The demographic characteristics, practice experiences, roles and development needs of family physicians who graduated between 2008-2018 from the Family Medicine Blended Learning 2 Year Diploma run by the Christian Medical College, Vellore, India

Abstract

English: Preamble: The ongoing professional development of India’s lean cadre of 250,000 General Practitioners and 30,000 Government doctors is constrained by limited options to update themselves. This negatively impacts on the ability of the country to create a critical mass of Family Physicians (FPs) who can clinically lead quality primary health care. Since 2006 the Christian Medical College (CMC) Vellore has run a 2-year blended learning Post Graduate Diploma in Family Medicine (PGDFM). In 2012 this offering was extended to the Medical University, Tamil Nadu, as a Master in Medicine in Family Medicine (M.MED FM). Between 2006 and 2016 they trained around 3000 private practitioners and 250 government doctors in Family Medicine.

The Study: Globally, graduate follow-up surveys explore the contribution of qualifications to professional life and inform curricular modification to support intended educational and practice outcomes. Notwithstanding extensive anecdotal information and a 2013 demographic survey of PGDFM & M.MED FM students, this is the first study to systematically assess FP graduate distribution, wellbeing, experiences of practice, their roles in the national health system and their professional development needs. A purposively designed, cross-sectional survey of all PGDFM & M.MED FM graduates who qualified between 2008 and 2018 was undertaken between March and July 2022. Data were descriptively analysed and the results constitute the substance of this dissertation.

Study findings: Of a population of 1213 FP graduates, 48% (n=581) responded to the study and 36% (438) completed the questionnaire. Most FPs were urban based, were relatively poorly paid, with female FPs earning significantly less than their male counterparts. FPs were largely hospital based and served mostly adult patients. They were under resourced, lacked technological support and most worked with an inadequate toolkit. Though well trained in consultation skills and the principles of FM, in practice their consultations were compromised by extreme time constraints and care continuity was hampered by an inadequate, patient held paper-based record system, poor back-referrals, and the impediments to relationship continuity characteristic of hospital settings. FPs did not engage adequately with polypharmacy. Most FPs engaged regularly in continuous professional development activities, but involvement in teaching, research and publication was confined to the few those who participated in faculty development programmes. High uptake of places and gender parity in enrolment suggests that the blended learning model made the qualification accessible to working doctors, especially women. The majority of FPs rated the influence of the PGDFM/M.MEDFM highly on their practice. They also identified important gaps, especially in respect of procedural skills and team management as learning areas that reflected common conditions seen in their work contexts.

Conclusion: The curriculum is inadequately synchronised with the reality of practice. This challenge is not unique to India and has implications for the meaning of Family Medicine as a discipline. It is important to understand what is central to the practice of a Family Physician and then to focus on developing the competencies needed to render these skills.

