NATIONAL CONFERENCE ON MEDICAL EDUCATION | Year:2005 | دوره:7 |Papers Count:3

THE HEALTH CARE SYSTEM AND DEPENDING TO THIS THE PRIMARY CARE PROVISION IS IN TRANSITION. THE HEALTH CARE NEEDS OF TURKISH SOCIETY HAD CHANGED, THE POPULATION HAS INCREASED, SHORTCOMINGS OF HEALTH CARE CENTERS IN URBAN AREAS HAVE INCREASED. RURAL RECRUITMENT AND RETENTION OF HEALTH PROFESSIONALS IS A CONSTANT PROBLEM. SOCIALIZATION OF HEALTH SERVICES HAD UNFORTUNATELY NOT BEEN PROVEN TO BE EFFECTIVE TO OVERCOME HEALTH PROBLEMS IN TURKEY. ACCESSION OF TURKEY TO EUROPE HAS BROUGHT NEW CHALLENGES TO THE HEALTH SYSTEM. NEW REGULATIONS AND DIRECTIVES OF THE EUROPEAN UNION ARE FORCING NOW FOR CHANGES.FAMILY MEDICINE IN TURKEY HAS BEEN FOUNDED IN THE EIGHTIES TO IMPROVE AND SUPPORT THE FORMER EXISTING PRIMARY HEALTH CARE SYSTEM, WHICH HAS BEEN SUPPORTED BY THE MINISTRY OF HEALTH OF TURKEY. AFTER NEARLY TWENTY YEARS OF FAMILY MEDICINE EDUCATION IN TURKEY, 1200 SPECIALISTS IN FAMILY MEDICINE HAVE GRADUATED FROM THESE PROGRAMS. DESPITE THESE EFFORTS MOST OF THE DOCTORS WORKING IN PRIMARY CARE DO NOT HAVE ANY SPECIAL EDUCATION IN PRIMARY CARE (FAMILY MEDICINE). NEW SOLUTIONS HAVE BEEN DEVELOPED TO ENHANCE THE NUMBER OF FAMILY PHYSICIANS AND TO CREATE BETTER WORKING CONDITIONS WITH BETTER SALARIES. A TRANSITIONAL TRAINING PROJECT FOR MEDICAL PRACTITIONERS IN PRIMARY CARE HAS BEEN DEVELOPED BY TURKISH FAMILY PHYSICIANS (TAHUD) IN COLLABORATION WITH THE MINISTRY OF HEALTH. FIRST PILOT TRAINING ACTIVITIES HAVE BEEN PROVEN TO BE PROMISING. NEW POSTGRADUATE TRAINING SCHEMES WILL INCREASE THE NUMBER OF FAMILY PHYSICIANS IN TURKEY AND THE QUALITY OF PRIMARY HEALTH CARE SERVICES.

TURKIYE ACCORDING TO THE ”SOCIALIZATION OF HEALTH SERVICES” LAW, HEALTH CARE HAS BEEN EXPECTED TO BE PROVIDED BY THREE DIFFERENT LEVELS OF CARE. THE MEDICAL PRACTITIONER IN PRIMARY CARE WAS EXPECTED TO SOLVE MOST PROBLEMS IN PRIMARY CARE AND TO RELIEF THE SECONDARY HEALTH CARE SERVICES. THIS HAS NOT BEEN PROVEN TO BE REAL NOWADAYS. PRIMARY CARE PHYSICIANS LACK TOOLS AND INSTRUMENTS TO PERFORM HIGH QUALITY HEALTH CARE IN THEIR COMMUNITIES. ADEQUATE PROVISION OF CPD AND MENTAL/PROFESSIONAL SUPPORT IS ALSO MISSING. RECRUITMENT OF NEW GRADUATES TO PRIMARY CARE SERVICES IS ANOTHER OBSTACLE AND PRIMARY CARE SERVICES ARE MOSTLY SEEN AS A SECOND CHOICE CLERKSHIPS IN FAMILY MEDICINE IN UNDERGRADUATE MEDICAL TRAINING PROGRAMS MAY HELP MEDICAL FACULTIES TO REACH THEIR EDUCATIONAL OBJECTIVES CONCERNING THIS. BESIDES SOME SHORT INTRODUCTORY LECTURES THE USE OF PRACTICAL SESSIONS, PROBLEM BASED LEARNING SESSIONS ARE WIDELY APPLIED TO ENHANCE THE LEARNING PROCESS IN STUDENTS. THE EDUCATIONAL AGENDA OF EURACT PROVIDES A GOOD FRAME FOR THESE PROGRAMS CHALLENGES TO OBTAIN SPACE AND SLOTS IN UNDERGRADUATE CURRICULA IS THE MAIN OBSTACLE OF SUCH NEW AND INNOVATIVE TRAINING PROGRAMS. PROVIDING EVIDENCE OF GOOD OUTCOMES IS ANOTHER PROBLEM BECAUSE OF LACK OF EXPERIENCE IN TURKISH CONTEXT, EVEN THE NORTHERN EUROPEAN AND AMERICAN POSITIVE EXPERIENCE OF THE LAST DECADES.

