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In Slovenia, quality of care at the primary healthcare level is formally a priority, but the legislation to ensure quality in this area is proceeding very slowly. The first steps towards a systematic quality control system in Slovenian family medicine were implemented with the initiation of an ongoing project of renewed family medicine practices in 2011 and the introduction of quality indicators. In 2017, an initiative by the Ministry of Health and the Department of Family Medicine at the Faculty of Medicine, the University of Ljubljana, aimed to develop a new approach to quality assurance and an improvement. It comprises four main parts: the family medicine practice team, a quality control group, a quality control office and the Ministry of Health. In this plan, quality is controlled and improved at the micro, mezzo and macro levels. The described system for quality assurance and improvement is still waiting to be implemented in practice, as there is a lack of human and financial resources., (© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Family medicine teachers require specific educational skills. A framework for their professional development is essential for future development of the discipline in Europe. EURACT developed a framework on educational expertise, and subsequently applied it in a curriculum of teaching-skills courses of various levels. The aim of this article is to describe the development of the teaching framework, and of an international three-level course programme for 'teaching-the-teachers'. Furthermore, we describe our experiences and lessons learned, in particular with regard to the level-three programme for proficient teachers, which was new. We conclude that it is possible to develop a theoretical framework of family medicine teaching expertise and to apply it in an international high-level educational programme for future experts in family medicine education. Research evidence of the usefulness of this approach is needed, and the threats for its further development into a sustainable activity are its high teacher/student ratio associated with relatively high costs and difficulties in recruiting suitable participants.

Background: The aim of our study was to describe variability in process quality in family medicine among 31 European countries plus Australia, New Zealand, and Canada. The quality of family medicine was measured in terms of continuity, coordination, community orientation, and comprehensiveness of care., Methods: The QUALICOPC study (Quality and Costs of Primary Care in Europe) was carried out among family physicians in 31 European countries (the EU 27 except for France, plus Macedonia, Iceland, Norway, Switzerland, and Turkey) and three non-European countries (Australia, Canada, and New Zealand). We used random sampling when national registers of practitioners were available. Regional registers or lists of facilities were used for some countries. A standardized questionnaire was distributed to the physicians, resulting in a sample of 6734 participants. Data collection took place between October 2011 and December 2013. Based on completed questionnaires, a three-dimensional framework was established to measure continuity, coordination, community orientation, and comprehensiveness of care. Multilevel linear regression analysis was performed to evaluate the variation of quality attributable to the family physician level and the country level., Results: None of the 34 countries in this study consistently scored the best or worst in all categories. Continuity of care was perceived by family physicians as the most important dimension of quality. Some components of comprehensiveness of care, including medical technical procedures, preventive care and health care promotion, varied substantially between countries. Coordination of care was identified as the weakest part of quality. We found that physician-level characteristics contributed to the majority of variation., Conclusions: A comparison of process quality indicators in family medicine revealed similarities and differences within and between countries. The researchers found that the major proportion of variation can be explained by physicians' characteristics.

The development of the EURACT (European Academy of Teachers in General Practice) Educational Agenda helped many family medicine departments in development of clerkship and the aims and objectives of family medicine teaching. Our aims were to develop and validate a tool for assessment of students' attitudes towards family medicine and to evaluate the impact of the clerkship on students' attitudes regarding the competences of family doctor. In the pilot study, experienced family doctors were asked to describe their attitudes towards family medicine by using the Educational Agenda as a template for brainstorming. The statements were paraphrased and developed into a 164-items questionnaire, which was administered to 176 final-year students in academic year 2007/08. The third phase consisted of development of a final tool using statistical analysis, which resulted in the 60-items questionnaire in six domains which was used for the evaluation of students' attitudes. At the beginning of the clerkship, person-centred care and holistic approach scored lower than the other competences. Students' attitudes regarding the competences at the end of 7 weeks clerkship in family medicine were more positive, with exception of the competence regarding primary care management. The students who named family medicine as his or her future career choice, found holistic approach as more important than the students who did not name it as their future career. With the decision tree, which included students' attitudes to the competences of family medicine, we can successfully predict the future career choice in family medicine in 93.5% of the students. This study reports on the first attempt to develop a valid and reliable tool for measuring attitudes towards family medicine based on EURACT Educational Agenda. The questionnaire could be used for evaluating changes of students' attitudes in undergraduate curricula and for prediction of students' preferences regarding their future professional career in family medicine.