Sepedi: Ketapele: Tlhabollo ya seprofešenale ye e tšwelago pele ya sehlopha sa bašomi ba go hloka maatla ba India ba 250,000 bao ba šomago bjalo ka Dingaka tša Kakaretšo le Dingaka tša Mmušo tše 30,000 e thibetšwe ke dikgetho tše di lekanyeditšwego tša go ikaonafatša. Se se ama gampe bokgoni bja naga bja go hlola bokgoni bja naga ya rena bja go hlola Dingaka tša Malapa (FP) tšeo di ka etelago pele tlhokomelo ya maphelo ya motheo ya boleng. Go tloga ka 2006 Kholetšhe ya Bongaka ya Bokriste (CMC) ya Vellore e laotše kopantšho ya mekgwa ya kabo ya thuto ya mengwaga ye 2 ya tša Diploma ya ka Morago ga Tikrii ika Bongaka bja Lapa (PGDFM). Ka 2012 thuto ye e ile ya katološetšwa Yunibesithing ya tša Bongaka, Tamil Nadu, bjalo ka Mastase wa Bongaka ka go Bongaka bja Malapa (M.MED FM). Magareng ga 2006 le 2016 ba hlahlile dingaka tša praebete tše di ka bago 3000 le dingaka tša mmušo tše 250 ka Bongaka bja Malapa. Dinyakišišo: Lefaseng ka bophara, dinyakišišo tša go latela dialoga di hlahloba seabe sa mangwalo a thuto bophelong bja seprofešenale le go tsebiša phetošo ya lenaneothuto go thekga dipoelo tše di ikemišeditšwego tša thuto le tirišo. Le ge go na le tshedimošo ye e tseneletšego ya dikanegelo le diphathišišo tša palo ya batho tša 2013 tša baithuti ba PGDFM & M.MED FM, tše ke dinyakišišo tša mathomo tša go lekola ka mokgwa wa thulaganyo kabo ya dialoga tša FP, bophelo bjo bo botse, maitemogelo a go šoma, dikarolo tša bona ka tshepedišong ya maphelo a bosetšhaba le dinyakwa tša bona tša tlhabollo ya seprofešenale. Phathišišo ye e dirilwego ka maikemišetšo a a kgethegilego, ye e putlaganyago le dialoga ka moka tša PGDFM & M.MED FM tšeo di swanelegago magareng ga 2008 le 2018 e dirilwe magareng ga Matšhe le Julae 2022. Datha e sekasekilwe ka go hlaloša gomme dipoelo di bopa mooko wa lengwalonyakišišo le. Diphihlelelo tša nyakišišo: Go palo ya dialoga tša FP tše 1213, 48% (n=581) e arabile nyakišišong gomme 36% (438) e tladitše lenaneopotšišo. Bontši bja di-FP di be di theilwe ditoropong, di be di lefša gabotse, ka di-FP tša basadi di hwetša mogolo o monyenyane kudu go feta balekane ba tšona ba banna. Di-FP di be di theilwe kudu sepetlele gomme di hlankela kudu balwetši ba bagolo. Ba be ba se na methopo, ba hloka thekgo ya theknolotši gomme bontši bo šomile ka sedirišwa seo se sa lekanego. Le ge ba tlwaeditšwe gabotse ka mabokgoni a ditherišano le melawana ya FM, ka go diragatša ditherišano tša bona di ile tša bewa kotsing ke dithibelo tša nako tše di feteletšego gomme go tšwela pele ga tlhokomelo go ile gwa šitišwa ke tshepedišo ye e sa lekanego, yeo e swerwego ke balwetši yeo e theilwego pampiring ya direkhoto, go romelwa morago mo go fokolago, le ditšhitišo tša go tšwela pele ga kamano yeo e lego seka sa maemo a sepetlele. Di-FP ga se tša tsenela ka mo go lekanego le polypharmacy. Bontši bja di-FP di be di tsenela ka mehla medirong ye e tšwelago pele ya tlhabollo ya seprofešene, eupša go kgatha tema go ruteng, nyakišišong le phatlalatšong go be go lekanyeditšwe go ba mmalwa bao ba tšerego karolo mananeong a tlhabollo ya mafapha. Go amogelwa mo go phagamego ga mafelo le go lekana ga bong ka go ingwadiša go šišinya gore motlolo wa go ithuta wo o hlakantšwego o dirile gore mangwalo a thuto a fihlelelege go dingaka tše di šomago, kudukudu basadi. Bontši bja di-FP bo lekanyeditše khuetšo ya PGDFM/M.MEDFM kudu tirišong ya tšona. Ba lemogile gape diphapano tše bohlokwa, kudukudu mabapi le mabokgoni a tshepedišo le taolo ya sehlopha bjalo ka mafelo a go ithuta ao a laetšago maemo a tlwaelegilego ao a bonagalago kamanong ya bona ya mošomo. Thumo: Lenaneothuto ga le sepelelane ka mo go lekanego le nnete ya tirišo. Tlhohlo ye ga se ya moswananoši go India gomme e na le ditlamorago go tlhalošo ya Bongaka bja Malapa bjalo ka thuto. Go bohlokwa go kwešiša seo se lego bohlokwa mošomong wa Ngaka ya Lapa gomme ka morago o tsepamiše kgopolo go hlabolla bokgoni bjo bo nyakegago go tšweletša mabokgoni a.

