📄 medicine

Provision of European undergraduate primary care education and placements: A cross-sectional questionnaire study

This cross-sectional study of 32 European countries reveals significant disparities in the quality and quantity of undergraduate primary care teaching, highlighting systemic discrimination against primary care educators and the urgent need for pan-European policy reforms to address workforce shortages and public health concerns.

Original authors: Alexander Harding, Odd Martin Vallersnes, Natalia Zarbailov, Sonata Varvuolyte, Anisia Jicol, Francesco Carelli, Inguna Ločmele, Anne Simmenroth Simmenroth_A@ukw, Helena Karppinen

Published 2026-06-30

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Alexander Harding, Odd Martin Vallersnes, Natalia Zarbailov, Sonata Varvuolyte, Anisia Jicol, Francesco Carelli, Inguna Ločmele, Anne Simmenroth Simmenroth_A@ukw, Helena Karppinen

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the European healthcare system as a massive, intricate orchestra. For the music to sound good and keep the audience (the public) healthy, you need a strong foundation. In this orchestra, Primary Care (PC) is the rhythm section—the steady beat that keeps everything together, handling everyday health issues before they become emergencies.

However, this paper suggests that the orchestra is struggling to find enough rhythm players, and the music school (medical school) isn't doing enough to teach students how to play that specific instrument.

Here is a breakdown of the study "Provision of European undergraduate primary care education and placements" using simple language and analogies.

The Big Problem: A Shortage of Rhythm Players

The authors, a team of researchers from universities across Europe, are worried. There is a global shortage of doctors who work in community settings (like family doctors or general practitioners). This shortage is so bad that it threatens public health and the stability of the entire healthcare system.

The study asks a simple question: Are medical schools in Europe teaching students enough about Primary Care to get them excited to become these doctors?

The Survey: Taking the Pulse of 32 Countries

The researchers sent out a questionnaire (a digital survey) to medical schools in 32 European countries. Think of this as a "health check-up" for how these schools teach future doctors.

Who answered? They got responses from 87 schools across 32 countries (a 43% response rate).
Who asked? The survey was organized by EURACT, a group dedicated to teaching family medicine.

What They Found: The Good, The Bad, and The Uneven

1. The Classroom vs. The Real World

The Good News: Almost all schools (95%) talk about Primary Care in the classroom. It's like every music school has a lecture hall where they talk about rhythm.
The Bad News: When it comes to actually playing the instrument (doing clinical placements in a doctor's office), the time is very short. On average, Primary Care makes up only 8.5% of a student's total clinical training.
The Analogy: Imagine a student spending 90% of their time learning to play the violin in a concert hall (hospitals/specialist care) and only 8.5% of their time learning to play the drums in a local community band (Primary Care).

2. The "North vs. South" Divide

The study found that the quality of this "drumming" education varies wildly depending on where you are in Europe.

Northern and Western Europe: Students get more time in community clinics (about 237–246 hours).
Central/Eastern and Southern Europe: Students get significantly less time (about 126–137 hours).
The Metaphor: It's like some music schools have a state-of-the-art practice room for the rhythm section, while others only have a small, dusty closet.

3. The Teachers Are Treated Like Second-Class Citizens

This is perhaps the most critical finding. The study found that the teachers who teach Primary Care are often treated unfairly compared to teachers in other specialties (like surgery or cardiology).

Pay: Primary Care teachers are often paid less, or sometimes not paid at all for their teaching time.
Career: It is harder for them to get promoted or get a permanent job at the university.
The Analogy: Imagine the school pays the violin teachers a high salary and gives them a nice office, but tells the drum teachers, "You can teach here for free, and if you want a permanent job, you have to ask every year." The study calls this discrimination.

4. The "Why" Behind the Shortage

The researchers asked the schools what stops them from teaching more Primary Care. The answers were like a list of broken instruments:

Not enough teachers: There aren't enough family doctors to take students.
No money: Schools and governments often don't fund these placements.
Bureaucracy: Rules are too strict, making it hard to hire teachers or pay them.
Attitude: Some university leaders don't think Primary Care is "real" medicine or important enough.

The Conclusion: Fixing the Orchestra

The paper concludes that Europe needs a "Pan-European" plan to fix this. You can't just have a few schools trying to fix the rhythm section while the rest ignore it.

The authors suggest two main steps:

Recognize Primary Care as a Specialty: Just like surgery or pediatrics, Primary Care needs to be officially recognized as a distinct and important specialty across all of Europe.
Fix the Policies: Schools and governments need to stop treating Primary Care teachers like second-class citizens. If you want more doctors to choose this path, you have to treat the teachers with respect, pay them fairly, and give them a clear career path.

In a Nutshell

The study is a wake-up call. Europe has a shortage of family doctors, and the root cause is that medical schools aren't giving students enough exposure to this field, and the teachers who try to teach it are being underpaid and undervalued. To fix the future of healthcare, the "rhythm section" of the medical education orchestra needs to be upgraded, funded, and respected.

