Last month in this blog I was looking forward to seeing people in person at Family Medicine Forum. It was fantastic to see so many colleagues, residents, and medical students in person, enjoying some excellent CME and discussing important issues like the Outcomes of Training Project.
On the Saturday we had a “University Partnership Fair” that brought together CFPC leadership, department heads, program directors, and other educational leaders from all across the country. It was a great opportunity to share ideas, learn about current and future concerns, and brainstorm together about advancing family medicine education.
There is understandably a range of views on the challenges associated with moving to a longer training program that will meet Canadians’ needs for excellent comprehensive family physicians who can work in a broad range of settings, as described in the CFPC’s Family Medicine Professional Profile and Residency Training Profile.
I personally think that modernizing training is critical for the future of family medicine. Over the past 25 years, training time has decreased by about 30 per cent, due primarily to much-needed and welcome changes to working hours to support patient safety and resident wellness, and to enhance learning. In that same time period, patient complexity has also increased and gaps in training have been uncovered (for example Indigenous health), and new areas like AI and technology in health care are emerging.
I like to think of training time as a key resource we have to offer our residents, many of whom already come into family medicine looking for opportunities to do more than two years of training. While CBME approaches might allow us to offer variable training durations, there are practical considerations around issues like examination, licensure, program design, and funding that also need consideration. Increasing the length of training to three years for all residents will mean we can offer that additional time to everyone. It also offers residents the opportunity to acquire more advanced skills in a range of areas within the core program. This will require us to rethink what, if any, additional training would be required beyond a core three-year program to support certain scopes of practice in areas where we currently offer enhanced skills training.
More time is needed, but is not, by itself, enough. We need to look at innovative models of training that more closely model the post-graduation practice environment (for example, more horizontal experiences, transition to practice “junior attending” roles, etc.).
Finally, I would be remiss if I didn’t note that training alone is not the only part of the system that needs change. Our practice environments also need to evolve to support those of us currently in practice as well as our new grads as they start their careers as independent family physicians … but that is for another blog.
Once again, thanks for all you do to support family medicine, both here in the department and in your communities.
Dr. Michael Green
Department Head