While everyone was having a blast in the Cultural Fest, I was making my way to the 5th Asia Pacific Primary Care Research Conference (APPCRC) 2015 jointly organised by the Academy of Family Physicians of Malaysia and the Family Medicine Specialists Association of Malaysia. Feeling miserable (and slightly jealous) on missing the fun, I vowed to make my first ever medical conference as enjoyable. In this account of my experience as a participant, allow me to walk you through the highlights of the conference.

From zero to (sort-of) hero

More than a year ago, I completed my pre-university course in a foundation programme offered by the National University of Malaysia (UKM), where producing an original research report was a pre-requisite for the course completion. Hence, being a clueless novice in research, I artlessly derived my own research proposal, and sought assistance from Prof. Dr. Tong Seng Fah, who was the Head of the Department of Family Medicine in UKM to help me materialise the research. Fast forward to a year and a load of hard work later, I finally managed to produce a research report with the title “Roles of Men in Family Planning – A Study of Married Men in UKM Primary Care Clinic”. As a part of the APPCRC organising committee, my mentor then suggested me to participate in the conference and have my research abstract submitted. I then improved the report with his extensive guidance, and then designed a research poster to be presented.


Prof. Dr. Tong and I, together with our research poster

APPCRC – Boosting primary care research

This was the 5th APPCRC held since its inaugural conference in 2009. It featured programmes catering for various levels of primary care researchers across the Asia Pacific region, and its network of participants has grown to include Malaysia, Singapore, Hong Kong, Myanmar, Indonesia, Australia and New Zealand. The conference aimed to provide a platform for researchers to share research findings and build research network with local, international, and regional partners. Hence, sessions of plenary talks, workshops, research presentations and panel discussions were arranged to address the theme of “Generating Evidence for Primary Care”.

Global challenges in primary care – Assembly, Application and Allocation

Some of the most eminent researchers in the field of primary care in Australia were invited as the plenary speakers of this year’s conference: Prof. Dr. Paul Glasziou from Bond University, Prof. Dr. Doris Young from University of Melbourne and Prof. Dr. Lyndal Trevena from University of Sydney. One of the talks addressed the issue of translating evidence into practice, which was a huge problem for family physicians considering the spectrum of diseases they have to diagnose. It was said that a regular family physician would need to diagnose over 13,000 different health problems presenting with acute, chronic, rare and even unexplained symptoms. To make things worse, the median time required for an evidence to affect clinical decisions and managements was 5.5 years, but each year 7% of guidelines and best practices were subjected to change! This showed an obvious lag between research and its application. Therefore, family physicians had to devise a realistic way to cope with the flooding evidence while juggling between consultations, teaching, administrative work and research. The solution proposed by Prof. Glasziou was 1. To get the best evidence-based search system to source the significant, valid and relevant evidences, 2. To keep a log book of clinical questions and ensure they are answered, and 3. To start a weekly research question-discussion journal club to discuss and plan actions for the questions, while appraising previous discussions and solutions.

Another issue discussed by the panels was to use clinical data to inform clinical practice. A common happening among primary care researchers was to have access to a myriad of data (big data) but have no idea on what to do with them. Here, Prof. Young emphasised the importance of primary healthcare networks to pool big data, improve data recording, data cleaning, and disease coding. This would serve as a reservoir of clean data for researchers’ extraction. A data linkage system would also promote transparent healthcare service, where extracted data can be analysed as a feedback loop for service providers. Nevertheless, major barriers such as clinical autonomy and the confidence of service providers to disclose clinical data stood in the way of revolutionising clinical care and research. Therefore, intense negotiation efforts needed to be done towards the larger goal of developing workable interventions that could positively enhance general practice.

Providing patient centred medicine has been the talk of the primary care setting for years, and was much simpler said than done. Patients in primary care were people with individualised perceptions, behaviours and beliefs in obtaining healthcare services. Hence, it was a daunting challenge to address each of their needs by tailoring the best decision for them. Shared-decision making was even harder to accomplish along the course of consultations with patients who were less informed about their own healthcare. Doctors would be required to assess the evidences based on their patients’ different needs, resulting in a wide variation of their own preferred decisions. As a means to overcome these obstacles, Prof. Trevena recommended the adoption of decision-making aids, which will give patients more knowledge and a more accurate risk perception of their own health problems to help them make an informed decision. She also proposed a 4-step model of shared decision making: to identify decisions, evaluate decisions, make decisions and appraise decisions.

Research – the drive towards quality primary care

Over 90 abstracts were submitted to the scientific committee of the conference, and more than 70 were approved for poster presentation. The majority of these researches were done by practicing primary care doctors on a myriad of topics ranging from the management of chronic illnesses to the workplace efficiency of a primary care clinic. A significant proportion of researches were carried out by officials in the government sector, and the rest from medical students. Browsing through the posters not only made me realise the shortcomings of primary care delivery, but also enlightened me on the core areas for improvement efforts, which are mainly the implementation of evidence-based medicine and the practice of efficient shared-decision making. It was clear that the Malaysian primary healthcare was progressing towards a direction of patient-centred practice as physicians were striving to use the best clinical evidence to improve individual outcomes. Presenting and talking about my research with competent and seasoned family physicians throughout the region enabled me to reflect on its quality and contribution to the field. It was truly a humbling and insightful experience, and I was inspired to venture more into the world of academia.


Dozens of posters in relation to almost every area of primary care

Learning beyond the medical degree

Participants of the conference were also able to attend one of three concurrent workshops: “Conducting a systematic review”, “Basic statistical analysis using SPSS” or “Using clinical data to improve practice quality”. In these workshops, researchers were able to further sharpen and expand their skillset in conducting and appraising a research. These interactive sessions were directed by coaches who were at the pinnacle of primary care research both locally and internationally. I opted for the workshop on conducting a systematic review with the hopes of satisfying my immense curiosity on its high position in the hierarchy of research evidence. I was taught on the qualities of a good systematic review, its appraisal, methodology and analysis. I learnt that behind every systematic review lies the tedious effort to cherry-pick the best outcomes of the studies included, and that even the slightest decision in the methodology applied should be supported by a solid justification. Attaining the ability to interpret tables, diagrams, figures and plots which once seemed perplexing thrilled me even more. Nevertheless, all that I learnt merely reflected the tip of the iceberg, and there is still a long way to go until the day that I can finally conduct my own systematic review.

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Primary care researchers working their way out in interpreting data of systematic reviews

A paradigm shift

Despite being one of the few medical students present at the conference, I felt a strong sense of belonging as a part of the medical community. On one occasion, I was mistaken as a doctor while interacting with another participant. When I attempted to clarify that I am still a student, she responded by saying that “It does not matter, you are going to be one anyway”. Medical students sometimes shy away from challenging situations by admitting their inexperience, but often forget that it is only a matter of time that they themselves become doctors. It is crucial then for us to realise that we are already part of the medical profession, and that the society views us as a representation of the medical community. Hence, there is always a need to progress and grow by equipping ourselves with knowledge and skills taught out of the classroom. A good way to start is through research, which is relevant and meaningful to our future practice.

It is an arduous task for family physicians to engage in research given their commitments in practicing, teaching and managerial responsibilities. Being at the APPCRC put me in the midst of many capable and dedicated family physicians who refused to concede in the face of extreme burden and expectations. Looking at their passion in contributing to the research scene changed my perception towards family physicians in general, as I finally realised the significance of their work in improving the morbidity, mortality and quality of life of the society. Hence, being at the forefront of healthcare delivery, putting primary care as the thrust of healthcare services is the way forward, and a way of achieving this is through extensive research which complements clinical practices and fine-tunes health policies.


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