The struggle for a unified specialty in general practice, primary health care and community medicine in Italy.
TL;DR
Developing a unified specialty in GP, PCCM is not merely a medical education reform but a strategic institutional priority for the National Health Service and establishing a dedicated scientific disciplinary sector and a pre-postgraduate curriculum is essential.
Abstract
Background
Despite increasing recognition of their central role, General Practice (GP) and Primary Health Care and Community Medicine (PCCM) remain structurally and academically fragmented in Italy, limiting the development of a coherent scientific and professional identity.
Aim
To explore clinicians' and trainees' perspectives on barriers and facilitators to developing a unified postgraduate specialty curriculum in GP, PCCM, and to identify conditions for change.
Methods
We conducted a participatory action research study, integrating a structured workshop with constructivist grounded theory analysis. Forty-four primary care professionals generated 176 qualitative data units, which were iteratively coded and organised into themes.
Results
Five interrelated themes emerged: (1) lack of interprofessional literacy; (2) power dynamics and professional tribalism; (3) recognition of a shared cultural matrix; (4) need for academic and professional identity; and (5) importance of building collaborative projects. Barriers extended beyond knowledge gaps to institutional fragmentation and status asymmetries. Participants identified a shared person-centred care model as a basis for integration, while the absence of a recognised scientific disciplinary sector was seen as a major barrier to legitimacy, research capacity and workforce attractiveness.
Conclusions
Developing a unified specialty in GP, PCCM is not merely a medical education reform but a strategic institutional priority for the National Health Service. Establishing a dedicated scientific disciplinary sector and a pre-postgraduate curriculum is essential to address workforce shortages, enhance professional attractiveness and reorient medical education and doctors identity towards community-based care. To be truly transformative, this innovation requires institutional and policy changes grounded in the recognition that medical education policy is also healthcare policy.