A Three-Month Internship in the Field of Family Medicine: an Inevitable Shortcut to Training the Human Resources Needed for the Family health Program

Letter to the Editor The family physician program in Iran was initially implemented in rural areas in 2005 and later expanded to cover urban communities up to 20,000 population(1). In this program, the family physician team serves as the first point of contact for patients within the healthcare system, and the family physician, as the central element of this team, requires competency in various medical and interpersonal areas. However, this program faced challenges that led to inconsistencies in the training of the required workforce. Efforts to strengthen the training of family physicians included introducing programs leading to certification and modular courses. Despite these efforts, challenges such as lengthy training schedules and uncertain outcomes, as well as limited acceptance, led to a lack of appeal for the general physicians(2). Despite the changes in the national general medical education program, in order to address this issue and to announce it in 2017, a national survey was conducted in 2021 to assess the extent of using the capacities of this national educational program to increase the presence of medical students in the healthcare fields. Severe weaknesses in the use of these capacities and the establishment of a family medicine internship program (optional or mandatory) were still observed. In such a way that only 37% of the educational programs of medical schools showed signs of a maximum one-month presence of interns in the field of family medicine (3). The General Medical Education Secretariat of the Ministry of Health began to address and diagnose this problem from the same year. After numerous expert meetings, using the six-element Carnegie model for educational change (4), it moved towards establishing family medicine internships as relatively long-term programs. In the first phase of these changes, it took action to implement a three-month internship in family medicine at 15 medical universities in the country. The elements of the Carnegie six-element model include: identifying problems with a user-centered approach, focusing on performance change, viewing the entire system as a factor in creating the current situation, determining success indicators and measurement methods, regular research for system improvement, and accelerating learning through the formation and enhancement of networked communities(4). Now, nine months after the announcement of these changes in leading universities, a rapid survey conducted at 15 universities shows that the situation of using family medicine educational field has visibly changed. Not only independent one-month family medicine internship programs have been launched in over 90% of these universities, but also more than 60% of these universities report the implementation of two to three-month independent family medicine internships and a range of changes in educational programs for medical students' participation in family medicine even before they start their internship. This rapid pace of change, in conditions where medical universities are facing financial and human resource shortages, indicates the suitability of the change model used to implement changes in the educational program. Certainly, this path has not been without its challenges, including issues such as a lack of physical space and human resources in the field of healthcare, a shortage of faculty members among family medicine, community medicine, and even trained family physicians for education, the high volume of traditional block-based internship programs, the need for an integrated and unified curriculum for a three-month family medicine internship, misinterpretation by some senior university officials regarding the training program in the healthcare system and its comparison to hospital-based training programs, the absence of a defined payment system for family physicians collaborating in education, and the lack of an efficient referral system in most universities involved, as reported by 15 participating universities in the intervention program. However, considering the serious determination of the Ministry of Health and Medical Education to launch an urban family health program and the urgent need for capable personnel to carry out this important task, it seems that, based on the recent rapid survey results, the implemented changes have been able to achieve acceptable results in the short term. According to the implemented planning, it appears that a unified family medicine internship program will be established in all medical universities of the country from the beginning of the 2024 April.