Introduction
Family medicine is a field that provides all-encompassing healthcare for individuals at the domestic level. It covers a number of medical fields such as behaviorism and psychology. Usually, it is viewed as the lowest stage of the national healthcare system. Various objectives of practicing family medicine include health promotion, prevention of diseases, counseling, diagnosis, treatment, and awareness creation among others. Its services are strategically located in a variety of locations to ensure accessibility. It involves people of all ages and sexes.
Therefore, a family physician should be in a position to deliver healing services that relieve patients from either acute or chronic conditions excellently. In addition, family medical practices are undertaken to facilitate the prevention and maintenance of the patient’s health condition. As a result, clinical services at the family level require practitioners to have completed a four-year course in family medicine, and a Master’s or Doctorate Degree. This essay explores the discrepancy between family medicine training and practice.
According to Wetmore et al., family medicine is governed by nine principles that physicians need to apply in the delivery of services to patients.16 The first principle includes an open-end commitment to diagnosis and treatment. Secondly, the parties involved should understand the context of the problem or disease. Nothnagle, Sicilia, Forman, Fish, Ellert, and Gebhard posit that they should also be in a capacity to visit the family healthcare facilities for preventive purposes. In addition, stakeholders should perceive the practice as a population at risk. The method is also based on the usage of a wide community network for support. Ravichandran, Al-Hamdan, and Mohamed suggest that practitioners should also recognise the subjective aspects of medicine. Lastly, they should create awareness of the necessity to manage the available resources efficiently.
Skills or Procedure List in Family Physician Residency Training Programme
The family physician must always be equipped with skills that are available in the training programmes. Graham, Roberts, Ostergaard, Kahn, Pugno, and Green reveal that many countries have well-documented lists training manual of procedures or skills for the family physician residency programmes. Some of the examples of such lists are discussed below.
Procedure List for American Curriculum
Graham et al. confirm that the USA curriculum for family medicine requires physicians to complete an undergraduate degree in a certified medical school. Furthermore, they have to study for three more years in specialised medical residency training that is relevant to family medicine. The curriculum also includes a practice model that demands students to provide continuity care to patients during the residency period.
Smith, Dollase, and Boss confirm that students are issued with licenses to become board certified members of family physicians.11 The certification is changed and/or renewed on a yearly basis based on various assessments that determine their knowledge, skills, and expertise. This practice is termed as Maintenance of Certification programme for Family Physicians (MCFP). According to Smith et al., the MCFP ensures that the physicians are gain professionalism through continuous learning, acquisition of cognitive skills, and practical performance. According to the American Academy of Family Physicians, practices that are implemented in the family medicine programmes are based on the aforementioned nine principles in an attempt to ensure efficient service delivery.
MCFP involves the following four steps.
Part I: This part deals with the professionalism of the family physicians. They should possess current valid, full, and unrestricted licence to practice family medicine in the United States. They must also comply with the ABFM guidelines for professionalism, licensure, and conduct.
Part II: This section entails self-assessment and continuous learning that is life-long. A family physician is required to complete the required number of self-assessment modules during the MCFP cycle and complete the required credits of continuous medical education.
Part III: This section deals with the cognitive expertise that requires a family physician to complete the MCFP examination successfully.
Part IV: This step entails performance in practice section. Family physicians are required to complete the required number of performance practice modules during the MCFP cycle.
Family physicians under the ABFM or MCFP program must ensure that they complete various modules in stages that take 3 years successfully to maintain certification. Those who have not completed, whose certifications have expired, or have never been in the MCFP program (not certified) must complete the re-entry process successfully to gain eligibility for examinations and certification status.1
Entry requirements for program include attainment of 50 points in MCFP modules, minimum of 1 part II module, minimum of 1 part IV module. An additional module of choice (Part II or Part IV), and completion of 150 credits of acceptable Continuing Medical Education (50 percent Division 1) that are acquired in three years is also considered. Interested candidates must also submit a 3-year MCFP process payment, application, and full examination fee for the MCFP examination. The last step involves successful completion of the MCFP examination.
Procedure List for the Saudi Board for Family Medicine
Effectiveness of the Saudi Arabian healthcare system is centred on the qualifications of family physicians that enable them to deliver superior services to the public. The Saudi Board of Family Medicine is mandated to supervise and guide the students in both ambulatory care and hospital-based medicine.
The Saudi Arabia designed this guide with an aim of producing physicians to provide high-quality healthcare to patients both in the hospital and in the community. However, development of competitiveness amongst the family medical professionals is achieved through consistent learning. Another goal is to ensure that the physicians are equipped with knowledge about comprehensive care. In this context, continued support is offered to patients irrespective of their family backgrounds. Lastly, an emphasis is laid on the progress and continuous development to ensure expansion of knowledge, especially on specialty programmes to improve healthcare services.
