Family medicine and primary health care made major advances since the Alma-. Ata Declaration of the World Health Organisation (WHO) in What was. Family Medicine. Report of a Regional. Scientific Working Group Meeting on Core Curriculum. Colombo, Sri Lanka, July WHO Project No.: ICP OSD. The College of Family Physicians of Canada (CFPC) would like to thank non- members), family medicine and primary care researchers, sister.
|Language:||English, Spanish, Japanese|
|Genre:||Business & Career|
|ePub File Size:||28.37 MB|
|PDF File Size:||19.18 MB|
|Distribution:||Free* [*Sign up for free]|
World Book of Family Medicine – European Edition 2 http://www. tvnovellas.info book pdf. Printed in Turkey on PDF | On Apr 1, , Keith D Ogle and others published Family medicine in Highly acclaimed in its first three editions, McWhinney's Textbook of Family Medicine is one of the seminal texts in the field. While many family medicine texts simply cover the disorders a practitioner might see in clinical practice, McWhinney's defines the principles and.
In the face of technological advances in medicine, the high cost of inpatient care, funding constraints, and restructuring and regionalization, hospital care has become specialized, more acute, and less accessible to urban family doctors. At the same time, family physicians have been tasked with providing increasingly complex outpatient, community-based primary health care. This care includes immediate hospital follow-up, long-term cancer survivorship care, comprehensive palliative care, postsurgical care, and long-term geriatric care along with the traditional comprehensive, continuous office-based care.
With these varied pressures, and with opportunities for focused practice eg, Certificates of Added Competence , the in-hospital role of family doctors in urban centres has changed.
Family doctors in our urban hospital setting are leaving hospital patient care, with the exception of a few family doctors in very specific areas such as obstetrics, newborn care, or chronic complex continuing care.
This change has been discussed in the literature, 1 — 5 albeit largely in the past 2 decades since the trend first became evident. For office-based family doctors who could include inpatient hospital work, Wong and Stewart suggested that geographic practice location was the strongest predictor of scope of practice that includes hospital-based care.
In , This declined to This decline was mirrored nationally, from Most recently, some well-known physicians taking a more informal pulse on community family doctor activities and attitudes questioned the hospital role of family doctors in urban settings.
In February , John Crosby, community family physician and author of much informal practical advice for family doctors, noted the same exodus of family doctors from hospital work. The list of family physicians was received from the department administrator who maintains and updates the list on a continual basis.
The survey was sent by mail with a fax-back option and by e-mail with a link to an online survey. High program satisfaction was achieved at both the new and well established sites. Family medicine residency programs developing community-based networks might consider and encourage the positive influence of interprofessional care and education.
Good communication between distributed sites remains a challenge. The first major urban site developed outside of Hamilton is located in Kitchener-Waterloo, Ont, where residents began participating in the full 2-year curriculum beginning in The local program has a separate Canadian Resident Matching Service stream established, and its first graduates completed their entire residency in the Kitchener-Waterloo area in The principle setting for the program in Kitchener-Waterloo is the Centre for Family Medicine, a family health team developed as the regional clinical teaching site for a new health sciences campus, which includes a pharmacy school, a regional medical school, and an optometry training clinic.
When the Kitchener-Waterloo program was established, the provincial Ministry of Health had designated the area as underserviced by family physicians. There has been a shift in training to community-based centres, highly valued by learners, in many programs. Family practice in Canada has been developing an interprofessional component also with the goal of alleviating the family physician shortage.
A review of the literature revealed no studies examining the key determinants of location choices of and satisfaction with family medicine residency training sites featuring an interprofessional component.
A mixed-method approach was used. In to , in-depth interviews were conducted with 11 first-year and second-year family medicine residents at the Kitchener-Waterloo site by one of the researchers M. Ethics approval was obtained from McMaster University and informed consent was obtained from participants.
Interviews were conducted until thematic saturation was reached through an iterative process by 2 of the researchers involving a minimum of 3 iterations. A semistructured interview format was used, with thematic analysis conducted independently by 2 of the researchers after each interview, followed by comparison and corroboration.
Immersion and crystallization techniques were used. Based on themes obtained from the interviews, a quantitative survey was developed with 3 sections: Ethics approval was obtained from McMaster University and the survey was distributed to McMaster family medicine residents at 2 sites, Kitchener-Waterloo and Hamilton, during to All 22 residents in Kitchener-Waterloo completed the survey and an equal number of participants was selected at random in Hamilton.
Participants received an honorarium of a small-value gift card. Completion of the survey was anonymous. The survey included open-ended and closed-ended questions with responses measured on a 5-point Likert scale. The in-depth interviews revealed 4 main themes: The survey was designed to reflect these themes.
Twenty-two residents from the Hamilton site chosen at random completed the survey as a comparison group.
