In 2023 the College of Family Physicians of Canada (CFPC) launched its crisis in family medicine campaign, an advocacy effort engaging family physicians, other health care professionals, and patients to demand urgent actions from the government to solve the crisis that is pushing the Canadian health care system to a breaking point.1 According to the CFPC, family physicians need “fair pay, a reduction in administrative burden, and support for interprofessional care teams.”1 We argue that in addition to structural improvements, family physicians also need enhanced scholarship competencies to lead innovation and research initiatives to address the challenges facing family medicine. As a discipline, family medicine needs its practitioners to address the crisis on its own terms: scholarship capacity-building can support the discipline to face the possibility of work exhaustion or burnout of health professionals, the provision of complex care, and an aging and increasingly diverse population.2-4
According to Ernest L. Boyer,5 there are 4 types of scholarship relevant to addressing the crisis in family medicine: scholarship of discovery, through which new knowledge and understanding of the crisis can be generated; scholarship of integration, in which evidence from various sources can be used to describe the crisis and identify potential solutions; scholarship of application, by which the solutions to the crisis can be tested and evaluated, and can support the spread and scale-up of successful solutions; and, scholarship of teaching, through which the evidence about the crisis is communicated to partners and other beneficiaries of the scholarship.
The role of scholar is defined in CanMEDS–Family Medicine,6,7 a competency framework designed for all family physicians, as demonstrating “continuous learning and teaching others” (ie, scholarship of teaching), “gathering, combining, and evaluating evidence” (ie, scholarship of integration), and “contributing to the creation and dissemination of knowledge” (ie, scholarship of discovery and scholarship of application). It is further described as a role that uses multiple ways of learning, and encompasses the evaluation of evidence relevant to the primary care context, the formulation of questions, the identification and synthesis of knowledge relevant to those questions, and the education of others. Compared with medical expertise and other competencies, the role of the scholar is commonly under-emphasized. The potential for scholarly competency as a means to address system strain in particular is an understudied area,2-4 and it is a conversation that we are not—but should be—having.
Family physicians are optimally positioned to generate contextualized and actionable knowledge pertaining to the crisis because their community-based discipline is anchored in strong patient-physician relationships.8 These relationships can serve as the foundation from which family physicians can co-generate, describe, test, and communicate the necessary contextual community-driven evidence to address the crisis.
How scholarship can equip family physicians to address the crisis in family medicine
Family physicians’ engagement with scholarship enables its integration into the discipline’s professional identity and equips family physicians with the competencies needed to adapt, advocate, and centre primary care in the face of complex and intersecting challenges faced by their practices and communities.
Adaptive expertise has emerged as an essential competency within complex systems. Going beyond the mastery of routine diagnostic and therapeutic procedures for single, common clinical conditions, adaptive expertise allows practitioners to recognize emerging challenges (eg, comorbidity, COVID-19 disease, health care workforce), reframe problems given new information, and improve or innovate based on this new understanding.9 Family medicine scholarship is an ideal space in which to teach, implement, and evaluate the application of adaptive expertise. By identifying knowledge gaps and scholarly questions, and by acquiring and interpreting data to answer questions, physicians engaged in scholarship develop well-honed critical thinking skills that are also essential to their roles as clinicians, teachers, and leaders. Moreover, outputs from family medicine scholarship play a direct role in creative solutions for the family medicine crisis.
Social accountability is fundamental to the role of family medicine in an era of intersecting crises (eg, housing affordability, climate change, aging population, drug poisoning). The harms experienced by patients and communities in the face of crisis have added another layer of complexity to clinical practice, and conventional biomedical approaches to health care are insufficient to address these harms on their own. Fortunately, family medicine as a community-based discipline can be responsive to, collaborate with, and advocate on behalf of patients and communities.10,11 Given its interdisciplinary and team-based nature, active participation in family medicine scholarship can develop the relational skill set that is needed to safely and meaningfully centre communities within conversations about practice change and policy. Importantly, patient-engaged and participatory research approaches help scholars experience co-designed priority setting, problem solving, and knowledge mobilization that are essential to alleviating the burden of many crises on members of primary care teams, including the patients and the communities these teams serve.
Valuing family medicine and its leadership role within the health system remains an ongoing challenge in the face of the hidden curriculum, which socializes medical trainees to devalue family medicine,12,13 and broader societal trends toward partialism.14 Family physicians are often perceived—and may perceive themselves—as the recipients and consumers of knowledge generated by others, rather than as creators of knowledge in their own right. We argue that by actively countering the myth of family physicians as nonscholars through participation in scholarship, family physicians can assert greater autonomy in setting best-practice and health policy and in attracting additional trainees to advance the basic and applied science critical for the evolution of the profession. Key family medicine scholarship activities include knowledge generation, knowledge synthesis activities (eg, substantive family physician contribution within clinical practice guidelines), and projects that leverage practice-based research and learning networks (ie, scholarship informed directly by family practice data and studies conducted within primary care clinics). Centring on family medicine voices within health care literature, practice guidelines, and policy discussions—work created by us, with us, and for us—are essential to revaluing our discipline within medical schools and at other decision-making tables.
How to build capacity for scholarship in family medicine
Drs Nicholas Pimlott and Alan Katz15 have described the ecology of family medicine research through levels of engagement in research by family physicians, ranging from reading research articles to leading research. A similar approach can be used to describe engagement in other types of scholarship. To build capacity for engagement in scholarship, it will be necessary to review how medical students and family medicine residents are exposed to scholarship, as will be outlined in a number of sections in the forthcoming Version 3.0 of the General Standards of Accreditation for Residency Programs, maintained by the Canadian Residency Accreditation Consortium—the CFPC, the Royal College of Physicians and Surgeons of Canada, and Collège des médecins du Quebec (personal communication with Linda Gibson, Accreditation Branch, Academic Family Medicine at the CFPC, November 5, 2024). We call on educators to not only provide trainees with critical appraisal and quality improvement training, but also to prioritize trainee participation in formal research activities.14 It will also be necessary to secure the resources to support an enhanced skills curriculum pertaining to scholarship; define a pathway for scholarship to be embedded in comprehensive primary care teams with commensurate compensation and protected time; and promote recognition by peers and chairs of family medicine departments, all toward developing a culture that truly values embedded scholarship. As a first step, department chairs should prioritize and support the development of faculty and should embed role models who can inspire and coach residents in teaching units.
Conclusion
Family physicians are already engaging in scholarship through the very nature of their work. We advocate for greater participation in scholarship as an important, defining feature of the discipline that will further strengthen its position within the health system and be an important contributor to the crisis in family medicine. The Blueprint 3.0, representing the CFPC’s Section of Researchers’ Strategic Plan,16 aims to build capacity by promoting the knowledge, skills, and supportive infrastructures to enable family physicians to fully engage in family medicine and primary care research and other scholarly activities. We propose that a way to address the crisis in family medicine is for the CFPC and its membership, including clinicians, educators, and researchers alike, to explicitly recognize scholarship as an essential thread that is woven through all the work undertaken by family physicians. Now is the moment for family physicians to express and celebrate their scholarly selves.
Footnotes
The opinions expressed in this article are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.
This article has been peer reviewed.
- Copyright © 2025 the College of Family Physicians of Canada
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.