The Brisbane Initiative: International Education for Leadership in Primary Care Research

The Brisbane Initiative has brought together leaders in primary care research from eight different countries in Brisbane, Australia in 2002. The goal of the Brisbane Initiative is to develop international support for and coordination of education for future research leaders in General Practice and Family Medicine. As this is directly related to the research program of the World Organization of Family Doctors (Wonca)1, the Brisbane Initiative will pursue its goals under the aegis of Wonca.

Internationally, there is clear disproportion in the amount of funding for research on uncommon problems versus what is spent for the common problems in health care. This has been called "the 10/90 gap", in reference to the fact that only about 10% of the research resources are directed at 90% of the health problems of the world population. Improving the health of populations requires a strong primary health care system founded in good science.

For this scientific base to be created and maintained a robust primary care research enterprise is required to enable primary care clinicians to:
· use the best clinical tools in a cost effective manner
· answer common clinical questions
· incorporate more effectively findings from other fields of research into practice in a cost-effective manner
· work with other health professionals and the makers of health policy to establish effective country and region-wide health care systems and policies

The primary care research enterprise is in the early stages of development. Strong, well-educated leadership is in relatively short supply. However, there are examples of leadership training in a number of countries including and extending beyond Masters and Ph.D. programs. To sustain primary care growth it is essential that the best and brightest students enter the field of general practice/family medicine and develop research interests and leadership skills. International collaboration is essential to bring together experience and critical mass.
Future research leaders in general practice/family medicine need to possess scientific skills: the ability to design projects with rigorous science, collaborate with researchers in other disciplines, apply for funding, and administer projects and research groups. But at the same time, they must be able to analyze the need for research from a general practice/family medicine perspective, to communicate results, and to pursue strategies to implement research into practice. These leaders will be instrumental in the further capacity building of primary care research as they will lead research programs, develop research strategy and educate future research leaders.

The Brisbane Initiative will address the international shortage of scientific leadership in primary care by enlarging the pool of available training resources and enriching the educational environment through cooperation both between existing primary care research units and between these units and other disciplines (e.g. industrial engineering, public health) with a program that transcends national boundaries. Further, the Brisbane Initiative will help to establish a critical mass of current and future leaders in primary care research by bringing together leaders from many nations.

The programs of the Brisbane Initiative will include projects that identify and support future leaders, which provide scientific and related training, and which support existing research leaders. Finally, we will explore ways to involve new primary care researchers in developing countries through the development of distance education techniques and mentoring opportunities. Specifically, these educational projects will include:

· Fellowships and visiting traineeships: These will range from rather short experiences for medical students (individual or group which will be designed to stimulate interest and be a tool for "talent spotting") at the one end to longer, more formal experiences for trainees at higher levels. These latter programs will be part of Ph.D., M.P.H. or Masters Primary Care programs.
· Formal Leadership Training Programs: These programs will build upon existing models and will be designed as post-doctoral (or post-masters) programs and will address specifically the need to develop the skills for scientific leadership in individuals who already have a good scientific background.
· Development of educational resources: The Brisbane Initiative will develop cooperative agreements between research units with expertise in primary care and related disciplines and make scientific education available internationally both through fellowships (above) and through a catalogue of distance learning programs as well as opportunities for on-site learning and mentoring.
· Development of Expert Groups: The Brisbane Initiative will support the development and funding of Expert Groups to provide a focus for primary care research with topic specific interests such as HIV or care of the ageing.
· Creation of International "Think Tanks" in primary care research: The Brisbane Initiative will bring together leaders in primary care research from many countries to continue to develop new structures and programs to help build the enterprise.
Building upon our two-year history of success will require financial support for secretariat and clearinghouse functions and ongoing operations. Funding will be required for the support of fellowships at all levels, especially fellowships for physicians from developing countries.

John Beasley (US), Geert Jan Dinant (The Netherlands), Frank Dobbs (Northern Ireland),,Michael Kochen (Germany), Andre Kottnerus (The Netherlands), David Mant (England), Chris del Mar (Austalia), Lucy McCloughan (Scotland), Walt Rosser (Canada), and Chris van Weel, Chair (The Netherlands)

References:
1. Van Weel C, Rosser WW. Improving Health Care Globally. Annals of Family Medicine 2004; 2(suppl. 2): in press
2. Global Forum for Health Research. The 10/90 Report on Health Research 2001-2002. Geneva: Global Forum for Health Research, World Health Organization, 2002.