The Big Ideas Soapbox at Family Medicine Forum (FMF) showcases concepts that could make a difference to clinical practice, faculty development, postgraduate or undergraduate education, patient care and outcomes, or health policy. This session offers a platform for innovators to share fresh ideas, innovative thinking, and fledgling developments with the potential to initiate change. Proposals are selected for presentation at FMF based on reviewers’ scores, and the innovators are invited to the Big Ideas Soapbox session to present and defend their ideas. Audience participation identifies the top proposals. These were the top ideas at FMF 2022.
Developing a sustainable health care mentorship program (top score)
Most Canadian physicians (about 90%) are concerned about climate change and more than 75% understand that it will have a substantial effect on the health of Canadians.1 A 2021 international study highlighted that participants cited lack of knowledge, lack of time, and, to a lesser degree, concern over whether such efforts would make a difference as barriers to engaging with the public about the linkages between climate change and health.2 How do we close the gaps to ensure that family physicians can make changes in their practices to contribute to a more sustainable health care system? How do we do this at the speed and scale required to respond to the climate emergency in our current context of physician burnout, competing priorities, and diverse family medicine clinic and practice models with varying levels of administrative support? There already exist many tool kits and resources as well as family medicine leaders with this expertise. Our hypothesis is that actually implementing such changes across the diverse landscape of family medicine clinics requires time, administrative effort, expertise, and especially financial support.
This proposal is to have a comprehensive sustainable health care mentorship program that is targeted to family medicine clinics to support them and cut down on the time and barriers to implementation. The program would provide interested clinics with sustainable health care mentorship, access to education, and focused financial resources to assist them in making the most impactful changes for their particular situations. Individual clinics would be supported in creating a menu of improvements and changes to reduce their carbon footprints and in implementing these actions. Measured outcomes would include survey feedback from participating clinics and carbon reduction achieved through implementation of changes at the individual clinic level.
Footnotes
Competing interests
None declared
Social prescribing to address social needs in family medicine
Family physicians are caring for people with increasingly complex and overlapping medical and social needs. Social factors impacting health have been especially exacerbated throughout the COVID-19 pandemic, including food and housing insecurity, isolation and loneliness, and declines in mental health. At the same time, clinicians are often left feeling underprepared and unsupported in addressing social needs. Social prescribing brings together the social and medical models of health, treating people in a way that is more careful and caring by shifting the lens from “What’s the matter with you?” to “What matters to you?” Just like medical prescriptions, social prescriptions should emerge from the foundational relationships family doctors develop with people and communities, build on the strengths of the recipient and the clinician, and involve tracking and follow-through.1
Social prescribing has a growing Canadian and international evidence base. A recent example of measuring impact is from Rx: Community,2 a first-of-its-kind social prescribing research project in Ontario. Run by the Alliance for Healthier Communities, this pilot project included 11 community health centres across the province, involving 147 health professionals, 1101 patients, 71 health champions, and 58 health champion–created programs. Through the program, patients reported improvements in mental well-being and self-management of health, decreased loneliness, and an increased sense of connectedness and belonging. Health professionals found social prescribing useful for improving well-being and decreasing repeat visits, citing the importance of a dedicated navigator. Overall, social prescribing achieved deeper integration between clinical care, interprofessional teams, and social support mechanisms, with community capacity increasing through cocreation. Social prescribing can transform how we address social needs in family medicine.
Footnotes
Competing interests
Dr Dominik Alex Nowak has received honoraria or consulting fees from the Alliance for Healthier Communities, Canada Health Infoway, the Centre for Effective Practice, the Ontario College of Family Physicians, the Ontario Medical Association, and TELUS.
References
Complexity thinking should be a bedrock of family medicine
How often have you found yourself thinking about your work and realizing it is “messy”? As generalists, we handle complexity regularly yet seldom reflect on our work in this way. This is problematic, because complex adaptive systems—human beings, communities, health services, and so on—behave in often unexpected and interconnected ways that are difficult to predict using traditional linear means alone. To improve care and optimize health outcomes, today’s family physicians need to be able to identify complex phenomena in their practices, how these phenomena can influence what happens next, and how to design, adapt, and evaluate family medicine services with a complexity perspective. Complexity thinking should be a core competency for modern family physicians; let us embrace our relationship with the messy, equip our discipline with the basic principles to understand it, and strengthen our position as leaders in health care excellence.
Embracing complexity thinking within family medicine will initially involve its explicit mention within the CanMEDS–Family Medicine competency framework,1 paired with training and professional development activities on such concepts as how to examine problems from multiple vantage points and measuring what matters. Once a critical mass of family physicians is conversant in these concepts, we can expect to see changes in the design, quality improvement, and evaluation of family medicine services. For example, our interventions will be better tailored to individual patient and community contexts, and we will be able to troubleshoot more effectively if we detect a service gap. Complexity science allows us to function at optimal scope and to be part of a continuously learning system of care.
Footnotes
Competing interests
Dr Ginetta Salvalaggio has direct financial relationships with the Alberta College of Family Physicians and the Edmonton Zone Medical Staff Association; is a member on advisory boards or speakers’ bureaus for Alberta Addicts Who Educate and Advocate Responsibly; and received peer-reviewed grants from the Canadian Institutes of Health Research, the Royal Alexandra Hospital Foundation, the College of Family Physicians of Canada, and the Northern Alberta Academic Family Medicine Fund.
Reference
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Uncertainty and opportunity: enhanced skills in a 3-year program
As the College of Family Physicians of Canada moves to an expanded 3-year residency program as outlined in its Outcomes of Training project,1 the future of enhanced skills (ES) training in family medicine remains uncertain and undefined. This is in the context of rising interest and engagement by family medicine residents in ES programs. One consideration is the development of a resident-driven and self-designed ES track in the 3-year training program that sets out specific goals, objectives, educational experiences, and outcomes in an area of interest or community need. This strategy can deliberately and explicitly support the priority areas as set out in the Outcomes of Training project, including maternity care, social accountability, and Indigenous health. This approach helps support learners who are not interested in pursuing a fourth year of ES training leading to a Certificate of Added Competence, while also providing them with additional preparation in a focused area.
The goal of this Big Idea is to deliberately incorporate ES training to help improve service delivery in communities by expanding family physician scope of practice in a focused area of need. Before implementation of the 3-year program, it is important to survey medical students and residents about their interest in this approach in the context of the College of Family Physicians of Canada’s foundational development work for a 3-year program. This educational design can be evaluated before implementation by providing it as a pilot program to determine levels of interest and engagement. Questions related to the implementation of an ES track could be incorporated into future versions of the Family Medicine Longitudinal Survey to evaluate whether this strategy improves confidence and competence in ES or if it leads to improved or increased service delivery in that area of interest or need after graduation.
Footnotes
Competing interests
None declared
These abstracts have been peer reviewed.
La traduction en français de cet article se trouve à https://www.cfp.ca dans la table des matières du numéro de février 2023 à la page e23.
The opinions expressed in commentaries are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.
- Copyright © 2023 the College of Family Physicians of Canada
Reference
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