Education | Family Medicine | School of Medicine

A Curriculum Framework for Social Accountability, Local and Global Health and Health Equity: Family Physician as Health Advocate

The CFPC states that “as Health Advocates, family physicians work in partnership with patients and communities, contributing their expertise and influence to improve health through an understanding of needs, as agents of change, and the mobilization of resources". This is closely linked to the concept of social accountability, and requires the family physician to be accountable to the community in which they work, whether they perceive this to be local, regional, national, or global.

Further, the CFPC proposes that “advocacy requires action: family physicians [must] engage patients, communities, or populations to call for change, and they [must] speak up when needed. [..] Family physician advocacy occurs within complex systems that require developing partnerships with patients, their families and support networks, other health care professionals, community organizations, administrators, and policy makers”.

At QFM we conceptualize “health advocacy” in the most comprehensive sense. We hope to train physicians who will be advocates around all determinants of health including but not limited to gender, local and global economics, culture, immigration status, place of birth, membership of a particular social, political or religious group, access to resources (economic, food, healthcare or other), environment as well as psychological and biological determinants of health.

Health Equity Curriculum

Our core family medicine health equity curriculum encompasses all family medicine residents at all sites in their 2 year program, as well as the PHPM residents in years 1 and 2. The organizing principle of the core curriculum is the family physician as health advocate, responsible for addressing inequities in access to healthcare and in health outcomes among their patient population. The core curriculum also tries to broaden residents’ awareness of threats to health equity among the global population, including threats related to conflict, migration, and the climate crisis.

The curriculum includes content related to the following. Content and delivery differ from site to site, and are evolving all the time:

Poverty and health

Indigenous health

Newcomer health and Cultural humility

Developmental disabilities

Health and human rights

Climate change

LGBTQIA2+ health

Substance use

Anti-oppression & anti-racism in healthcare

Equity oriented healthcare and trauma informed care

Core content may be met through online modules and reflective pieces, clinical experiences, academic sessions at each site, and other activities (research, conferences, etc). One academic day in Kingston rounds out the Global Health curriculum by giving residents the opportunity to explore “non-core” topics such as conflict and health, urban planning and health, and migration to name a few, and includes sessions run by experts from across the university as well as community agencies.

Please see below for examples of Health Equity/Social Accountability curriculum

Online Modules

Climate change and health

Indigenous Health

Poverty and Health

Health and Human Rights

Newcomer health and cultural humility

Horizontal clinical experience (KTI only)

Street health

Newcomer health

Trellis-HIV (unhoused population and people who use substances)

HIV-Infectious disease

Prison health

Addictions medicine clinic

Academic days (examples)

Addictions medicine day

Global Health PGY-1 (including urban planning, anti-oppression, climate advocacy, complex humanitarian disasters, prison health, response to the opioid crisis, etc)

Indigenous health day

Global health book club

Poverty walking tour

Equity Oriented Care academic day

Primary care of adults with Intellectual and Developmental Disabilities

Canadian Health Equity Experience

Residents may choose as some of their core or elective rotations clinical experiences that focus on the health and needs of people experiencing health inequities in Canada.  Relevant populations would include Indigenous communities (urban Indigenous people or others), persons experiencing the health effects of poverty, new immigrants and refugees to Canada, persons with intellectual and developmental disabilities, persons with substance use disorders, persons who are experiencing homelessness, members of the LGBTQ2+ community with special health needs, or incarcerated individuals, to name a few.

First, it is noted that every clinical rotation should include members of many of the above groups, since these groups are represented in the general population, and often disproportionately represented in people needing care. As such, there are learning opportunities around health equity in every clinical rotation.

Additionally, however, each site has unique opportunities, some of which are outlined here (please speak with site directors for further information about additional learning opportunities). Residents with special interests are also encouraged to seek out elective opportunities in other places.