Background: Due to the importance of family medicine and a relative shortage of doctors in this discipline, it is important to know how the decision to choose a career in this field is made., Objective: Since this decision is closely linked to students' attitudes towards family medicine, we were interested in identifying those attitudes that predict intended career choice in family medicine., Methods: A cross-sectional study was performed among 316 final-year medical students of the Ljubljana Medical Faculty in Slovenia. The students filled out a 164-item questionnaire, developed based on the European definition of family medicine and the EURACT Educational Agenda, using a seven-point Likert scale containing attitudes towards family medicine. The students also recorded their interest in family medicine on a five-point Likert scale. Attitudes were selected using a feature selection procedure with artificial neural networks that best differentiated between students who are likely and students who are unlikely to become family physicians., Results: Thirty-one out of 164 attitudes predict a career in family medicine, with a classification accuracy of at least 85%. Predictors of intended career choice in family medicine are related to three categories: understanding of the discipline, working in a coherent health care system and person-centredness. The most important predictor is an appreciation of a long-term doctor-patient relationship., Conclusion: Students whose intended career choice is family medicine differ from other students in having more positive attitudes towards family physicians' competences and towards characteristics of family medicine and primary care.

Unlabelled: The paper describes experiences in the development of an international textbook of family medicine. The process of its development has started in Slovenia, where the Slovenian authors have written a textbook, adhering strictly to the European definition of family medicine and its core competencies. The format and the approach were also adopted by Croatian authors, who have used most of the material from the Slovenian book, but have modified some of the chapters according to the situation in the country and have added some of their own. This activity has created an opportunity for a truly international collaboration in the area of education of family medicine, with a creation of an international consortium, which would be responsible for the core content of the book and local adaptations of the book according to the specificities and needs of different countries., Conclusion: This innovative approach in the development of teaching material may be interesting for a variety of smaller countries in Europe and worldwide., (Copyright © 2014 by Academy of Sciences and Arts of Bosnia and Herzegovina.)

Objective: The European Academy of Teachers in General Practice / Family Medicine (EURACT) has developed an educational agenda, the key document for teaching family medicine in Europe. The aim of our study was to find out how final year medical students at the beginning of their family medicine clerkship understand the discipline of family medicine., Methods: The attitudes toward family medicine were paraphrased and developed into a 164-item questionnaire, which was administered to 335 final-year medical students at the beginning of their clerkship. Using combinatorial optimization with genetic algorithms we selected 30 items which yielded the highest Cronbach alpha reliability coefficient. Finally, we performed a factor analysis to find which dimensions of family medicine were recognised by the students and compared them with the domains defined in the EURACT definition., Results: The 30-item questionnaire had a Cronbach alpha reliability coefficient of 0.919. The differences between male and female students were not very significant (p=0.061). With the factor analysis we recognised seven factors, belonging to three out of six domains of the EURACT educational agenda: primary care management, personcenteredness and comprehensive approach., Conclusion: Final-year medical students at the beginning of their family medicine clerkship understand some of the dimensions of family medicine rather well, but they are not aware of some important competences of family doctors. There is a necessity to teach students about specific problem solving skills and the importance of balance between the health needs of an individual patient and the community., (Copyright © 2014 by Academy of Sciences and Arts of Bosnia and Herzegovina.)

This article includes a personal history of a family physician working in Ukraine. In June 2012, Pavlo Kolesnyk, Ukrainian Assistant Professor and a Family Doctor was awarded the second Montegute Scholar grant and had the chance to attend the Wonca Europe Conference 2012 in Vienna. In many developed countries, family medicine is already well established. In Ukraine, which has the legacy of a socialist health care system the implementation of the discipline started only at the end of the last century. The changes in the health care system were of greater importance in primary care and family medicine. It gave greater decentralization of the health care system and supported investment in primary care. This article describes the development of family medicine in undergraduate and postgraduate education. Whilst family medicine is officially a priority of health care policy, there is still a long process ahead. Family medicine needs financial support from the government and doctor's wages have to be increased, to prevent this branch of medicine being unpopular among graduating medical students.

After decades of developing family medicine, one can see that it has been successful in defining its principles and in proving the importance of its contribution using quantitative measures of quality that are prevailing today. But if family medicine needs to make a real contribution to society, it needs not to forget that using only rationalistic approach is not enough to define its quality and that caring for a fellow being is as important as science. Our contribution to changing the world for the better should be in constantly reminding that personal care is essential for every doctor regardless the speciality. This largely neglected feature of medicine can be best taught and researched in the context of family medicine, because it represents the very essence of the discipline. This implies that we must often take a different path from other disciplines when we address the issues of policy, research and education and use every opportunity to stress the importance of personal care.

