Revitalizing Generalist Practice: The Montreal Statement

Reeve, Joanne; Beaulieu, Marie-Dominique; Freeman, Tom; Green, Larry A.; Martin, Carmel M.; Okada, Tadao; Palmer, Victoria; Sturgiss, Elizabeth; Sturmberg, Joachim P.; Weel, Chris van

doi:10.1370/afm.2280

Cited by 8 publications

(11 citation statements)

References 4 publications

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“…The primary components of EGP are 'person-centred decision-making' and 'interpretive medical practice', 6 and as confirmed in the present study, family medicine experts in Japan also viewed these elements as critical to their practice, acknowledging that this is the core expertise of generalist care. 8 In addition, Japanese family doctors cited care integration and effective use of healthcare resources as positive impacts of EGP, consistent with earlier findings. 7 Reeve et al 7 identified 'lack of a consistent understanding of distinct expertise', 'competing priority inhibiting EGP', 'lack of consistent development of skills in interpretive practice', and 'lack of resources for manageable monitoring building'.…”

Section: Comparison With Existing Literaturesupporting

confidence: 84%

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Perspectives on expert generalist practice among Japanese family doctor educators: a qualitative study

et al. 2021

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BackgroundExpert generalist practice (EGP) is increasingly being viewed as the defining expertise of generalist care. In Japan, several family doctors consider it important and relevant in the Japanese context. However, no study has examined Japanese family doctor educators’ perceptions of EGP.AimTo explore Japanese family doctor educators’ perceptions of EGPDesign & settingA qualitative study among family doctor educators in JapanMethodWe conducted focus group interviews using a semi-structured interview guide following a short lecture on EGP. We adopted a qualitative description method and used the framework method to conduct thematic analysis.ResultsParticipants included 17 family medicine trainers in Japan, including 11 directors and five associate directors of family medicine training programmes. The results suggested that the concept of EGP was important and applicable to primary care in Japan. Participants’ perceptions on EGP pertained to the following four areas: impact of EGP, triggers for EGP, enablers for EGP, and educational strategies for EGP.ConclusionThe concept of EGP may be useful in clinical practice in Japan, especially in complex patient care. A clearer framework for or description of EGP, and of non-traditional methods such as ascetic practice and awareness of the self, were proposed as possible educational strategies.

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Section: Comparison With Existing Literaturesupporting

confidence: 84%

“…[5][6][7] Whole-person, individually-tailored clinical decision-making is seen as the defining expertise of generalist care internationally. 8 Such expertise should be fostered through formal training, not merely experiential learning. 5 In Japan, like many other countries, generalist care is seen as increasingly important.…”

Section: Introductionmentioning

confidence: 99%

Perspectives on expert generalist practice among Japanese family doctor educators: a qualitative study

et al. 2021

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“…The central goal of this transformation is to produce excellent community-focused personal physicians, 50 broadly-educated expert generalists 51 who establish and sustain ongoing, trusting relationships with patients over time and across place. As clinically-competent, trusted partners and advisors who understand patients' goals and life circumstances, personal physicians provide, or work with others to provide, health care services that patients want and need.…”

Section: Discussionmentioning

confidence: 99%

The Time Is Now: A Plan to Redesign Family Medicine Residency Education

Green

Miller

Frey

et al. 2022

Fam Med

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A new graduate medical education program in family medicine is urgently needed now. We propose an innovative plan to develop community-based, community-owned family medicine residency programs. The plan is founded on five guiding principles in which residencies will (1) transition to independent, community-owned organizations; (2) sustain comprehensiveness and generalism; (3) emphasize collaborative learning and interprofessional education; (4) develop local educators with national guidance; and (5) share resources, responsibilities, and learning. We describe actionable steps to begin the process of transforming residencies and strengthening primary care. As community-based and locally-run organizations, residencies will gain self-determination in how time is allocated, budgets are spent, and teams function. Building on the momentum of the National Academy of Medicine’s 2021 primary care implementation plan and recommendations by family medicine organization leaders, we propose a Decade of Family Medicine Residency Transformation. We encourage individuals and organizations spanning disciplines, health care systems, and communities, to join forces to reimagine and recreate the preparation of outstanding personal physicians dedicated to individual and community health and well-being.

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“…Strengths of this review include its broad search and use of a mixed-methods approach to include all relevant empirical study designs to produce insights greater than reported with quantitative and qualitative findings that are separated. 11 , 22 , 29 – 31 Studies from all countries are eligible for inclusion and the international team includes learners, researchers, and clinicians, which will promote critical discussions on the interpretations. A limitation of this protocol is that the team is composed of physicians and researchers based in general practice.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Yet recruitment into generalist specialties in many developed countries, including the US, UK and Canada is less than anticipated to meet societal health care needs. [5][6][7] Professional bodies have repeatedly endorsed training in generalism across the specialties 2,[8][9][10][11] and equipping graduates with a generalist skill-base is a key target outcome at an undergraduate level. 12,13 Health systems have also established targets and programmes to attempt to increase the number of generalist-trained doctors, such as the NHS Long Term Plan in the UK, 14 which emphasises both the need to develop generalist skills as well as specifically aiming for more general practitioners (GPs).…”

Section: Introduction Background and Rationalementioning

confidence: 99%

Characterising generalism in clinical practice: a systematic mixed studies review protocol

et al. 2021

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BackgroundGeneralist physician care is associated with improved patient outcomes. Despite initiatives to promote generalism in educational settings, recruitment to generalist disciplines remains less than required to serve societal needs. Increasingly this impacts not just general practice but generalist specialties such as internal medicine, surgery and paediatrics. One potential factor for this deficit is a lack of explicit attention to generalism as a praxis, including clarifying key aspects of generalist expertise.AimTo examine empirical clinical literature on generalism and characterise how generalism is described and delivered by physicians in primary and secondary care.Design & SettingSystematic mixed studies review including quantitative, qualitative, mixed-methods studies and systematic reviews of physician generalist practice.MethodMedline, Psycinfo, Socioindex, EMBASE, OVID Healthstar, Scopus, Web of Science will be searched for English language studies from 1999 to present, using a structured search. Given study heterogeneity we will not perform quality appraisal. Two reviewers will perform study selection for each study. Data extraction will focus on how generalism is defined and characterised, including the clinical care provided by generalists and patient experiences of generalist care. Quantitative and qualitative data will be summarised in tabular and narrative form. Convergent synthesis design will then be used to synthesise quantitative and qualitative data.ConclusionFindings will characterise generalism and generalist practice from a grass-roots clinical perspective. By identifying similarities and differences across generalist disciplines, this work will inform more focused educational initiatives on generalism at undergraduate and postgraduate level, including collaborations between generalist disciplines.

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Revitalizing Generalist Practice: The Montreal Statement

Cited by 8 publications

References 4 publications

Perspectives on expert generalist practice among Japanese family doctor educators: a qualitative study

Perspectives on expert generalist practice among Japanese family doctor educators: a qualitative study

The Time Is Now: A Plan to Redesign Family Medicine Residency Education

Characterising generalism in clinical practice: a systematic mixed studies review protocol

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