Satisfaction with civilian family medicine residency training

DISCUSSION

The results of this study showed that GDMOs were satisfied with many aspects of their family medicine residency training; however, a number of military-specific areas for improvement were identified. This might provide valuable data for family medicine residency programs that accept trainees from the Medical Officer Training Program or the Military Medical Training Program. After completion of a family medicine training program, Canadian Armed Forces GDMOs require not only the broad and generalist skill sets of their civilian counterparts, but are also expected to practise in difficult environments, often with little colleague support. Additionally, GDMOs care for a diverse population comprising soldiers and, when deployed, wounded or ill combatants and indigenous civilians. Therefore, this study aimed to determine how satisfied GDMOs were with their training and how prepared GDMOs felt for practice after completing their residency in a civilian family medicine training program.

Most respondents thought that family medicine residency was relevant to their role as a GDMO. The degree to which GDMOs were satisfied with training depended on the domain of training. Specifically, most respondents were satisfied with their emergency medicine and psychiatry training, and some were satisfied with their sports medicine, base clinic, and critical care training. However, respondents were less satisfied with trauma and occupational health training. These results are similar to studies from other residency programs in the United States. Specifically, LeClair et al showed that in the United States Army, family physicians did not believe that their residency programs prepared them for military-specific practice management.⁶ Additionally, military residents were surveyed regarding their preparedness for deployment; DeZee et al found that military-trained internists required additional training in military-specific areas of practice such as humanitarian assistance medicine.⁷ Our results indicated that the GDMOs’ satisfaction with domains of training was related to the length of time spent on those areas of training. The GDMO participants reported higher satisfaction with emergency medicine and psychiatry, for which the average lengths of training were 8.4 weeks and 5.3 weeks, respectively. They reported lower satisfaction with training in occupational health, trauma, and sports medicine, for which the lengths of training were 0.2 weeks, 2.5 weeks, and 2.5 weeks, respectively.

Not surprisingly, those who completed a portion of their training on a Canadian Armed Forces base perceived their residency training to be in appropriate areas of focus more than the other participants did and on average spent more time in occupational health training. These results indicated that a rotation on a base would likely be heavily slanted toward occupational health and that occupational health would be immediately relevant to GDMOs’ future practice.

It is noteworthy that a substantial number of the study participants’ first postings were to 1 of the 4 large military bases of the Canadian Armed Forces. These bases often provide the bulk of the expeditionary forces deploying to austere locations and 3 of the 4 bases also house large medical units focused on front-line health care. Of the 143 reported deployments, 66 (46%) were to Afghanistan, a mission with a heavy burden of physical trauma. This context might explain the low level of satisfaction with residency training in the domains of trauma, sports medicine, and occupational health. Compared with other participants, those who deployed first to Afghanistan were more satisfied with their residency training in terms of relevance to their role as a GDMO.

In terms of preparedness to practise, less than half of the GDMO participants believed their training prepared them to lead a health care team and work in austere environments. While it is not the purview of family medicine training programs to specifically prepare residents for work in a military environment, the fact that only 32% of respondents believed they were prepared to lead a health care team might represent an area for improvement in family medicine training in general. These leadership skill sets are vital not only to GDMOs but also to family physicians in general. Indeed, the importance of these skills has recently been highlighted in the CanMEDS 2015 framework, with manager being replaced by leader as 1 of the 7 core physician roles.⁸

The findings of this survey might inform a modified training program for GDMOs, specifically with an increased focus on trauma management, occupational health, and sports medicine. In the United States some programs have attempted to incorporate military-specific education into training programs, such as deployment courses² and implementation of operational medicine rotations⁹ and curricula,¹⁰ which have generally been well received and led to improved skills in their trainees. Although it is recognized that family medicine training is broad and care must be taken to avoid diluting other learning opportunities, it might be possible to address these areas of perceived training gaps with minor curriculum changes. It is also likely that many civilian family medicine trainees would benefit from similar curricular refinements, as the skills associated are also relevant to many rural and remote areas of Canada.