More than 4 million Canadians do not have family physicians.1 To fill this gap and allow Canada’s health care system to function adequately, it is estimated that 50% to 55% of medical undergraduates would need to choose careers in family medicine.2 In 2006, 31.7% of medical school graduates selected family medicine as their first choice, up from 27.9% in 2005, 26.4% in 2004, and 24.8% in 2003.3 This recent increasing trend is encouraging, as it comes after a decade-long steady decline in the number of students choosing family medicine residencies4; however, the supply of new family physicians is still not meeting the demand.
Studies cite various barriers that prevent students from choosing family practice, including a lack of exposure to family physician role models, inadequate understanding of the practice possibilities in family medicine, disparaging comments about family medicine made by clinical supervisors in other medical disciplines, perceived low levels of prestige and remuneration, and concern about few opportunities for research in family medicine.3,5
Increasing exposure
One strategy for increasing the number of medical school graduates who select family medicine residencies involves broadening medical student exposure to primary care and family physicians. An important way that the College of Family Physicians of Canada is addressing this goal is by supporting student family medicine interest groups (FMIGs).
These FMIGs are student-run, faculty-supported groups that aim to promote family medicine as a career choice to medical students.6 Family medicine interest groups organize such activities as family physician speaker series, mentorship programs with family medicine residents and practising physicians, and research and clinical skills workshops. Informing students about opportunities in family medicine through FMIGs is one way to improve awareness of the diverse career options in family medicine, and FMIGs can receive funding to do so.
Our experience at McGill University in Montreal, Que, is that FMIGs might be effective in increasing student interest in family medicine, and might have contributed to the recent trend of more students choosing family practice residencies; however, there is little evidence to support this claim. Research into the effectiveness of FMIGs could confirm whether they influence medical students to choose family medicine careers and would validate their cost-effectiveness.
Erasing stigmas
In light of the need for such research, McGill University’s FMIG leadership undertook an introductory survey of a group of first- and second-year McGill University medical students before and after they attended the first FMIG session of the academic year. This session consisted of an audiovisual presentation entitled “Family Medicine: Everything You Wanted to Know But Were Too Underexposed to Ask.”
The interactive, 20-minute presentation, given by one of the authors (E.C.), a family medicine resident at the time, addressed common misconceptions about family physicians, explaining that they are able to work in emergency medicine, perform obstetric procedures, and provide primary pediatric care. The presentation also emphasized positive reasons for choosing family medicine (such as lifestyle, flexibility, and whole-person care) as well as the rewards and challenges for family doctors today. Our survey showed that a brief, cost-effective intervention could increase medical student awareness of the breadth and scope of family medicine.For example, the number of students who were aware that most of Canada’s emergency rooms are staffed by family physicians rose from 62% before the presentation to 91% afterward. Furthermore, before the presentation only 58% of participants knew that family physicians could work in neonatal intensive care units; this number increased to 91% after the presentation.
Whether this enhanced awareness led to an increased interest in family medicine has yet to be determined. Similar studies at other universities would shed additional light on the role of FMIGs in addressing the family physician crisis in Canada. A notable by-product of this endeavour would be to provide medical students and family medicine residents the opportunity to do methodologically sound research, which in turn would help in their training as future clinician-researchers.
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