The scope of the medicine-training programme in Saudi Arabia covers hospital, ambulatory, home-based, emergency, and long-term care facilities. Although the programme takes four years, a spiral-educating curriculum that involves repetition, re-exposure, and re-emphasis is also adopted to ensure that the residents gain more skills. This situation guarantees development of coherent knowledge that is integrated in every section of the facilities. Furthermore, Tenore, Sharp, and Lipsky reveal that the Saudi board ensures that the physicians are competent and have an attitude drives them to offer comprehensive care based on the patients’ social and physical factors.
Rakel and Rakel reveal that the curriculum framework is divided into five sections namely competencies (covering primary care management), person-centred care, and skills for solving problems in family medicine. The others include an approach that is comprehensive and a community-based orientation.
The second section of the framework is principles in family medicine that entails the context and continuity of care. It ensures that care is delivered comprehensively through coordination of individuals and teams. Ericsson reveals that it focuses on bio-psychosocial approaches and safety of the patient. The third section is the family medicine theme that includes prevention and wellness, acute and chronic illness and community and population medicine. In the fourth section, the main issue is the family medicine physician who is categorised as a medical expert, communicator, collaborator, professional, manager, health advocate, and a scholar. Lastly, the fifth section primarily deals with the medical priority topics.
The core skills that are learnt under the Saudi Arabia family medicine program includes obstetrics ultrasound, injectable long term contraceptives, fitting of diaphragm, intrauterine contraceptive device insertion and removal, and obtaining virginal and cervical cytology. It also entails removal of foreign bodies in the cornea, nose, external ear, skills in biopsy, use of wood light, scraping of microscopy, urine dipstick, and drainage of superficial abscesses, and laceration repair and removal of suture among others.
UK Family Medicine Curriculum
The UK family medicine curriculum defines knowledge, skills and qualities of general practitioner and the essential teaching and learning activities. The curriculum is the basis of training and assessment that is used across the whole UK. The training program in the family medicine specialty in UK takes about three to four years. The contextual statements in the curriculum include the general practitioner (GP) consultation practice, patient safety and quality care, the GP (in the wider professional environment), and enhancement of the professional knowledge.
Comparisons of the Family Medicine Procedures Lists
Some comparisons can be drawn from the three family medicine curriculums. At the outset, the nine principles of family medicine are universal. This situation has made the training process easier since students can borrow knowledge from the three curriculums. Secondly, the curriculums adopt similar rotation of the learners in an attempt to acquaint them with diverse procedures that are applied in family medicine.
In Saudi Arabia, the programme is based on spiral learning whereby every section is re-visited to lay emphasis on family medicine practice. This strategy ensures development of competent medical personnel with a view of improving service delivery at family healthcare centres. Another difference is noted on the skills and competencies. Unlike Saudi Arabia, the UK curriculum includes skills in dealing with patients with mental problems, intellectual disabilities, and drug and alcohol abusers.
Discrepancy between Training and Practicing Family Medicine
According to Bradner, Crossman, Vanderbilt, Gary, and Munson, discrepancy between family medicine practicing and training is on the rise due to inadequate ways of integration theoretical aspects that are learnt during classroom sessions. This scenario is evident where exercising clinical ethics is required. In the field of practice, a physician under the family medicine is required to save life. However, according to a research that was conducted by Henshaw and Van Vort in the USA, most of the family medicine physicians carry out activities that are not recommended by the terms of the profession.
Eubank, Dominic, and John posit that practitioners rampantly conduct abortion procedures to get rid of unintended pregnancies.19 This activity is contrary to requirements of the practitioners’ profession to save life. The result indicated that about 5-percent of the resident agreed to perform abortion while the majority have recommended that the practice should be carried out during the first trimester of pregnancy. The action of abortion in the family medicine is perceives as immoral.
Gender parity is also a discrepancy that is seen in the field of family medicine. Most of these practitioners are males. The perception of belief of not doing practically what is learnt can arise due to such. For instance, it can be difficult for a male practitioner to carryout abortion or other operations that entails the reproductive system of the opposite sex. The access of family planning services by women can be achieved through women empowerment and inclusion of many practitioners who are women. According to Forrest, the American Medical Women’s Association ensures that most females undergo reproductive health at internship levels to improve their skills on contraception and abortion.
Obstacles faced by Family Physicians on Service Delivery
According to Cuddy, Keane, and Murphy, family medicine has been faced with challenges that lead to shortage of practitioners. Those who manage to secure jobs in family medicine ambulatories and hospitals succumb to stress, ergonomic, and psychosocial problems. These challenges have adverse impacts on service delivery; hence, most of the physicians perceive family medicine problematic and hectic.
