Symposiums & Workshops

What does it take to become an expert and to achieve a satisfying career in general practice?

The aim of this symposium is to give an overview of the trajectory from GP resident to a specialist in Finland. We take a glance at what kind of job the residents dream of, and how they assess their competence and reflect their developmental needs in the beginning of their education process. We discuss how GP supervisors’ professional agency is constructed to face the challenges competence-based medical education poses to supervising. Finally, we present the GP specialists’ perception of their training and education and their vision of their future work as specialists. With the invited presentations, we aim to provide ideas on how to improve the quality of GP education and career satisfaction of GPs and their supervisors.

BACKGROUND
Analysis of consultations is the foundation for the consultation skills we teach and should be an ongoing activity to cover new types of consultations in new times of society.
METHODS
An overview of methods for qualitative analysis of consultations with examples.
RESULTS
Interviews can tell how patients and general practitioners understand and experience things. Video recordings of consultations or observation can tell about what they do and how they do it.
CONCLUSION
Consultations are often analysed using other methods than interviews.

Program

Welcome

Ann Dorrit Guassora: Overview of methods: Analysing consultations

Cæcilie Hansen: Conversation Analysis: Relational competence in general practice consultations

Ann Dorrit Guassora: Speech acts: Agenda setting in video consultation in general practice

Jenny Paananen: Conversation analysis: Understanding in multicultural GP consultations

Ingjerd Jøssang: Conversation analysis: How patients’ explanations for medically unexplained symptoms are thematized

Mette Bech Risør: Affect theory: Consultations concerning medically unexplained symptoms
Summing up: Participants’ research and possible networks

General practitioners (GPs) play a crucial role in assessing suicidality, often serving as the initial point of contact for individuals dealing with mental health issues. Given the time constraints in primary care settings, the use of concise assessment tools and interventions is imperative. Within the POKAL research group, the project “suicidality” aims to enhance suicide prevention through various approaches:

1. Interviews: Employing a qualitative approach, the project explores how GPs manage patients with suicidal tendencies, gaining insights into their experiences, strategies, challenges, and motivations. These insights contribute to the development of innovative intervention strategies.
2. Assessment: Developing and validating a brief, primary care-specific questionnaire designed to assess suicide risk and protective factors. This tool provides immediate guidance during the diagnostic process, thereby improving patient care.
3. Systematic literature Review: Identifying concise interventions for managing suicidality in primary care and discussing the most promising options.

News reminds us of ongoing climate change and the deteriorating state of the nature, and increasing evidence shows the threat this poses on human health. Theory supports that loss of biodiversity and auto-immune inflammation are interrelated, while noncommunicable diseases such as diabetes type 2 are strongly interrelated with sedentary living. This symposium presents the concepts of planetary health and global carrying capacity, thereby helping to focus action. We also assess the mental barriers hindering action both in clinical work and society, with a focus on choices that can be made by the general practitioner. Choosing medication, patient guidance and wise use of diagnostics link the risk of over-treatment to global sustainability. If mother Earth was the patient, she would need secondary prevention. However, accurate action can still change outcomes.

Prescribing nature for health
Annika Kolster

Caring for the planet while caring for patients
Hanni Rönnlund

What is Planetary health
Olga Gilbert

Background: The aim of this symposium is to give up-to-date overview about prediabates and diabetes in general practice as well as to introduce results of the Savitaipale cohort study.

Methods: Savitaipale is a rural community in South-Eastern Finland with 4,200 inhabitants. The baseline survey was carried out in 1996-1999, 10-year follow-up in 2007-2008, and 22-year in 2018-2019. All people born between 1993-1956 and living in the Savitaipale were included. Data included questionnaires, clinical assessments, blood tests and information from health registries.

Results: This symposium will comprise the following papers:
• The continuum of dysglycaemia: pathophysiology and  classification.
• Epidemiology and risk-factors for dysglycaemia in Savitaipale study.
• Role of the glucose tolerance test in detecting diabetes and prediabetes: one or two hour test?
• Importance of recognizing dysglycaemia.

Conclusions: We will cover most important aspects of diabetes and prediabetes in general practice.