Afrikaans: Aanhef: Die voortgesette professionele ontwikkeling van Indië se betreklik klein kader van 250 000 algemene praktisyns en 30 000 staatsdokters word aan bande gelê deur beperkte opsies om hulself op te dateer. Dit het 'n negatiewe impak op die land se vermoë om 'n kritieke massa huisartse (algemene praktisyns) te lewer wat klinies leiding kan bied in gehalte primêre gesondheidsorg. Sedert 2006 bied die Christelike Mediese Kollege (CMC) Vellore 'n tweejaar gemengde leer Nagraadse Diploma in Huisartskunde (PGDFM) aan. In 2012 is hierdie aanbod uitgebrei na die Mediese Universiteit, Tamil Nadu, as 'n Meestersgraad in Geneeskunde in Huisartskunde (M.MED FM). Tussen 2006 en 2016 het hulle ongeveer 3 000 privaat praktisyns en 250 staatsdokters in huisartskunde opgelei. Die studie: Wêreldwyd ondersoek opvolgopnames onder gegradueerdes die bydrae van kwalifikasies tot die professionele lewe en beïnvloed dit kurrikulêre wysigings om beoogde opvoedkundige en praktykuitkomste te ondersteun. Ten spyte van uitgebreide anekdotiese inligting en 'n 2013-demografiese opname van PGDFM- en M.MED-huisartsstudente, is dit die eerste studie wat stelselmatig die verspreiding, welstand, praktykervarings, en rolle van gegradueerde huisartse in die nasionale gesondheidstelsel en hul professionele ontwikkelingsbehoeftes beoordeel. n Doelgerig ontwerpte, dwarssnitopname van alle PGDFM- en M.MED gegradueerde huisartse wat tussen 2008 en 2018 gekwalifiseer het, is tussen Maart en Julie 2022 onderneem. Die data is beskrywend ontleed en die resultate vorm die kern van hierdie proefskrif. Studiebevindinge: Uit 'n populasie van 1213 gegradueerde huisartse het 48% (n=581) op die studie gereageer en 36% (438) het die vraelys voltooi. Die meeste huisartse was stedelik gebaseer, en is relatief swak betaal, met vroulike huisartse wat aansienlik minder as hul manlike eweknieë verdien het. Huisartse was grootliks hospitaalgebaseerd en het meestal volwasse pasiënte bedien. Hulle het onvoldoende hulpbronne gehad; tegnologiese ondersteuning het ontbreek, en die meeste het met 'n ontoereikende gereedskapskis gewerk. Alhoewel hulle goed opgelei was in konsultasievaardighede en die beginsels van 'n huisartskunde, is hul konsultasies in die praktyk in die gedrang gebring deur uiterste tydsbeperkings en is sorgkontinuïteit belemmer deur 'n onvoldoende, pasiënt-gehoue ​​papiergebaseerde rekordstelsel, swak terugverwysings en die hindernisse tot verhoudingskontinuïteit wat kenmerkend is van hospitaalomgewings. Huisartse het nie voldoende met polifarmasie omgegaan nie. Die meeste fakulteitslede het gereeld aan deurlopende professionele ontwikkelingsaktiwiteite deelgeneem, maar betrokkenheid by onderrig, navorsing en publikasies was beperk tot die paar wat aan fakulteitsontwikkelingsprogramme deelgeneem het. Hoë opname van plekke en geslagspariteit in inskrywings dui daarop dat die gemengde leermodel die kwalifikasie toeganklik gemaak het vir werkende dokters, veral vroue. Die meerderheid huisartse het die invloed van die PGDFM en M.MEDFM op hul praktyk hoog aangeslaan. Hulle het ook belangrike leemtes geïdentifiseer, veral met betrekking tot prosedurele vaardighede en spanbestuur as leerareas wat algemene toestande in hul werkkontekste weerspieël het. Gevolgtrekking: Die kurrikulum is onvoldoende gesinchroniseer met die werklikheid van die praktyk. Hierdie uitdaging is nie uniek aan Indië nie en het implikasies vir die betekenis van huisartskunde as 'n dissipline. Dit is belangrik om te verstaan ​​wat sentraal staan ​​tot die praktyk van 'n huisdokter en dan te fokus op die ontwikkeling van die bevoegdhede wat nodig is om hierdie vaardighede te bemeester.

