Giving Voice to Young European Family Doctors
Fabian Dupont is the embodiment of the international family doctor. Recently appointed professor, he has travelled and studied around the world, gained the highest academic qualifications, and is an expert in multimedia communication.
Fabian studied medicine from 2009 to 2017 in Munich, Namur (BE), Lausanne (CH), Madrid (ESP), Bristol (UK), Florida (USA), East & South Africa and Wellington (NZ). He completed his master’s studies in Medical Education and Curriculum Management (MHPE) in Maastricht, Netherlands. In 2019, he won the WONCA VDGM Research Award for his teaching. He has also received the GMA Prize for Innovation in Medical Education. He is active in many German and International organisations. He is an alumnus of the German National Academic Foundation (Studienstiftung des deutschen Volkes), the Max Weber Program, and the Elite Network of Bavaria (Elitenetzwerk Bayern)
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Family medicine practice in Aachen-Frankenberg
“….I realized, at the end of the day, that medicine is probably the only subject where you can combine one profession with something that includes people all over the world. That’s what made me even more interested in medicine and I wanted to see how medicine was done in different parts of the world.”
Lets start at the beginning of your career and your introduction to medicine…
Fabian Dupont: I think I always wanted to be a doctor. When I finished secondary school, I was a bit hesitant because I wanted to do something that involved many different languages and international experiences, which made me doubt if medicine was right for me. But I realized, at the end of the day, that medicine is probably the only subject where you can combine one profession with something that includes people all over the world. That’s what made me even more interested in medicine and I wanted to see how medicine was done in different parts of the world.
DMacA: Tell us about university?
FD: I wanted to do medicine but I wanted to have the international side to it. My surname is French and people everywhere, for some reason, expect me to speak fluent French. Back then I didn’t, so I decided I would start medical school in France because the best way to learn about a country and also its language is to live in it and work or study in it. That was my way into medical school and I learned a lot about the French culture, around learning and medicine, which is very different to how it works in Germany, especially when it comes the approach to medical education. I went back to Germany to continue medical school and I think this is when it really kicked off and I spent time at a large number of different medical schools around the world trying to fit in as many international experiences as I could. I really didn’t plan it in that way but every time there was even a remote suggestion that this could be done in another country, I was the first to put up my hand and say, yes, I want to do it. So I ended up going to many different places during my undergraduate studies.
DMacA: How did that work, and was your university prepared to accredit all this travel?
FD: I did go to a medical school where they were fairly accommodating to international experiences and I really liked that they would go the extra mile to make sure things were accredited. Normally that would apply to maybe one semester and one internship abroad but it was definitely not intended for 13 different medical schools that I got to go to. That was definitely not their intention but it made it easier. And, to be honest, what I think made it possible in the end was that I got a lot of help funding it by different organizations.
Many times people would say, “well, it’s quite unlikely that this will be recognized”, “we can’t guarantee that this is going to be accredited to your degree”. And when that happened I would smile to myself and think, let’s worry about that afterwards. In 80% of the time it was fully accredited to my degree. Some things weren’t but, at the end of the day, I think I learned so much more during these experiences that, while I might have lost half a year from medical school, I got so much more out of it.
DMacA: Thirteen medical schools. That is pretty cool. How do you learn medicine in a language that you’re not fluent in.
FD: That’s a very good question, and there are two sides to it. The academic medicine part, that’s easy. It’s sounds like a paradox but that’s the easiest part of being in another country because most of the words derive from Latin. The academic language is always very straightforward and it’s always the same structure. If you have understood the curriculum, you know there’s going to be this exam and what is going to be relevant for the exam, and you can move forward with it quite easily. You need very little of a country’s language to follow an academic program- that’s my perspective.
But to have a meaningful conversation with someone in the supermarket, that’s where it gets hard. And, it gets difficult when you go to a GP practice, when you need to understand the ulterior motive of someone coming in. It’s not about the back pain, it’s not about this… That’s excellence in language, or in communication.
Your question was, how did I learn the medical part? The academic part was the easiest. It was the social interaction and being with friends where everyone talks at the same time. That’s the part where language is very complicated.