Mental disorders are typically diagnosed through a comprehensive clinical assessment in general practice. The assessment encompasses a variety of factors, including the patient’s self-report, detailed medical history, observation of nonverbal cues, identification of core symptoms, and the administration of psychometric tests. In this symposium we will present three studies aimed at enhancing and optimizing this process.

Mina Dahli will present results from her PhD thesis: “Mental health problems in Norwegian general practice. Identification, presentation, and diagnosis”.

Ole Rikard Haavet will present findings from the Norwegian study: “Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office”.

Line Thordal Jakobsen will present findings from her study: ”Mental health in patients with type 2 diabetes in general practice: Optimizing the approach for identification”.

Kaj Sparle Christensen will present findings from the study: “Assessment of mental disorders using the Stress Anxiety Depression (SAD) questionnaire in Danish general practice”.

Many consultations in general practice concern mental health issues. Still, there is a lack of non-pharmacological mental health interventions which are evidence-based in a general practice setting. The aim of the symposium is to present findings from existing mental health interventions in general practice and discuss their clinical implications.

We present the feasibility and effects of three intervention studies from Danish and Norwegian general practice. The Healthy Mind Study concerns problem-solving therapy for patients with low mental well-being and a concurrent chronic somatic condition. The Caregiver Care Study focuses on identifying and accommodating the support needs among caregivers to severely ill patients. The ICIT Study includes a structured, work-focused communication tool targeting patients with medically unexplained physical symptoms.

A panel discussion will focus on the way forward for general practice-based mental health interventions, including which patient groups to target, which interventions to deliver, and which professions to deliver them.

The status of primary care education in the Nordic countries is high. Could we strive for even better? New data is emerging in a European survey from 32 countries by the Basic Medical Education Committee of EURACT.
1. The first presentation offers an overview of primary care undergraduate education in Europe in 2023, reflecting the requirements and reality in universities. Especially the northern data is extracted for comparison.
2. Numerous European examples will create hope. Emphasis is placed on Nordic innovations.
3. Ideas about resources and provision of primary care education will be debated in a panel discussion. Is the GP specialist training and continuous professional development in line with undergraduate education, to strengthen the core values as a bedrock?

Interactive methods will be used to activate participants during the symposium.

Feeling lonely, insecure, or not needed by others reduces quality of life and has a negative impact on health, need of health services and mortality, especially among older adults. Changing a patient’s attitudes from passive recipient to active agent in one’s own life may be a solution to improve health and clinical outcomes. Self-care is essential in the treatment of chronic diseases, but capability varies among patients. Supporting self-management requires empowering patient-centered approaches supporting patient’s self-efficacy. This symposium aims to assist participants to recognize important psychosocial issues related to health and wellbeing, to alleviate loneliness and to improve wellbeing through targeted interventions. Presenting novel strategies, including a tool for screening self-care preparedness, nature-based social prescribing and digital community referral, these presentations display person-centered, empowering care models such as “Circle of Friends”, participatory care planning and Forest walks which are promising in improving wellbeing.

Ulla Mikkonen: ”How do we assess self-care preparedness?”
Nina Tusa: ”Does participatory care planning in chronic diseases improve quality of life and clinical outcomes?”
Kaisu Pitkälä: ”Loneliness as a risk factor for health and how to alleviate it among older people.”
Annika Kolster: ”Promoting health by nature-based social prescribing, who needs a referral?”

At the Symposium we will bring together GPs that work with POCUS training from different European countries to give their proposal for the best way to teach and learn POCUS. We wish to contribute to the exchange of ideas which can serve as an inspiration and lay a solid foundation for the use of POCUS in general practice.

By that, meaning that we want to get inputs about the different ways to describe how a curriculum and teaching programmes could be in different countries.

Unsustainable medical overuse and climate changes threaten, among other things, our societies’ ability to provide universal, equitable healthcare. The Norwegian college of general practice has therefore launched a project to bolster the health literacy of the general population by evoking insight that more medicine is not necessarily better for the individual, and to stimulate collective moral engagement, introducing sustainability and solidarity as strong societal values. In the project, we co-develop communication materials and initiatives involving health professionals, patients and citizens. Our aim is to support GP generalism and stewardship of common welfare benefits, and to inform the public about medical overuse, threats to healthcare and climate sustainability, and prudent use of general practice. In the symposium, we will summarize the rationale for the project, present current project outputs and sketch our plans for how the project will be further developed on a national level in Norway.

