Are early career family physicians prepared for practice in Canada? A qualitative study

Abstract

Background In Canada, the College of Family Physicians of Canada (CFPC) introduced Competency Based Medical Education to prepare and train family medicine residents to be competent to enter and adapt to the independent practice of comprehensive family medicine. Despite its implementation, the scope of practice is narrowing. This study aims to understand the degree to which early career Family Physicians (FPs) are prepared for independent practice. Method A qualitative design was used for this study. A survey and focus groups were conducted with early-career FPs who completed residency training in Canada. The survey and focus groups examined the degree of preparedness of early career FPs in relation to 37 core professional activities identified by the CFPC’s Residency Training Profile. Descriptive statistics and qualitative content analysis were conducted. Results Seventy-five participants from across Canada participated in the survey, and 59 participated in the focus groups. Early career FPs reported being well prepared to provide continuous and coordinated care for patients with common presentations and deliver various services to different populations. FPs were also well prepared to manage the electronic medical record, participate in team-based care, provide regular and after-hours coverage, and assume leadership and teaching roles. However, FPs reported being less prepared for virtual care, business management, providing culturally safe care, delivering specific services in emergency care hospitals, obstetrics, self-care, engaging with the local communities, and conducting research activities. Conclusions Early career FPs do not feel fully prepared for practice in all 37 core activities in the Residency Training Profile. As part of the introduction of the three-year program by the CFPC, the postgraduate family medicine training should consider providing more exposure to learning opportunities and developing curricula in the areas where FPs are unprepared for practice. These changes could facilitate the production of a FP workforce better prepared to manage the dynamic and complex challenges and dilemmas faced in independent practice.

Response to Lavergne et al

“…Across multiple domainssuch as primary care, emergency care, hospital inpatient care, advocacy, and scholarship-early career family physicians have indicated that their training prepares them for some professional activities but not others. 9 Ongoing results of the CFPC FMLS show that the most second-year family medicine residents believe they have had good exposure in areas like mental health, chronic disease management, and providing care across the life cycle. However, many have identified limited exposure to intrapartum care (16%), palliative care (17%), office-based clinical procedures (19%), practice in long-term care homes (38%), in-hospital clinical procedures (58%), and care for Indigenous populations (38%).…”