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 individuals or teams 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 2023.
Educational contribution to a physician resource problem (top score)
In response to the family physician crisis,1 Queen’s University in Kingston, Ont, is launching a new campus dedicated to family medicine. Students will meet existing MD program objectives through a redesigned curriculum organized around the human life cycle. After participating in a “Transition to Medicine” unit, students will learn through cases constructed around common reasons young adults seek care from family physicians, moving through courses on each phase of the lifespan, with 1 unit highlighting complexity. In the second year, they will revisit these presentations with increasing depth while exploring new, more complex presentations through a family medicine lens. They will learn in small groups with family medicine tutors. They will participate in early and varied community placements including longitudinal placements in family practices, “community week,” and a 1-month-long placement at the end of the first year. Their residency positions in family medicine are assured upon successful completion of the MD curriculum.
We hypothesize that by grounding medical education in family medicine from the first day of medical school, through featuring family medicine expert teachers and focusing entirely on a generalist approach to medicine, our students will embrace managing uncertainty and caring for patients across the lifespan in many different settings. As students will not need to participate in the Canadian Resident Matching Service process, we hypothesize they will experience less stress regarding career planning and have a more integrated transition to postgraduate training. We are hoping that this curricular reform will start to address the hidden curriculum in undergraduate medical education.2 While it will take many years to measure the success in terms of students ultimately practising as family physicians who provide comprehensive care, we will measure their experiences with the hidden curriculum earlier in their training and assess their comfort levels as they approach residency and independent practice.
Footnotes
Competing interests
None declared
Reference
After the ABCs of pediatrics, is there a place for the XYZs of geriatrics?
Many structured clinical tools (SCTs) facilitate the delivery of preventive care by primary care clinicians (PCCs). These include the Centre Hospitalier Universitaire Sainte-Justine’s ABCs program for child health in Montréal, Que; HEADSS (home, education and employment, peer group activities, drugs, sexuality, and suicidality or depression) for adolescent health1; and a variety of clinical preventive care checklists for adults. We noted that there are no widely used SCTs for preventive care of elderly patients. To address this gap we conducted a scoping review, which included an expert panel. Our goal was to map existing geriatric SCTs and assess the feasibility of their use in primary care. In light of the results, we are developing a tool that PCCs can easily use with older patients. Along the same lines as the ABCs of pediatrics, we are developing the XYZs of geriatrics.
We believe that the XYZs will help integrate preventive care of elderly patients into family medicine practice. Falls, cognitive disorders, malnutrition, etc: What should PCCs prioritize and how should they perform screening? We are working to ensure that the XYZs answer these questions. In addition, the XYZs will help standardize geriatric preventive care practices so that every older adult receives the preventive care they deserve. We also believe that the XYZs could be used with health sciences learners as an educational framework for preventive care of elderly patients. We have garnered support from multiple medical clinics and organizations to begin a pilot implementation of the XYZs once the design is finalized. This will allow for the evaluation of multiple aspects, including clinician and patient satisfaction and the tool’s impact on the rate of adverse events such as falls, hospitalizations, and functional decline.
Footnotes
Competing interests
None declared
Implementation guide for environmental stewardship in long-term care
Health care contributes 4.6% of greenhouse gas emissions in Canada1 and is already being impacted by a changing climate itself; thus, mitigation of emissions from health care institutions and their supply chains is urgently needed. Additionally, long-term care (LTC) has been disproportionately impacted by the COVID-19 pandemic,2 and with our country’s aging population, supporting and adapting LTC facilities is more crucial than ever before. We have created 2 guidebooks oriented to hospitals and LTC facilities focused on educating clinicians about the impact of their decision making on the climate and providing key steps and actionable items for senior leadership. These guides fill the gap between an evident desire to move toward sustainability and the practicalities of implementation. The guidebooks include background information on climate change and health systems as well as a road map to sustainability. The centrepiece is the action item checklist, which includes categories such as leadership, supply chain, and, most importantly for clinicians, education and drugs and devices.
Every test and medication has its own carbon footprint. These recommendations provide simple ways for clinicians to adjust their practices in ways that naturally promote a culture of sustainability while decreasing the carbon footprint of health care facilities. Additionally, many of the action items provide instant cost savings, and those that involve an upfront investment often lead to return on investment in the long run. Through dissemination of these guidebooks and early feedback, we are discovering that providing easy-to-implement strategies allows leadership and clinicians to move past indecision and uncertainty and focus on high-yield interventions, a strategy that we hope to see lead to more action and less delay in decision making. Additionally, resident involvement in sustainability initiatives is emphasized and provides the further benefit of promoting social inclusion, wellness, and community engagement.
Footnotes
Competing interests
None declared
Formulating a theory of adaptive expertise for family medicine
The rapidly evolving health care system is compelling physicians to adapt and innovate. Arguments have been made for reshaping physician education to emphasize training of clinicians to be adaptive experts.1 Contrasted with routine expertise, adaptive expertise is a complex metaskill crucial for addressing clinical situations fraught with ambiguity and uncertainty. Adaptive expertise extends beyond routine expertise and involves recognition of the gap between a current novel situation and similar, more routine situations. While there are a few conceptual frameworks of adaptive expertise developed within the health professions, there does not exist a framework specific to family medicine. Developing such a theory has important implications for competency-based family medicine education and is essential for defining the theoretical construct necessary for robust assessment. We propose applying the theory construction methodology developed by Borsboom and colleagues2 to formulate a theory of adaptive expertise in the context of family medicine practice.
Borsboom and colleagues’ theory construction methodology is conducted heuristically as a series of 5 sequential steps.2 In step 1, the domain of empirical phenomena that becomes the target of explanation is identified. In step 2, a proto-theory—a set of theoretic principles that putatively explain the empirical phenomena—is constructed. This is done through abductive reasoning; the proto-theory outlines how the phenomena would arrive if the theory were true. In step 3, the formal model is constructed. In step 4, an investigation is made to determine if the model can adequately explain the empirical phenomena. In step 5, a systematic investigation of the theory’s overall worth is conducted by evaluating whether the identified phenomena are reproduced faithfully and whether the explanatory principles are sufficiently parsimonious and substantively plausible. Examples will be provided for each step to illustrate how a theory of adaptive expertise for family medicine could be constructed and evaluated.
Footnotes
Competing interests
None declared
These abstracts have been peer reviewed.
Cet article se trouve aussi en français à la page 91.
The opinions expressed in commentaries are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.
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