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Research ArticleResearch

Future practice of comprehensive care

Practice intentions of exiting family medicine residents in Canada

Ivy F. Oandasan, Douglas Archibald, Louise Authier, Kathrine Lawrence, Laura April McEwen, Maria Palacios Mackay, Marie Parkkari, Shelley Ross and Steve Slade
Canadian Family Physician July 2018; 64 (7) 520-528;
Ivy F. Oandasan
Director of Education and the lead for the national implementation of the Triple C Competency-based Curriculum at the College of Family Physicians of Canada in Mississauga, Ont, and Professor in the Department of Family and Community Medicine at the University of Toronto.
MD CCFP MHSc FCFP
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  • For correspondence: i.oandasan@utoronto.ca
Douglas Archibald
Education Research Scientist at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute in Ottawa, Ont, and Assistant Professor in the Department of Family Medicine at the University of Ottawa.
MA PhD
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Louise Authier
Postgraduate Program Director in the Department of Family Medicine at the University of Montreal in Quebec at the time of the study, and is Associate Professor in the Department of Family and Emergency Medicine at the University of Montreal.
MD CCFP FCFP
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Kathrine Lawrence
Associate Professor and Residency Program Director in the Department of Family Medicine at the University of Saskatchewan in Regina.
MD CCFP FCFP
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Laura April McEwen
Director of Assessment and Evaluation for Postgraduate Medical Education and Assistant Professor in the Department of Pediatrics at Queen’s University in Kingston, Ont.
MA PhD
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Maria Palacios Mackay
Assistant Professor in the Department of Family Medicine and Co-Director of the Office of Global e-Health at the University of Calgary in Alberta.
DDS MSc PhD
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Marie Parkkari
Assistant Curriculum Instructional Designer for the Postgraduate Family Medicine Program at the Northern Ontario School of Medicine and a doctoral student in education at Lakehead University in Thunder Bay, Ont.
MSc
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Shelley Ross
Associate Professor and Education Researcher in the Department of Family Medicine at the University of Alberta in Edmonton.
MA PhD
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Steve Slade
Vice President of Data and Analysis for the Association of Faculties of Medicine of Canada in Ottawa and Director of the Canadian Post-M.D. Education Registry at the time of the study.
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Article Figures & Data

Tables

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    Table 1.

    Demographic characteristics of residents who responded to the T1 and T2 surveys (aggregate data from 6 family medicine residency programs)

    CHARACTERISTICT1, N (%)T2, N (%)
    Age, y
      • < 2552 (15.2)0 (0.0)
      • 25–29176 (51.6)160 (49.2)
      • 30–3460 (17.6)110 (33.8)
      • 35–3923 (6.7)31 (9.5)
      • ≥ 4013 (3.8)18 (5.5)
      • No response17 (5.0)6 (1.8)
    Marital status
      • Single194 (56.9)131 (40.3)
      • Married98 (28.7)120 (36.9)
      • Common law45 (13.2)59 (18.2)
      • Divorced4 (1.2)8 (2.5)
      • Prefer not to answer0 (0.0)5 (1.5)
      • No response0 (0.0)2 (0.6)
    Children
      • Yes or expecting54 (15.8)82 (25.2)
      • No285 (83.6)238 (73.2)
      • Prefer not to answer2 (0.6)3 (0.9)
      • No response0 (0.0)2 (0.6)
    Sex
      • Female210 (61.6)199 (61.2)
      • Male119 (34.9)122 (37.5)
      • Prefer not to answer0 (0.0)1 (0.3)
      • No response12 (3.5)3 (0.9)
    Childhood environment
      • Inner city0 (0.0)17 (5.2)
      • Urban or suburban222 (65.1)195 (60.0)
      • Small town46 (13.5)44 (13.5)
      • Rural42 (12.3)34 (10.5)
      • Remote or isolated6 (1.8)5 (1.5)
      • Mixture of environments22 (6.5)23 (7.1)
      • No response3 (0.9)7 (2.2)
    Place of medical school graduation
      • Canadian medical graduate276 (80.9)271 (83.4)
      • International medical graduate55 (16.1)51 (15.7)
      • No response10 (2.9)3 (0.9)
    Total341 (100.0)325 (100.0)
    • View popup
    Table 2.

