The family medicine residency program is based on 99 priority topics set out by the College of Family Physicians of Canada (CFPC). The national consensus on and clarity of these topics is contrasted by the 387 guidelines from various organizations pertaining to family practice in Canada, of which a number have been endorsed by the CFPC.1
With this avalanche of guidelines and opinions, it is not surprising that guidelines are poorly implemented.2,3 As a family medicine resident, I come across this phenomenon in daily practice manifested as different habits in diagnosis, treatment, and preventive care guided largely by academic reading patterns and personal preferences.
To study for the CFPC examination, I use the highest-yield documents and try to work my way through an array of literature often not applicable to Canada. At graduation I will have inherited a number of personal preferences from my preceptors, which are undoubtedly helpful but not necessarily effective or evidence-based.
International examples show us that this is not a necessary outcome of guidelines in primary care. A core role of the Dutch College of General Practitioners has been the development of primary care guidelines that are led by family physicians, allowing substantial patient, specialist, and funding agency input. Currently 91 guidelines are in use, which cover 70% to 80% of the conditions seen in family practice.4 The guidelines have been shown to improve the process and structure of care as well as patient outcomes.5
If the CFPC can reach consensus on the 99 topics, it will also be able to spearhead the development of primary care guidelines that better reflect primary care, lead to better health outcomes, and have a positive effect on the well-being of family medicine residents.6
Footnotes
Competing interests
None declared
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