1. Middle-sized primary health centre as an optimal environment for learning medicine ?

2. Historical background Primary Health Centres were founded in early sixties of the 20 th century in all Slovenian communities. Their basic purpose was to enable and practice comprehensive and quality health care adjusted to real needs of each communitie’s population. These Centres incorporated dentistry services, general practices and different medical specialities in (so called) dispensary departments Private practices either solo or group, were replaced completely, and health planning and managing have been put in local authorities’ hands. Nowadays, Slovenian primary care is a bit fragmented among different specialities as well between public sector and »private« health care providers.

3. More about our community PHCC is located in commune on the south Slovenian border with population of approximately 25 thousand inhabitants. The biggest Slovenian SPA is 5 kilometre far away. Important highway and railway are passing through. Tourism, trading, farming and vine producing are traditional business in our region

4. More about our PHCC Employed staf:7 specialists in general medicine, paediatrician, psychiatrist, gynaecologist, internist, two specialist in labour medicine and four dental doctors. Each primary care doctor worked together in team with a nurse. She is dealing preferably with office administration. There are surgeries of three private practitioners, well equipped laboratory, urgent service with our own ambulance cars, pharmacy, home nursing service and centre for treatment and prevention of illicit drug addiction – all in the same building.

9. Teaching stuff and trainees Two lady-physicians are tutors for postgraduates and two younger physicians are tutors for medical students An average of three or four students and one or two residents each year An average number of consultations is over 50 per working day.

10. Teaching methods (1) All teaching methods are adopted to Medical Faculty curriculum. The most frequently used are: Reading Observations Office demonstration and office practice Case discussion, case presentation One to one teaching

11. Teaching methods (2) Problem based learning Reflection on consultation Case simulation Emergency service attachment A problem list construction Lecturing Preparing a project or material Field work

12. Tutors’ opinions  Main advantages and opportunities for learners: - well organized urgent service (4/4) - well equipped laboratory (3/4) - interdisciplinary collaboration (2/4) -satisfactory level of informatics support (1/4)  Main barriers for more efficacious education: -work overload -shortage of time

13. Tutors’ self-evaluation The effects of teaching:  “Explaining issues to students helps me re-evaluate my practice”.  “Students’ participation strongly influenced my approach to managing chronic illnesses.”  “Frequently, J am afraid that it couldn’t be possible to fulfil some expectations of trainee. The cooperation with other colleagues and experienced medical stuff were crucial when J was trying to meet the most of learners needs.”  “It helps me to renew my knowledge and clinical skills.”

14. Learners’ attitudes and comments (1) A( female student): ”Work in urgent ambulant is very useful and dynamic. J needed more time for history taking and examination. Administrative overload had a strong influence on my working motivation”. B (male student): “There are too much paper work in GPs’ office. Some of these administrative tasks seems to be completely unnecessary. Otherwise, it is could be a very dynamic work. C (female student): “It is very interesting and very stressful work, especially when you are “urgent doctor” at the same time.”

15. Learners’ attitudes and comments (2) D (male- resident): “J am very satisfied with working environment and possibilities for professional development within this Centre. Access to internet and informatics support, including electronic patient records could be of ultimate importance for a young physicians in primary care. However, J have missed some learning methods video recording and self-evaluation in small groups”

16. Instead of conclusion Typical Slovenian middle-sized Primary health centre complies with the majority of conditions that are list in 6 chapters of EURACT’s most recent educational agenda (2004). Successful implementation of teaching process into family practice settings depends on variety of factors which could be anticipated and measured. Additional tools and procedures for evaluation of efficiency of teaching processes should be developed and applied in primary care settings.

17. The word doctor literally means teacher; good teachers are those who can inspire, guide, educate, lead, and bring out the best in others Brennan MG, Lancet 2003