THE EVOLUTION AND CHALLENGES OF ACADEMIC FAMILY MEDICINE: INSIGHTS FROM THE BANJA LUKA DECLARATION RAZVOJ IN IZZIVI AKADEMSKE DRUŽINSKE MEDICINE: SPOZNANJA IZ BANJALUŠKE DEKLARACIJE Aleksander STEPANOVIĆ1* , Igor ŠVAB1 , Biljana ĐUKIĆ1 , Ranko ŠKRBIĆ2 1University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenija 2University of Banja Luka, Faculty of Medicine, Department of Pharmacology, Toxicology and Clinical Pharmacology, Banja Luka 78000, the Republic of Srpska, Bosnia and Herzegovina Received: Jul 07, 2024 Accepted: Aug 23, 2024 Invited editorial *Correspondence: aleksander.stepanovic1@guest.arnes.si 10.2478/sjph-2024-0021 Zdr Varst. 2024;63(4):160-163 160© National Institute of Public Health, Slovenia. Stepanović A, Švab I, Đukić B, Škrbić R. The evolution and challenges of academic family medicine: Insights from the Banja Luka declaration. Zdr Varst. 2024;63(4):160-163. doi: 10.2478/sjph-2024-0021. ABSTRACT Keywords: Family medicine Academic medicine Primary healthcare Southeast Europe WHO IZVLEČEK Ključne besede: družinska medicina akademska medicina osnovna zdravstvena dejavnost SZO Academic medicine encompasses education, research and clinical practice, and plays a crucial role in advancing medical science and training physicians. However, the field faces a crisis, with fewer graduates pursuing academic careers. Family medicine emerged as an academic discipline in the second half of the 20th century, contributing significantly to science and primary healthcare. Despite its recognised status, the World Health Organization has yet to formally define it as an academic discipline. Nevertheless, the discipline must continually update its academic dimension in order to address future challenges. The international conference in Banja Luka, attended by deans or representatives of Medical Faculties in Southeast Europe, emphasized family medicine’s role in primary healthcare and academic medicine, adopting the Banja Luka Declaration to promote family medicine as an independent academic discipline. The conference aims to inspire global support for family medicine as an academic discipline. Akademska medicina zajema izobraževanje, raziskave in klinično prakso ter ima ključno vlogo pri napredku medicinske znanosti in usposabljanju zdravnikov. Kljub temu se sooča s krizo, saj se manj diplomantov odloča za akademsko kariero. Družinska medicina se je kot akademska disciplina pojavila v drugi polovici 20. stoletja in pomembno prispevala k znanosti in primarnemu zdravstvenemu varstvu. Kljub priznanemu statusu Svetovna zdravstvena organizacija še ni formalno opredelila družinske medicine kot akademske discipline. Vseeno pa mora ta stroka nenehno posodabljati svoje akademsko področje, da se sooči z izzivi, ki so pred njo. Mednarodna konferenca v Banja Luki, katere so se udeležili dekani in predstavniki iz jugovzhodne Evrope, je poudarila vlogo družinske medicine v primarnem in akademskem zdravstvenem varstvu ter sprejela Banjaluško deklaracijo za spodbujanje družinske medicine kot neodvisne akademske discipline. Cilj konference je spodbuditi globalno podporo za akademsko družinsko medicino. 1 THE CHALLENGES OF ACADEMIC FAMILY MEDICINE 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. 10.2478/sjph-2024-0021 Zdr Varst. 2024;63(4):160-163 161 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. 2 BANJA LUKA DECLARATION 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 10.2478/sjph-2024-0021 Zdr Varst. 2024;63(4):160-163 162 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. CONFLICTS OF INTEREST The authors declare that no conflicts of interest exist. FUNDING The study was not financed. ETHICAL APPROVAL Since it is an editorial article with no research, we did not ask for ethical approval. AVAILABILITY OF DATA AND MATERIALS Since it is an editorial article with no research, we do not have data and materials LLM STATEMENT During the preparation of this article the authors used the GPT language model to: • review and amend grammatical and spelling mistakes, • ensure linguistic consistency and coherence, • test and fine-tune the article’s wording, • format the references. After using this model, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication. ORCID Aleksander Stepanović: https://orcid.org/0000-0003-4155-0001 Igor Švab: https://orcid.org/0000-0003-1303-4974 Biljana Đukić: https://orcid.org/0009-0005-7396-7030 Ranko Škrbić: https://orcid.org/0000-0002-6643-1781 10.2478/sjph-2024-0021 Zdr Varst. 2024;63(4):160-163 163 REFERENCES 1. 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