Preparing medical graduates for general practice

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Working as GPs in a rural area of Greece with young doctors just qualified from medical school, we face many challenges every day in handling our patients' health needs effectively.

We realize that it is common for young doctors to face difficulties in medical problem-solving and decision-making processes. They are not familiar enough with odds and likelihood ratios and can find it hard to accept and handle medical uncertainty - something common in general practice settings. Additional difficulties present in the consultation process because the young doctors have to communicate with different kinds of patients, and often fail to establish an effective doctor-patient relationship. We believe that all these issues can be attributed not only to their inexperience, but also to inappropriate training regarding those skills.

Furthermore, in our everyday work we have to treat mainly elderly patients, provide palliative care for terminal diseases, practice preventive medicine and offer health education. All of those areas require special attention and training, which is not found in many medical schools.

We recently participated in the 11th Conference of the European Society of General Practice in Kos, Greece, where we had the opportunity to exchange information about medical education with young colleges from other European countries. We believe that those problems are not uncommon even in countries with a long tradition in general practice.

We would like to make some proposals:

1. Emphasis must be given during basic medical training to areas such as:
   
   • The decision-making process. Medical students should learn how to collect data from a history and clinical examination, and how to interpret it correctly in order to request the appropriate laboratory tests, reach the diagnosis and form an effective management plan.
     
   • Communication skills and the doctor-patient relationship¹. Medical students could further develop these skills by using video-taped patient interviews and assess their own performance².
     
   • Evidence-based medicine2. Medical students must learn to use proven information as well as to prove their own ideas.
     
   • Use of the internet as a source of current medical information². Especially in remote areas, the internet can be the only means of quick, cheap and reliable information.


2. In addition, during GP training schemes:
   
   • More time should be spent in rural settings and less in hospitals.
     
   • Epidemiological and community orientated studies should be included.
     
   • Care of the elderly, palliative care, health promotion and prevention activities must form an important part of the training.

Sofia Panagiotidou
Medical school,
University of Ioannina, Greece
Ioannis Tsialios
Medical school
Aristotle University of Thessaloniki, Greece

References

1. Liangas G, Lionis C. General Practice in Greece: A student's and supervisor's perspective, Australian Journal of Rural Health 2004; 12: 112-114.

2. Halaas GW. The rural physician associate program: new directions in education for competency. Rural and Remote Health 5: 359. (Online), 2005. Available from: http://rrh.org.au (Accessed 19 December 2005).