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Fighting bias against family medicine in the hidden curriculum

For some time now, those of us who work in medical education have been speaking about the “hidden curriculum.” The hidden curriculum refers to the many different things – ideas, behaviours, norms, values, and so on – that students learn informally while they are in medical school. These are the lessons that faculty members do not set out to explicitly teach students but that we pass on nonetheless.

 

Unfortunately, the hidden curriculum often weighs in with stereotypes of certain specialties. And I’m guessing that it is probably true that the hidden curriculum frequently portrays family medicine in a negative light more often than it does areas in specialty medicine.

 

Lately, we are seeing this bias having an especially strong impact on the decisions medical students are making as they enter the CaRMS process. This year, in the first iteration of the CaRMS match, there were 209 unfilled positions across Canada, and 138 of these positions were in family medicine. Also, notably, Queen’s medical school graduates choose family medicine as a career less frequently than graduates of other medical schools in Canada.

 

Many factors, of course, contribute to this problem. But I don’t think there is any denying that the hidden curriculum plays a part and that, inadvertently, medical education is steering students toward specialty medicine rather than family medicine.

 

I am writing this blog to say that I want to start taking action to correct this undesired effect of the hidden curriculum at Queen’s.

 

As a first step, Drs. Anthony Sanfilippo (Associate Dean, Undergraduate Medical Education), Ross Walker (Associate Dean, Postgraduate Medical Education) and Michael Green (Head, Department of Family Medicine) will be forming a working group to consider how best we can address this problem.

 

While this working group goes about its important undertaking, I would also like to ask all of you in the medical faculty to think about how you teach or mentor our undergraduate medical students. I think we all need to reflect on anything we do – or don’t do – that might indirectly make a student think less of family medicine. I know that none of our faculty who have backgrounds in specialty medicine would ever intentionally steer a student away from family medicine. However, we would all do well to keep a heightened awareness of the unintended consequences our words and actions can have. 

 

It has never made sense that the hidden curriculum would be biased against a field as important as family medicine, but it makes even less sense now than ever. Currently, there are concerted efforts by the Ontario government to create “Ontario Health Teams” and there is no question that primary care will be a backbone to an integrated system of care. Now, then, is a moment in which we as medical educators need to make sure we’re finding ways to make our students passionate about family medicine, as it will only be growing in its centrality to the health system in the coming years.

 

If you have any thoughts about how we as a medical school can address this issue, please share them in the comments below. Or better yet, please stop by the Macklem House – my door is always open.

 

--Richard

Steven Bae, QMed 2019

Tue, 04/02/2019 - 18:35

Hi Dr. Reznick,

This is an interesting topic and wanted to share my opinion!

Perhaps one reason Queen's students frequently pursue Royal College specialties is the disproportionate exposure to specialists we have. As a medical student who matched to a Royal College specialty, part of my decision was reinforced by having positive role models in my field. Our curriculum, both in lectures and clinical rotations, is delivered in vast majority by specialists. These are opportunities where students become inspired and mentorship relationships often develop. So, while I certainly believe the “hidden curriculum” plays a role, I would also say there are many inspiring specialists at Queen’s we learn from that likely drive student interest in specialist fields.

I also found family medicine observerships relatively inaccessible in pre-clerkship. I think addressing this, as well as including family physicians more in the teaching curriculum, and fostering opportunities for mentorship relationships are potential strategies to help promote interest in an under-appreciated field!

Steven Bae, QMed 2019

Thanks Steven,

I certainly appreciate your perspective. I do know that for a relatively small Department of Family Medicine, the teaching load on a per Faculty a per faculty basis is relatively high. So although your explanation may well be correct, we probably need to explore further avenues to address the discrepancy.

Thanks so much for commenting.

Richard

Richard Reznick

Hi Steven and Dr. Reznick,

Very interesting topic, and glad we can have a forum like this to discuss and give our ideas. I was speaking to another member of the QMed 2019 class last night and said the same thing as you Steven. As I am just finishing up pre-clerkship, I have found that we don't seem to be taught by family medicine physicians outside of the family medicine course in first year (as well as sometimes in informal clinical skills sessions). After just completing the GI course, and currently in neurology and psychology, I think that there is an opportunity for family medicine doctors to be integrated in the teaching of our second year courses, especially for presentations they commonly see/treat. For example, I can most definitely generalist physicians teaching our lectures on GERD, constipation/diarrhea, headaches, depression/anxiety within the GI, neurology and psychology courses. For some lectures it might even be an improvement in the teaching because it may have the potential to be taught more at our current level of understanding.