Technical Summary: Provision of European Undergraduate Primary Care Education and Placements

Problem Statement
Despite evidence linking the quality and quantity of Undergraduate Primary Care Teaching (UGPCT) to the recruitment of primary care (PC) clinicians, there is a critical shortage of PC doctors across the European Union. This shortage threatens public health, system resilience, and economic stability. While it is established that clinical exposure to PC during medical school influences career choice, there is a lack of comprehensive European data regarding the quantity, quality, and resource allocation of UGPCT. Previous studies were limited in scope (e.g., single-country or single-year data) or failed to establish statistically significant regional correlations. Consequently, policy and decision-making regarding workforce planning lack an evidence base.

Methodology
The study employed a cross-sectional survey design targeting medical schools across 32 European countries during the spring of 2023.

Instrument: A validated questionnaire, originally used in UK surveys and adapted linguistically and culturally for European contexts, was distributed via the European Academy of Teachers in General Practice/Family Medicine (EURACT) Basic Medical Education Committee.
Sampling: The study utilized an "emancipatory approach," aiming to empower marginalized groups and address power imbalances. Sampling focused on maximal variation (rural/urban, traditional/progressive). All schools were sampled in countries with fewer than ten medical schools; a maximum of ten were sampled in larger countries to ensure representation of smaller nations.
Data Collection: 201 medical schools were invited; 108 responses were received, with 87 valid responses from 32 countries (43.3% response rate).
Analysis: Quantitative data were analyzed using SPSS 29 (descriptive statistics, Chi-square, Fisher's exact, Mann-Whitney U, and Kruskal-Wallis tests). Qualitative free-text data underwent thematic analysis by multiple researchers to identify emergent themes without a predetermined framework.
Regional Classification: Countries were categorized into Northern, Western, Central/Eastern, and Southern Europe based on EuroVoc classifications.

Key Contributions
This study provides the first detailed, continental-scale dataset on UGPCT provision across 32 European nations. Its primary contributions include:

Quantification of Provision: Establishing the current volume of PC teaching hours and placement duration relative to total clinical curriculum.
Resource Mapping: Documenting the availability of human and financial resources supporting UGPCT, including teacher development and remuneration structures.
Identification of Systemic Barriers: Highlighting discriminatory policies, funding disparities, and organizational structures that hinder UGPCT.
Regional Disparities: Providing statistically significant evidence of variations in teaching provision, funding, and status between European regions.

Results

Curriculum Provision: PC is taught in university settings in 95.1% of schools, yet many institutions remain uncertain about the definition of PC teaching. PC comprises an average of only 8.5% of total clinical teaching hours. Notably, some schools reported having no clinical UGPCT.
Regional Variations: Significant disparities exist ( $p < 0.001$ ). Northern (237 hours) and Western Europe (246 hours) offer significantly more placement hours than Central/Eastern (126 hours) and Southern Europe (137 hours).
Recruitment and Status: While recruitment of PC teachers was rated neutrally overall, free-text comments revealed significant challenges, including lack of payment, restrictive university policies, and language barriers. The perceived status of GP/FM teaching was significantly lower in Southern Europe compared to other regions.
Funding and Remuneration: A majority of respondents (67.9%) were unaware of the financial resources allocated to UGPCT. Where data existed, 38.8% of schools did not pay practices for student placements, and 28.4% paid PC teachers less than other specialties. Practices in Southern and Central/Eastern Europe were paid significantly less frequently than those in the North and West.
Organizational Structure: Schools where teaching and research were organized within the same department demonstrated superior outcomes: more teaching hours, better pay, higher status, and greater curriculum influence compared to schools with separated departments.
Discrimination and Challenges: Thematic analysis identified "lack of GPs," "funding," and "discriminatory practices" as the primary challenges. Comments highlighted systemic discrimination, such as PC teachers being excluded from academic positions, lack of recognition for their work, and political barriers to innovation.

Significance and Claims
The paper asserts that the current state of UGPCT in Europe represents a public health concern requiring pan-European action. The authors claim that:

Policy Gap: The lack of data has prevented effective policy-making; this study provides the necessary evidence to guide decisions on workforce planning.
Systemic Inequality: There is evidence of discrimination against PC academic and clinical teachers, enacted through restrictive and asymmetric policies regarding career progression, pay, and training.
Structural Solution: Integrating teaching and research within the same department is associated with better UGPCT outcomes, suggesting a structural pathway for improvement.
Specialty Recognition: The authors propose that recognizing Primary Care as a distinct specialty in all European countries is a necessary step to address inequalities and establish a functional training continuum.
Workforce Crisis: The study concludes that without addressing these educational deficits and discriminatory policies, the shortage of PC clinicians will persist, endangering equitable access to healthcare and public health resilience across Europe.