    Type of FM practice envisioned

    “AFTER COMPLETING YOUR RESIDENCY, HOW LIKELY ARE YOU TO PRACTISE IN THE FOLLOWING FM PRACTICE TYPES?”DATA COLLECTION PERIODCI P VALUEχ2 P VALUE
    T1, %T2, %
    Comprehensive care delivered in 1 clinical setting (eg, office) (N for T1 = 336, N for T2 = 316)
      • Not at all likely or somewhat unlikely25.635.8NS< .001
      • Neutral31.88.5< .01
      • Somewhat likely or highly likely42.655.7NS
    Comprehensive care provided across multiple clinical settings (eg, hospital, long-term care facility, office)
    (N for T1 = 340, N for T2 = 319)
      • Not at all likely or somewhat unlikely5.615.0< .01< .001
      • Neutral24.76.3< .01
      • Somewhat likely or highly likely69.778.7NS
    Comprehensive care that includes special interests (eg, sports medicine, emergency medicine, palliative care)
    (N for T2 = 312)
      • Not at all likely or somewhat unlikelyNA14.7NANA
      • NeutralNA14.4NA
      • Somewhat likely or highly likelyNA70.8NA
    Focused practice with a commitment to ≥ 1 specific clinical areas (eg, sports medicine, maternity care, emergency medicine, palliative care, hospital medicine) (N for T2 = 314)
      • Not at all likely or somewhat unlikelyNA49.4NANA
      • NeutralNA14.0NA
      • Somewhat likely or highly likelyNA36.6NA
    • FM—family medicine, NA—not asked in T1, NS—not significant.

    • View popup
    Table 3.

    Changes from entry to exit (T1 to T2) in residents’ intentions to practise in domains outside the ambulatory clinical setting: The 7 family medicine clinical domains outside of ambulatory care are palliative or end-of-life care, care in long-term care facilities, intrapartum care, care in emergency departments, in-hospital clinical procedures, hospital care, and care in the home.

    “IN YOUR FUTURE PRACTICE AS A FAMILY PHYSICIAN, HOW LIKELY ARE YOU TO PROVIDE CARE IN EACH OF THE FOLLOWING DOMAINS, PRACTICE SETTINGS, AND SPECIFIC POPULATIONS IN THE FIRST 3 YEARS?”T1, N (%)T2, N (%)
    Care across the life cycle only16 (5.8)15 (5.6)
    Care across the life cycle plus 1 domain35 (12.8)36 (13.3)
    Care across the life cycle plus 2 domains63 (23.0)45 (16.7)
    Care across the life cycle plus 3 domains66 (24.1)49 (18.1)
    Care across the life cycle plus 4 domains50 (18.2)49 (18.1)
    Care across the life cycle plus 5 domains25 (9.1)32 (11.9)
    Care across the life cycle plus 6 domains13 (4.7)21 (7.8)
    Care across the life cycle plus 7 domains6 (2.2)23 (8.5)
    Total274 (100.0)270 (100.0)
    • View popup
    Table 4.

    Change in the number of domains outside the ambulatory clinical setting residents report they are likely to include in their future practices

    NO. OF DOMAINS OUTSIDE AMBULATORY CLINICAL SETTINGT1, N (%)T2, N (%)P VALUE*
    Care across the life cycle plus 0 to 3 domains180 (65.7)145 (53.7).005
    Care across the life cycle plus 4 to 7 domains94 (34.3)125 (46.3)
    • ↵* Fisher exact test.

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Canadian Family Physician: 64 (7)
Canadian Family Physician
Vol. 64, Issue 7
1 Jul 2018
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Future practice of comprehensive care
Ivy F. Oandasan, Douglas Archibald, Louise Authier, Kathrine Lawrence, Laura April McEwen, Maria Palacios Mackay, Marie Parkkari, Shelley Ross, Steve Slade
Canadian Family Physician Jul 2018, 64 (7) 520-528;

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Ivy F. Oandasan, Douglas Archibald, Louise Authier, Kathrine Lawrence, Laura April McEwen, Maria Palacios Mackay, Marie Parkkari, Shelley Ross, Steve Slade
Canadian Family Physician Jul 2018, 64 (7) 520-528;
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  • Article
    • Abstract
    • Comprehensive care in FM
    • The CFPC Patient’s Medical Home model
    • Defining comprehensive care
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