IsiZulu: Isandulelo: Ukuthuthukiswa kobungcweti okuqhubekayo kweqembu elincane laseNdiya lodokotela abangama General Practitioners abanga-250,000 kanye nodokotela bakaHulumeni abanga-30,000 kuvinjelwe yizinketho ezimbalwa zokuzivuselela. Lokhu kuthinta kabi ikhono lezwe lokwakha iqembu elibalulekile lodokotela bomndeni abubye baziwe phecelezi ngama - Family Physicians (ama-FPs) abangahola ukunakekelwa kwezempilo okuyisisekelo okuseqophelweni eliphezulu. Kusukela ngonyaka wezi-2006 iChristian Medical College (CMC) Vellore ibilokhu iqhuba i-Post Graduate Diploma in Family Medicine (PGDFM) yokufunda ehlanganisiwe yeminyaka emibili kwezokwelapha umndeni. Ngowezi-2012 lezi zifundo zelulelwa eMedical University, iTamil Nadu, njengeMaster in Medicine in Family Medicine (i-M.MED FM). Phakathi konyaka wezi-2006 nowezi-2016 baqeqesha odokotela abazimele abayizi-3000 kanye nodokotela abangaphansi kukahulumeni abangama-250 kwezokuLashwa Kwemindeni. Ucwaningo: Emhlabeni jikelele, izinhlolovo zokulandelela iziqu zihlola igalelo leziqu empilweni yobungcweti futhi zinikeze ulwazi ngokuguqulwa kwezifundo ukuze kusekelwe emiphumelweni yezemfundo kanye nendlela ethile ehlosiwe. Naphezu kolwazi oluningi olumayelana nezindaba kanye nocwaningo lwezibalo zabantu lwangonyaka wezi-2013 lwabafundi be-PGDFM kanye ne-M.MED FM, lolu ucwaningo lokuqala lokuhlola ngokuhlelekile lwasatshalaliswa kubafundi abaphothule i-FP, inhlalakahle, okuhlangenwe nakho kokusebenza, izindima zabo ohlelweni lwezempilo lukazwelonke kanye nezidingo zabo zokuthuthukiswa kobungcweti. Ucwaningo oluhlelwe ngenhloso, oluhlanganisa bonke abaphothule i-PGDFM kanye ne-M.MED FM abaphothule phakathi konyaka wezi-2008 nowezi-2018 lwenziwa phakathi kukaNdasa noNtulikazi wonyaka wezi- 2022. Kuye kwahlaziywa imininingwane ngendlela echazayo futhi imiphumela yakha umongo walolu cwaningo. Okutholakele ocwaningweni: Kubantu abayi-1213 abaphothule izifundo base bethweswa iziqu ze-FP, abanga-48% (n=581) baphendule ocwaningweni kanti abanga-36% (438) bagcwalise uhlu lwemibuzo. Iningi lama-FP lalihlala emadolobheni, lalikhokhelwa kancane, kanti ama-FP abesifazane ayehola kancane kakhulu kunabesilisa. Ama-FP ayesebenza kakhulu esibhedlela futhi ayekhonze iziguli eziningi ezazingabantu abadala noma asebekhulile. Babengenazo izinsiza ezanele, bengenakho ukwesekwa kwezobuchwepheshe futhi iningi labo labe lisebenza ngamathuluzi anganele. Nakuba beqeqeshwe kahle ngamakhono okubonisana kanye nezimiso ze-FM, empeleni ukubonisana kwabo kwaphazamiseka ngenxa yemingcele yesikhathi esibi kakhulu futhi ukuqhubeka kokunakekelwa kwaphazanyiswa uhlelo lwamarekhodi olusekelwe ephepheni olunganele, oluphethwe yisiguli, ukudluliselwa okungekuhle emuva, kanye nezithiyo zokuqhubeka kobudlelwano obubonakalayo esimweni sasesibhedlela. Ama-FP ayengavamile ukusebenzisa imithi enhlobo nhlobo. Iningi lama-FP lalihlanganyela njalo emisebenzini yokuthuthukiswa kobungcweti eqhubekayo, kodwa ukubandakanyeka ekufundiseni, ocwaningweni nasekushicileleni kwakulinganiselwe kwabambalwa ababengabamba iqhaza ezinhlelweni zokuthuthukiswa kothisha. Ukwanda kwezikhala kanye nokulingana ngokobulili ekubhaliseni kusikisela ukuthi imodeli yokufunda ehlanganisiwe yenza iziqu zitholakale kodokotela abasebenzayo, ikakhulukazi abesifazane. Ama-FP amaningi anike ama-PGDFM/M.MEDFM umphumela ophezulu emsebenzini wawo. Baphinde bahlonza amagebe abalulekile, ikakhulukazi maqondana namakhono enqubo kanye nokuphathwa kweqembu njengezindawo zokufunda ezikhombisa izimo ezivamile ezibonakala ezimweni zabo zomsebenzi. Isiphetho: Uhlelo lwezifundo aluhambisani kahle neqiniso lwesimo salapho kusetshenzwa khona. Le nselele ayiyona inkinga yaseNdiya kuphela futhi inomthelela encazelweni ye-Family Medicine njengesifundo. Kubalulekile ukuqonda ukuthi yini ebalulekile futhi ewumongo ekusebenzeni kukaDokotela Womndeni bese ugxila ekuthuthukiseni amakhono adingekayo ukuze kuhlinzekwe la makhono.