Cuddy et al. notes that such professionals have variously complained that the amounts of workload in the field result in reduced self-drive. According to a Canadian-based research, family physicians encounter various obstacles. Simoens, Scott, and Sibbald note that the absence of morale in the specialty programme has in turn led to deteriorating performance. Several strikes have also been evidenced in Britain and Another challenge concerns the privileges that are offered to other family physicians. Some physicians prefer working on the exclusive and emergency areas. Such services can be provided in both rural and urban family healthcare setups. In the rural settings, due to their critical nature that requires quicker delivery of service, emergencies are difficult to handle where care is not provided sufficiently. In such situations, Spurgeon, Barwell, and Maxwell posit that most physicians are unable to meet the scope of family medicine specialty.12
According to Berger and Mohr, family medicine training and practice has been affected by various financial challenges that have led to shrinking of the scope of service delivery. Some patient issues such as injections, surgeries, and fractures among others require lengthy procedures. This situation makes the hospital work to look less attractive due to free services that are often accompanied low reimbursement of funds. Sturm posits that such situations have various led to the resignation of some physicians; hence, staff shortage has become an apparent phenomenon in family medicine. According to White, a study that was conducted by the AAFP indicated a drop of family physicians by 19-percent in most ICUs between 1987 and 1998.
Conclusion
The essay has elaborated the scope of family medicine. This specialty has a vast range of healthcare services that are guided by the nine principles. It is also clear that various countries such as the US, the UK, and Saudi Arabia have almost comparable family medicine curriculums. However, a major difference is noted in the applicability and duration of the training programs. The best way to equip students with sufficient healthcare skills in family medicine is through the implementation of in-depth training programs and practice with respect to the scope of the specialty. Nonetheless, dissatisfaction at the workplace has common amongst domestic healthcare specialists. Therefore, there is a need to focus on the formulation of solutions that are encountered by family physicians. This strategy will reduce the discrepancy between training and practice in family medicine; hence, health promotion will be guaranteed at the domestic level.
References
American Academy of Family Physician. Recommended Curriculum Guidelines for Family Medicine Residents; 2010. Web.
Berger J, Mohr J. A Fortunate Man. The Story of a Country Doctor. London: Writers and Readers Publishing Cooperative; 1976.
Cuddy N, Keane A, Murphy A. Rural general practitioners’ experience of the provision of out-of-hours care: a qualitative study. Br J Gen Pract 2001; 51(465): 286-90.
Ericsson K. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine 2004; 79(10):70-81.
Graham R, Roberts R, Ostergaard D, Kahn N, PugnoP, Green L. Family Practice in the United States: A Status Report. JAMA 2002; 288(1):1097-1101.
Forrest J. Epidemiology of Unintended Pregnancy and Contraceptive Use. American Journal of Obstetrics and Gynaecology 1994; 170(1): 1485-88.
Nothnagle M, Sicilia J, Forman S, Fish J, Ellert W, Gebhard R, et al. Required procedural training in family medicine residency: a consensus statement. Family Medicine-Kansas City 2008; 40(4):248.
Ravichandran, K., Al-Hamdan, N. A., & Mohamed, G. (2011). Knowledge, attitude, and behaviour among Saudis toward cancer preventive practice. Journal of Family and Community Medicine, 18(3):35.
Henshaw S, Van Vort J. Abortion Services in the United States, 1991 and 1992. Family Planning Perspectives 1994; 26(1):100-6.
Simoens S, Scott A, Sibbald B. Job satisfaction, work-related stress and intentions to quit of Scottish GPs. Scott Med J 2002; 47(4):80-6.
Smith S, Dollase R, Boss J. Assessing Students’ Performances in a Competency‐based Curriculum. Academic Medicine 2003; 78(1):97-107.
Spurgeon P, Barwell F, Maxwell R. Types of work stress and implications for the role of general practitioners. Health Serv Manage Res 1995; 8(3):186-97.
Sturm R. Effect of managed care and financing on practice constraints and career satisfaction in primary care. The Journal of the American Board of Family Practice, 2002; 15(5):367-77.
Tenore J, Sharp L, Lipsky M. A national survey of procedural skill requirements in family practice residency programmes. Family Medicine-Kansas City 2002; 33(1):28-38.
Walsh W. The Use of Imagination, Educational Thought and the Literary Mind. London: Chatto and Windus; 1959.
Wetmore S, Rivet C, Tepper J, Tatemichi S, Donoff M, Rainsberry P. Defining core procedure skills for Canadian family medicine training. Canadian Family Physician 2005; 51(10):1364-5.
White B. Are the Edges of Family Practice Being Worn Away? Family Practice Management 2000; 7(2):35.
Bradner M, Crossman S, Vanderbilt A, Gary J, Munson P. Career advising in family medicine: a theoretical framework for structuring the medical student/faculty advisor interview. Medical Education Online 2013; 18(1):1-7.
Eubank D, Dominic O, John R. Teaching adaptive leadership to family medicine residents: What? Why? How. Families, Systems, & Health 2012; 30(3):241-52.
Rakel D, Rakel R. Textbook of Family Medicine. Philadelphia: Saunders; 2011.