The symposium will present results and publications from the SOFIA project, which is finalized in 2024. The symposium is therefore a summary of the research results during seven years of research. Throughout the research project we investigated the development, refinement, and implementation of the SOFIA intervention, which introduced extended consultations to patients with severe mental illness in a Danish general practice setting, with the aim of lowering the excess mortality and enhancing the patients’ quality of life by improving detection and treatment of physical symptoms and somatic illness. The symposium will be centered around the following four areas:

• Designing the SOFIA intervention: Fieldwork with patients and practitioners
• Implementing the SOFIA intervention: Challenges in reaching and recruiting patients with severe mental illness in general practice
• Performing the extended consultations in practice: Improving the patient-GP relation
• Moving into the future: The implementation of extended consultations in the Danish General Practice wage agreement in 2022

General practice is the key organisational setting in terms of offering integrated, longitudinal, patient-centered care for patients with multimorbidity. However, to be able to prioritise those whose needs for healthcare are greatest, we need to;

1) understand which patients with multimorbidity are in most need of extra care in general practice,
2) investigate what models of care are feasible and how these affect the patients, general practice, and the surrounding health system and society.

In Denmark, an intervention consisting of an extended consultation for patients with complex multimorbidity is being evaluated in a pragmatic cluster-randomized trial in 250 general practices in 2023 and 2024. In these two symposia, we will present results from some of the research projects connected to this trial, and discuss how we can use these results to continuously improve the way we manage multimorbidity in general practice.

Scandinavian Journal of Primary Health Care, SJPHC, is the scientific journal of the Nordic Federation of General Practice. The journal publishes research related to general practice to facilitate continuing development of family medicine.

Presenting study results in a scientific journal is a core activity for researchers. The steps from preparing a scientific manuscript with high quality and of interest to the journal’s readers, and answering reviewers’ comments are vital for the process.

In this symposium the editorial board of SJPHC presents what happens “behind the scenes” between submission and decision on a manuscript. What are the pitfalls, “dos and don’ts”, for a manuscript to get accepted for a review round and for final acceptance?

The symposium will provide participants, by presentations and discussions with the audience, an opportunity to learn how to write an article that is more easily accepted and to better understand the review process.

Coding of diagnosis in general practice can capture the patient’s problems to adapt the care, help getting insight in own practice, and build a ground for research on primary care. The usefulness is dependent of a correct coding with a well-suited classification system.

The ICPC used in some Nordic countries are developed to capture a broad spectre of health issues, but is not fine-grained. Therefore, in Norway some GPs have used an enriched version of ICPC-2 with a possibility to more detailed coding that improve the insight in the problems seen.

The newly introduced ICPC-3 give the possibility to use more specific codes through a model with regional or national codes. In this workshop we will present a Norwegian tool to assess own coding practice, use of ICPC-2 enhanced version and present ICPC-3. WE aim to use a combination of short presentations intertwined with small group discussion and polls based on clinical cases from daily practice.

The consultation is an arena of importance in general practice. There are several frameworks for consultations skills that are being taught, built from research by Balint, Byrne and Long and further developed into modern frameworks. In the nordic countries different frameworks are used and taught to medical students and trainees in general practice. This workshop will briefly present the different frameworks, discuss their pros and cons and offer a practical role play based training in using them. The work shop will focus on shared decision making as a tool to prevent medical overactivity in the clinical setting, how to reach common ground with the patient and in which way a framework for the consultation can help the GP in doing so.

Continuity of care within general practice entails the consistent delivery of healthcare services by the same healthcare professional or team over time. This involves a provision of care to a patient by a healthcare provider who is well-acquainted with the patient’s medical history, needs, and preferences. Continuity of care is associated with improved patient outcomes, heightened satisfaction, and more efficient utilisation of healthcare resources.

Despite extensive studies, interpreting results can be challenging as research often delves into different qualitative aspects of the concept. Many studies exploring the effects of continuity of care encounter difficulties in isolating its specific impact from confounding factors such as patient characteristics, comorbidities, and socioeconomic factors.

