Undergraduate and continuing medical education and the primary health care physician
The United Arab Emirates does not currently possess an adequate number of well trained Family Practitioners and only a small proportion of the medical work force are employed in Primary Care. Continuing medical education is important in Family Medicine and, to date, there has been no study in this subject carried out in the United Arab Emirates. It was decided to evaluate and assess the current situation within Family Medicine and the amount of continuing medical education received by medical practitioners in Abu-Dhabi. Accordingly, 3 studies were carried out to provide this information. Initially, a perspective, descriptive study was carried out, involving all Primary Care Practitioners. There was an 80% response, yielding 86 completed questionnaires. The study revealed a perceived low prestige for Family Medicine among Family Practitioners, over half of whom (58%), felt that they did not have the confidence of the public. Only 3% of Family Practitioners were Emirati Nationals. 23% had received training in Family Medicine but only 3% had formal qualifications. It is unlikely that the Government will spend large sums of money on the training of expatriate doctors through a residency programme but there should be a practical alternative. There is a clear need to increase the numbers of Emirati National doctors. It was seen as important to determine how medical students and Interns graduating from the United Arab Emirates University, made their career choices. A second, cross-sectional, descriptive study, was set up. A questionnaire was administered to all final year students in the Faculty of Medicine and Interns in the University hospital. There was an 80% return yielding 48 questionnaire for analysis. The leading reason for selecting a speciality was personal interest 85% and half of the respondents were of the opinion that there was no organised career structure in Family Medicine in the United Arab Emirates. 52% did not wish to enter Family Medicine although 85% appreciated the importance of this speciality. There was also a general feeling that Family Medicine was poorly organised within the Emirates (90%). Continuing medical education is a systematic attempt to facilitate change in doctors' practice. Differences observed over time in patients' health and in doctors' performance and their knowledge and skills, are the types of change that have been the focus of research in continuing medical education. Medical education is successful when it results in improved outcomes for patients, but there may not be much connection between traditional didactic instruction and improvement in clinical practice. Evidence suggests that continuing medical education activities that are learner focused, take place in small groups and adhere to the principles of adult learning, are beneficial to practising physicians and their patients. It was decided to carry out a study designed to ensure the effect of a practiced based, small group, continuing medical education programme on the knowledge and clinical practice of primary health care doctors in the management of hypertension. A randomised, controlled trial was carried out in four Primary Health Care Centres in Abu-Dhabi, two of which were designated as the intervention centres and the other two, the control centres. The first part of the study was the establishment of the intervention, which was a small-group, practice-based, continuing medical education programme (6 hours) in the care of hypertensive patients, relevant to primary care practice. The second part was a study of the effectiveness of the programme, obtained by an evaluation of knowledge and practice, three months before and three months after the intervention. There was no change in the knowledge of care of hypertensive patients between the control and intervention groups but there was evidence that the continuing education programme had changed some aspects of the clinical practice and the performance of primary health care doctors, in the management of hypertension. The results suggested that this form of medical education could be effective.