Objectives: To determine the views of Slovenian family physicians on medically unexplained symptoms (MUS) and learn more about potential types of treatment for such patients., Methods: Five focus groups, comprising 24 family medicine physicians (FMPs) from two Slovenian University centres, were convened. Conversations were led towards the research objectives by professionally trained researchers and followed a preliminarily established protocol. Qualitative content analysis of audio and transcripts of the discussions was performed using ATLAS.ti software to establish categories ('codes') relevant to issues regarding MUS., Results: Slovenian FMPs emphasized the importance of good communication and trust between physicians and patients with MUS. Systemic barriers to effective management of MUS arising from the Slovenian health system were highlighted. FMPs stressed the need for more education in the recognition and treatment of MUS in primary care. From the discussions, 64 codes comprising broader research fields of MUS were developed, then grouped into a further eight categories: communication; doctor-patient relationship; causes of MUS; patient characteristics; physician characteristics; courses of action so far; positive relationship with patients; proposals for treatment., Conclusions: The results are valuable in terms of investigating the treatment of patients with MUS in Slovenia, thereby opening new avenues of research on the subject of MUS.

Background: Since the early 1990s former communist countries have been reforming their health care systems, emphasizing the key role of primary care and recognizing family medicine as a specialty and an academic discipline. This study assesses the level of academic development of the discipline characterised by education and research in central and eastern European (CEE) countries., Methods: A key informants study, using a questionnaire developed on the basis of a systematic literature review and panel discussions, conducted in 11 central and eastern European countries and Russia., Results: Family medicine in CEE countries is now formally recognized as a medical specialty and successfully introduced into medical training at undergraduate and postgraduate levels. Almost all universities have FM/GP departments, but only a few of them are led by general practitioners. The specialist training programmes in all countries except Russia fulfil the recommendations of the European Parliament. Structured support for research in FM/GP is not always available. However specific scientific organisations function in almost all countries except Russia. Scientific conferences are regularly organised in all the countries, but peer-reviewed journals are published in only half of them., Conclusions: Family medicine has a relatively strong position in medical education in central and eastern Europe, but research in family practice is less developed. Although the position of the discipline at the universities is not very strong, most of the CEE countries can serve as an example of successful academic development for countries southern Europe, where family medicine is still not fully recognised.

Family medicine is a discipline that has only recently joined the academic arena. Because of this, the academic contribution of this discipline to universities has not been clarified yet. On the other hand, the medical schools suffer from well-known challenges, that have been largely known in the discussions about the crisis of academic medicine. The article explores the possibilities of mutual cooperation between family medicine and the universities. In order to profit from the qualities of academic medicine and family medicine, a partnership between the two needs to be established. It should be built on acceptance of differences and adaptation of family medicine to the rules of the academia, which should be done without sacrificing its principles. The author describes three potential scenarios how family medicine can be introduced in the undergraduate curriculum: a) as a subject at the end of the curriculum, b) as collaboration in early patient contact and teaching clinical skills and c) as part of the integrated curriculum. The author concludes that both family medicine and the medical school have a lot to benefit from mutual cooparation. This requires compromises that are not always easy., (Copyright 2012 by Academy of Sciences and Arts of Bosnia and Herzegovina.)

BackgroundPredictD is a risk algorithm that was developed to predict risk of onset of major depression over 12 months in general practice attendees in Europe and validated in a similar population in Chile. It was the first risk algorithm to be developed in the field of mental disorders. Our objective was to extend predictD as an algorithm to detect people at risk of major depression over 24 months.MethodParticipants were 4190 adult attendees to general practices in the UK, Spain, Slovenia and Portugal, who were not depressed at baseline and were followed up for 24 months. The original predictD risk algorithm for onset of DSM-IV major depression had already been developed in data arising from the first 12 months of follow-up. In this analysis we fitted predictD to the longer period of follow-up, first by examining only the second year (12–24 months) and then the whole period of follow-up (0–24 months).ResultsThe instrument performed well for prediction of major depression from 12 to 24 months [c-index 0.728, 95% confidence interval (CI) 0.675–0.781], or over the whole 24 months (c-index 0.783, 95% CI 0.757–0.809).ConclusionsThe predictD risk algorithm for major depression is accurate over 24 months, extending it current use of prediction over 12 months. This strengthens its use in prevention efforts in general medical settings. [ABSTRACT FROM AUTHOR]