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Research ArticleResearch

Family medicine training in housecalls

Survey of residency program directors across Canada

Elizabeth Mui, Thuy-Nga (Tia) Pham and Chase Everett McMurren
Canadian Family Physician November 2018, 64 (11) e498-e506;
Elizabeth Mui
Care of the Elderly Fellow at the University of Toronto in Ontario.
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  • For correspondence: elizabeth.mui@mail.utoronto.ca
Thuy-Nga (Tia) Pham
Academic family physician and Assistant Professor at the University of Toronto and the physician lead of the South East Toronto Family Health Team.
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Chase Everett McMurren
Physician lead for the PrimaryCare@Home Program at Taddle Creek Family Health Team, a psychotherapist and Medical Director of the Al & Malka Green Artists’ Health Centre at Toronto Western Hospital, an investigating coroner for the Province of Ontario, and Lecturer in the Department of Family and Community Medicine at the University of Toronto.
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Geographic distribution of residents: A) Family medicine residents represented in the survey (n = 2083); B) all Canadian family medicine residents based on CaRMS 2014–2015 admissions data (n = 2928).

    CaRMS—Canadian Resident Matching Service.

  • Figure 2.
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    Figure 2.

    Breakdown of HBPC training availability by program and site

    FM—family medicine, HBPC—home-based primary care.

  • Figure 3.
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    Figure 3.

    Availability of home visit arrangements

  • Figure 4.
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    Figure 4.

    Barriers to HBPC training as reported by program directors

    HBPC—home-based primary care.

    *Other includes “has not been established as a goal for our program” and “limited focus on HBPC.”

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    Figure 5.

    Enablers to HBPC training as reported by program directors

    HBPC—home-based primary care.

  • Figure 6.
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    Figure 6.

    Program directors’ self-reported attitude ratings in response to the statement “HBPC training is difficult to coordinate and implement. Its barriers outweigh its educational benefits”

    HBPC—home-based primary care.

  • Figure 7.
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    Figure 7.

    Program directors’ self-reported attitude ratings about the importance of HBPC training for family medicine residents

    HBPC—home-based primary care.

Tables

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    Table 1.

    Description of HBPC survey questions

    SURVEY COMPONENTDESCRIPTION
    Demographic characteristics
    • Program location by region: Western Canada (west coast and the Prairies), Ontario, Quebec, Atlantic Canada

    • Total number of family medicine residents within program

    • Training setting distribution: Urban, suburban, rural, other*

    HBPC† training (multiple choice, free text)
    • Presence and type of HBPC training available

    • Barriers to HBPC training

    • HBPC lectures: Availability, whether mandated, number of hours, and rotation during which lectures occur

    • Home visit experiences: Availability, whether mandated, number of hours, home visit attendees, and availability and characteristics of a formal curriculum‡

    Comments (free text)
    • Additional barriers

    • Other HBPC training methods

    • Enabling factors

    HBPC attitudes (rated on a 5-point Likert scale)Level of agreement with the following statements:
    • “HBPC training is difficult to coordinate/implement. Its barriers outweigh its educational benefits”

    • “HBPC training is an essential part of family medicine training”

    • “Clinical HBPC experiences (home visits) are valuable learning experiences for family medicine residents”

    • “Clinical HBPC experiences (home visits) prepare residents in the core family medicine competencies”

    • HBPC—home-based primary care.

    • ↵* The estimated percentage breakdown of family medicine residents’ primary training setting, across all streams of a program.

    • ↵† Includes various models of home-based physician services including ongoing comprehensive primary care in the home by a sole practitioner or an interprofessional team, and episodic housecalls by a primary care physician.

    • ↵‡ Formal curriculum was defined as a structured curriculum to facilitate home visits for resident trainees.

    • View popup
    Table 2.

    Geographic distribution of respondents and nonrespondents

    LOCATIONNO. OF RESPONDENTSNO. OF NONRESPONDENTS
    Western Canada (west coast and the Prairies)32
    Ontario51
    Quebec31
    Atlantic Canada20
    • View popup
    Table 3.

    Regional comparison of home visit training availability and mandatory requirements, if available in the program

    LOCATIONHOME VISIT AVAILABILITYHOME VISITS MANDATED*
    ALL SITESSOME SITESYES, ALL SITESYES, SOME SITESNO, ALL ELECTIVEOTHER “OPPORTUNISTIC” TRAINING
    Western Canada (west coast and the Prairies)121101
    Ontario310130
    Quebec303000
    Atlantic Canada111100
    • ↵* Home visit experiences required in the program. These could be in an informal capacity, and this does not indicate availability of a structured clinical home visit curriculum.

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Canadian Family Physician: 64 (11)
Canadian Family Physician
Vol. 64, Issue 11
1 Nov 2018
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Family medicine training in housecalls
Elizabeth Mui, Thuy-Nga (Tia) Pham, Chase Everett McMurren
Canadian Family Physician Nov 2018, 64 (11) e498-e506;

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Elizabeth Mui, Thuy-Nga (Tia) Pham, Chase Everett McMurren
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