Learning and teaching to educate future GPs

For learners a proper education means a shortcut to the acquisition of enough knowledge and skills to practice safe medical practice, instead of collecting own ‘ try and fail ’ experiences. Systematic introduction of a division between primary and secondary care and introduction of the gatekeeping role of GPs in the UK in 1948, the introduction of the specialist training in family medicine in 1961, recognition of the importance of primary care by members of the World Health Organization in 1978, and a EU directive on free movement of physicians in 1993, were all important political decisions paving the way for the development of education of the discipline. Although in some countries the start of specialty training happened as an instant decision of visionary politicians, in other countries this process took years and decades. In any case, nowadays postgraduate family medicine specialist training has become a reality in most European countries, and in others it is part of health care reforms pushed by the World Bank. The Defi nition of the Discipline and the Educational Agenda has set the scene for teachers to formulate curricula that follow the notions of comprehensive and holistic patient care expressed in these documents (1,2). The discussion paper by Wensing and Kersnik in this issue indicates important goals for the future development of the discipline in using knowledge by health professionals and patients in daily practice (p. 238). General practice should use technological advances but continue to practice comprehensive medicine in spite of reductionist health policy demands for collection of quality indicators, cutting an individual into small pieces. In addition, community orientation and the social aspects of our profession are being documented by Hetlevik and co-workers in this issue of The European Journal of General Practice (p. 212). Given the high numbers of family medicine teachers in Europe, we are now in a phase of refi ning particular parts of the educational programme, taking into consideration a changing world, with patients with more information available, people migrating across the globe, and fresh views of young doctors. Ways of trainees ’ selection, trainers ’ education and the whole process of training and assessment are under constant scrutiny of the discipline. In this issue, Guldal and co-workers have analysed needs of teachers in 15 countries. From their interesting fi ndings, they concluded that GP teachers need suffi cient time and resources to carry out their teaching tasks and teaching should not just be an ‘ add-on ’ to clinical tasks (p. 233). Teaching the teachers using programmes developed by EURACT and partners and other teacher courses should be mandatory for trainers in GP (3,4). We have to learn and teach teachers to educate future GPs. There are still white spots on the European map regarding speciality training and family physicians might not be regarded by national insurance schemes. However, in some countries specialty training has achieved a high standard, so researchers started to look in diff erent phases of training, for example the selection process, which is discussed by Vermeulen and co-workers in this issue of The European Journal of General Practice (p. 201). The authors gave us an overview of selection processes in Europe and analysed the selection process in the Netherlands. They are critical to set criteria locally, which might be unfair and — even more important — not uniform for the country. They call for national competency based selection programmes, which already exist in the UK and Denmark. Other countries should follow this example. Generally, we lack studies on the eff ectiveness of diff erent approaches in teaching general practice from these countries. In this issue Capobussi et al., published a nice study on the eff ectiveness of general practice attachment in reaching the educational goals of their speciality training programme in Italy (p. 206). After specialist training, GPs are left to their own ingenuity how to follow fl oods of new scientifi c information. Taylor and co-workers describe a promising national concept developed by the RCGP in the UK, supporting young GPs by connecting, networking and introducing in managing bodies of the organization (p. 229). I think we should be happy about the growing evidence on the development of postgraduate teaching and diminished variations between countries. However, undergraduate education in family medicine is even more outside proclaimed EU ‘ harmonization ’ . Application European Journal of General Practice, 2012; 18: 199–200