“…. Many people I talked to would tell me, that it’s a fun hobby to have, but it’s not an academic role. If you want to do research, you have to do real research. When I think about it now I smile because medical education is a key element of academia and the role of universities.”
DMacA: So you’ve completed medical school and you went down the specialty pathway…
FD: I was quite keen to go down neurology route, or at least the academic part. But doing research, I realized that what I actually liked most, and I think this might have come up a couple of times now, is that I really liked the education and the communication part much more than the raw data, working with Excel sheets. I preferred educating people. I spent some time in Uganda and in East Africa, where we did a tropical medicine study on Neurocysticercosis, and I really enjoyed the community education part of this program, much more so than actually sitting down working the numbers. I know it’s necessary, and I like it now, but it’s what made me doubt whether neurology was really where I wanted to end up. And another reason for that, I think, was a lack of role models that I could identify with- another topic that became very important later in my work.
I realized that medical education was the thing so I decided to go into medical education and primary care because primary care is the only subject where you can teach general medicine, because general practice essentially is general internal medicine.
DMacA: You’re very modest in your description of your career, because with a doctorate in neurology and going down that specialized pathway, you were a bit of a high flier. So I’d like to ask you about something else- the Max Weber program.
FD: Germany has a few scholarship programs, and they’re quite helpful when you want to go overseas, if you want to go and spend time abroad, because it’s very costly. I went twice to the US, and the US is crazy expensive when you look at how much it costs on a daily basis.
I was very lucky that there is a national scholarship foundation and a regional scholarship foundation in Germany. The Max Weber is the regional scholarship branch of the National German Scholarship Foundation that helps students go abroad. It’s a program to accompany your study and there are many different tracks that you can choose. There’s the financial part, for which I am very grateful. Then there’s the networking part which is very helpful because, it helps you to get into contact with people who might help you organize things which is very helpful for the experiences abroad. You need to have people on the other side to get to these places and have things accredited. And there’s also the curricular aspect to it. And that was very useful. They were soft skill classes, they had academic education classes where you would learn about how academia works, and you could actually start your own seminar series within the network. We started a seminar series that was called ‘Spotlight Neurology’ which was quite successful and was implemented all over the country afterwards. And, it essentially it brings students and professors together who are very keen to share their current work and research and talk about what they do.
DMacA: This was clearly an academic leadership program for high fliers, and which you’ve taken on to the next stage. Tell me about your leadership journey, because you started off with the German Federation and now you’ve moved to the international sphere.
FD: After medical school, I did a Master’s program in Medical Education because I felt the medical education element was really important to me. Many people I talked to would tell me, that it’s a fun hobby to have, but it’s not an academic role. If you want to do research, you have to do real research. When I think about it now I smile because medical education is a key element of academia and the role of universities. I had quite a lot of international experience but after medical school, the first step was to do the Masters in Medical Education in Maastricht. This was, I think, the first step into the international world as a doctor. I did my primary care training in Germany at the same time so I had these two roles at the same time.
At that time, I’d never I’d never heard about EYFDM (European Young Family Doctors Movement), ‘Vasco da Gama’ as it was called back in 2018. And the reason I actually went to my first event in Bratislava ,was that they had a junior researcher award. Back then I had what I thought was a really good idea, and which I still think is very interesting, of a competency based blended learning curriculum for primary care and how you can implement that well in an undergraduate medical curriculum in Europe, and there’s an education and research track to it. I presented that and I was chosen for the junior research award. That’s was my first contact with them, and I really liked the people. And then I met a group of people who said, we don’t really have a special interest group medical education and asked if that was something I wanted to be part of. Then I was elected as the council member and one thing followed another after that and I’m here now. We started our podcast and we have a few research projects on medical education in the EYDFM network.
The European Young Family Doctor’s Movement (EYFDM) Podcast invites interesting guests with extraordinary jobs in Family Medicine. From rural health care, to exciting training opportunities, to the presidencies of EYFDM and WONCA, it’s all there. The podcast is accompanied by a research study: “Podcasts play an important role in modern life and education. Click here for more info: https://forms.gle/JYPkxeZWHUk2Gzeb7
DMacA: Tell us about your innovations in communication, I’m interested in your podcasts.
