General medicine in Europe: nation you go training you find

General medicine in Europe: nation you go training you find

Over the last few decades, General Medicine (MG) has established itself internationally as an autonomous and essential specialization, with specific skills and tasks. This implied the need to implement a structured training course in order to allow Mg specialists to acquire all the basic skills necessary to be able to operate in the field of primary care. However, this process has not translated into homogeneous applications in Europe, mainly due to the structural diversity of European national health systems. Below we compare the training courses of specialization in Mg of the main European nations.
France

At the end of the cycle of university studies in medicine (six years in total), students must take a complicated and selective national exam in order to access the specialization in Mg. During this three-year training period, consisting of six semesters, there are also two hundred hours of theoretical lessons. At the end of the three years it is necessary to discuss a thesis to obtain the right to exercise the medical profession and the title of specialist in Mg.
Germany

After the end of the university training course (6 years), the qualification to carry out the medical profession is obtained through an exam consisting of several phases. The subsequent medical specialization in Germany is a professional path managed entirely by the Medical Associations. The German program is conceived as a training inserted within a normal medical activity and, therefore, the achievement of the specialization is understood as the recognition of professional experience gained and documented in a specific specialty. During the five-year period of specialized training in Mg, the doctor initially works as an assistant, with a path that may partly differ depending on the region of belonging. In general, the first 36 months of training take place in a hospital setting and the following 24 months are dedicated to MG, with activities to be carried out in the clinics of experienced doctors. During the specialization, specialization courses must be followed and the start of the training process in a specific specialist branch takes place through an interview with the head of the department that the trainee would like to attend. In order to formally acquire the specialist title from the Order of Doctors, a final examination is finally carried out.
England

Once the Medical School has been completed (minimum 5 years), the newly graduated student enrolls in a regularly paid internship lasting two years, which can be considered a sort of formal and practical qualification to practice the medical profession. At the end of this path, the young doctor in training becomes eligible to enter the real specialization path in general medicine, after passing a computerized multiple choice test with clinical and ethical questions. The specialization in Mg provides a training course lasting a minimum of 3 years, in which the rotations are mainly divided into two areas: the hospital one (one year) and the real territorial one (two years). In addition to practical training in the field, weekly lessons are also provided with compulsory attendance. In order to complete the specialization course, the trainee will finally have to pass a final exam aimed at evaluating both theoretical and practical and communicative knowledge.
Italy

After completing a six-year university course, the recent graduate can enroll in the order of doctors, acquiring the right to exercise the medical profession. In order to access the specialized training (managed by the universities) of any medical branch, the doctor must pass a national competition. However, in a very peculiar way, in Italy Mg is not considered a real specialization from a regulatory point of view and the post-graduate training of future family doctors is not the prerogative of the universities, but of the regions and the orders of provincial doctors. . In order to become Mmg, it is therefore necessary to follow a three-year regional specialization course, which can be accessed after passing a specific regional competition. In general, the practical training is divided into: 12 months to be spent in a general medicine clinic, 6 months in an internal medicine hospital ward, 6 months in local health facilities, 3 months in the emergency room, 3 months in an internal medicine ward, general or specialist surgery, 4 months in a pediatric ward / pediatric clinic of free choice, 2 months in an obstetrics and gynecology ward. The theoretical activity is divided into weekly lessons and seminars. At the end of the three years each doctor will carry out a final exam consisting in the elaboration and discussion of a thesis.
Spain

Once the 6-year cycle of university studies has been completed, graduate students can enroll in the Order of Doctors. However, to be able to work in the Spanish National Health Service, a specialization qualification is required. In order to be admitted to a graduate school, doctors must pass a particularly selective and complicated national competition. The duration of the specialty in Mg is four years and half of the specialization course is intended for practice at the health houses. In addition, trainees must attend hospital internships for about 18 months, while the remaining six months are intended for multiple rotations in hospital or outpatient facilities of the NHS.
Final remarks

A very heterogeneous picture clearly emerges from the comparison of training programs in Mg in the main European countries. The duration of the programs varies from 5 years in Germany, two of which spent in Mg, to 3 in France and Italy, of which only one was spent in Mg. England shows a very special post-graduate training system, characterized by two equal years for all recent graduates before starting the actual specialized training programs. However, in practice, English trainees are the ones who spend the most time in MG (28 months in total). Finally, the training program in Mg in Spain has a duration of 4 years, of which two in the local area. And, just not to forget, Italy is the only country where MG is a sort of “second class” specialty, not comparable to all the others.

* Center for Studies in Social and Healthcare Policy and Planning
Mario Negri Irccs Pharmacological Research Institute, Milan

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