In most countries of the world attention is being focused on the importance and relevance of Primary Health Care. The family physician is a central figure in this context. In Bahrain, the Ministry of Health considers the development of Bahraini, family physicians as a major component of its policy. Accordingly, new career opportunities and training facilities are being offered in this field.
The Primary Health Care system of a community is very closely linked to the culture of its people. Within the framework of developing such a system it is essential that physicians and the community share a common cultural background. Consequently, the Family Practice Residency Program (F.P.R.P) is designed to develop the manpower and future leaders of this system in Bahrain. This overview will attempt to clarify several questions regarding the F.P.R.P.
Q. What is Bahrain's F.P.R.P ?
A. The FPRP in Bahrain was started in September, 1979 as a three year postgraduate residency training program in Family Medicine affiliated with the American University of Beirut (AUB). The Arab Board Council for Family & Community Medicine recognized the program in 1989 as a postgraduate specialty program in family and community medicine. Beginning 1996 the program was modified to 4 years training and started an affiliation with the Irish College of General Practitioners (ICGP) and The Royal College of Surgeons in Ireland (RCSI). Upon successful completion of the program, it is expected that the graduated physician will be able to competently and confidently manage over 90 percent of his/her patients, and refer the others to the proper secondary care channels when it is needed; these will include both sexes and all age groups. By this, he or she will be able to contribute greatly to the planning and execution of community health programs. The F.P.R.P is a rigorous, dynamic program, strongly supported by the Ministry of Health of Kingdom of Bahrain. It is responsive to the changing needs of the health care system and is constantly reviewing the content of the training to make it appropriate to practice needs of the family physician in Bahrain.
The first training year:
The first two months of the program consist of an integrated orientation to Family and Community Medicine. The remaining period of the first year is spent in the main hospital (Salmaniya Medical Complex) rotating through Internal Medicine & Pediatrics. These rotations are designed to give the resident an opportunity to learn the pathophysiology of diseases and the management of difficult problems. During this year, the resident attends primary care centers one day per week to practice and learn the skills of Family Medicine.
The second training year:
During the second year of training, the resident is primarily attached to Surgery, Psychiatry, Ob/Gyn and Radiology departments. He/she is given a one month block course on various issues related to Family Medicine. The resident attends in the health center one day per week for further primary care training where more emphasis is given to the management skills.
At the end of the second year, and after successfully completing the major hospital rotations, the resident will be eligible to sit for Part I Joint Board Certifying examination, which is conducted by the ICGP, RCSI & Ministry of Health. Upon successfully completing the Part I Joint Board Certifying examination, he/she will be promoted to the third residency year.
The third training year:
During the third year of training the resident is primarily attached to E.N.T, Accident & Emergency, Ophthalmology and Dermatology departments. He/she will also receive various block courses on various components of Family Medicine which are conducted by the tutors from the FPRP and ICGP. The resident will continue to attend primary care centre once per week to learn the comprehensive application of the skills of the practice of Family Medicine.
In Primary Health Care centers, close supervision is provided to maximize in-depth acquisition of knowledge and skill development. In this setting the resident will also acquire a deeper understanding of doctor-patient relationships, family and community dynamics as well as clinical medicine. Health Center experience is provided on a continuous and gradually expanding basis throughout the four residency years that will emphasize the importance of continuity of care.
The fourth training year:
The final 4th year is devoted exclusively to ambulatory primary care medicine; most of it is practiced in the health centers, under the supervision of the F.P.R.P tutors. During this year, the resident will polish his/her clinical skills; develop the needed attitude and ability to function effectively as an independent Family Physician.
During all four years of training, all residents are engaged actively in different educational activities consisting of case discussions, journal clubs, clinical and bedside teachings, and an integrated core content series of lectures, seminars and workshops.
Community medicine training:
Training in Community Medicine which includes Public Health, Biostatistics and Epidemiology; it is provided to all the residents. This is accomplished by giving condensed two and half month courses and series of weekly sessions on issues related to community medicine. Teaching this part of the curriculum is provided by specialists in this field both from Bahrain, Irish Collage of General Practitioners (ICGP) and Royal Collage of Surgeons (RCSI). Each resident is asked to develop a research project, relevant to Bahrain, putting into practice the principles being learned. This research is considered as a prerequisite for entering the final Part II examination.
Ongoing evaluation of the resident and the program is a continuous process throughout the four years of training to ensure adequacy of teaching and proper performance of residents. Residents are evaluated at the completion of each rotation by the tutors and the training instructors. A written exam, an oral exam and an Objective Structured Clinical Examination (OSCE) are given to the residents at the completion of the second year, (Part I) and the final year (Part II) of their training.
After successfully completing the training, the resident will be certified as a specialist in Family Medicine and will be awarded the Joint Board Certificate in Family Medicine which is issued by the Joint Board of ICGP, RCSI and Ministry of Health.
All graduates of the joint board will be eligible to sit for the final Arab Board examination.
Q. Where does the training take place?
A. The training is conducted in the Health Centers and the Salmaniya Medical Complex. Several new, modern and well equipped health centers are in existence in Bahrain. Naim Health Center is considered as the main training center for Family Physicians. This health center has a seminar room, library and several consultation rooms. It is well equipped with an operating theater, dentistry, laboratory, radiology, and pharmacy. The supporting staffs in the health center are oriented to provide quality community care. It is in such a stimulating environment that much of the education and training takes place. Other peripheral health centers are also used for training which serves the purpose of broadening the practice exposure in the community.
Q. Who is on the teaching staff of the F.P.R.P?
A. The teaching staff includes program chairman, full time tutors, part time tutors and hospital medical education coordinators. All are experienced in clinical as well as in academic medicine. The program also utilizes services of certified family physicians who have demonstrated interest and skills in residents training. In addition, professors from the Arabian Gulf University and consultants from the Salmaniya Medical Complex representing a wide spectrum of clinical specialties and specialists in community medicine participate in the program teaching activities.
Tutors in Family Medicine and other specialties, from the RCSI & ICGP visit the program for the block courses. They provide clinical teaching in the health centers as well as series of seminars and case discussions to all residents.
Q. Who is an eligible candidate for the F.P.R.P?
A. Requirements for application to the program are:
Qualification as a physician from an accredited medical school.
One year of internship in an accredited hospital.
Successful completion of the Kingdom of Bahrain Medical Licensing Examination.
A minimum of one year rotations in the health services in Bahrain with a minimum of 2 months should be spent in Primary health care.
Passing the pre-entry written evaluation and the program selection committee interview.
Q. How to apply?
A. Application forms are available at the office of the Secretary Office of the F.P.R.P in Naim Health Center and on the web site. The training year starts on the first day of February each year.
Q. Are there other criteria for selection?
A. The F.P.R.P recently has put more effort on the selection process. Previous experience could be taken into consideration and the training program is modified to take into account such experience. It can accommodate physicians who have postgraduate clinical experience especially in Pediatrics, Internal Medicine, Gynecology and Obstetrics and others.
Q. What are future career opportunities of a Family Physician graduate?
A. Family Medicine is an ongoing specialty in the region. Career development may go along several lines: practicing family physician, academic family doctors, health planning and administration or gaining sub-specialty training or degree in any field of medicine.
Q. Where can further information be obtained ?
A. To obtain further information about the F.P.R.P please contact the office of the Chairman of Family Practice Residency Program at Naim Health Center on Telephone 17-263597 or write:
The Office of F.P.R.P.
Naim Health Center
Ministry of Health
P.O. Box 42