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Amaç: Çalışmamızda aile hekimliği sisteminde aktif olarak çalışan hekimlerin sahada karşılaştıkları sorunlar ve UÇEP 2014’ün bu sorunları kapsama durumu değerlendirilmiştir. Gereç ve yöntem: Çalışmamız niteliksel araştırma deseninde tasarlanmıştır. Kesitsel tipteki araştırmada veri toplama aracı olarak “kritik olaylar tekniği” kullanılmıştır. Doğal çalışma ortamlarında müdahale olmaksızın kritik olaylar tekniği aracılığıyla toplanan hekimlerin karşılaştıkları olumlu ve olumsuz olayların betimleyici analizi yapılmıştır. Araştırma 2016 yılında T.C.S.B. Halk Sağlığı Kurumuna bağlı sözleşmeli aile hekimi olarak aktif görevde olan (aile hekimliği uzmanları ve pratisyen hekimler) 55 hekim ile yapılmıştır. Kritik olaylar tekniği ile veri toplama sürecinde aile hekimlerinden aile hekimliği pratiğinde yaşadıkları üç olumlu üç olumsuz olayı yazmaları istenmiştir. Bu olaylardan elde edilen veriler 6 kişilik bir analiz ekibi tarafından içerik analizine tabi tutulmuş, kategoriler geliştirilmiş ve açıklanmıştır. Bulgular: Veri setinde 299 olay (134’i olumlu, 165 ’si olumsuz) toplandı. Bu çalışmada, hekimlerin anlattığı kritik olaylardan “Ruhum Yoruldu” metaforu ortaya çıkmıştır. Hekimlerin kendi bilimsel bilgi ve tıbbi başarılarından, meslektaş takdirinden içsel motivasyonlarının arttığı, sağlık müdürlüklerinin küçük bir yardımı ve takdiriyle de dışsal motivasyonlarının arttığı belirlenmiştir. Ulusal ÇEP 2014 ve araştırmamızda bulunan kategoriler birbirleri ile karşılaştırıldığında araştırmamızda elde edilen 12 alt kategoriden (motivasyon, hekim davranışı, hasta davranışı, hasta türü, hasta ve yakınları ile iletişim, sağlık çalışanları ile iletişim, başvuru nedeni, olay, otorite, örgütlenme, bürokratik işlemler, ödül ve ceza) 3 başlığın (sağlık çalışanları ile iletişim, örgütlenme, otorite, ödül ve ceza içerisinde yer alan sağlık çalışanına şiddet ) temel hekimlik uygulamaları içinde yer almadığı görülmektedir. Özellikle ödül ve ceza başlığı altındaki hastaların sağlık çalışanını cezalandırma yöntemleri arasında sözlü ve fiziksel şiddetin şıkça yer aldığı görülmektedir. Ulusal ÇEP 2014 temel hekimlik uygulamaları başlığı altında hekimin kendi hak ve hukukunu koruması ile ilgili herhangi bir başlık yer almamaktadır. İletişim becerileri ve sağlık hukuku temel başlığı altında bu konuların ele alınması gerekmektedir. Ulusal ÇEP 2014 içerisindeki öğrenme düzeyleri ile olumlu ve olumsuz olaylar arasında herhangi bir ilişki bulunamamıştır. Sonuç: Araştırma bulguları aile hekimlerinin yaşadığı olumlu ve olumsuz olaylarla ilgili önemli bulgular ortaya koymuştur. Bu çalışmadan elde edilen veriler birinci basamakta yaşanan sorunların önemli bir kısmına ışık tutmaktadır. Ulusal ÇEP 2014’ün yeniden revize edilme aşamasında sahada yaşanan sorunlara çözüm açısından ve mezun olan öğrencinin sahada karşılaşacağı sorunlarla önceden müdahale açısından yeni başlıklar eklenmesine katkı sağlayacaktır.
