Nicolas Senn is professor and director of the Institute of family medicine at the University of Lausanne in Switzerland
In Lausanne, Switzerland, we are in the process of transforming our medical curriculum with new learning objectives (PROFILES), with the perspective of finally having a stronger focus on family medicine and primary care (PC). Before embarking in these important changes, we thought that it would be good to visit another University renowned for its strong PC teaching and research tradition.
So we, eight people, four from the Swiss Institute of family medicine and four from the medical pedagogy unit of the faculty of medicine, decided to go to Glasgow to learn about how academic PC developed over 40 years there. Academic primary care is only 10 years old in Lausanne! It turned out to be an excellent idea. The welcome was exceptional and we had the opportunity to meet wonderful people. Jill Morrison organised the whole visit and introduced us to the Glasgow program. We were also given an opportunity to see how Glasgow addresses some key teaching challenges. Among them, we found these two particularly interesting:
When should primary care medicine been taught and by whom? The Glasgow program offers an early and continuous exposure of medical students to general practitioners during their training. They do it in different ways, but mostly through weekly “vocational studies” courses during the first two years.
How to improve students’ wellbeing? Glasgow does this by giving more time to the students: Wednesday afternoons are for sport, not for studies. This seemed a great Idea. “Mens sana in corpore sano” - nothing new, just do it.
On the research side, we found it interesting to meet the teams of Frances Mair and Stewart Mercer. Both are developing high quality projects in a dynamic environment. Especially of interest for us was how academic PC research institutions in Scotland have strong links under a common umbrella: the Scottish school of primary care, funded by the government. This is probably the best way to develop together high quality primary care research projects and to be more visible in a highly competitive medical research environment.
However, we were surprised to find that the faculty of medicine split research and teaching teams in two distinct entities. A mistake, they said, and we believed them!
Our visit also provided us with some elements of answers to a more fundamental question: What is primary care? Indeed, so often, patients or other colleagues are asking difficult questions: what are the specificities of primary care? What and how should we teach primary care? How to develop research in primary care? Which topics are relevant? By meeting people in Glasgow and learning about what there are doing we perhaps gained some answer these questions. Of course multimorbidity and its corollaries - polypharmacy, chronic diseases, models of care - is always present, as is the overlap between primary care and public health, as both have to manage social determinants of health. Our visit to Glasgow providing us with a clearer and richer understanding of what we are and what we do in primary care.
Our team’s visit was not only important for what we learned and shared, but also simply to see that we were not the only ones struggling with developing academic primary care. From that perspective, strengthening ties. Our thanks go out to the great teams of Glasgow. We had a lovely time there.