FD: After this competency based blended learning curriculum was presented, Covid hit us, which was a very bad thing for society, but for medical education, in many ways it was very good. We’d been working on it for two years, implementing all these modules, designing all the cases for students and also for professional actors. And then Covid struck. We were really far advanced in establishing a blended learning curriculum, which we were able to implement very quickly. The university was very quick in accepting this as the main program within a couple of months, because there was nothing else around, which was good, because then I had the opportunity to be in a role where I could make educational decisions and make changes. One of the things that we had implemented as part of this program in Germany was an accompanying podcast. It’s a primary care podcast, focusing on clinical presentation. So that was our first step into podcasting. It’s a medical podcast so it doesn’t have the biggest reach but its got about 32,000 people listening to it. That’s how we got interested in podcasts.
We also identified what we called the ‘Instagram effect’. People had listened to the podcast, sometimes repeatedly, to prepare for the exam, and they have done so in a very different setting to where you would normally read a medical textbook or where you would listen to a lecture. It was a very asymmetric relationship because everyone was at home during Covid. But these students felt really close to specific lecturers and any learning message they would convey would mean quite a lot to these students.
We did this parallel research track on the competencies of the future and one of the competencies, which was important to European young GP’s, was doctors and patients well-being. We did another workshop and that’s when we had this idea. One of the role-modelling effects that we saw with Covid was this ‘Instagram effect’, where people recognize you as a lecturer but you don’t necessarily recognize the people who speak to you. And so we decided to do a study on how people consume podcasts, especially when it’s about, medical career advice or professional identity formation. We proposed that to the EYDFM Council a couple of years ago and they were quite keen to try it out. We got a grant from Saarland University, my home university, and so we got this podcast started in Sydney last year. We started recording and preparing for it in Sydney and that’s how it began and we’re doing a study on it. If you look on Spotify, EYDFM podcast on Apple Podcasts, you can see
The Board of the Young GPs Association
DMacA: Finally, let me ask you about something else that you’ve alluded to in the conversation, but which is very close to your heart and mine. And that’s about the wellbeing of young doctors and how we build that into the future education.
FD: If we look at medical education, and if we look at the challenges that are to come, both in our population and in primary care, we have a scarcity of workforce, we have a severely stretched workforce as it is, and we have an aging population in many countries.
Then there are additional influences on the health care system, be it either politically or by a pandemic, which stretches our workforce even further. And then to top it off, we train our medical graduates for more than a decade to be competitive, to go into a selection process, to always give 110% to, reduce their personal well-being just so they can pass an exam. It gets to a level where it is very threatening to the person him or herself, because life happens at the same time. And people forget about life happening at the same time. And we have a big problem with people dropping out. We have a big problem of people not working full time. We have a big issue with people being overworked or going into burnout. And we will have an even bigger problem, if all this is taken together and extrapolated for the next 2 or 3 decades. So I think this is a change that we need to go through as a society, but also especially as doctors, because we train each other in a way to forget about ourselves during that training.
If you speak to doctors, a very few have found this sweet spot and are content. Very many are very frustrated, very overworked, and feel like they’re being pushed around by bureaucracy, by patients, by standards that they have to uphold. And a lot feel they have very little self-efficacy in their daily lives. And that’s something that we need to change.
There are many different things we have to change and I think the cultural change towards wellbeing, and making this a key element of our future curricula, is one of the key elements that we need to address, especially as an organization. It requires organizational changes, personal changes, but there needs to be a cultural change in how we see doctors and being a doctor.
DMacA: Thank you very much. That’s a wonderful message to end on- the wellbeing of doctors. Thank you very much indeed.
“Very many are very frustrated, very overworked, and feel like they’re being pushed around by bureaucracy, by patients, by standards that they have to uphold. And a lot feel they have very little self-efficacy in their daily lives. And that’s something that we need to change… It requires organizational changes, personal changes, but there needs to be a cultural change in how we see doctors and being a doctor.”