Purpose: In our study, the doctors who are active in the family medical system have assessed the problems that they encounter in the field and the circumstances of covering these problems in the 2014 UÇEP. Tools and methods: Our work is designed in a qualified research pattern. The “critical events technique” has been used as a data collection tool in cutting-edge research. Imaginary analysis of the positive and negative events that doctors gathered through the technique of critical events without interference in the natural work environments was made. Research in 2016 at T.C.S.B. 55 doctors (family physicians and practitioner doctors) are active as contractual family physicians associated with the Public Health Institution. With the technique of critical events and the process of data collection, family doctors were asked to write the three positive three negative events they experienced in the practice of family medicine. The data obtained from these events was submitted to content analysis by a team of 6 people, categories developed and explained. Results: 299 events (134 positive, 165 negative) were collected in the data set. In this study, the metaphor of the critical events the doctors talked about "the Spirit was tired" was revealed. It has been determined that the doctors have increased their inner motivation from their own scientific knowledge and medical achievements, from the appreciation of their colleagues, and that their external motivation has increased with a small help and appreciation of the health departments. The National CEP 2014 and the categories in our research compared to each other from the 12 subcategories obtained in our research (motivation, doctor behavior, patient behavior, patient type, patient and relatives, communication with health workers, application cause, event, authority, organization, bureaucratic processes, reward and punishment) 3 titles (communication with health workers, organization, authority, reward and punishment) are not included in the basic medical practices (communication with health workers, organization, authority, reward and punishment). In particular, the methods of punishment of patients under the title of reward and punishment of the health worker appear to include oral and physical violence. Under the title of National CEP 2014 Basic Medical Practices there is no title related to the protection of the doctor’s rights and laws. Under the basic headline of communication skills and health law these topics should be addressed. There was no connection between the level of learning and the positive and negative events in the national CEP 2014. Results: The research findings revealed significant findings about the positive and negative events that family doctors experienced. The data obtained from this study keeps the light on a significant part of the problems that occur in the first stage. The National CEP 2014 will contribute to the addition of new titles in terms of solution to the problems in the field and pre-intervention with the problems the graduate student will encounter in the field.
Aim: The aim of this study is to identify the problems faced by the family physicians in the field and to evaluate whether these issues are covered by the National Core Curriculum 2014 (NCC 2014). Materials and Methods: The study has cross-sectional design. In 2017, physicians who actively worked as family physicians were invited to participate in the study via social media. 55 family physicians (family medicine specialists and general practitioners) responded to this invitation. The Critical Incidents Technique was used as the data collection tool in the study. The Critical Incidents Technology data form was sent by e-mail to the physicians who would participate in the study. In this technique, physicians were asked to write down three negative incidents that caused penalty and three positive incidents that caused rewarding with details in the work environment. The qualitative data on the positive and negative incidents collected were individually read, analyzed and categorized by a team of six. The categories that were specified are compared with fundamental physician skills of the NCC 2014. Results: 299 incidents (134 positive, 165 negative) were collected from 55 physicians by Critical Incidents Technique. After the analysis of the results; emotions, patient characteristics, communication, application, health service and rewarding - penalty categories were determined. Comparing categories with the NCC 2014, both positive and negative incidents were found in the main titles of NCC 2014. It was determined that the negative incidents experienced by the family physicians were related to 16 titles in NCC 2014. These titles, are predominantly at 3-4 degree learning level, related with forensic case examination, child and newborn examination, monitoring growth and development of child, consciousness assessment and mental state examination, examination of corpse, preparing death certificate, reporting and notification, providing health services in unusual circumstances. Especially, the incidents described in the two sections regarding reporting and issuing the notification and providing health care in unusual circumstances are all negative and causing the family physicians to be penalised. It has been seen that physicians use the metaphor “my soul is tired” to describe the incidents. It was determined that patients frequently applied verbal and physical violence to the health care workers as punishment method. Conclusions: The graduate competencies of the undergraduate medical education programs and the skills of the physicians for solving the problems they encounter in health care services does not always match one-to-one. The use of resources at the national level like NCC 2014 in education provides important contribution to compensate these contradictions. The obtained data shed light on a significant part of the problems experienced in the first step. Taking into consideration the problem areas that are determined during the revision of the NCC 2014 would be an important step for the solution. For family physicians, in order to present their professional knowledge and skills in a safe environment, educational institutions, graduates and, most importantly health system managers must be acquainted with and collaborate with each other.
Alan : Sağlık Bilimleri
Dergi Türü : Ulusal
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