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  • Healthcare issues across the globe: Part I

    By Aliye Runyan, MD
    AMSA Education and Research Fellow

    I recently attended the America's medical education meeting and IFMSA general assembly. There was very interesting and often passionate discussion on the importance of primary care, and how it is practiced in various countries in the Americas. There is consensus that quality of care is important, and that culturally sensitive standards for quality of medical care must be developed. Most agree than universal curricula are not the answer. The point was made that primary care is a critical part of comprehensive health care services, and not an end in itself – there is obvious need for specialists in many cases. The point was made that primary care must be incentivized, respected, and treated with the same standards as any other specialty, as well as taught (and experienced by students) from the first year of medical school. Using evidence based medicine was brought up multiple times – as this may not be the cultural norm.

    Some of the faculty brought up criticisms of the Alma Ata declaration of 1978 (the first international declaration to underline the importance of primary care for all) by stating that it prompted some countries to focus on only the most basic health care needs ( in the name of “primary care”) while not pushing resources to develop comprehensive health care services.

    Out of this conversation came the overwhelming sentiment of the need to “teach learners how to learn” – meaning to train physicians to adapt to our changing health care world by teaching them how to problem solve, navigate issues other than just strict science, to understand their accountability to the society at large, and to respond to the needs of society.

    Competency based medical education

    This was a wonderful segue into the discussion around competency based education, which is becoming the norm in the US and Canada. The themes behind competency based education include greater accountability, training relevant to society, supporting students learning at their own pace, and adjusting for “new competencies” such as teamwork, patient safety, humanitarian needs, and social justice. There is more focus on evaluation and outcomes of learning. One speaker presented a continuum from societal health needs à competencies à curriculum à evaluations, to highlight how competencies might determine curriculum, which is then evaluated for constant improvement. Assessment methods, such as 360 feedback, where an individual is evaluated by peers, supervisors, and colleagues on the health care team, come into play as the value of subjective judgment and observation is considered. The higher number and more diverse the observations, with open ended questions like “would you send a family member to see this doctor?” provide a larger picture of a physician’s abilities than a multiple choice test or standardized exam. They also take into account humanistic qualities and professionalism.

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  • Primary Care is....

    ....the underdog. Is undervalued. Is misunderstood. Is antiquated. Is dysfunctional. Needs a makeover. Could use a LOUD cheerleading section.

    PRIMARY CARE…
    Is brimming with hope. Is timeless. Makes communities healthier. Is team-based care. Is the future of health care. Is THE place for higher quality care and lower spending.

    Today we start celebrating National Primary Care Week. Let's give primary care a voice - your voice!

    1. Print the “Primary Care…” signboard. Write what primary care means to you on any sheet of paper.
    2. Write out your message. Need inspiration? Click here
    3. Have someone take your picture, aiming for a head and shoulders shot but feel free to get creative. The important thing is that the message is clear and visible.
    4. Get it to us! Upload it using the upload bar on this page. Tweet it using the hashtag #voicesforpcare. Or email it to us at voices@primarycareprogress.org.

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  • Reflecting on National Primary Care Week

    Hi, my name is Angela Kuznia, I am a fourth year medical student and chair of AMSA’s National Primary Care Week (NPCW) 2011 planning committee. This is my second year serving in this position, and my fourth year celebrating NPCW. I wanted to take this opportunity to reflect on my NPCW experiences and my own path towards a career in primary care.

    NPCW 2008: I was a first year medical student and new AMSA member at the Michigan State University College of Human Medicine. I was knee-deep in textbooks, class notes, and flashcards, with highlighter stains on my hands (and sometimes my sheets), learning to survive my first semester of medical school. I attended several lunchtime NPCW events hosted by my school’s AMSA chapter and learned about opportunities for primary care physicians in the National Health Service Corps and various career paths in primary care. This was my first real introduction to AMSA as well, and it gave me a much needed big-picture perspective on medicine at a time when I was busy memorizing biochemical pathways and physiology equations.

    NPCW 2009: I had survived the academic rigors of my first year, and was soaking up as much knowledge as possible in my second year coursework. I had gotten more involved in AMSA by this time, and had become president of my school’s chapter. My executive board put together an impressive NPCW line-up, including collaborative events with the Pediatrics, Geriatrics, and Family Medicine interest groups. Most excitingly, we hosted a round-table discussion of potential health care policy changes featuring local family physicians and both Democratic and Republican state legislators who debated a number of issues. Over 100 people, including medical students, physicians, faculty, and members of the public, attended the evening event. The arguments were heated, and created a buzz of excitement that lasted for quite a while on our campus.

    NPCW 2010: I was in the midst of my intense third-year Internal Medicine rotation, and had spent much of the summer preparing for NPCW 2010. I still had no idea what specialty I was interested in. I was unable to participate in any NPCW events at my local AMSA chapter due to my grueling clinical schedule, but was active in an administrative role in a number of rewarding ways. My planning team dreamed up an exciting theme, recruited over a dozen partner organizations, created an in-depth programming menu, awarded 22 AMSA chapters with grants, and presented a poster at the AMSA National Convention based on data collected during NPCW. I was exhausted at the end of it all, but was also proud of what I had accomplished and the AMSA membership’s appreciation for all things NPCW.

    NPCW 2011: I finally decided on a specialty (surprise….Family Medicine!) and have been coordinating NPCW while completing my residency applications and scheduling interviews. We established an awesome partnership with the organization Primary Care Progress (PCP) this year, decided on the theme “Innovations in Primary Care”, and received a record number of NPCW grant applications. It seems like things came together a lot more easily this year…maybe because I’ve been busy and unable to worry as much (probably true), maybe because I’ve actually learned how to be a good leader (hopefully true), and maybe because of the excellent AMSA-PCP folks I’ve been lucky enough to have on my team (definitely true). I hope that this year’s NPCW is the greatest success yet, and that we are able to continue expanding and improving NPCW in years to come.

    What have been your experiences with NPCW? Maybe it’s your first time celebrating, or maybe you were inspired to pursue a career because of something you learned during an NPCW long ago. Whoever and wherever you are, I’d like to wish you a happy National Primary Care Week on behalf of this year's planning team! Thanks for sharing it with us!

    --Angela

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