Moose Factory

Weeneebayko Area Health Authority provides health services to over 10,000 Cree peoples in five First Nations communities and one mixed-ethnicity municipality (Mooseonee) in the Mushkegowuk Territories of Western James Bay. The base hospital, Weeneebayko General Hospital, is located in Moose Factory island at the mouth of the Moose River. The community is the oldest English-speaking settlement in Ontario and the second of the Hudson Bay Company in Canada dating back to 1670.

Comprehensive primary care is provided including emergency medicine, obstetrics, hospitalist, surgical assist, outpost coastal community primary care and office clinic. Residents will be exposed to numerous technical and advanced procedures and practise in a logistically and medically complicated learning environment under the close supervision of an experienced supervisor.

The rotation philosophy is designed to be first and foremost an educational experience, and not at all a 'service' rotation. As part of their training, residents will participate in a weekly seminar course that addresses the non-clinical aspects of Indigenous peoples' health including history, politics, law, anthropology, epidemiology and community development. Residents will find the rotation highly demanding and equally rewarding.

All residents applying to this rotation must already have completed their core rotations in Emergency Medicine, Internal Medicine, Orthopedics, Obstetrics and Pediatrics, as general abilities in these areas will be assumed and are necessary for adequate performance in this rotation. Residents are also expected to have completed their core Aboriginal health curriculum.

Moose Factory is a core family medicine site for PGY2.

Kingston Community Health Centres

KCHC is a multi-service, multi-site Community Health Centre. It provides clinical and social services at three main locations where it makes special efforts to serve people who have a higher risk of poor health, or people who are having difficulty finding health care because of language or cultural barriers, poverty or isolation. In all activities, special attention is paid to the social, emotional, and financial needs of our clients since these are the pre-requisites of health.

The KCHC rotation is a clinical family practice rotation which incorporates a strong introduction to multidisciplinary team work (OT, Social Work, Dietitian, Diabetes Educator, Footcare Nurse), an optional introduction to the Women’s Clinic at KGH (therapeutic abortions), and a family practice obstetrics component. Residents at KCHC will also have the opportunity to interact with and discover other program areas such as Better Beginnings for Kingston Children (BBKC) Immigrant Services for Kingston and Area (ISKA), Pathways for Education (P2E) and Street Health Centre (SHC).

Intellectual and Development Disabilities

Queen’s Department of Family Medicine has a long history in providing its family medicine residents with a strong foundation in caring for adults with intellectual and developmental disabilities. The IDD Program for PGY1 residents include didactic teaching, as well as opportunities for family medicine residents to participate in the clinical Health Check Program. This program focuses not only on educating residents about providing primary care to IDD patients, but also on fostering an understanding among residents abou the ethical and the medical considerations specific to IDD patients.

Family Medicine residents also have the opportunity to do an elective in Care of Adults with Intellectual and Development Disabilities through Queen's. This four-week rotation includes complex continuing primary care of adults with IDD, an adult IDD consulting clinic, dual diagnosis psychiatry, developmental genetics clinic, epileptology and sleep disorders clinic, and physical and rehabilitation medicine clinics. There are also special clinics such as seating clinic and enteral feeding clinic, as well as opportunities to observe allied health professional assessments (i.e. OT, PT, SLP, and psychology). The elective is open to interested family medicine residents.

International Global Health Experiences

Given the short duration of Family Medicine residencies, few residents elect to take the time for international electives. The Department of Family Medicine is moving away from a model where residents can select their own international elective sites to one where residents are strongly encouraged to choose from available international electives supported and approved by the Department. Nevertheless, residents are still able to come forward to propose electives of their choosing by completing the International Elective Application Form.

Criteria for a “valid” international elective that is likely to be approved by QFM are listed in the Assessment of Acceptable International Electives Check List.

Residents are encouraged to embark upon the preparation process early and must seek approval from their academic advisor, then from their site director. Once approved, residents must fulfill all the requirements for pre-departure preparation prior to leaving on their elective. Residents are encouraged to start this process at least 3 months prior to their planned elective.

Pre-Departure preparation

All residents planning overseas clinical experiences (OCE) must participate in pre-departure preparation.  Each resident planning an OCE must have their planned experience approved by the program director.  It is at the program director’s discretion to approve or disallow overseas travel.  Once approved, it is the residents’ responsibility to contact the appropriate people to plan their pre-departure preparation.