Taking advantage of small opportunities like this, to have more family medicine physicians at the forefront of teaching, may help balance our exposure to the different fields needed by our society.

Leah Allen, QMed 2019

Dear Dr. Reznick, Steven and Leah,
I wanted to echo the statements made by my fellow students, as I have also had the same thoughts regarding why Queen's tends to produce less family physicians than other schools.

I completely agree with Leah in that I think there is significant opportunity to have physicians co-teach/guest lecture certain blocks or topics that are commonly seen in generalist specialties like family medicine, but also emergency, and paediatrics. I think this could be used in almost every block, but Neurology comes to mind specifically, as I felt the depth and breadth of knowledge expected of us was extreme and impractical and having some clinical pearls and approaches to diagnoses, clinical exams etc. from a generalist would have been incredibly helpful.

This format would also provide opportunities for positive role modeling of healthy generalist-specialist relationships and communication (e.g. an SGL on writing an effective consult letter/making a phone call to a specialist in the community or on call about the condition(s) being covered in that unit. In my (very limited) clinical experience thus far as a third-year clerk, I have seen that these relationships can be fraught with tension, judgment, poor communication, and unprofessionalism. As Stephen mentioned, I think the lack of sufficient access to family medicine observerships, research, and mentorship opportunities are other major deterrents for students. I understand the department's residents have recently established a mentorship program, but it was exclusive to first years and being in second year at the time, I was not able to participate.

I think more education about career prospects with respect to availability (supply vs. demand), societal need, and compensation structure would also be helpful to address the negative perception of family medicine and the rise of unmatched Canadian medical graduates. I think some people equate the "competitiveness" of specialties with their prestige and are more motivated to pursue positions with few available residency spots (e.g. dermatology, plastic surgery, ophthalmology, radiology), thereby inflating the demand for these specialties above the supply and increasing the rate that students go unmatched for these positions. I have also noticed that professional esteem seems to be correlated with financial compensation, leaving specialties like family medicine, paediatrics, and psychiatry toward the bottom in both respects.

Finally, I think the school (and hospitals) could benefit from leadership from administrators, physicians, clinical tutors, and lecturers at every level of the hierarchy to acknowledge this problem (as you have done) and start changing the Queen's culture. Everyone needs to be more mindful about the way family medicine and other generalist careers are characterized and stop making or condoning derogatory remarks (e.g. "just" family, you're too smart for family med, raise your hand if you're going into family medicine... If you're willing to admit it etc.). As someone who wants to pursue family medicine, I have been disheartened by several staff and residents' comments when they hear that I'm interested in family/generalism. I'm sad to say that I didn't realize family medicine was so undervalued by the medical community until I got to Queen's :(. This may not be the best place, but if you're interested in student members of your working group, I would be interested in participating.

Thank you for initiating this much-needed conversation at our medical school.

Lyndsey Gott, QMed 2020

Dr. Karen Schultz, Queen's Family Medicine

Tue, 04/02/2019 - 18:39

A well functioning medical system has a "quadruple aim" that looks to optimize the patient experience, lower costs, improve the patient experience and the clinician experience. Hidden curriculum and detrimental hierarchical beliefs prevent optimal functioning in all aspects of that quadruple aim. In addition, those in positions of respect and authority who role model such beliefs demoralize medical students and residents about to start their career in FM and sets the wheels in motion to perpetuate the hidden curriculum for those planning on becoming a specialist.
Unfortunately this hierarchical issue impacts many areas in medicine, not just FM. Work done to address this could have far reaching positive impact and is work that must happen if we are going to achieve what we should be focusing on--that of putting the patient as the motivator for all we do, not just in the clinical care we provide for them but in the clinical environment we create through our actions.
I applaud our Deans and Dr. Green for addressing this and look forward to seeing the outcome of the working group that is about to get underway.

Dr. Karen Schultz, Queen's Family Medicine

Thanks Pinky,

Your perspective and reflections are right on. It’s overdue that we more formally addressed this issue, but I’m committed to making progress. Thanks again for your thoughtful comments.

