Santero Kujala

Evaluation of undergraduate medical education in Finnish community‐oriented and traditional medical faculties: a 10‐year follow‐up

This study focused on Finnish physicians’ views of their undergraduate medical education. Differences between traditional and community‐oriented medical faculties were examined and changes which had taken place during a 10‐year follow‐up period were also assessed.

Choosing a medical specialty – Study of Finnish doctors graduating in 1977–2006

Background: Choosing a medical specialty is an important element predefining a physicians career and life. Although there has been some research in this area of interest, there has not been much research where the profession has been researched as a whole, or where trend data over different generations has been presented. Aim: The aim of our study was to ascertain the motives affecting physicians’ choice of a medical specialty. Methods: The study cohort comprised random sample of 7758 doctors who were registered in Finland during the years 1977–2006. Altogether 4167 questionnaires were returned, giving a response rate of 54%. An electronic questionnaire was used in data collection, supported by a traditional postal questionnaire. Results: Of the respondents, 76% thought the diversity of the field had affected their choices of specialty considerably or very much. For physicians under 35 years old, especially the good example set by colleagues (48%), and opportunities for career development (39%) were more important motives compared to those of older physicians. Conclusions: According to this study, diversity of the work is the main motivating factor affecting physicians’ choices of specialty. Especially, younger physicians follow the example set by more experienced colleagues.

Factors Associated with Physicians' Choice of Working Sector: A National Longitudinal Survey in Finland

ObjectiveTo analyse factors affecting physicians’ choice to work in either the public or the private sector.MethodWe undertook a longitudinal data analysis in the years 1988, 1993, 1998 and 2003 (n = 12 909) using a multilevel modelling technique. Factors related to economic factors, physician identity, appreciation as well as demographic factors were hypothesised to influence sector choice.ResultsPhysicians seem to make their career choices prior to graduation, at least to some extent. Wage levels, the physician’s personal characteristics and whether or not the physician knew his or her place of work before graduation were the key factors affecting the decision-making process in the years 1988, 1993, 1998 and 2003. Physicians for whom wages were important were less likely to choose the public sector. Also, physicians who regarded themselves as entrepreneurial preferred to work in the private sector. If a physician had worked in the public sector during his or her medical training before graduation, the probability of applying for a vacancy in the public sector was higher.ConclusionIt is not only economic factors, such as salary, that are involved in the physician’s decision to choose the working sector.

Medical education and the corresponding professional needs of young doctors: the Finnish Junior Physician 88 Study

Summary. The Universities of Kuopio and Tampere in collaboration with the Ministry of Social Affairs and Health and Finnish Medical Association carried out the ‘Junior Physician 88’ study in 1988, the purpose of which was to shed further light on the life situation and future plans of young doctors and their views concerning undergraduate and postgraduate medical education. The study concerned all the doctors registered during the years 1977–1986 in Finland (n= 5208). After randomization, a postal questionnaire was sent to one half (n= 2631) of these doctors. After the first reminder letter, 1745 questionnaires (66.3%) were returned. According to the views of the respondents undergraduate hospital teaching was adequate but the teaching of practice in health centres, school health care, team‐work, health care of the elderly, home health care, rehabilitation, environmental health care and administration did not meet the professional needs of doctors. All doctors were satisfied with the hospital teaching in their undergraduate curriculum. However, only the doctors who graduated from the two modern universities in Kuopio and Tampere were satisfied with their undergraduate health centre teaching.

Where have all the GPs gone – where will they go? Study of Finnish GPs

BackgroundIn this paper a specialist in general practice is referred to as a general practitioner (GP). In Finland only half of all GPs work as a health centre physician. The present aim was to establish what the working places of specializing and specialized physicians in general practice are, and where they assume they will work in the future.MethodsThe study population comprised 5,357 physicians licensed in Finland during the years 1977–1996. Altogether 2,956 questionnaires were returned, a response rate of 55.2%. Those either specializing (GP trainees, n=133) or already having specialized (GPs, n=426) in general practice were included in the study. Respondents were asked what kind of physician’s work they would most preferably do. They were further asked what work they assumed they would be doing in the year 2020.ResultsAltogether 72% were working in public primary health centres and 14% in the private sector. Of GPs 53% and of GP trainees 70% would most preferably work in health centres. Of GPs 14% would most preferably work as private practitioners and 9% as occupational health physicians. Sixteen per cent assumed they would be working as private practitioners and 35% assumed they would be retired in the year 2020. Of GP trainees 57% assumed they would be working as health centre physicians in 2020.ConclusionsAccording to the present findings many experienced GPs will leave their work as a health centre physician. Moreover, several GP trainees do not consider health centre physician’s work as a long-term career option. These trends may in the future reflect a recruiting problem in many primary health centres.

Use of quality improvement methods in Finnish health centres in 1998 and 2003.

Objective. To evaluate how widely quality improvement methods are used in Finnish primary health centres and how the use has changed over five years. Design. Two national cross-sectional postal enquiries. Setting and subjects. The questionnaire in 1998 was sent to every other physician graduated during the years 1977–1986, and the questionnaire in 2003 to every other physician graduated during the years 1982–1991. The response rates were 73.9% and 62.2%. The answers of primary healthcare physicians (n =503 vs. 344) were analysed. Main outcome measures. The availability of 13 quality improvement methods was solicited. The change over five years was analysed. Results. Opportunity to obtain continuing medical education (CME), in-service training, meetings, opportunity to consult a colleague in own speciality, and agreed guidelines on how a certain problem should be solved were highly reported both in 1998 and 2003. The biggest improvement (16.8%) concerned clinical guidelines. There was also progress with regard to quality improvement manuals at the place of work, opportunity to consult a colleague in another speciality, and computer-assisted monitoring of own work. Conclusion. Many quality improvement methods were highly reported in both 1998 and 2003 in Finnish health centres. The biggest positive change concerns clinical guidelines.

Factors associated with general practice specialty training satisfaction – results from the Finnish Physician Study

What Is Already Known In This Area Finland has a well-established specialty training programme for general practice. The views of qualified Finnish GPs on specialty training have not previously been studied. What This Work Adds Qualified GPs were more satisfied than GP trainees overall with their specialty training. Clinical training relevant to the GP’s work is the strongest predictor for satisfaction. Areas of dissatisfaction related to tutoring, administrative training and research. Suggestions for Future Practice Qualified GPs’ feedback could provide a valuable addition to the total transformational quality management of GP training.

The non-clinical contents of GP training need more attention. Results from the Finnish Physician Study.

Abstract Background: The competencies required of a GP are complex and ever-expanding. GP training should adequately cover all the content areas. Objectives: The aim was to assess GPs’ and GP trainees’ satisfaction with their specialist training and with the contents of training. Trends in assessments over a ten-year period were investigated. Methods: Data from Finnish national surveys of physicians conducted in 1998, 2003 and 2008 were analysed with 606, 457 and 324 GPs and GP trainees respectively being sampled in the present study. Respondents were asked how satisfied they were with their own specialist training in general, and how much instruction they had received in 12 specific areas during their specialist training. Results: Satisfaction with GP training slowly increased during the study years. In 2008, 59% of respondents were satisfied with their training, compared to 46% in 1998. The best covered content area was clinical work. Major shortcomings were reported in many of the content areas analysed, e.g. management and leadership. Conclusion: Although the trend in satisfaction with GP training in Finland is for the better, there are shortcomings, especially in many of the non-clinical content areas of training. More attention needs to be paid to these areas in the future.