Pharmacists teaching in family medicine residency programs: National survey

Objective

To determine the percentage of family medicine residency programs that have pharmacists directly involved in teaching residents, the types and extent of teaching provided by pharmacists in family medicine residency programs, and the primary source of funding for the pharmacists.

Design

Web-based survey.

Setting

One hundred fifty-eight resident training sites within the 17 family medicine residency programs in Canada.

Participants

One hundred residency program directors who were responsible for overseeing the training sites within the residency programs were contacted to determine the percentage of training sites in which pharmacists were directly involved in teaching. Pharmacists who were identified by the residency directors were invited to participate in the Web-based survey.

Main outcome measures

The percentage of training sites for family medicine residency that have pharmacists directly involved in teaching residents. The types and the extent of teaching performed by the pharmacists who teach in the residency programs. The primary source of funding that supports the pharmacists’ salaries.

Results

More than a quarter (25.3%) of family medicine residency training sites include direct involvement of pharmacist teachers. Pharmacist teachers reported that they spend a substantial amount of their time teaching residents using a range of teaching modalities and topics, but have no formal pharmacotherapy curriculums. Nearly a quarter (22.6%) of the pharmacists reported that their salaries were primarily funded by the residency programs.

Conclusion

Pharmacists have a role in training family medicine residents. This is a good opportunity for family medicine residents to learn about issues related to pharmacotherapy; however, the role of pharmacists as educators might be optimized if standardized teaching methods, curriculums, and evaluation plans were in place.     

Knowledge of CanMEDS–Family Medicine roles: Survey of Canadian family medicine residents

Objective

This study evaluates the self-perceived awareness of the new CanMEDS–Family Medicine (CanMEDS-FM) roles by family medicine residents.

Design

A 22-question online survey.

Setting

Canadian family medicine residency programs.

Participants

All residents enrolled in a Canadian family medicine residency as of September 2010 received the survey between May and June 2011. A total of 568 residents participated.

Main outcome measures

Survey respondents indicated their awareness of, their exposure to, and the perceived importance of the CanMEDS-FM roles.

Results

The survey response rate was 25.1%. In total, 88.9% (463 of 521) of family medicine residents were aware of the CanMEDS-FM roles; there was no statistically significant difference in awareness between first- and second-year residents. Family medicine expert and communicator were most frequently chosen as the most important CanMEDS-FM roles, while manager and scholar were selected the least often. Overall, 76.4% of family medicine residents thought that their core family medicine teaching was guided by CanMEDS-FM, while 41.8% thought the same about off-service rotations.

Conclusion

It appears that most family medicine residents are aware of the CanMEDS-FM roles. While core family medicine training and evaluation seem to be grounded in CanMEDS-FM, residency program directors should endeavour to ensure that the same principles apply during off-service rotations.     

Shifting into third gear: Current options and controversies in third-year postgraduate family medicine programs in Canada

Objective

To summarize current options for postgraduate third-year programs in family medicine in Canada and compile current controversies about the expanding number of programs available and the trend toward subspecialization in family medicine.

Design

A literature search was conducted by the Regina Qu’Appelle Health Region Library research staff for Canadian family medicine fellowships and residency programs using MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature from the beginning of 2005 to September 1, 2011. All available websites for programs offering third-year options were reviewed.

Setting

Canadian family medicine residency programs.

Methods

A list of current third-year residency programs was generated from the Canadian Post-MD Education Registry. In addition, the current Canadian Resident Matching Service website was reviewed, along with every program-specific website, for current third-year programs offered.

Main findings

More than 30 different options for third-year residency programs are available, including a number of community-influenced and resident-directed enhanced-skills programs. In 2010 to 2011 there were 237 postgraduate third-year family medicine residents compared with 128 in 2010 to 2011, an increase of 109 positions.

Conclusion

Controversies over the benefits to the patient population, the practice patterns of third-year residency graduates, and the influence of a subspecialty trend against a stated goal of comprehensive family medicine continue to exist, while the number of available third-year residency options continues to expand.     

Choosing family medicine residency programs: What factors influence residents’ decisions?

Objective

To describe key determinants for residents’ selection of a new community-based, interprofessional site for their family medicine training, and to evaluate residents’ satisfaction with their programs.

Design

Combined qualitative and quantitative methods using in-depth interviews and a survey.

Setting

McMaster University, including the new site of the Centre for Family Medicine in Kitchener-Waterloo, Ont, and a long-established site in Hamilton, Ont.