Richard

Richard Reznick

Shahram Yousefi

Wed, 04/03/2019 - 00:39

I have never fully understood the issue here. The pay in FM is decent and the hours are great. It is also very satisfying arguably to help people help themselves.

Is it perhaps a question of competition and prestige? I remember when I did my undergrad in engineering, the hardest program was known (and truly was) to be electrical and most people picked it first to make a point. If someone liked mechanical for instance and got in, they would feel obliged to explain they "really preferred" it over EE. I thought it was a really bad case and many did suffer from this desire to appear atop.

Can we incentivize better? Can we elevate the prestige?

Shahram Yousefi

Frank Poce Meds70

Wed, 04/03/2019 - 15:04

In reply to by Anonymous (not verified)

I spent 35 years in full time family/general practice. Mainly as a fee for service doc in a small group. We were readily available to see our patients and they actually could get thru on the phone! No work, no pay. General practice was "satisfying" but we certainly did not have the "great hours" that you have noted. I hope that the working group invites some "non academic" FP/GPs to add comments as to why there is a falling out for graduates enrolling in family practice.

Frank Poce Meds70

Frank, thanks so much for your comment and bringing the perspective of a family practitioner working at the coal face. I’m confident that you’re correct that there is a misperception in just how hard family doctors work. And I’m also sure you’re correct that the perspectives of colleagues like you, working in the community, need to be prominently heard in our medical education circles.

Thanks again,

Richard

Richard Reznick

Dear Shahram,

Thanks for your perspective. It’s always great to receive the viewpoint is coming from another discipline.

I think the issue is that to frequently, we hear inadvertent, subliminal, or overt negativity directed at family medicine. More often than not, I’m guessing it’s not covert. Unfortunately, this makes the issue more difficult to manage. You are absolutely correct, that family medicine is a fabulous career choice. Certainly in the last 10 years there have been significant advances in remuneration for the specialty which a decade ago or more was really lagging behind other areas of medicine. You’re also correct in your analysis of it today terrific specialty in that one Gets to be a true generalist, often challenged with difficult and undifferentiated problems.

Once again thanks for your perspective.

Richard

Richard Reznick

Susan Phillips, Queen's Family Medicine

Wed, 04/03/2019 - 11:41

Thanks for opening the discussion on this. I am wondering whether you think it is a local (i.e. Queen's specific) or a systemic problem as this will change the possible solutions. I believe it is both - the CaRMS data for Queen's suggest a local effect superimposed on a systemic one.

Susan Phillips, Queen's Family Medicine

I totally agree Susan. This is for certain, a systemic problem. However the data would suggest that it is particularly true at Queen’s that fewer of our graduates going to family medicine then what would be the national average. All the more reason to start exploring it in a serious way.

Thanks for your comment.

Richard

Richard Reznick

Dear colleagues
I dont think this is local; in addition, there is evidence that graduates in family medicine tend to focus on few clinical domains overtime as they move forward in their career. when discussing with colleague in the USA, I also get a sense of a similar situation if not more difficult. Queen's has trained and welcomed numerous leaders in family medicine andMike, your Family Medicine Chair, is a stellar person. Thus i am confident about the future. Best regards. France Légaré family physician and Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation

France Légaré

David LeBrun

Wed, 04/03/2019 - 14:23

My own specialty of pathology has been the least popular first choice among CARMS applicants for years. Therefore, it seems fair to ask whether pathology and other specialties may be similarly disadvantaged by the "hidden curriculum". May I suggest that Drs. Sanfilippo, Walker and Green consider expanding the mandate, and possibly the membership, of the working group to consider other specialties?

David LeBrun, Queen's Department of Pathology and Molecular Medicine

David LeBrun

David,

This is a terrific point. I’m certain there may be some parallels. I will certainly bring this up with Mike, Tony and Ross. One reflection however is that the exposure that our medical students get to Pathologyin terms of curricular content could be improved so that our students would have more experiences to make a informed choice about possibly going into your specialty.

Thanks for your comments.

