Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

10.08.2013 Views

36 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 CHOICE TO BECOME A DOCTOR : STUDENTS CHARACTERISTICS, ENVIRONMENT AND EXPECTATIONS OF THE TRAINING AND WORK The student’s profile (interests, own medical experiences, academic strengths) and environment (family, school teachers, own GP) influence the choice to study medicine. The perception about the medical curriculum and about the actual work of a doctor (science, interesting topics, and useful profession) and the prestige of ‘becoming/being a doctor’ were mentioned. G12 « j’ai été dans le milieu médical parce que j’étais moi-même malade en étant enfant et donc, j’ai passé plus d’un an dans les hôpitaux et c’est un peu ça qui m’a attirée pour la médecine » GF3 «...dan ben ik met mijn huisarts gaan praten....en die zei geneeskunde is niet moeilijk maar het is wel hard werken, maar je kunt dat wel. ...En dat was eigenlijk doorslaggevend... » G6 « un besoin de reconnaissance. Ca devait être bien d’être à l’hôpital, de dire « je suis chirurgien » « ma famille, en disant « tiens, tu veux faire chirurgien, qu’est-ce que c’est bien, c’est grandiose » IMAGE OF GENERAL PRACTICE BEFORE STARTING MEDICAL SCHOOL Before starting medical school, most students (freshmen) had a limited idea (except for students with a parent who is a medical doctor) on what it means to work as a medical doctor in general or as a GP in particular. In the beginning of their education the image/perception that the respondents (GPs and specialists) have of a general practitioner, comprised: • work content: variety of tasks, relationships with patients, • working conditions: solo GP with high availability and who works hard, • professional identity: the GP has a central role, is a confident for the patients but some interviewees think that he has a lower prestige than other medical specialists and earns less. SF3 « …De huisarts heeft de centrale rol in de medische wereld.» G3 « on travaille seul » «je ne pensais pas que les médecins généralistes pouvaient travailler en groupe à cette époque-là » S1 « le seul point négatif, c’était vraiment le fait que quand j’allais la voir, c’était pour un certificat médical… » « je n’allais chez elle que quand j’étais malade …j’associais médecine générale à petits bobos » « Le généraliste, c’est celui qui fait les bobos » This general picture is based on contacts with their own GP, other GPs and the media (TV series, newspaper). The students who start with a specific specialty in mind, mostly think this specialty suits to them or they are attracted (a surgeon who saves lives, a hero). SF7 « Ik wou graag iets heelkundig gaan doen. Het was vooral het spannende dat me aantrok. Je beeldt u een dokter in en je wilt dat heel graag doen. Voor mij was opereren echt zo ingrijpend met iemand zijn leven bezig zijn. Dat is natuurlijk ook alles wat je ziet in programma’s zoals ER. » 3.5.2 Factors related to any specialty choice during medical education PERCEPTIONS ABOUT THE DIFFERENT SPECIALTIES The factors that influence many students’ decision process concern their perception of the characteristics related to the different specialties. They describe:

KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 37 • the work content and professional identity: variation of tasks, patient contact, technical aspects, intellectual challenge, level of professional autonomy, • the working conditions in both settings (hospital, primary care): work climate, possibility of working in a team, work-life balance SF13 «Inhoudelijk vond ik het (= huisartsgeneeskunde) nu ook niet heel bevredigend. Je werd met veel sociale problematiek geconfronteerd en uiteindelijk zag ik van serieuze pathologie maar 2 of 3 zaken» G3 « j’avais vraiment envie de travailler à l’hôpital parce que c’est là que j’avais vu mon père travailler et c’est ce milieu-là qui me plaisait » INFORMATION SOURCES: CURRICULUM, ROLE MODELS AND THE MEDIA The information students use to decide upon their specialty choice originates mainly from lessons during their medical training and experiences during their clerkships. The latter is the first real contact with the profession and therefore clerkships are seen to have an enormous impact on the decision process. Students see role models (teachers, supervisors of practice training) during education and clerkships, but also in their private life (GPs in the family) as one of the most important information sources and factors influencing their decision. Some students also describe the media as an information source. G6 « dès que j’y (general practice) ai mis le premier pied, la première minute, je me suis dit « c’est ça que je veux faire ». Donc, le stage a vraiment été déterminant pour moi. Et il n’y a eu que quinze jours et il m’a amplement suffi pour me convaincre. » SF7 «…de huisarts die ons gezin opvolgde…is dan gescheiden en had problemen met haar kinderen….door dat haar carrière zo zwaar doorwoog en haar privéleven daar onder leed. Ik denk dat dat een heel negatieve indruk op mij heeft nagelaten» GF2 «Moest er bijvoorbeeld een figuur gelijk die prof van heelkunde verschijnen in de huisartsengeneeskunde die ook zo een indruk geeft dan zou die mij waarschijnlijk overtuigd hebben ten opzichte van die van heelkunde…ik ben er zeker van dat ik niet de enige ben waar dat zo een invloed heeft. Want dat is het enige beeld waar we ons aan kunnen vastklampen eigenlijk om een keuze te maken hé. Oké, ik had mijn vader (die huisarts is) ook, maar voor de rest, wij weten niet wat dat inhoudt hé. » LACK OF A FIRM BASIS TO CHOOSE A SPECIALTY In general, students report that they lack a clear base to build their career choice upon. They miss information and active support in their decision process. Furthermore many interviewees mention the low amount of practice training that comes too late. Because of that, students get no (or get it too late) good picture of the real profession and they mention that their view based on the teaching courses often does not match the experiences during clerkships. On top of that, the process of choice seems to be very dependent on the particular services during the clerkship: the hospitals and the doctors (role models) working in these services largely influence the choice of the future physician. Students describe both positive and negative experiences in terms of: seeing interesting pathologies, performing instructive procedures by themselves, having enthusiastic and competent teachers and residents, being respected as a student-doctor and the overall atmosphere at the service/practice.