The objective of this workshop is to foster discussions on concepts, methodological pitfalls, and potential solutions in studies focusing on continuity of care in general practice. Emphasis will be placed on studies utilising available registry data in the Nordic countries.

Family Medicine will continue to experience profound change in the coming years. An aging population, clinician workforce shortages, and deepening financial pressures are placing significant stress on healthcare systems. Patients also have readily available alternative health care options from local competition, from virtual care competitors that could come from anywhere in the world, and from outside groups looking to disrupt the status quo in healthcare delivery. To meet patient needs we must redesign and adapt to the changing health care environment.

In this workshop we plan to give an overview of our work on developing innovative workforce models and support systems that utilize new technologies, including AI. These new models are demonstrating significant progress in our goal of transforming our current family medicine delivery model. We also hope to learn from what others are doing and develop potential future collaborations to help us accelerate this critical work.

Obesity has gradually been defined as a disease, rather than a risk factor, although this is still highly controversial. Current diagnostic criteria of overweight and obesity, using Body mass index (BMI), have been criticized for poor correlation with health, and for both over- and underdiagnosing the condition. The rapid increase in weight-reducing surgery and new medical treatments such as GLP-1 analogues, demands a reliable diagnosis to ensure adequate and sustainable use of available treatment options.

The aim of the WS is to discuss how, and if, obesity should be defined and diagnosed, and to explore the impact on general practice. Current and proposed definitions of obesity will be presented and reflected upon from clinical and scientific perspectives. Discussions will take place in groups as well as collectively. The result will be included in development of guidelines.

In this workshop, we want to gather aficionados and constructive skeptics of eHealth to form a future Nordic Network of eHealth in Primary Care. Experiences with the forced rise in digital consultations in primary medical care during the COVID-19 pandemic call for an evaluation of the current “new normal” situation. This workshop starts by providing an overview of the status and ongoing research on key examples of digital consultations in Denmark, Finland and Norway (such as video consultations, chat, e-consultations and telephone consultations). Next, participants are invited to share their perspectives and unanswered questions. The aim is to delineate a path forward for future collaboration, including the establishment of a Nordic Network of eHealth in Primary Care. Emphasis is placed on cultivating essential knowledge and evidence to support a clinically meaningful, equitable and organizationally sustainable integration of digital consultations in the context of Nordic welfare systems.

Digital decision support and artificial intelligence play an increasing role in general practice, both in and outside office hours. Technology is seen as a possible answer to the high workload, for example telephone triage tools for optimal redirection, symptoms checkers for self-triage, and chatbots for communication with patients about management of minor ailments. Yet, evidence-based knowledge seems to be limited. What is known, which experiences exist, and which aspects do we need to have a focus on in future research?

In this workshop, we walk through existing evidence, open up for sharing experiences, and end with a discussion that will be guided by critical reflections on dominating discourses, quality in communication, and ethical issues such as trust and privacy.

Background
Continuous quality measurement is quite largely introduced in Nordic general practice. However, many GPs and primary care organisations struggle with turning the quality measures into actual quality improvement (QI). During last decades, Nordic organisations supporting quality in general practice have gained experience and understanding about the important elements of successful QI interventions.

Aim and learning objectives
To share and discuss real-life examples of successful (or unsuccessful) QI interventions in Denmark, Finland, Island, Norway and Sweden.

Method
Workshop starts with a presentation about the common barriers for QI in Nordic countries and is followed by short oral presentations from each of the Nordic countries. Each presentation is followed by a short discussion. Finally, each presenting organization will host group-work and informal discussion with the congress participants (see detailed program below).

Conclusion
By completing the workshop, participants will gain information and inspiration for carrying out successful QI interventions in general practice. They will also know more about the barriers for QI and get concrete ideas on how to overcome them.

Private health insurance has become increasingly common in several Nordic Countries. Surveys from Denmark and Norway have found that GPs sometimes refer patients holding private health insurance without further clinical consideration, although most of the GPs associated private health insurance with overtreatment and inequality in health. Perceived pressure and negative reactions from patients are associated with accommodating to requests rather than acting as a gatekeeper.

To support GPs in their gatekeeping role, Choosing Wisely Norway published in 2020 a recommendation to avoid referrals covered by private health insurance that are not medically warranted.