The purpose of pre-departure preparation is to ensure that residents are ready to go—that they have completed their preparation including safety preparation required by QFM and by Queen’s University, that they are thoughtful about the experience upon which they are embarking, and that they will serve as good ambassadors for the department and country.  The purpose of post-return debriefing is to allow residents to critically reflect on their experiences, and to contribute in some form to the ongoing Global Health education and dialogue within the Department of Family Medicine.

There are many steps which must be completed for the rotation to be deemed acceptable to the department.

3 months or more prior to departure:  

Have your selected rotation approved by your academic advisor and program director (see review checklist if you are applying for international elective which is not pre-approved).

Meet with the Queen’s faculty member who is supervising your elective. This may be a person who is directly involved in the elective site you are travelling to. If there is no such person at QFM, you are likely to be directed to Dr Eva Purkey to support planning of your elective and pre departure preparation

Note that there are many pre departure requirements for international electives and these will vary depending on location and planned activities (clinical, research, etc). Embarking on such a process will require time. Ensure you have time to prepare properly.

Falkland Islands

The Falkland Islands is a British Overseas Territory, population of approximately 3000, and while it is an autonomous entity, they are dependent on Britain for most services, including health care.  The setting, while in the South Atlantic Ocean, is quite familiar to any Canadian from a small town or northern or coastal environment. The 28-bed King Edward VII Memorial Hospital in the capital town of Stanley provides opportunities for emergency work, including trauma coming from the fishing fleets; OB; newborn care; hospitalist and some OR assisting. They are very lucky to have a full-time general surgeon and anesthetist on site as well as a good laboratory and X-Ray/Ultrasound facility.

Because of the large military base on the southern part of the east island with 2200 personnel and family members, there is a close working relationship between the medical officers providing primary care and the hospital which provides secondary care when needed. 

The following opportunities are available:

For PGY2s

A 2-month core Rural FM experience, which would be centered in the main town of Stanley at the hospital under the supervision of Dr. Rebecca Edwards, the Chief Medical Officer and other staff GPs as appropriate. This would include clinic work, hospitalist, emergency experience and periodic flying visit "house calls" to other islands in the archipelago. One of the main purposes for a resident to take up this experience would be to assess their interest in applying for the PGY3 scholarship year with return of service.

For PGY3s

The Falkland Islands Scholarship: a fully-funded PGY3 full year designed to provide enhanced skills training (identical to our rural skills year) to one of our residents in return for a one-year return of service, paid at 150,000 Pounds (about CDN$ 300,000 at today's rate). Training would be done mainly in Ontario with opportunity to also spend time in Falklands. The year would include enhanced training in Obstetrics, neonatal care, trauma, hospitalist medicine, plastic surgery and procedures, emergency medicine as well as other relevant electives.

Thailand

Mae Sot is a vibrant city in Northern Thailand on the border with Burma (Myanmar) home to a large migrant population from Eastern Burma. Burma has experienced civil war since the 1960s, however a military coup in February 2021 further destabilized the country resulting in a new influx of migrants to Thailand. Over 30 years, ethnic health organizations have been developed and based in Mae Sot Thailand, to provide health and social services for the migrant and ethnic minority populations. While Burma is a site of active conflict, Mae Sot is in Thailand and is secure, has a good quality healthcare system, and good transportation networks, making it an ideal place for Queen’s students from many disciplines over the years to gain valuable global public health experience. Mae Sot is a setting where students can work directly with ethnic minority groups, displaced populations and people affected by war, yet do so a safe and secure setting with well established partners who have some functionality in English and have worked previously with international learners. Residents and other learners have participated in both clinical (predominantly medical students) and research electives with community partners in Mae Sot, building on 20 years of partnership between QFM faculty members and local organizations.

In addition to partnerships in Mae Sot, QFM faculty have developed education and research partnerships with Mae Fah Luang University in Chiang Rai, Thailand.