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Twenty-five Years On: Revisiting Bosnia and Herzegovina after Implementation of a Family Medicine Development Program.
Geoffrey Hodgetts
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4027-8384
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Family Practice.
Background: The wars that ravaged the former Socialist Federal Republic of Yugoslavia in the 1990’s resulted in the near destruction of the healthcare system, including education of medical students and the training of specialist physicians. In the latter stages of the war, inspired by Family Medicine programs in countries such as Canada, plans to rebuild a new system founded on a strong primary care model emerged. Over the next fifteen-years, the Queen’s University Family Medicine Development Program in Bosnia and Herzegovina (B-H) played an instrumental role in rebuilding the primary care system through educational initiatives at the undergraduate, residency, Masters, PhD, and continuing professional development levels. Changes were supported by new laws and regulations to insure sustainability. This study revisited B-H 8-years after the end of the program to explore the impact of initiatives through understanding the perspectives and experiences of individuals at all levels of the primary care system from students, deans of medical schools, Family Medicine residents, practicing physicians, , Health Centre Directors and Association Leaders.
Methods: Qualitative exploratory design using purposeful sampling. Semi-structured interviews and focus groups with key informants were conducted in English or with an interpreter as needed and audiotaped. Transcripts and field notes analyzed using an interpretative phenomenological approach to identify major themes and subthemes.
Results: Overall, 118 participants were interviewed. Three major themes and 9 subthemes were identified including (1) The Development of Family Medicine Education, (subthemes: establishment of departments of family medicine, undergraduate medical curriculum change), (2) Family Medicine as a Discipline (Family Medicine specialization, academic development, and Family Medicine Associations), and (3) Health Care System Issues (continuity of care, comprehensiveness of care, practice organization and health human resources).
Conclusions: Despite the impact of years of war and the challenges of a complex and unstable postwar environment, initiatives introduced by the Queen’s Program succeeded in establishing sustainable changes, allowing Family Medicine in BH to continue to adapt without abandoning its strong foundations. Despite the success of the program, the undervaluing of Primary Care from a human resource and health finance perspective presents ongoing threats to the system.
Keywords
Family Medicine Education, Evaluation, Qualitative, Curriculum Development, Global Health
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CURRENT STATUS: Published
Published
On 13 Jan, 2020
No community comments so far
Editorial decision: Accept
On 03 Jan, 2020
Submission checks complete
On 02 Jan, 2020
Editor invited
On 02 Jan, 2020
Editor assigned
On 02 Jan, 2020
Version 2
Posted 31 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 30 Dec, 2019
Editor assigned
On 27 Dec, 2019
Submission checks complete
On 26 Dec, 2019
Editor invited
On 26 Dec, 2019
No comments provided
Editorial decision: Major revision
On 29 Nov, 2019
Review #3 received
Received 28 Nov, 2019
Review #2 received
Received 19 Nov, 2019
Reviewer #3 agreed
On 15 Nov, 2019
Reviewer #2 agreed
On 13 Nov, 2019
Reviewers invited
Invitations sent on 12 Nov, 2019
Reviewer #1 agreed
On 12 Nov, 2019
Review #1 received
Received 12 Nov, 2019
Editor assigned
On 10 Nov, 2019
Submission checks complete
On 09 Nov, 2019
Editor invited
On 09 Nov, 2019
First submitted
On 06 Nov, 2019
Metrics
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PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
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This preprint is under consideration at BMC Family Practice. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Twenty-five Years On: Revisiting Bosnia and Herzegovina after Implementation of a Family Medicine Development Program.
Geoffrey Hodgetts
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4027-8384
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Published
On 13 Jan, 2020
No community comments so far
Editorial decision: Accept
On 03 Jan, 2020
Submission checks complete
On 02 Jan, 2020
Editor invited
On 02 Jan, 2020
Editor assigned
On 02 Jan, 2020
Version 2
Posted 31 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 30 Dec, 2019
Editor assigned
On 27 Dec, 2019
Submission checks complete
On 26 Dec, 2019
Editor invited
On 26 Dec, 2019
No comments provided
Editorial decision: Major revision
On 29 Nov, 2019
Review #3 received
Received 28 Nov, 2019
Review #2 received
Received 19 Nov, 2019
Reviewer #3 agreed
On 15 Nov, 2019
Reviewer #2 agreed
On 13 Nov, 2019
Reviewers invited
Invitations sent on 12 Nov, 2019
Reviewer #1 agreed
On 12 Nov, 2019
Review #1 received
Received 12 Nov, 2019
Editor assigned
On 10 Nov, 2019
Submission checks complete
On 09 Nov, 2019
Editor invited
On 09 Nov, 2019
First submitted
On 06 Nov, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Family Practice.
Background: The wars that ravaged the former Socialist Federal Republic of Yugoslavia in the 1990’s resulted in the near destruction of the healthcare system, including education of medical students and the training of specialist physicians. In the latter stages of the war, inspired by Family Medicine programs in countries such as Canada, plans to rebuild a new system founded on a strong primary care model emerged. Over the next fifteen-years, the Queen’s University Family Medicine Development Program in Bosnia and Herzegovina (B-H) played an instrumental role in rebuilding the primary care system through educational initiatives at the undergraduate, residency, Masters, PhD, and continuing professional development levels. Changes were supported by new laws and regulations to insure sustainability. This study revisited B-H 8-years after the end of the program to explore the impact of initiatives through understanding the perspectives and experiences of individuals at all levels of the primary care system from students, deans of medical schools, Family Medicine residents, practicing physicians, , Health Centre Directors and Association Leaders.
Methods: Qualitative exploratory design using purposeful sampling. Semi-structured interviews and focus groups with key informants were conducted in English or with an interpreter as needed and audiotaped. Transcripts and field notes analyzed using an interpretative phenomenological approach to identify major themes and subthemes.
Results: Overall, 118 participants were interviewed. Three major themes and 9 subthemes were identified including (1) The Development of Family Medicine Education, (subthemes: establishment of departments of family medicine, undergraduate medical curriculum change), (2) Family Medicine as a Discipline (Family Medicine specialization, academic development, and Family Medicine Associations), and (3) Health Care System Issues (continuity of care, comprehensiveness of care, practice organization and health human resources).
Conclusions: Despite the impact of years of war and the challenges of a complex and unstable postwar environment, initiatives introduced by the Queen’s Program succeeded in establishing sustainable changes, allowing Family Medicine in BH to continue to adapt without abandoning its strong foundations. Despite the success of the program, the undervaluing of Primary Care from a human resource and health finance perspective presents ongoing threats to the system.
Figure 1