Self-reported implementation of the recommendation is associated with already being committed to the gatekeeping role.

The researchers will present the studies and Choosing Wisely Norway. Through this workshop we will discuss challenges of GPs´ gatekeeping role regarding referrals of patients holding private health insurance, and future solutions for both societies and healthcare services.

The concept of sustainability pertains to situations where it is urgent to avoid depleting resources to ensure the ability to meet future needs. Health care produces 5% of global CO2 emissions, and these emissions should be curbed as quickly as possible. However, general practice can play a broader role in avoiding medical overuse and improving the sustainability of universal, equitable health services. And general practice can contribute to many aspects of sustainable development as indicated by e.g. UN-SDG 10 (reduced inequalities), 11 (sustainable cities and communities) and 12 (responsible consumption or use of resources). In the workshop, we will present general practice initiatives to bolster sustainability in the Nordic countries, with a main focus on salutogenesis and reducing medical overuse and climate emissions. The discussion topic will be how to bring these initiatives forward among the Nordic countries, and promote universal and equitable health care and sustainable development in general.

The aim of this workshop is (i) to increase the awareness and knowledge between climate change and health and how to deal with it in clinical setting; and (ii) collectively explore our everyday working life and actions to reduce greenhouse gas footprint, how to engage coworkers and patients.

Methods
This workshop will start with presentations from doctors from Denmark and Sweden and how they have worked for reducing carbon footprint in clinical setting. There will be a presentation of clinical cases with specific examples for inspiration before inviting participants for a discussion on how they can greenify their professional activities.

Climate change and environmental pollution have a direct effect on health. In addition, healthcare is one of the causes of climate change and pollution, and thus a threat to the health of patients. GPs should think about how they can promote the health of their patients in a way that does not unnecessarily burden the environment. This concerns lifestyle advice that promotes both health and the environment. It concerns choosing treatment that is medically optimal, and protects the environment. It’s about sustainable housing, materials and transport. And GPs need to be aware of changing epidemiology and emerging diseases due to climate change.

After playing the ’GP & Planetary Health Game’, the awareness of the participants about the consequences of climate change for health has increased. They have more knowledge about the contribution of healthcare to climate crisis and pollution. They discussed their responsibility and received tools for their own practice.

Current European guidelines recommend that general practitioners intervene to reduce the risk of cardiovascular disease (CVD) for an ever-larger proportion of the general population, and through increasingly complex care pathways. While this may have benefits in terms of fewer cardiovascular events, estimates suggest that GPs who aim to implement these guidelines will end up spending all their time available for patient care on CVD prevention only – and yet fall short. We aim to shed light on the dilemma and discuss possible strategies to manage it.

The following introductory presentations will be given:

• Screening for hypertension – opportunistic or universal?
• Treatment goals for hypertension: What is the evidence?
• Lipid lowering treatment – treat to target or fire and forget?
• Lipid lowering treatment and the legacy of Anders Forsdahl

Small-group discussions will center around the following questions:

• Is the development towards stricter guideline recommendations feasible and sustainable? What is your approach?

Clinical practice is never simply straight forward. Doctors are practicing complex competencies in a clinical world embedded with uncertainty and where the textbook knowledge only provides some of the answers. Clinical decision-making therefore requires that doctors can combine experience-based knowledge with evidence-based knowledge, but also that doctors can constructively process all kinds of formal and informal feedback.

The ability to reflect is necessary for efficient use of feedback and essential for clinical practice in order to handle complex competencies. It has been argued that the ability to reflect on one’s own role and performance is the key factor in expertise development. It therefore seems rational to try to teach and assess it in medical specialist training.

In this workshop we will present Global Assessment of Reflection Ability (GAR) which is a newly developed assessment tool. It includes a preparation phase in which the trainee produces a mind map or similar written presentation and subsequently a structured conversation between trainer and trainee with focus om formative aspects and reflection on the trainee’s own practise.

Validation studies have shown good feasibility and acceptability among both trainers and trainees. The time consumption is relatively low which makes it possible to conduct several GARs during a learning process.
During the workshop we will present data from our validation studies and the participants will be able to try out GAR in small role plays.

