Why family medicine residencies might become longer
College of Family Physicians of Canada will look at possibility of adding a year
As family doctors face increasingly complex patients and new approaches to providing care, officials with the College of Family Physicians of Canada want to address a question that's long been kicked around — should family medicine residencies be longer?
Medical school graduates in Canada seeking to become family doctors must do a two-year residency following graduation.
But that's shorter than residencies in other western countries. Now the college will seek to determine if it should be extended by a year here.
Dr. Nancy Fowler, the college's executive director of academic family medicine, said the review isn't an indication there's some kind of problem with doctors coming out of residency, but to ensure doctors are as well prepared as possible when they enter practice.
"We're really just trying to do this to be responsive and responsible in setting our expectations for our training programs," she said.
Considering training outcomes
Fowler said part of the reason for doing the review is because of a shift in teaching toward competency-based medical education, which moves away from simply counting the hours a resident trains.
"It's very outcomes-oriented and, as you can imagine, it's hard for a generalist discipline like family medicine to entirely set strict limits or boundaries on their skill sets."
Family doctors need to know how to care for any patient who walks through the door. Fowler said part of the aim is to see if there can be a better definition of the expected outcomes of training.
The college recently developed a professional profile that lays out the scope of work for family doctors, which includes primary care, emergency care, home and long-term care, hospital care and maternal and newborn care.
It's from this starting point Fowler said the college would begin engaging panels of doctors, regulatory officials, patients, educators and government officials in early 2019, a process she expected could take up to two years to complete.
Adapting to a community's needs
Fowler said the aim is to determine how well doctors are doing when they hit the workforce and whether they're able to adapt to the needs of the place they will go to practise.
While Fowler said she has every confidence doctors leave their residencies prepared for the primary-care aspect of medicine, it's the more acute skills where the college wants certainty, particularly as the demands on doctors can be much broader for those who go to rural and remote communities.
"I don't have any worry that folks aren't capable of doing those things. I think what we sometimes hear is whether they have the confidence, whether they've had just that extra bit of experience to really solidify their confidence."
Dr. Tim Holland, president of Doctors Nova Scotia, said that while an extended residency may be one way to address any concerns, whether it's the best way "is definitely an open question."
"There might be other avenues, such as better mentoring opportunities, or ongoing continuing medical education that might also help address that problem," he said.
Beginning in medical practice can be an overwhelming thing and "you never feel fully prepared," said Holland.
But he said residents also get to a point where they recognize "no amount of training is going to make you feel more prepared, that you have had all the training you could possibly have to be able to take such a giant shift in your career."
One way medical schools have attempted to better prepare residents for the varied work environments they might encounter is the creation of residency spaces set exclusively in rural and remote locations.
It's a move that's paid off for residents at Dalhousie University and the communities where they work. A high percentage of people opt to remain, said a spokesperson for the medical school.
"Our rurally-trained residents report a high degree of satisfaction with their experience, as the nature of rural practice affords them many learning opportunities they may not encounter in an urban centre where there are more specialists and specialty residents on staff," Jennifer Lewandowski said in an email.
'Significant growth and learning' early on
The chair of family medicine at Memorial University in Newfoundland and Labrador said their rural residencies are also better preparing residents.
"Even our residents who are in urban settings in St. John's for the majority of their time complete a minimum of seven months in a rural area to ensure they receive the rural exposure and experience of learning in this environment," Dr. Katherine Stringer said in an email.
Stringer said "it is already well recognized" the first five years of practise for a doctor are "years of significant growth and learning" and she echoed Holland's comments about the value of mentorship opportunities.
"More [residency] time does not automatically equate to better outcomes."
Concerns about workforce effects
Fowler said part of the review work would be evaluating the success of rural residency programs at medical schools across the country.
Holland said an obvious concern about extending residencies would be the effect it could have on new family doctors entering a system that seems to have an insatiable need.
Fowler stressed that any changes, if they were to happen, would be done in consultation with government partners to determine the best way to do it while having the least effect on the overall system.
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