Evaluating the International Fellowship in Family Medicine

Kay Mohanna

The University of Worcester School of Allied Health and Community in conjunction with Midland Faculty of the Royal College of General Practice (RCGP) has developed, with the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka, a twelve-month, post-MD International Fellowship. Its leads are me, representing the University of Worcester, and Professor Antoinette Perera of the University of Colombo.

The University of Worcester has a licence to issue up to ten annual Certficates of Sponsorship for tier five visas. To begin with, a proposal was made several years ago to the Pro Vice Chancellor for Research, Dr John Paul Wilson, to accept four Sri Lankan post-MD fellows as visiting researchers for one year, to carry out the first arm of a two-centre study (Worcester and Colombo) research project, with the aim of publication in a peer reviewed journal . This scheme does not enable General Medical Council registration but clinical attachments are provided. In the first year of the scheme these included St Richards Hospice, Worcester; Davenhill Surgery in Bromsgrove and Corbett Medical Practice in Droitwich.

A Memorandum of Understanding between the University of Worcester and the University of Colombo’s Postgraduate Institute of Medicine was signed. The latter selected the first four trainees who arrived in 2016.

Trainees are encouraged to look for training and educational opportunities which are not available in Sri Lanka and to take back that experience to further strengthen Colombo’s postgraduate programme and family medicine in general in Sri Lanka. Placements in practice aim to strengthen their capabilities as future clinic heads with knowledge of service improvement, employment, health and safety and quality assurance issues.

Colombo’s Postgraduate Institute of Medicine pays a monthly stipend to each trainee for living costs plus support for computers, books and materials as needed. It also covers travel expenses to and from the UK. The University of Worcester sends a ‘Living Certificate’ to the University of Colombo every three months to confirm satisfactory attendance and trigger this stipend. Some National Teaching Fellowship funding has been used to buy bedding and a basic ‘Welcome Pack’ of groceries on arrival. In the pilot year, the University of Worcester made no charge for the scheme or any of the teaching or included educational activities. Neither did the clinical supervisors in practice. Through the generosity of the Midland Faculty of the Royal College of General Practitioners, free attendance was given at professional development events.

An initial evaluation of the scheme was based on exit interviews with all four of the Sri Lankan GP Fellows, written reports from their clinical supervisors, regular appraisals and the trainees own written portfolios and reflective statements.

Overall the first cohort of trainees felt that the clinical placements were successful. One remarked that by ‘participating the Clinical Commissioning group meetings, Practice Quality improvement meetings and referral management meeting I got an insight about how the National Health Service UK is supervising and commissioning the UK primary care system, which is lagging in Sri Lankan setup.’ Another said that ‘I, with my other colleagues got the opportunity to visit the RCGP head office in Euston Square London and meet and discuss matters pertaining to our training and its future
developments, with the RCGP international chair, which I think is my duty to uplift the Family Medicine in Sri Lanka.’

The President of the College of GPs in Sri Lanka, Dr Carmel Fernandopulle, has written to the RCGP president Dr Terry Kemple, commending the Worcester scheme. Trainees have met the President, the Chair of International Committee and the Head of RCGP International who are all now aware of the difficulty faced by Sri Lankan GPs wishing to become consultants in their own country by accessing overseas experience. The Chair of the Sri Lankan College of GPs visited London during the pilot year to approach the RCGP.

There is a long way to go before the regulations about the recognition and GMC registration of international doctors in general practice can be addressed in law, but the success of this programme is part of the case being made by the RCGP.

Since the pilot we have had a total of ten Fellows who have each attended for a year and they have been mostly attached to my practice, the Darwin Medical Practice in Lichfield, thanks to the support of my partners. Research projects have included optimising wound care, factors associated with exacerbations of COPD and ‘belongness’ in GP education. The most recent Fellow was recalled at the start of the present global pandemic by the Sri Lankan government along with all UK based Sri Lankan training Fellows, to join with their COVID response. Two more are awaiting COVID induced changes to international travel to make an application to come to the University of Worcester. Following their year in the UK all of the Fellows have received promotions to Consultant in General Practice and taken up positions as clinic leads. The project has also resulted in an article published in the British Journal of General Practice with another to follow shortly.

Kay Mohanna is Professor of Values Based Healthcare Education, University of Worcester.

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