Participants

Eleven first-year and second-year family medicine residents from the Kitchener-Waterloo site participated in in-depth interviews. Forty-four first-year and second-year family medicine residents completed the survey, 22 in Kitchener-Waterloo and 22 in Hamilton.

Methods

Kitchener-Waterloo residents participated in in-depth interviews during their residency programs in 2008 to 2009 using a semistructured format to explore their choice of site and the effect of an interprofessional environment on their education. Common themes were established using qualitative analysis techniques; based on these themes, a survey was developed and distributed to residents from both sites to further explore factors influencing site selection, satisfaction, and effects of interprofessional education.

Main findings

Residents identified several reasons for selecting a new community-based, interprofessional family medicine residency program. Reasons included preference for the location and opportunities to learn in an interprofessional teaching environment. A less hierarchical structure and greater opportunities for one-on-one teaching also influenced their choices. Perception of poor communication from the well established site was identified as a challenge. Residents at both sites indicated similarly high levels of program satisfaction.

Conclusion

Residents selected the new community-based family medicine site for reasons of geographic location and the potential for clinical learning experiences and interprofessional education. High program satisfaction was achieved at both the new and well established sites. Family medicine residency programs developing community-based networks might consider and encourage the positive influence of interprofessional care and education. Good communication between distributed sites remains a challenge.     

Protected block time for teaching and learning in a postgraduate family practice residency program

Objective

To explore the elements necessary for a high-quality educational experience in a family practice residency program with respect to scheduling, learning environment, and approaches to teaching and learning.

Design

An interpretative, qualitative study using a generative-inquiry approach.

Setting

The Nanaimo Site of the University of British Columbia Family Practice Residency Program.

Participants

Fifteen physician instructors and 16 first- and second-year residents.

Methods

Data were gathered from 2 qualitative focus group interviews with residents; 2 qualitative focus group interviews with physician instructors; and structured and semistructured observation of 2 in-class seminars, with a focus on residents’ engagement with the class. Results were analyzed and categorized into themes independently and collectively by the researchers.

Main findings

Protected block time for teaching and learning at the Nanaimo Site has been effective in fostering a learning environment that supports collegial relationships and in-depth instruction. Residents and physician instructors benefit from the week-long academic schedule and the opportunity to teach and learn collaboratively. Participants specifically value the connections among learning environment, collegiality, relationships, reflective learning, and the teaching and learning process.

Conclusion

These findings suggest that strategic planning and scheduling of teaching and learning sessions in residency programs are important to promoting a comprehensive educational experience.     

Assessment of communication skills in family medicine

Objective

To assess the communication and interviewing skills of incoming residents and provide formative feedback to residents early in their training.

Design

New residents completed a 15-minute objective structured clinical examination (OSCE) assessing communication skills and a 12-question, self-administered content quiz at the start of their residency. Each resident was directly observed by a family physician in the OSCE and provided with 15 minutes of structured feedback, with an opportunity for questions and discussion. The entire process remained private and did not affect summative evaluations.

Setting

Family medicine residency training program at the University of Alberta in Edmonton.

Participants

First-year family medicine residents.

Main outcome measures

Residents’ scores on the OSCE and the content quiz; residents’ rating of the usefulness of the assessment and the likelihood it would lead to practice change.

Results

A total of 61 residents (93.8%) completed the skills assessment (50 Canadian graduates, 11 international graduates). The mean score for the content quiz was 20.6 out of a total possible score of 24. Resident scores ranged from 8 to 24. The mean score on the OSCE practice interview was 21.1 out of 30, with a range of 13 to 29. Learner feedback indicated that the skills assessment was useful (4.68 out of 6) and would lead to a change in practice (4.43 out of 6).

Conclusion

The introductory communication OSCE and quiz offer new residents an opportunity to gauge their baseline skill level, become aware of program expectations early in their training, and garner specific suggestions in a nonthreatening environment. This tailored approach helps orient residents while taking into account their previous experiences.     

Residency research requirements and the CanMEDS-FM scholar role: Perspectives of residents and recent graduates

Objective

To explore the perspectives of family medicine residents and recent family medicine graduates on the research requirements and other CanMEDS scholar competencies in family practice residency training.

Design

Semistructured focus groups and individual interviews.

Setting

Family practice residency program at the University of British Columbia in Vancouver.