Reference:
Lillevang G et al. How to enhance and assess reflection in specialist training. A mixed methods validation study of a new tool for global assessment of reflection ability. BMC Medical Education (2020) 20:352

Leadership, hiring, supervision, visions, structure, working environment, dreams, future, problems, and opportunities. All these are areas that general practitioners deal with in their everyday life. But when it comes to passing these leadership skills on, it is something both general practitioners and trainees often find difficult to go about.

The aim of the workshop is to inspire supervising general practitioners how to open the door to the management room for their trainees and to inspire trainees how to reach out and go about questions to improve their leadership skills during specialisation.

The workshop will give an introduction to the topic and to the “specialists in leadership” campaign among general practitioner trainees in Denmark. The workshop will combine small group discussions of leadership cases in groups of 5-7 persons, plenary discussions and polls using interactive response applications based on cases from daily general practice leadership.

All fields of medicine, not the least general practice/family medicine (GP/FM), need ambitious qualitative research characterized by consistent theoretical grounding and thorough analysis. An interesting question, however, arises regarding the readiness of medical doctors for such academic endeavors. In this symposium, we will discuss what we currently see as dilemmas, possibilities, and potential ways forward regarding the quality of qualitative research in GP/FM.

First, we will introduce core ideas about what high quality in qualitative research might mean in practice. Next, this will be illustrated by “case” examples where qualitative researchers in/on the field of GP/FM from Norway and Finland, with reference to their own empirical studies, reflect on their personal journeys and evolution with attention to research quality assessment in design and methodology. Ultimately, active audience engagement is invited to foster collaborative insights, enhancing the robustness of qualitative research within the field of GP/FM.

We have common challenges in general practice specialist education in the Nordic countries. Population migration to centers is associated with concentration of services and subsequent lack of doctors in rural areas. These have implications on specialist training as we will have to solve wicked problems such as:

• How to ensure the rural areas can get doctors (and nurses)?
• How to organize supervision and workplace-based assessment of trainees in rural health centers, possible without a trainer on the premises?
• What is the role of remote work or telemedicine during specialist training?

Wicked problems are the ones with many interdependent factors making them seem impossible to solve. Because the factors are often incomplete, in flux, and difficult to define, solving wicked problems requires a deep understanding of the stakeholders involved. In the workshop, participants will be actively involved in finding concrete solutions.

Practice based research networks (PBRNs) have been set up successfully in several European countries including Finland and Norway. PBRNs are instrumental to high quality research in general practice. The benefits of such networks are ample: Researchers get easy access to GPs and their patients, GPs and their patients are offered the opportunity to participate in research, links between academic institutions and GPs are strengthened, and there is great potential for collaboration between PBRNs in different countries. Thus, PBRNs foster a culture that makes research in general practice possible and feasible.

We aim to inspire GPs and primary care researchers to get involved in PBRN based research. Ultimately, some participants may want to set up a PBRN in their own environment. The workshop will include presentations of examples, opportunities and challenges for PBRN based research, small group discussions focused on research ideas and possibilities for future collaboration across the Nordic countries.

Two short lectures followed by interactive activities led by the Swedish researchers.

Clinical decision making is increasingly challenging in general practice. On one hand timely and precise diagnosis is warranted to improve health outcomes for a range of cancers. On the other hand, the individuals’ quest for answers about their health, enhanced by the vast dissemination of new health technologies, private health insurances etc., must be counterbalanced to reduce inappropriate resource utilization and adverse health outcomes. Concern for severe disease among patients and GPs awareness of timely diagnosis also plays a significant role in the decision-making processes.

The purpose of the workshop is to induce reflections upon cancer diagnosis in own clinical practice. We will combine research-based evidence with knowledge and experience from clinical practice through actively engaging discussions with the participants.

This workshop highlights and integrates Core Values 2 and 4 from the Nordic Federation of General Practice, by focusing on timely, warranted diagnosis and treatment, and person-centered, evidence-based medicine.

Along with a greater demand on the general practice workforce, both young and older doctors seem to have an increasing interest in flexible working conditions in general practice. This includes working as rotation doctors (Nordsjøturnus), as locums or part time. How does the increasing future need for physician workforce in general practice align with the physicians’ desire to work in more flexible ways? And how does these ways of doing general practice affect aspects like:

• Continuity of care
• Local knowledge
• Patient Safety
• Professional development/specialization

We will present relevant research from Norway and Denmark. In groups and plenary, we will discuss flexibility in general practice work, the consequences of it as well as the need for future research in the field.

