Educating future physicians for Ontario: phase II.

In 1990, a collaborative project was launched to determine what the people of Ontario expect of their physicians and how the programs that prepare future physicians should be changed in response. The project, called Educating Future Physicians for Ontario (EFPO), brought together the five Ontario medical schools, the Council of Ontario Faculties of Medicine (COFM); a nonprofit, charitable organization, Associated Medical Services (AMS); and the Ontario Ministry of Health. The first phase ran for five years and was described in the November 1998 issue of Academic Medicine. After an external review, the project was continued for a second phase (EFPO II) for four more years until December 1998; that second phase is the topic of this article. EFPO II (1) focused more on residents' education; (2) emphasized four of the EFPO I-created physician roles in project activities; (3) maintained the province-wide, inter-institutional medical education framework of phase I, but fostered greater involvement of the seven sites (five medical schools and two regional health centers) in project activities; (4) stressed five project components (e.g., needs assessment and community partnerships) and worked for collaboration among components at all sites; (5) enhanced the original EFPO I Fellowship Program by adding residents and community fellows to the existing fellowships and by initiating leadership development activities, all of which bode well for the future leadership of medical education in Ontario. Students and residents played a vital role in EPFO II. Most of EFPO II's objectives were met, but the overall view of external reviewers was that the project was less successful than EFPO I. For example, the impact on clinical education, especially residency education, was less than anticipated. On the other hand, the project helped encourage the wide adoption of the eight physician roles that originated in EFPO I and advanced faculty development and assessment activities based on these roles. A third phase of EFPO concerning continuing medical education was planned, but support was not available. However, one of the funders will continue to support the successful fellowship and leadership program and the provincial education network for the next three years. Overall, the two phases of EFPO substantially modified medical education in Ontario to make it more responsive to evolving social needs.

Cold/flu knowledge, attitudes and health care practices: results of a two-city telephone survey.

The purpose of this paper is to describe knowledge, attitudes and practices of cold and flu self-care and health care utilization, and to identify the predictors of health care utilization for the cold and flu among residents of London and Windsor. Using a random digit dialing survey method, 417 residents were interviewed between November-December, 1993 and February-March, 1994. This survey revealed good knowledge about colds and flu and understanding of appropriate physician visits. Only seven percent reported a doctor visit for their last cold. Socio-demographic, health status, attitude and knowledge level variables were subjected to a logistic regression analysis to identify which variables predicted self-reported physician visits. Only attitudes and health status showed statistically significant log odds (3.6 and 1.5, respectively). In summary, consistent with other studies, attitude and health status, not knowledge, appear to be significant predictors of physician visits for colds/flu.

How an ethics workshop for preceptors affects medical students.

OBJECTIVE: To determine whether a workshop on medical ethics attended by family medicine preceptors would affect their students' learning of ethics, and what educational and experiential factors affected the students' learning about ethics. DESIGN: A 3-hour workshop planned by a group of family physicians and ethicists and taught by a faculty member and an ethicist was offered to family physician preceptors. Students entering the clerkship were invited by letter to complete written answers to two clinical papers. Their answers were compared with "ideal" answers based on a weighted composite of the responses of 12 family physicians with a particular interest in ethics. The scores of students assigned to preceptors who had been offered the workshop were compared with those of students assigned to a control group of preceptors. Clerks were also asked about influences on their answers. PARTICIPANTS: The 86 preceptors participating in the family medicine programs at the University of Western Ontario, divided by random selection within geographic clustering into an experimental group of 50 and a control group of 36. Preceptors offered the workshop were considered to be in the experimental group whether or not they attended. The student questionnaire was sent to all students entering the family medicine clerkship program in the academic year 1989-1990 and some in the following year, until sufficient responses were received. Responses were analyzed from 32 clerks in the experimental group and 36 in the control group. MAIN OUTCOME MEASURE: Performance of students whose preceptors were invited to the workshop against performance of students whose preceptors were not invited to the workshop. RESULTS: No significant differences were noted between the performance of students whose preceptors were offered the workshop and those whose preceptors were not. CONCLUSION: The single outcome measure and the volunteer bias make conclusions difficult to draw. Further studies varying interventions and outcome measures are warranted.

Academic family medicine in Canada.

