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SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE IN BRUNEI DARUSSALAM

SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE IN BRUNEI DARUSSALAM. Brunei Darussalam Background Primary Health Care System & background Outpatient Services Basic Specialty Training (Family Medicine) Career Progression Advanced Specialist Training (Family Medicine)

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SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE IN BRUNEI DARUSSALAM

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  1. SPECIALTY TRAINING AND CAREER STRUCTURE FOR FAMILY MEDICINE IN BRUNEI DARUSSALAM

  2. Brunei Darussalam Background Primary Health Care System & background Outpatient Services Basic Specialty Training (Family Medicine) Career Progression Advanced Specialist Training (Family Medicine) Challenges OUTLINE

  3. Population 390,000 Young population – 39.2% below 19 years Malay 66.6% 4 districts – Brunei Muara District (69.3% of population) Life expectancy 77.8 yrs female & 75.2 yrs male Infant mortality rate 7.6 per 1000 live births BRUNEI DARUSSALAM

  4. PRIMARY CARE SERVICES IN LINE WITH MINISTRY OF HEALTH NATIONAL HEALTH CARE PLAN (2000-2010) TO PROMOTE PRIMARY HEALTH CARE Decentralisation NOW BEFORE RIPAS Hospital Brunei/Muara – 7 H/Cs (June 2000- March 2001) Belait - 3 H/Cs (Oct 2002) Tutong - 4 H/Cs (Oct 2002) Postgraduate Training

  5. Health centres (14) and clinics (13) providing outpatient services and maternal and child health services Travelling health clinics (13) Flying medical services (4) School health services PRIMARY HEALTH CARE SYSTEM

  6. Mukim Serasa Mukim Mentiri Mukim Berakas Mukim Gadong Mukim Kota Batu Mukim Sengkurong Mukim Kilanas Mukim Lumapas Mukim Pengkalan Batu

  7. 1 private hospital – Jerudong Park MC Ministry of Defence – 5 medical centres Brunei Shell Petroleum – Panaga Health Centre Private GP clinics – 21 OTHER PHC PROVIDER

  8. First point of contact for patients Gate-keeper to secondary care (referral rate 1-5% & admission rate <1%) Comprehensive & holistic care Minor illnesses & chronic cases OUTPATIENT SERVICES

  9. SERVICES IN HEALTH CENTRES MEDICAL RECORD TRIAGE LABORATORY RESULTS OPD DOCTOR CONSULTATION

  10. SERVICES IN HEALTH CENTRES TREATMENT ROOM PHLEBOTOMY DISPENSARY RADIOLOGY

  11. SERVICES IN HEALTH CENTRES MCH DENTAL DIETICIAN COMMUNITY PSYCHIATRY

  12. Extended hours services (out of hours) DOTS for tuberculosis treatment Smoking cessation clinic Well women clinic Weight management clinic Ophthalmology clinic OTHER SERVICES

  13. Vocational training rotations Masters in Primary Health Care (Feb 2004) – previously Postgraduate Diploma in Primary Health Care (Feb 2000) MRCGP [International] (Nov 2005) FAMILY MEDICINE TRAINING

  14. Rotations organised by Division of Outpatient Services 2 years hospital rotations and 1 year GP placement Previous clinical experience can be accredited prior to joining the program VOCATIONAL ROTATIONS

  15. Components of hospital training 6 months - internal medicine, paediatrics and obstetrics & gynaecology (3 months of community MCH for male doctors) 3 months – psychiatry and accident and emergency 3 months - surgery / dermatology / ENT (optional clinical placement) VOCATIONAL ROTATIONS

  16. Postgraduate Diploma in Primary Health Care - February 2000 3 years part time academic modular programme & vocational training 2 cohorts – 23 doctors graduated Awarded by St George’s Hospital Medical School, London, United Kingdom PRIMARY CARE TRAINING

  17. Nov 2003 – RCGP examiners attended the 2nd cohort PGDipPHC exams PGDipPHC accredited as MRCGP[INT] 1st cohort awarded MRCGP[INT] by Accreditation by Prior Experiential Learning (APEL) PRIMARY CARE TRAINING

  18. Masters in Primary Health Care – Feb 2004 15 modules in 3 years Awarded by Universiti Brunei Darussalam Gradual handover to local tutors from St George’s Hospital Medical School, London 4 cohorts of doctors undergoing training – maximum of 8 per cohort MASTERS IN PRIMARY HEALTH CARE

  19. MASTERS IN PRIMARY HEALTH CARE

  20. MASTERS IN PRIMARY HEALTH CARE YR 1 YR 2 YR 3 MSc 9 X 3000 WORDS ESSAYS TAUGHT MSc (6 drs) 3 X 3000 WORDS ESSAY 1 x 20000 WORDS THESIS RESEARCH – BASED MSc (2 drs)

  21. Brunei Darussalam accredited as centre for MRCGP [International] examinations 2nd site to Oman - November 2005 Exam based qualification – open to local and overseas doctors 2 components a) OSCE (12 stations) b) MCP (Multiple Choice Paper) MRCGP [INTERNATIONAL]

  22. After completion of their GP training – some general practitioners have been given expanded roles such as in MCH services, school health services, HPEU, district health officer, KBS, KBM, TB, academic/medical education, e-health and administration WHAT NEXT AFTER BST?

  23. CAREER PROGRESSION

  24. New concept and development for family medicine specialty Progression and expanded role of general practitioners GP with special interest/subspecialty Improve quality of care given to patients To provide equivalent quality specialist care in primary care setting ADVANCED SPECIALIST TRAINING

  25. Increase accessibility of specialist care to the community Recognition of general practitioners as a specialist care provider Wider scope of recognition as an area of specialty In line with proposed new scheme of service ADVANCED SPECIALIST TRAINING

  26. Increase workload of general practitioners for chronic care management Reduce referral to hospital Reduce workload and waiting time of hospital specialists Able to prescribe certain restricted specialist drugs ADVANCED SPECIALIST TRAINING

  27. Identified priority areas Clinical areas Non clinical areas Medical education Public health Ethics and medical law Healthcare quality Health promotion and education E-health / Health informatics Research Health management & planning ADVANCED SPECIALIST TRAINING

  28. Diabetes Minor surgery Endocrinology Dermatology Gastroenterology Rehabilitation Elderly health Palliative medicine Sports medicine Adolescent health Cardiology Men’s health Women’s health Child health Mental health Infectious disease e.g. tuberculosis Respiratory disease STI Rheumatology ADVANCED SPECIALIST TRAINING

  29. 3 years (2 years + 1 year elective) Collaboration with RCGP for clinical placements and fellowship portfolio assessments – MOU signed May 2009 Postgraduate Dip/MSc (GP with special interest) + Clinical placement +/- FRCGP Starting September 2009 ADVANCED SPECIALIST TRAINING

  30. New recruitment for GPs– emphasis on training and postgraduate qualifications All local Bruneian doctors wishing to pursue career in GP have to go through mandatory vocational training rotations and MSc PHC CURRENT SITUATION

  31. MRCGP [International] is a required qualification to enter Advanced Specialist Training program (in collaboration with RCGP) 38% (30 out of 78) have vocational training / postgraduate qualifications in family medicine CURRENT SITUATION

  32. Continuing battle for family medicine to be recognized as a specialty Increasing demand and expectation from patients and colleagues Recruitment and retaining problems for trained family medicine doctors CHALLENGES

  33. THANK YOU

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