KCE Reports 90 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion 37<br />

• the work cont<strong>en</strong>t and professional id<strong>en</strong>tity: variation of tasks, pati<strong>en</strong>t<br />

contact, technical aspects, intellectual chall<strong>en</strong>ge, level of professional<br />

autonomy,<br />

• the working conditions in both settings (hospital, primary care): work<br />

climate, possibility of working in a team, work-life balance<br />

SF13 «Inhoudelijk vond ik het (= huisartsg<strong>en</strong>eeskunde) nu ook niet heel bevredig<strong>en</strong>d. Je<br />

werd met veel sociale problematiek geconfronteerd <strong>en</strong> uiteindelijk zag ik van serieuze<br />

pathologie maar 2 of 3 zak<strong>en</strong>»<br />

G3 « j’avais vraim<strong>en</strong>t <strong>en</strong>vie de travailler à l’hôpital parce que c’est là que j’avais vu mon<br />

père travailler et c’est ce milieu-là qui me plaisait »<br />

INFORMATION SOURCES: CURRICULUM, ROLE MODELS AND THE MEDIA<br />

The information stud<strong>en</strong>ts use to decide upon their specialty choice originates mainly<br />

from lessons during their medical training and experi<strong>en</strong>ces during their clerkships.<br />

The latter is the first real contact with the profession and therefore clerkships are se<strong>en</strong><br />

to have an <strong>en</strong>ormous impact on the decision process.<br />

Stud<strong>en</strong>ts see role models (teachers, supervisors of practice training) during education<br />

and clerkships, but also in their private life (GPs in the family) as one of the most<br />

important information sources and factors influ<strong>en</strong>cing their decision.<br />

Some stud<strong>en</strong>ts also describe the media as an information source.<br />

G6 « dès que j’y (g<strong>en</strong>eral practice) ai mis le premier pied, la première minute, je me suis<br />

dit « c’est ça que je veux faire ». Donc, le stage a vraim<strong>en</strong>t été déterminant pour moi. Et<br />

il n’y a eu que quinze jours et il m’a amplem<strong>en</strong>t suffi pour me convaincre. »<br />

SF7 «…de huisarts die ons gezin opvolgde…is dan gescheid<strong>en</strong> <strong>en</strong> had problem<strong>en</strong> met<br />

haar kinder<strong>en</strong>….door dat haar carrière zo zwaar doorwoog <strong>en</strong> haar privélev<strong>en</strong> daar<br />

onder leed. Ik d<strong>en</strong>k dat dat e<strong>en</strong> heel negatieve indruk op mij heeft nagelat<strong>en</strong>»<br />

GF2 «Moest er bijvoorbeeld e<strong>en</strong> figuur gelijk die prof van heelkunde verschijn<strong>en</strong> in de<br />

huisarts<strong>en</strong>g<strong>en</strong>eeskunde die ook zo e<strong>en</strong> indruk geeft dan zou die mij waarschijnlijk<br />

overtuigd hebb<strong>en</strong> t<strong>en</strong> opzichte van die van heelkunde…ik b<strong>en</strong> er zeker van dat ik niet<br />

de <strong>en</strong>ige b<strong>en</strong> waar dat zo e<strong>en</strong> invloed heeft. Want dat is het <strong>en</strong>ige beeld waar we ons<br />

aan kunn<strong>en</strong> vastklamp<strong>en</strong> eig<strong>en</strong>lijk om e<strong>en</strong> keuze te mak<strong>en</strong> hé. Oké, ik had mijn vader<br />

(die huisarts is) ook, maar voor de rest, wij wet<strong>en</strong> niet wat dat inhoudt hé. »<br />

LACK OF A FIRM BASIS TO CHOOSE A SPECIALTY<br />

In g<strong>en</strong>eral, stud<strong>en</strong>ts report that they lack a clear base to build their career choice upon.<br />

They miss information and active support in their decision process. Furthermore many<br />

interviewees m<strong>en</strong>tion the low amount of practice training that comes too late. Because<br />

of that, stud<strong>en</strong>ts get no (or get it too late) good picture of the real profession and they<br />

m<strong>en</strong>tion that their view based on the teaching courses oft<strong>en</strong> does not match the<br />

experi<strong>en</strong>ces during clerkships. On top of that, the process of choice seems to be very<br />

dep<strong>en</strong>d<strong>en</strong>t on the particular services during the clerkship: the hospitals and the doctors<br />

(role models) working in these services largely influ<strong>en</strong>ce the choice of the future<br />

physician. Stud<strong>en</strong>ts describe both positive and negative experi<strong>en</strong>ces in terms of: seeing<br />

interesting pathologies, performing instructive procedures by themselves, having<br />

<strong>en</strong>thusiastic and compet<strong>en</strong>t teachers and resid<strong>en</strong>ts, being respected as a stud<strong>en</strong>t-doctor<br />

and the overall atmosphere at the service/practice.

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