Combined results of the interviews and survey are explained below. During the in-depth interviews, almost all the residents identified location and community as important factors in choosing the Kitchener-Waterloo site:. I really like the city. Among the factors determining choice of a residency program site Figure 1 , the following 6 factors were the most frequently identified by residents in the survey: Most of the Kitchener-Waterloo residents who were interviewed expressed that the interprofessional environment was a positive factor in their program:.
I really do.
I believe we learn more here than other people do. The ability to work in an interprofessional team was identified as an influencing factor by Similar percentages of Kitchener-Waterloo and Hamilton residents had completed a horizontal elective with an interprofessional provider Approximately half of the residents at each site had had 11 or more interactions with interprofessional providers Similar percentages Figure 2 of the Kitchener-Waterloo and Hamilton residents indicated they had collaborated with various interprofessional providers, including nurse practitioners, nurses, dietitians, physiotherapists, social workers or mental health therapists, and pharmacists.
There were substantially more exposures to chiropractors, chiropodists, and respiratory therapists at the Kitchener-Waterloo site, reflecting differences in the team compositions. Percentage of residents who collaborated with interprofessional providers.
Residents were also surveyed about their future plans to collaborate with the above-mentioned interprofessional providers Figure 3. Generally, Kitchener-Waterloo residents planned future collaboration more than Hamilton residents. Percentage of residents with plans for future collaboration with interprofessional providers. The influence of interactions with interprofessional providers on learning style, communication skills, awareness of other professionals, team dynamics, change in patient care, knowledge level, teaching style, ability to work within a health care team, and number of referrals to interprofessional providers was also determined through the survey.
There were no significant differences noted between the 2 groups of residents in any of these variables.
Both groups of residents reported positive interactions with interprofessional providers Figure 4. Percentage of residents influenced by positive interactions with interprofessional providers IPPs.
Almost all interviewed Kitchener-Waterloo residents stated that the less hierarchical structure, one-on-one teaching, and excellent teaching opportunities in a community-based practice were important factors in their programs:.
I like the more individual attention. Almost all the interviewed Kitchener-Waterloo residents voiced frustrations with communication from the central site in Hamilton to their new site.
They just cancelled the videoconferencing. It was purely bad communication from Hamilton.
Residents were surveyed on whether experiences were available, whether the experiences prepared them for future practice, and whether they believed experiences should be mandatory for the following areas: There were no statistically significant differences between the 2 sites for any of these areas except for the availability of opportunities to learn critical appraisal skills Kitchener-Waterloo There was no significant difference in critical appraisal skills preparedness Kitchener-Waterloo Percentage of residents who believed the following to be true: Experience in various areas of practice was available; experience in various areas of practice prepared them for future practice; and experiences in various area of practice should be mandatory.
Most of the residents in both sites thought their residency training was preparing them well for their future family medicine practice Kitchener-Waterloo Overall, Factors included location in a known community, an interprofessional learning environment, a less hierarchical structure, opportunities for more one-on-one teaching, and the potential for excellent teaching experiences. Community-based and academic sites have been noted to have some differences that might be seen as complementary to each other in family medicine clerkship, as most medical schools use community preceptors as clinical teachers.
Family medicine residency programs across Canada are developing networks involving many communities previously not involved in training residents. Training in new sites often links communities, governments, and universities in an effort to assist with recruitment and human resource distribution to help with the shortage of family physicians. Residents valued the ability to learn in an interprofessional environment. Clinical exposure to other health care professionals facilitated their education.
Barr stated that there are 4 foci for interprofessional education IPE: Poorly planned and delivered IPE can reinforce professional differences, so its use needs to reflect local needs, opportunities, and resources.
Intentional team training and development can lead to the expression of a high-functioning interprofessional team. Perceived poor communication from the well established central site to the new site was identified as a challenge.
Residents in both sites indicated similarly high levels of program satisfaction including with the teaching quality by family physicians and other health care professionals. The Department of Family Medicine at McMaster University has acknowledged the challenge of communication and has demonstrated support by a number of measures, including improved videoconferencing links, strengthened administration, and increased local autonomy.
A future area of study might be to explore resident training site selection, satisfaction, and burnout. Recruitment of family physicians to rural and traditionally non-academic communities might depend on addressing experiences that deter family medicine residents from these sites while enhancing training in areas that are satisfying.
For example, rigorous training in family medicine with hands-on procedural opportunities and breadth of experiences and care has been associated with early career satisfaction in family medicine.
This qualitative and quantitative study found that residents select a new community-based family medicine site for reasons that include geographic location and the potential for clinical experiences.
Interprofessional education and care were also highly valued. Program satisfaction in a new site was high and similar to that in a well established site. A less hierarchical structure, opportunities for one-on-one teaching, and excellence in teaching were identified as important factors influencing preference for a community-based program.
Family medicine residency programs developing community-based networks might consider and encourage the positive influence of interprofessional care and education within community settings.
Good communication between central and distributed sites is a challenge that needs to be addressed by the wider program. Intentional support can be provided by specific measures such as use of technology and increased local autonomy. Community-based training for residents has been highly valued by residents and preceptors.