Abstract:
Preamble: The ongoing professional development of India’s lean cadre of 250,000 General Practitioners and 30,000 Government doctors is constrained by limited options to update themselves. This negatively impacts on the ability of the country to create a critical mass of Family Physicians (FPs) who can clinically lead quality primary health care. Since 2006 the Christian Medical College (CMC) Vellore has run a 2-year blended learning Post Graduate Diploma in Family Medicine (PGDFM). In 2012 this offering was extended to the Medical University, Tamil Nadu, as a Master in Medicine in Family Medicine (M.MED FM). Between 2006 and 2016 they trained around 3000 private practitioners and 250 government doctors in Family Medicine.
The Study: Globally, graduate follow-up surveys explore the contribution of qualifications to professional life and inform curricular modification to support intended educational and practice outcomes. Notwithstanding extensive anecdotal information and a 2013 demographic survey of PGDFM & M.MED FM students, this is the first study to systematically assess FP graduate distribution, wellbeing, experiences of practice, their roles in the national health system and their professional development needs. A purposively designed, cross-sectional survey of all PGDFM & M.MED FM graduates who qualified between 2008 and 2018 was undertaken between March and July 2022. Data were descriptively analysed and the results constitute the substance of this dissertation.
Study findings: Of a population of 1213 FP graduates, 48% (n=581) responded to the study and 36% (438) completed the questionnaire. Most FPs were urban based, were relatively poorly paid, with female FPs earning significantly less than their male counterparts. FPs were largely hospital based and served mostly adult patients. They were under resourced, lacked technological support and most worked with an inadequate toolkit. Though well trained in consultation skills and the principles of FM, in practice their consultations were compromised by extreme time constraints and care continuity was hampered by an inadequate, patient held paper-based record system, poor back-referrals, and the impediments to relationship continuity characteristic of hospital settings. FPs did not engage adequately with polypharmacy. Most FPs engaged regularly in continuous professional development activities, but involvement in teaching, research and publication was confined to the few those who participated in faculty development programmes. High uptake of places and gender parity in enrolment suggests that the blended learning model made the qualification accessible to working doctors, especially women. The majority of FPs rated the influence of the PGDFM/M.MEDFM highly on their practice. They also identified important gaps, especially in respect of procedural skills and team management as learning areas that reflected common conditions seen in their work contexts.
Conclusion: The curriculum is inadequately synchronised with the reality of practice. This challenge is not unique to India and has implications for the meaning of Family Medicine as a discipline. It is important to understand what is central to the practice of a Family Physician and then to focus on developing the competencies needed to render these skills.
