op één lijn 56 3e uitgave 2016 Crossing borders Research exchange guest BY CANDAN KENDIR ÇOPURLAR, GP TRAINEE FROM TURKEY I am a last year Family Medicine (FM) / General Practitioner (GP) resident in Izmir, Turkey. I’m also the West side exchange coordinator of the Vasco da Gama Movement in Turkey (a network of GP residents and GPs) and European Co-Liaison Person for the ASPIRE Global Leader program. In the second year of my residency, I decided to do an exchange in the Netherlands. By doing this, I hoped to improve myself as a researcher, practice my teamwork, and learn from different approaches to patients in primary care. Searching the internet, I decided to apply for a research position with CAPHRI. After the approval, I have spent three months in Maastricht, from April 2016 to July 2016. Application, Approval and Preparations I contacted the head of the Department of Family Medicine in Maastricht (Prof. Job Metsemakers) about my plan. We started an online conversation. I wanted to observe Primary Health Care (PHC) settings and spend time in the department. We agreed on combining research at the department with daily PHC visits. In September 2015, I met Prof. Job Metsemakers at the WONCA Europe Conference in Istanbul, Turkey. He introduced me to dr. Marjan van den Akker who would be my research coordinator at the UM and she helped me to define my research question. In Turkey, we have a small department, but no research school such as CAPHRI. If you manage to find an e-mail address of one of the supervisors, then the process is similar to the ways of collaborating in the Netherlands. However, finding a contact person at our Department, can be challenging, but everyone is welcome as well. Though unfortunately, we have few exchange researchers coming over. Research My research in The Netherlands focused on the “Relationship of Cardiovascular Diseases with Comorbidity” using data from the Registration Network called RNH (RegistratieNet huisartsen). I was asked to lead the group meetings which is different from what I am used to in Turkey. In addition, most junior researchers in Maastricht present their results in the department and they follow-up each other’s work. In Turkey we form a team with our supervisors but we don’t schedule regular meetings and our supervisors 8 usually lead the meetings. That results in less selfconfidence, more delays and many unfinished studies. Also, we don’t present our results within our department which causes unawareness among other researchers about each other’s work. Specialty training in both countries During my research exchange, I also had a chance to meet young GP residents and join them during patient consultations and a GP training session. In The Netherlands, the trainees take an active role in PHC settings and gain experience there. The important part from my point of view is that altough they do their own consultations, they always have access to supervision. Furthermore, they have a chance to discuss their cases with other trainees during training sessions (= terugkomdag). They also record their patient consultations at regular intervals and watch the videos with other residents in these sessions. In Turkey, a new system called “Educational Primary Health Care Centers” has been developed and GP residents see patients in these settings. The difference between our countries is that in these settings patients are registered to trainees and supervisors do not see or treat the patients. Another difference is that Turkish trainees have to deal with all the administrative work. They have to follow up pregnant women, children, elderly people and if they miss a follow up period, their salaries are cut by the Ministry of Health. On the other side, in these settings, Turkish trainees get experience in future work and develop their skills to manage a PHC and staff. Health Care System During my visit, I got the privilege to visit a PHC in a rural area and a PHC in an urban area. In the Netherlands, Dutch Health care centers are well organized compared to Turkey. ‘huisartsen’ are gate keepers and all patients have to be registered with a GP. They deal with acute diseases, chronic diseases, prevention and health promotion. In addition to that, they do minor surgeries. They are organised in teams where everyone is aware of their position and function. In Turkey, PHCs only started to develop after 2005. That’s why there are still some gaps in the system. GPs are not gatekeepers and patients can access secondary and tertiary care directly. This results in some problems: unawareness of physicians about their patients’ up-to-date status, Pagina 7
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