The Evolution and Challenges of Academic Family Medicine: Insights from the Banja Luka Declaration

Academic medicine is an area of medicine that focuses on education, research and clinical practice. It plays a crucial role in introducing new medical technologies and diagnostic tools, improving healthcare delivery and training new generations of physicians, making it a driving force for the development of medical science and the profession. For more than a decade, the medical profession has been concerned that academic medicine is facing challenges and that fewer and fewer top graduates are opting for an academic career. There are several reasons for this, two of which are particularly important. Academic institutions have often failed to respond to the needs of society and have become isolated in their narrow thinking as a result. In addition, young people have not pursued academic careers for economic reasons. In Slovenia, this crisis is reflected in the excessive focus on the routine management of healthcare challenges. A specific issue is that academic medicine in Slovenia is located between the health and education systems and is regulated by both (1).

Since the second half of the last century at the latest, family medicine has emerged as an academic discipline that contributes to science (2). In 2002, the World Organization of Family Doctors (WONCA) defined family medicine as an academic and scientific discipline with its own educational content, research, evidence-based clinical activity and clinical specialty focused on primary healthcare, and has maintained this position ever since (3, 4).

The importance of family medicine for the various dimensions of family medicine has been summarised in policy documents. The importance of teaching has been emphasised in recent EURACT documents (5). EQUIP, the organisation of the WONCA Network for Quality, has also emphasised the importance of a specific approach to the quality of healthcare (6). The need for development in training and research is considerable, as the European General Practice Research Network (EGPRN) has documented in detail in a series of articles (7, 8).

The academic reputation of general practice is a key factor in assessing its status in different countries. In countries with developed primary healthcare, family medicine is considered an established academic discipline with proven health benefits. However, the World Health Organisation (WHO) has not yet issued a declaration defining family medicine as an academic discipline (9).

Family medicine is constantly evolving and adapting to the needs of the times and society. It is therefore essential that it constantly updates and adapts academically to ensure the best possible training and practice for future generations of doctors. The future challenges in family medicine concern training, research and the quality and safety of clinical work.

Studies are needed to demonstrate quality and safety in GP practice. The academic community should work with other stakeholders and policy makers at an international level to ensure sufficient funding to conduct high quality research. Challenges in clinical practice include ensuring high quality care for all patients, managing the increase in remote consultations, ensuring safety and dealing with the shortage of medical staff. New models of working will emerge and the role of academic family medicine will be to guide and prioritise the benefits of these new organisational models.

The European Academy of Teachers in General Practice (EURACT) has issued several recommendations for training in this area. None of these challenges can be addressed without the support of family medicine as an academic discipline with a strong foundation in universities (10).

The development of academic family medicine is a long process that is not yet complete. In the Southeast Europe region, Slovenia serves as an example for other countries in this respect. Two medical faculties have independent departments of family medicine, both of which teach family medicine to medical students and are integrated into the faculties' curricula. Family physicians attain the highest academic titles and hold leading positions in science and research, both at home and abroad (11, 12). Family medicine is also taught at all medical faculties in the region, but its position within the undergraduate curriculum varies considerably. Most countries have introduced specialist training in family medicine according to EU standards, and actively participate in international academic organisations for family medicine.

From 21 to 22 March 2024, an international conference was convened on the initiative of the deans of the medical faculties of Ljubljana and Banja Luka to address these challenges. The conference was attended by 18 deans and representatives of family medicine departments of medical faculties from seven countries in Southeast Europe, as well as representatives of WHO and UNICEF. The aim of this meeting was to emphasise the role of family medicine as the basis of primary healthcare and to recognise this profession as an academic discipline that has its place in the curricula of medical faculties. The adopted declaration emphasises the importance of harmonising the curricula of the different medical faculties in the region in order to facilitate the exchange of students and staff. The importance of primary healthcare is also reflected in the reports of WHO and UNICEF (13).

At the meeting, the Banja Luka Declaration was adopted, which emphasises the importance of academic family medicine for the development of the field of family medicine and medical faculties in the region. By signing the declaration, the deans reaffirmed their commitment to the promotion of family medicine as an independent medical specialisation with its specific competences, quality standards and research areas. They agreed that family medicine is equal to other medical disciplines, i.e. it is also a scientific and academic discipline with its own approaches to undergraduate and postgraduate education. Family medicine has the potential to actively support the academic development of faculties.

In order to achieve these goals, five initiatives were proposed in the Banja Luka Declaration. These are: Promoting research initiatives in family medicine at the national and international level; Mutual support in providing mentorship for academic development, including doctoral programmes; Facilitating faculty and student exchanges; Promoting interdisciplinary learning and improving the exchange of ideas at all levels of study; and Mutual support in policy dialogues to provide policy makers with collective expertise for effective health policy making.

Although the declaration was signed by academic representatives from South-Eastern European countries, it has the potential to support the wider development of academic family medicine worldwide. This opportunity was recognised by WHO, whose representatives attended the conference. The WHO Regional Director for Europe, Hans Kluge, emphasised the importance of the conference for WHO and stressed that academic family medicine is one of the pillars for the future development of family medicine. Faculties must provide students and trainees with knowledge, skills and attitudes related to the core values of family medicine.

Hopefully, this conference will motivate other countries and medical faculties around the world to join the initiative. For this reason, information about the conference has been sent to WONCA Europe and WHO to disseminate the declaration within their networks.