Aim: To build a Nordic research network on flexibility in general practice work.

General practice is the key organisational setting in terms of offering integrated, longitudinal, patient-centered care for patients with multimorbidity. However, to be able to prioritise those whose needs for healthcare are greatest, we need to answer the following questions; 1) which patients with multimorbidity are in most need of extra care in general practice, 2) what kind of extra care is needed and 3) if we implement such an extra care model, how does it affect the patients, general practice, and the surrounding health system and society? The workshop consists of three parts addressing each of the three main questions. For each question, we follow a three-step approach: Firstly, a researcher presents the current knowledge in the field. Secondly, the participants reflect on the presentations and how these correspond with their values and priorities, and thirdly we facilitate a plenary discussion.

General practitioner (GP) Cathrine Abrahamsen has developed and tested a structured communication tool as part of her PhD. This structured communication tool named, Individual Challenge Inventory Tool (ICIT), is based on cognitive-behavioral therapy (CBT) principles, is specifically adapted and found feasible for the primary care setting 1. The structured communication tool ICIT, which promotes a possibilities-focused approach instead of fixating on limitations, has been demonstrated to reduce sick leave, enhance function and quality of life, and alleviate symptoms for patients with medically unexplained physical symptoms 2. Over the last two years, more than 500 Norwegian GPs have enthusiastically participated in ICIT training.

During this workshop, you will gain knowledge about the development, feasibility, and efficacy of a structured communication tool. You will have hands-on experience testing segments of the tool and engage in group discussions about the potential implementation of this tool in other countries.

References
1. Abrahamsen C, Lindbaek M, Werner EL. Experiences with a structured conversation tool: a qualitative study on feasibility in general practice in Norway. Scand J Prim Health Care 2022: 1-7.
2. Abrahamsen C, Reme SE, Wangen KR, Lindbæk M, Werner EL. The effects of a structured communication tool in patients with medically unexplained physical symptoms: a cluster randomized trial. Eclinicalmedicine 2023; 65.

Background: To address the increasing burden chronic diseases, personalized preventive care is needed. Many problems have a multidimensional background and effective collaboration with public health and social domain is needed. Positive Health, as the elaboration in six dimensions of the general concept ‘Health as the ability to adapt and to self manage, in the face of social, physical and emotional challenges’ has been implemented in the Netherlands and abroad.

Objectives: In the workshop participants will understand the essence of Positive Health, will experience it for themselves and learn how to apply the tools into practice with their patients. The implementation and research so far in the Dutch primary care and the first experiences in Iceland, Germany and Belgium will be shared.

Take Home Message: Positive Health can be a solution for the health challenges we face today. It empowers patients, resilient communities and stimulates working pleasure in the GP practice.

Children’s health and needs change over time. In the modern context, general practitioners (GPs) observe a shift from infectious diseases and malnutrition to predominantly social and mental issues in children and their families. The GP has a pivotal role in ensuring the holistic well-being of children. The ’Children in General Practice’ research group in Copenhagen will present findings from a comprehensive study aimed at augmenting psychosocial elements during pediatric consultations in general practice.

This workshop will:

• Unveil research findings on psychosocial assessments.
• Tackle key topics including:
• Identifying age-related vulnerabilities.
• Strategies for recognizing psychosocial vulnerabilities within the GP consultation framework.
• Discussing a child health record tailored to psychosocial indicators.
• Navigating triadic communication dynamics involving the parent, child, and GP.

Participants will gain insights into the latest research and contribute to the advancement of pediatric care practices in general practice.

Most healthcare workers probably find empathy an important trait when working with patients. We know that empathy improves communication between healthcare workers and patients, improves patient satisfaction, treatment compliance and clinical outcomes. Establishing an empathic relationship with our patients can lead to fewer conflicts and complaints and also can increase healthcare workers work satisfaction. Despite its importance, not all medical schools and workplaces put enough effort into cultivating empathy. Findings from several studies suggest that empathy is a skill that can be developed and strengthened over time. While some people are naturally more empathetic, it’s a trait that can be cultivated through intentional efforts and practice. In this practical workshop we will introduce some exercises that can be used while teaching medical students and training healthcare workers to try to put them in patients shoes and thereby cultivate and enhance empathy.

