L'adquisició de les competències professionals en l'especialitat de medicina de família i comunitària a Catalunya. Una aportació des de la formació

Abstract

This thesis is a study of postgraduate medical training and the acquisition of professional competences in this process. This formative model is of pedagogic interest because it fits perfectly well with present training models since it combines education and work. Two great objectives are proposed. Firstly, the objective is to analyse and contrast tutors' and residents' perceptions on the acquisition of professional competences in the postgraduate training process within Family and Community Medicine; secondly, the information obtained will provide clues to suggest proposals for the improvement of acquisition of competences. Research is designed taking as starting point the hypothesis that there are differences between tutors and residents in their perceptions on the acquisition of competences. It is a descriptive study that combines quantitative and qualitative information.Firstly, work is carried out with the help of questionnaires to obtain a first opinion from all tutors and trainees in 3rd year in Catalonia, followed later on by focus groups in order to be able to deepen our understanding and to interpret the data obtained quantitatively. This process is carried out in a parallel way with tutors and residents. The questionnaire consists of two parts. First, it has a scale of 42 competencies, grouped in 10 competency areas (clinical expertise, instrumental abilities and handling abilities, communication, consideration for the family, regard for the community, preventive activity, teaching, management aspects and research) in which tutors and residents have to evaluate the degree of capacitation of the latter ones. The second part consists of other questions regarding postgraduate training in relation to this acquisition of competencies. Among the data obtained statistically, with the prior understanding that qualitative data cannot always be subscribed, we must emphasize that tutors' perceptions on the degree of capacitation in each area are either very similar to or above those of the residents, and generally quite positive except with regards to regard for the community, which is clearly "failed", and to teaching and research skills where residents are close to achieving a "pass". The most valued competency areas are clinical expertise, handling abilities, communications and preventive activity, with the other competency areas maintaining a more intermediate position. With regards to the formative model (methodological strategies, formative evaluation...), tutors' perception is also more positive than the residents' one. To conclude, of all the results obtained globally and from their discussion, some contributions are extracted: - The foundation of the formation continues to be individual attendance. - Competency areas linked to a more global medicine (family and community) are less consolidated. - Difficulties are still observed for practicing a medicine centred on the person. - Research remains a weak point. - There is sensitivity for communication and teamwork. - Competencies really consolidate themselves where they are put into practice. Context plays a crucial role. - Tutorials, self-learning and modelling constitute the basic methodological axis. - There is little evaluative culture. - The pressure on the social security system and the lack of time interrupt the formative process. The following are some of the proposals suggested to improve the postgraduate medical training: - Improve the quality of teaching: formation, teaching space, recognition, accreditation criteria with various tools. - Improve Continuous Active Tutorials: focus them on the resident and increase their frequency for R1 and R2. - Rotate between various primary health care tutors. - Enhance cooperative learning. - Develop continuous evaluation mechanisms with simple tools that are easy to handle. - Enhance those areas which give primary health care a differentiating character (family, community, preventive...). - Seek consensus in border action areas.

Date of Award	4 Apr 2003
Original language	Undefined/Unknown
Supervisor	Esteban Pont Barceló (Director)