'The Junior Doctor Project': A Report from the Wonca Europe Preconference
General Practice / Family Medicine in Europe has grown since the establishment of national colleges and academies in general practice / family medicine in the 1960s and 1970s. They created a scientific base for the discipline and formulated the essentials of the tasks and duties of a general practitioner. In most European countries GP/FM is nowadays recognized as a unique specialty with a well-defined position in the health care system and a specific vocational training scheme.
International contacts and exchanges blossomed in the eighties. Several network organisations were founded and prosper today, including EURACT (the European Academy of Teachers in General Practice, EGPRN (European General Practice Research Network), and EQUIP (European Working Party on Quality in Family Practice). In the 1990s, such international togetherness led to an European umbrella structure for GP/FM. On the 4th of October 1995, we celebrated the inauguration of 'the European Society of General Practice / Family Medicine - The WONCA Region Europe', during a pan European Conference in the European Parliament in Strasbourg.
In addition, a European Journal of General Practice was founded in 1995, and this peer reviewed scientific journal was indexed in the NLM in 2003. In recent years, Wonca Europe has devoted much thought and writing, captured in the European Journal, to clarify and promote a unification process in our discipline in Europe. During the WONCA Europe Regional Conference in London in 2002, the document 'A European Definition for General Practice/ Family Medicine was discussed and accepted.
The twelve tutors of the Junior Doctor Conference. From left to right:
Egle Zebiene, Lithuania; Filipe Gomes, Portugal; Justin Allen, UK; Yvonne
van Leeuwen, the Netherlands; Fons Sips, the Netherlands; Mladenka Vric-Keglevic,
Croatia; Athanosios Simeonidis, Greece; Peter Manschot, the Netherlands,
Geurt Essers, the Netherlands; Herman Bueving, the Netherlands; Ben Bottema,
the Netherlands; Roar Maagaard, Denmark.
Participants of the JDP conference, enjoying the scenery of Amsterdam
Yet, Europe remains a patchwork of different health care structures. Similarly,
the position of the GP in these systems is divergent as are the training
programmes to become a general practitioner. No common standards exist
for the duration of the schemes, training and coaching systems, certification
and recertification terms, formal position of the trainees, and the role
and duties of the trainers.
When our College of General Practitioners in the Netherlands organized the WONCA Europe Regional Conference 2004, we were eager to learn how trainees in our profession and the youngest generation of general practitioners, together called 'Junior Doctors', regard the European situation. We were keen to enhance their involvement in the process of unification.
We
planned an Invitational Preconference to discuss these matters with the
'Junior Doctors'. We invited national colleges and academies, members
of the WONCA Region Europe, to nominate delegations of young doctors,
preferably members of boards or committees involved in the training schemes
in their countries. Eleven countries nominated three delegates each and
these 33 representatives were matched with an equal number of trainees
from the Netherlands. The participants were distributed in six international
groups. Each group had two GP tutors, a EURACT council member and a GP
trainer, a senior staff member of the training scheme in the Netherlands.
Two months before the conference, group tutors asked participants to fill
in a personal file, collecting information about their study carrier,
their training situation and some personal information. The aim was to
make acquaintance in a virtual way and exchange relevant information on
beforehand. Later they were asked to describe the health care structure
in their counties, with special emphasis on the position of the general
practitioner in their system, and describe their training scheme, and
its strengths and weaknesses. They were also asked to comment on the 'The
European Definition of General Practice / Family Medicine'.
The Preconference was held the 31st of May and the 1st of June, and continued during the WONCA Regional conference on the 2nd and 3rd of June. After an opening address, the participants worked for two days in their groups. They recognized the great differences among the national health care systems and the position of GP/FM in these structures. They discussed the most relevant features as are described in 'the European Definition': the gate keeping function of the general practitioner; the importance of a cooperative and non-competitive relationship between GPs and specialists regarding quality of care for their patients; the record holding for their patients and the importance of referral letters to specialists and reports from specialists examinations and interventions; and the influence of different reimbursement systems for GPs on quality, efficiency and cost effectiveness.
They
also compared the different training systems in their countries. Trainees
were surprised to recognize the differences in personal guiding during
their training episode. They recognized the importance of having a personal
trainer or tutor responsible for their personal and professional development.
After the Wednesday plenary exchange of group discussion, the participants
developed and presented on Thursday afternoon, June 4th to the Wonca Europe
Conference delegates their overall conclusions. The main points were:
- There
should be more (political) actions to implement the European Definition
of GP/FM in all the European countries.
- Participation
of Junior Doctors in International Conferences must be facilitated in
the future. A reduced conference fee for Junior Doctors and a programme
fitted to their needs will be very useful. Continuation of a Junior
Doctor Programme for the next WONCA Europe Regional conferences is recommended.
- International exchange of trainers and training programmes could be stimulated.
The most important result of this preconference meeting for Junior Doctors was their decision to establish a European Network Structure for Junior Doctors. The network organisation should be part of and under the aegis of WONCA Region Europe. They formulated a declaration of intent to work out in detail this initiative, and presented that to Dr Philip Evans, President of the WONCA Region Europe.
We owe a debt of gratitude to the College of General Practitioners in the Netherlands and Dr. Arno Timmermans, its President, who gave us the opportunity to organize this conference; and to our National Institute in charge of the vocational training scheme in the Netherlands (called the SBOH), who sponsored the project. Dr. Justin Allen, President of EURACT, was very helpful in the planning and collaboration. Professor Harry Crebolder was our highly respected intermediary to EURACT and the Conference Organizing Committee. Professor Chris van Weel, former President of WONCA Region Europe, was very helpful with his creative suggestions in planning this conference and his stimulating support in realizing the project. The dedication of the 12 group tutors was the mainstay of our success. It was a great pleasure for our working party to organize this conference. The enthusiastic involvement of the young participants in European matters is a promise for the future. The new network organization for Junior Doctors is the best way to involve them in the unification process of GP/FM in Europe.
The
JDP Working Party of the WONCA Europe Regional Conference
Fons Sips, Chairman
fonssips@hotmail.com
Ingrid van der Heijden, Secretary
Erik Teunissen
Justian Hofmans