GPs report a lack of tools to use when facing patients with relationship problems. Relationship problems are important risk factors for several health problems, and sexuality is an essential part of an intimate relationship. Patients with chronic disease and disabilities will often undergo changes in sexual functioning. This is rarely addressed by health care workers and opportunities for helpful support are missed. Tools are available to enhance sexual functioning, also by prescription from the doctor.

Sexual dysfunction has various explanations and is a common issue presented to GPs. Despite various medical explanations, the quality of the relationship remains the most crucial factor for individuals to be content with their sexual lives.

The objective of this workshop is to present research-based tools for assessing and strengthening couple relationships and sexual health. Additionally, we aim to discuss how these tools can be implemented in a GP practice.

Doctors’ professional wellbeing is associated with better quality of care for patients. With increasing professional experience, GPs develop coping methods supporting work-related wellbeing. During early 2024 the Nordic young GP (NYGP) network is carrying out a survey to learn more about young doctors’ professional wellbeing and factors that support resilience, dividing them into those related to 1) the workplace 2) personal wellbeing and work-life balance and 3) the education program.

At this workshop, we wish to invite to a discussion about resilience and how to promote wellbeing based on results from the NYGP survey. As the healthcare systems and specialisation programs are organized differently in the Nordic countries, discussion with international peers can give insight into building coping methods, thereby improving one’s own professionalism.

By identifying useful strategies supporting joy at work and during specialisation, we aim to influence the development towards a sustainable work climate in general practice.

GPs would need to work 27 hours per day to follow all primary care guidelines. Guidelines are intended to improve quality of care, but if we followed them, the healthcare system would collapse.

The “Time Needed to Treat (TNT)” is a new method, recently published in The BMJ, to estimate how much of the available clinician time that would be needed to implement a specific recommendation. TNT is intended to help guideline panels consider clinician time as a finite resource, and as a tool for clinicians to communicate about unreasonable recommendations. The agenda is to increase the likelihood that we spend our time on the issues with most importance to the individual patient, and with the patients with the greatest care needs.
Participants will learn to estimate TNT, and explore the usefulness, applicability, and feasibility of TNT in their contexts. We will also seek input to develop the TNT concept.

Clinical placements in medical education are necessary to integrate theoretical knowledge and practical skills through workplace learning. In Norway, mandatory placements in primary care are about to extend from 8 to 10 weeks, at the same time as competence requirements for clinical supervisors are strengthened and the number of medical students increases. Simultaneously, universities experience recruitment and retention difficulties among general practitioners as supervisors. The backdrop of the “GP crisis” also affects medical students’ training possibilities.

How should medical education meet these challenges?

Which actions are needed to make it attractive for GPs to become clinical supervisors?

“FRONESIS” is a Greek term often translated to “practical wisdom”, and the name of an innovative research project aiming for “More clinical placement sites and better supervision for medical students in general practice”. We want to share thoughts behind and preliminary results from this project as basis for discussion on these shared challenges.

Palliative care (PC) improve quality of life of patients and their families as well as promote a more appropriate use of health services. GPs have the potential to be a key player in the coordination and continuity of PC in the home of dying patients. In Denmark, the Danish College of General practice, has developed and disseminated a PC guideline from 2014. However, the delivery of PC to patients in primary care, may not be optimal due to limited knowledge combined with a lack of continuity, tradition and incentives.

In this workshop, we aim to identify present opportunities and challenges in contemporary palliative care in general practice, and to discuss ways to improve current practices.

We will invite Nordic GPs to share their experiences with the delivery of high quality PC. Furthermore, we will present a newly developed systematic tool to address the palliative need for patients, and ask participants to share their feedback on the tool.

The workshop will include a combination of short presentations, individual reflections and group discussions. Discussions will be facilitated by moderators and include different prompts (e.g. vignettes and practice tools).

Knowledge from the workshop will be used as empirical data in an on-going research project on palliative care in primary healthcare.