Family medicine training in housecalls: Survey of residency program directors across Canada

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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.
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Figure 2.
Breakdown of HBPC training availability by program and site
FM—family medicine, HBPC—home-based primary care.
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Figure 3.
Availability of home visit arrangements
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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.
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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.
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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.

Table 1.

Description of HBPC survey questions

SURVEY COMPONENT	DESCRIPTION
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.

Table 3.

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

LOCATION	HOME VISIT AVAILABILITY		HOME VISITS MANDATED^*

	ALL SITES	SOME SITES	YES, ALL SITES	YES, SOME SITES	NO, ALL ELECTIVE	OTHER “OPPORTUNISTIC” TRAINING
Western Canada (west coast and the Prairies)	1	2	1	1	0	1
Ontario	3	1	0	1	3	0
Quebec	3	0	3	0	0	0
Atlantic Canada	1	1	1	1	0	0

↵* 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.