CLINICAL EDUCATORS FACE MANY CHALLENGES IN THE WORLD OF PRACTICE. PERSISTING SOURCES OF CLINICAL ERROR – COGNITIVE, PERCEPTUAL, MANUAL, PROCEDURAL, ETHICAL, INTERPERSONAL AND INTRAPERSONAL – ARE NOTICED, BUT MAY REMAIN UNCORRECTED AND THEIR EXPLANATIONS UNSTUDIED! MISTAKES ARE SO COMMON THAT THEY SEEM ALMOST ‘NORMAL’ EVERYDAY BEHAVIORS, BUT THEY CAN HAVE DANGEROUS CONSEQUENCES. FEW CLINICAL TEACHERS ARE TAUGHT HOW TO BE EFFECTIVE MENTORS AND SUPPORTIVE FRIENDS WHO LISTEN TO TRAINEES ON A REGULAR BASIS, AND GUIDE THEM THROUGH THEIR UNCERTAINTIES AND DILEMMAS, AND CORRECT THEIR PERFORMANCE ERRORS. CLINICAL EDUCATION ALSO FACES SOME EXCITING CONCEPTUAL CHANGES! PRACTICE IS SCIENTIFICALLY INFORMED, BUT IS SEEN BOTH AS MUCH MORE COMPLEX THAN BIOSCIENCE, AND SIMULTANEOUSLY MANAGED BY HUMAN COMMONSENSE. CLINICIANS MUST UNDERSTAND THAT UNIFACTORIAL, CONTEXT-FREE SCIENTIFIC METHOD CANNOT HANDLE COMPLEXITY! CLINICIANS FACE IRREDUCIBLE UNCERTAINTY ABOUT EXACTLY WHAT’S WRONG IN EACH PATIENT. CONFIRMATION ATTEMPTS SUCCESSIVE APPROXIMATIONS TO DIAGNOSTIC ACCURACY (OR GUESSING). “WHAT’S ENOUGH?” EVIDENCE HAS NO ‘TRUE’ ANSWER! TRADE-OFFS, JUDGMENT AND DECISION-MAKING ARE NOT SCIENTIFIC PROCESSES. DECISION MAKING BALANCES PREDICTIONS OF OUTCOMES AGAINST THE PATIENT’S HOPES AND PERSONAL CIRCUMSTANCES, AND THE HEALTH SYSTEM’S RESOURCES. EVIDENCE-BASED MEDICINE CAN FINE-TUNE THE PROBABILITIES, BUT “WHAT’S IMPORTANT?” OVER-RIDES THE NUMBERS. NEW RESEARCH IN MANY FIELDS IS EXPOSING MECHANISMS RELEVANT TO CLINICAL PRACTICE –PATTERN RECOGNITION, INTUITION, EMPATHY, NON-PROPORTIONAL EMOTIONS, WORKING INTELLIGENCE, INFORMATION OVERLOAD, GUT FEELINGS, FUZZY LOGIC, GENE-ENVIRONMENT INTERACTIONS AND SO ON - BUT ARE CURRENTLY LITTLE NOTICED BY CLINICIANS. AN SIMPLE PARADIGM EXPLAINS HOW YOUR PERCEPTUAL, EXPERIENCING MIND, PLUS YOUR ADD-ON VERBAL, LOGICAL AND NUMERICAL EXPLAINING MIND, AND YOUR EXECUTIVE WORKING MEMORY MIND MANAGE PRACTICE FROM CASE PRESENTATION TO ACTION. THESE MINDS INTEGRATE CLINICAL PERFORMANCE, BUT ARE LIMITED AND FLAWED THEMSELVES. PRACTICE MUST NOW BE UNDERSTOOD, STUDIED AND TAUGHT AS A RIGOROUS GROWING DISCIPLINE WITHIN A NEW BROAD SCHOLARSHIP OF HUMAN PRACTICAL THINKING AND ACTION. THE CLINICAL TASK INCLUDES PERSON/PATIENT MANAGEMENT, DISEASE MANAGEMENT, HEALTH SYSTEM MANAGEMENT AND SELF-MANAGEMENT. MANAGEMENT RESEARCH APPLIES PRACTICAL SCIENCE TO THE JUDGMENTAL AND BEHAVIORAL ERRORS WITHIN THESE MANAGEMENT TASKS! CLINICAL EDUCATORS MUST FOSTER INDIVIDUAL SELF-AWARE PRACTICE. “NOTHING IS SO PRACTICAL AS A GOOD THEORY!”