Participants

Convenience sample of 6 second-year family medicine residents and 6 family physicians who had graduated from the University of British Columbia family practice residency program within the previous 5 years.

Methods

Two focus groups with residents and individual interviews with each of the 6 recently graduated physicians. All interviews were audiotaped, transcribed, and analyzed for thematic content.

Main findings

Three themes emerged that captured key issues around research requirements in family practice training: 1) relating the scholar role to family practice, 2) realizing that scholarship is more than simply the creation or discovery of new knowledge, and 3) addressing barriers to integrating research into a clinical career.

Conclusion

Creation of new medical knowledge is just one aspect of the CanMEDS scholar role, and more attention should be paid to the other competencies, including teaching, enhancing professional activities through ongoing learning, critical appraisal of information, and learning how to better contribute to the dissemination, application, and translation of knowledge. Research is valued as important, but opinions still vary as to whether a formal research study should be required in residency. Completion of residency research projects is viewed as somewhat rewarding, but with an equivocal effect on future research intentions.     

Family physicians' attitudes toward education in research skills during residency: findings from a national mailed survey

OBJECTIVE

To determine the attitudes of practising Canadian family physicians toward education in research skills during residency, to identify what determines these attitudes, and to investigate the effect of education in research skills on future research activity.

DESIGN

Mailed survey.

SETTING

Primary care.

PARTICIPANTS

Stratified random sample of 247 practising physicians who were members of the College of Family Physicians of Canada.

MAIN OUTCOME MEASURES

Physicians’ attitudes toward education in research skills during residency, their perceptions of the value of research in primary care, and their current involvement in research activities.

RESULTS

Overall response rate was 56%. Nearly all respondents agreed that critical appraisal skills are essential to the practice of modern family medicine. Most agreed that it is very important that the evidence base for primary care medicine be developed by family physicians, yet only one-third agreed that research skills ought to receive more emphasis during residency training, and fewer than one-quarter agreed that practising family physicians should have strong research skills. Fewer than half the respondents agreed that a core goal of family medicine residency training should be to promote and develop an active interest in research. While three-quarters agreed that research projects during residency can be formative learning experiences, only about 40% indicated that research projects should be required, and only about 20% considered their own resident research projects to have been highly influential learning experiences. Respondents whose residency programs had research in the curriculum were significantly more likely to have found their research projects to be highly influential learning experiences (P <.05), and those who had successfully completed research projects were less likely to believe that they lacked the necessary skills and expertise to conduct their own research studies. Those who had successfully completed resident research projects participated in postresidency research activity at a significantly higher rate than those who did not complete projects (P <.01).

CONCLUSION

Despite a conviction that research is important in primary care, only a few practising family physicians in our sample believed that strong research skills are important or that education in research skills should receive more emphasis during residency training. Resident research projects are not invariably influential learning experiences, although some evidence indicates that successful completion of a project makes future participation in research more likely.     

Availability and Potential Impact of International Rotations in Emergency Medicine Residency Programs

Background

Interest in international emergency medicine (IEM) is growing. With the globalization of medicine, IEM as a field has expanded from disaster relief efforts to opportunities for resident education. Numerous accounts have been published voicing the educational benefits of international rotations (IRs). As such, many residencies now offer opportunity for IRs.

Objective

To evaluate the availability and utilization of IRs in emergency medicine (EM) residency programs.

Methods

EM residency program directors were surveyed from the 126 Accreditation Council for Graduate Medical Education-accredited programs with ≥2 years of residency graduates. Directors were asked about availability of IR, categorized as: 1) required; 2) elective (with or without pre-designated sites); or 3) not available.

Results

One hundred eleven (88%) program directors reported data on 2240 graduates over 2 years. IRs were offered by 101 (91%) programs. No program required an IR. Among programs offering IRs, most (69%) did not have pre-designated sites. Eighty-nine of 101 programs (88%) allowing IRs had at least one resident completing an IR; 23 of 111 programs (21%) had more than 30% resident participation in IRs. Programs offering IRs at pre-designated sites had 210 of 727 (29%) residents complete an IR, compared to 272 of 1469 (19%) in programs without pre-designated sites (p < 0.001). Four-year programs had twice as many IR participants (32%) compared to 3-year programs (17%; p < 0.001).

Conclusions

More residents participated in IRs when a pre-designated site was available compared to programs without. This suggests that programs interested in supporting IRs consider developing pre-designated sites to accommodate residents.