the data and opinions obtained throughout all this process,
the Research Committee produced a final document of
recommendations.
Personal contact: jbanquev@gmail.com