Family Medicine development in the republic of Moldova – trends in European Education of Family Physicians
Natalia Zarbailov, MPH, PhD, Associate Professor, Family Medicine Department, State University of Medicine and Pharmacy”Nicolae Testemitanu”, EURACT Council member, Republic of Moldova
Francesco Carelli, MD, MSc, Professor of Clinical Medicine and Elective Courses Family Medicine, University in Milan and in Roma, EURACT Director of Communications, Italy
As new medical specialty, the Family Medicine was created in Moldova in the middle of ’90s last century, as a necessity of restructuring the health system and connecting it to the provisions of the World Health Organisation Declaration of Alma-Ata in 1978.
In various countries of Central and Eastern Europe, the implementation and the development of family medicine have been evolved in not uniform rate, based on the principles that have made the health systems to require family medicine as a priority direction of change. The characteristics that make family medicine the best medical specialty for primary care are: easy access to health services, prime contact, gatekeeper function, coordination of care, continuity of care and rational use of available resources.
As in other countries, in Moldova, the family medicine as an emerging specialty in the health system, has undergone medical society traditional beliefs. Like that, family medicine is different from other disciplines and the demonstration of this difference requires a discipline complexity description.
It is important to establish boundaries around this discipline as defined in the European Definition, so that family physicians should not be taking place of narrow specialists. As a result, this situation often led to a confrontation between them, to resistance by the specialists and to the need of defense of the family doctors in front of the medical society. It is vitally necessary that the medical society understands that Family Medicine is one of many medical disciplines and can not be placed in an inferior position. The Family Medicine must benefit from equal rights of education, research findings, publication, participation and political decisions. To explain tasks of family doctors and their role in the health system is important, but much more important is an accessible and clear understanding for the whole population what family medicine is, this usually is not promoted enough.
To strengthen the collaboration with other medical specialties it is important not only to define the disciplines, but to collaborate for the benefit of patients and population as a whole. The exchange of experience must be bidirectional, including the direction from family physicians to “narrow” specialists, the family medicine having a significant impact on maintaining the general health. The population is the most powerful supporter for family doctors and this should not be ever forgotten.
The primary care reform and the transition to work after the principle of family medicine took place in Moldova in several stages since 1993. We find that after a period of almost 20 years, family medicine has been implemented and installed as an academic and practical specialty, becoming a reality of primary care system in Moldova. The inauguration and the development of a new medical field was not a simple one: it has led to the changing of the legislation granting medical services. Along with the introduction of compulsory medical insurance, the role of family medicine has been well established and the functions of family doctors have been clearly defined.
To ensure a continuous professional education for family physicians, a professional curriculum and an educational standard of the specialty were developed. The training of medical staff started with the primary specialization of doctors who had already been working in primary care setting. As a result, many internal medicine physicians and pediatricians in outpatient units have become family doctors. Later on, the three years residency training has been introduced as vocational training for graduates. And finally, since 2007 the university training for VI year medical students was elaborated and introduced in the medical curricula.
Since 2007, Moldova joined EURACT, the educational branch and organized network of WONCA Europe, which aims to promote teaching and learning in General Practice / Family Medicine at the highest level. From that moment, Moldova received structured support at all levels of education, offered by EURACT for organizations and individuals. By the time of the elaboration, the university training program for students from the State Medical University in Moldova was adjusted to the specialized Educational Agenda developed by the European Academy of Teachers in General Practice / Family Medicine (EURACT) in 2005. The current rotation in Family Medicine is provided for V year students, and it also assumes the clinical exposure of students to clinical activities, by the participation in a 6 weeks clinical stage.
In such a manner, the European trends in education of family physicians, took into account by Moldova academicians, and EURACT recommendations based on research and other European countries experiences, has been applied in medical education.
The university curriculum for family medicine education in Moldova contains 12 from 15 recommended topics, listed as Minimal Core Curriculum for Family Medicine (European Journal of General Practice, 2011; 17: 217–220).
The main challenges for Moldova’s Medical education and Family Medicine practice is to continue to follow the European trends and to become a WONCA member. The postgraduate vocational training adjustment, the medical licence standards development are the main objectives for family medicine academicians. The criteria for accreditation of family medicine clinics and the analysis of quality for medical care rendered by family physicians according to the standards and clinical protocols, are the priority fields to be developed, for what Moldova needs methodological support from professional European networks.