Fifty years ago family practice in Canada had no academic presence. Stimulated by a number of general practitioners and with the support of the Canadian Medical Association, the College of General Practitioners of Canada (CGPC) was founded in 1954. In 1962, conferences on education for general practice attended by the Association of Canadian Medical Colleges and the CGPC led to pilot postgraduate residencies in family practice supported by Department of National Health and Welfare. The first certification examination was held in 1969 and, by 1974, all Canadian medical schools had a family medicine residency program. Today departments of family medicine contribute substantially to undergraduate education in all 16 schools. In Canada, the medical profession, governments and the medical schools have demonstrated the importance they place on appropriate education for family physicians.

Teaching About Culture and Health in Ontario Medical Schools: Learning about culture and health through patient-centered care.

Questionnaire surveys and on-site visits determined that culture and health are not a formal part of a curriculum for all students in any undergraduate or family medicine residency program in Ontario medical schools. Electives and other opportunities exist, but only some students benefit. Suggestions from the programs on how to improve such learning and make it universally available are noted. Patient-centered care is endorsed as a suitable model for learning about culture and health in the context of community teaching practices.

Defining fitness and aptitude to practice medicine.

This article describes the use of the critical incident technique to define noncognitive behaviours, referred to as 'fitness and aptitude', that physicians should demonstrate in their practice. A total of 484 behaviours were categorized under four categories: attitude and personal attributes; communication; practice organization; and professional competence. Each category was further subdivided into subcategories. The communication category was by far the largest, representing 46% of all behaviours. The behaviours were written as objectives so that they could be included in a medical school curriculum and evaluated with much less subjectivity.

Defining fitness and aptitude to practice medicine.

The results of a study to determine the qualities and characteristics necessary for physicians to demonstrate in their practice reinforce the need for a medical school to emphasize the non-cognitive domain in its curriculum. The behaviors described in this study were written as educational objectives so that they could be evaluated with less subjectivity.

The ivory tower: rest home or rat race?

In this review the author considers the need for academic family physicians, describes their work, reviews the rewards and stresses of the jobs they do, and finally offers direction for someone considering such a career.

The first d.I. Rice award visits: a report.

The Donald I. Rice Merit Award was established for presentation to a family physician who is well regarded nationally or internationally. Its purpose is to allow the recipient to visit different parts of Canada, through arrangements made with College chapters and Departments of Family Medicine. The recipient may give talks, share in workshops and meetings, and generally provide stimulus for sharing ideas to promote new directions in family practice. The award consists of a handsome plaque and an honorarium in the amount of $5,000, plus travel expenses for recipient and spouse. In this article Dr. Brian Hennen, the first recipient of the Award, reports on his visits and offers a personal review of the state of family practice and family-practice education as he perceived it.

Measuring the complexity of clinical problems.

Recent studies on clinical problem-solving show that a considerable proportion of the problem-solving strategy employed by doctors and medical students is "case specific" or "system specific." Such studies have failed to consider adequately the starting place of the problem-solving process, that is, the inherent complexity of the problem being considered. In presenting clinical problems to students and writing problem-solving skills assessments, educators have demonstrated no quantifiable ways of grading the complexity of the clinical problems they select for instruction or examination purposes. The author in this study reports on the development and application of a complexity index to 29 clinical problems used in a new graduate curriculum. The index uses five components of problem complexity: symptoms, physical signs and investigations, socioeconomic and behavioral factors, diagnoses, and management plans. A test has been made of its interrater reliability between two observers applying it independently in one application. Trials to establish the validity of the complexity index with various criterion groups of physicians and educators are discussed. Suggestions for further refinement of such an index and its application in research in the quality of care and in medical education are offered.

Family medicine education in Canada, 1983.

We now have good information about family medicine in terms of content, principles, and practice load. Undergraduate, residency and continuing education are improving, but some family medicine programs still have limited support from their university's faculty and governments. Residency in-training assessment and the certification process are better developed than is evaluation of new family doctors' practice performance. Research in the family medicine base is expanding, and residents are increasingly involved in projects. Family medicine teachers are now on a par with other clinical faculty, because they must meet tougher criteria for appointment and promotion. The political leadership of family medicine education, shared by the College of Family Physicians of Canada and academic departments, requires strong consensus and persistent activity.

Learning continuity of care.

CONTINUITY OF CARE HAS FOUR DIMENSIONS: chronological, geographical, interdisciplinary and interpersonal. This article reviews ways in which these dimensions are currently being taught, and summarizes strategies by which teaching can be made more effective. (Can Fam Physician 1981; 27:831-833).

Family medicine: the discipline, 1979.

In order for any discipline to remain current, and therefore to grow, it must constantly be aware of its own definition. From this definition will come the need for constant revision, exclusion of outdated or inappropriate material and inclusion of new knowledge. This article examines the principles by which family medicine can perform these functions.