EDUCATION. Course coordinators, supervisors, former students, and others recently gathered to celebrate the Early Professional Contact (EPC) course that has been offered for 20 years. A new version of the course is being launched in the new medical program, where general medicine and primary care are given greater scope in the clinical-based training of the medical students.
Much time, love, and commitment went into the Early Professional Contact course, which made its debut in the autumn of 2001. This became clear during the seminar on Thursday, February 23, celebrating the twentieth anniversary of the course. The seminar was followed by refreshments at General Medicine’s premises, which were decorated for the occasion.
The Early Professional Contact (EPC) course was offered in the first four semesters of the old medical program. The new medical program admittedly allows less time for EPC, but more attention is given to general medicine and primary care. We will return to this topic below.
Students wanted experience from the medical care system
The course was developed in the late 1990s by a teaching team at the former Department of Community Medicine. The Swedish National Agency for Higher Education had conducted a national evaluation of Sweden’s medical programs which identified various weaknesses. The National Board of Health and Welfare’s study of the medical care system and its conditions also identified shortcomings in the general objectives of the education. The medical program in Gothenburg rests on a long tradition of given great weight to the natural sciences. As the EPC course evolved, the early years of the program focused entirely on helping students gain a solid foundation in basic scientific subjects. However, many of the students were eager for work experience in the medical care system at an early stage, such as that already introduced in many other medical programs in Sweden.
Gunilla Hellqvist, a specialist in general medicine, was tasked with leading the development of the new course, and she eagerly took on the assignment.
“I felt it was my calling. I thought it was incredibly important to get the course started on a good footing, based on both my own experiences from my time as a medical student and the stories of the students who had their first encounter with the medical care system in their fifth semester, which could sometimes be shocking,” Hellqvist says.
The team developing the course emphasized finding dedicated and clinically experienced physicians in health centers and inpatient care and providing them with really solid supervisor training. Sven Johansson, a retired doctor specializing in general medicine and former district physician at Askim Medical Center, was one of the early members of the EPC course and was present at the anniversary seminar.
“It has meant a lot in allowing me to broaden my work as a district physician and impart my experience and knowledge to the next generation. Clearly, it served as a great motivator of students to get out into clinical work and meet patients,” Johansson says.
Increased acceptance
Gunilla Hellqvist also became the first coordinator of the Early Professional Contact course. She tells us that the new course initially met with resistance on Medicinareberget:
“World-class biomedical researchers questioned what students would do in the medical care so early in their education. They presumably could only engage in simple study visits because the students did not yet know much about pathology. Above all, many of the teachers feared that students would fail to concentrate on basic science studies,” Gunilla recalls.
“Of course, we did not intend to have students making diagnoses, but we considered it important for them to meet patients early, to be able to ask about how patients experience being in a hospital and how they are affected by their illness,” says Bernhard von Below, a specialist in general medicine, former district physician at Floda Medical Center, and one of EPC’s early course coordinators.
When the course began, several scientific and educational studies were initiated on its efficacy and how it was received, with results being published in medical journals like Läkartidningen and presented at several conferences.
“One of the studies showed that Early Professional Contact actually increased student motivation and interest in embracing basic science teaching. It became a turning point for the opposition to the course,” von Below recalls.
The students completed their clinical-based training within EPC in small groups–four students in each group. Half of the course started in inpatient care and the second half in primary care.
For the first course, supervisors from general medicine, internal medicine, geriatrics, medical rehabilitation, and surgery were recruited. Later gynecologists, orthopedists, ophthalmologists, and doctors in the field of child and adolescent psychiatry also took part. All medical doctors received four days of training on the course’s purpose, design, knowledge basis, core values, content, teaching approaches, and group dynamics.
Creative writing provides perspective
The course also incorporates a humanistic world view, where individuals and their entire life situation have a bearing on illness and recovery. The author Merete Mazarella, a former professor emerita of Nordic literature at the University of Helsinki, taught the medical students creative writing. Mazarella formerly played an active role at Uppsala University, where she had also been appointed an honorary Doctor of Medicine. Her intent was to give aspiring medical doctors access to a language other than strictly medical parlance, increasing the possibility of seeing things in new perspectives.
During her brief talk, Mazarella noted, “The ingenious aspect of the humanities is that opposing truths can be equally true.
I sincerely hope that the opportunity to discuss and interpret texts in groups will remain a part of medical training. The need is really even greater in more advanced semesters, where the pressure on students has increased and the humanities provide a welcome opportunity to express their views.”
Returns in the new medical program
From the start the course was based on explicit educational principles suitable for the objectives and content of the course. Student-centering was and remains an important watchword. This principle continues to characterize the teaching of EPC. Although the scope of the Early Professional Contact course has been reduced to the first two semesters, its sister course Consultation Knowledge continues the theme.
The shift toward Close Care has led to an increased focus on primary care and general medicine in the new medical program. The program now has a total 68 days of clinical-based training in primary care, including 35 days (seven weeks) in the twelfth and final semester.
Read this article on EPC (in Swedish, with English summary) in the September 2005 issue of Läkartidningen: https://lakartidningen.se/klinik-och-vetenskap-1/2005/09/tidig-yrkeskontakt-starker-brstudenternas-professionella-utveckling/
BY: ELIN LINDSTRÖM
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