Richard

Richard Reznick

Brian Hennen, Professor Emeritus at Dalhousie and Western universities, Queen's graduate, Meds'62

Wed, 04/03/2019 - 14:43

Congratulations for tackling this important issue. A few suggestions: study the fee schedules carefully to compare income potential (students at UG and PG levels can quickly figure out what their potential incomes may be in family practice compared with consulting specialty practice; review the general provincial approaches to supporting primary medical care comparing inter-professional opportunities in primary care in the community with secondary/tertiary care in the hospital-based environment; include in your review not only Family Medicine residents but also residents in the secondary/tertiary specialties. While Queen's performance is found to be lacking comparatively, this is a national problem. Look where there has been some success, e.g. NOMS, what are they doing right?

Brian Hennen, Professor Emeritus at Dalhousie and Western universities, Queen's graduate, Meds'62

Brian,

These are all excellent suggestions. I will certainly pass them on to our group. I agree, we need to look very broadly, including an examination of what other jurisdictions have done to address this issue.

Thanks for your thoughtful response.

Richard

Richard Reznick

Sandy Boag, Queen's Pathology and Molecular Medicine

Wed, 04/03/2019 - 15:05

I'll add my support to Dave LeBrun's comments... it's an ongoing challenge to get Queen's meds students to apply to our program and to pathology programs in general. We need to not only prepare our students to practice but also to choose the best type of future practice for themselves. You will find very few pathologists who are unhappy with their career choice!

As I'm sure the working group is well aware this issue is likely due not only to a "hidden curriculum" but also our "visible curriculum" and even our admissions practices.

Sandy Boag, Queen's Pathology and Molecular Medicine

Sandy, your comments are most appropriate. As you and I have often discussed, this is a multi dimensional issue. And I’m sure you’re accurate, that the vast majority of individuals who have gone into pathology find it an incredibly rewarding specialty.

Thanks for your comment.

Richard

Richard Reznick

Terry Carscadden Meds ‘64

Wed, 04/03/2019 - 15:58

Challenging situation.
Benefits of FM/GP
Great advantage to get to know the patients, their anxieties, feelings, reactions to their conditions,etc. The more one knows the patient (children included of course) the better the care that the doctor can give.
The variety makes it interesting as well as challenging. Patents can usually relate better than with specialists.
Possible Issues.
Some specialists are not very cordial and only want to get on with diagnosis and treatment. I have had personal experience with this as well as patients.
I suppose there are more pros and cons.
As long as one knows and likes what they are doing and are not in the business of making money they will do well.
I would strongly recommend the UGs talk to FPS and GPS
Many specialists have spoken to me and said they couldn’t do what FP/GPs do.

Terry Carscadden Meds ‘64

Terry,

Your comments are very perceptive. I have certainly been the beneficiary of excellent care from family doctors over the years, and you are absolutely correct they, more than any other healthcare provider can be in a unique position to quarterback all elements of a patient’s care, particularly if the issues become complex.

You are also correct, that your specialty provides a unique privilege to be able to be very much part of the patient’s life, in a very unique way.

Thanks,

Richard

Richard Reznick

Ron Abrahams MD meds 77

Wed, 04/03/2019 - 16:18

Thank you for this discussion I have been practising in Vancouver as a family physician but also with an expertise in perinatal addiction .
I have always championed primary care as essential To improving outcomes with this population of patients .
Our Med school elective where med students are exposed both in the community and in our hospital unit to our practice is very popular among students here in Vancouver as well as nationally and internationally.
I can say that many of the students who came through the elective and were considering going into specialties actually changed their minds and decided that family practice would be more interesting and professionally gratifying for them.
So I guess what it comes down to is exposing med students to primary care and not apologizing for it as educators .

Ron Abrahams MD meds 77

Thanks Ron,

This is a very interesting and instructive experience. As you are suggesting, it is those seminal experiences in medical school that are so critical in guiding our students towards a direction that we lead to a very satisfying career.

Richard

Richard Reznick

Ramita Verma, Meds 2020

Mon, 04/08/2019 - 17:50

In reply to by Anonymous (not verified)

Hello Dr. Abrahams,

I actually did this Perinatal Addictions elective just a few months ago at BC Women's Hospital and couldn't agree more! I think having exposures to these types of family medicine electives are inspirational for students to see the potential of FM. From my knowledge, practices vary immensely between different individuals. Seeing a role model family physician practicing in various aspects of healthcare that I as a med student am interested in is great validation in knowing that "I could do something like this" in the future.

Ramita Verma, Meds 2020

Charles T. Low, MD, CCFP (Ret'd.)

Wed, 04/03/2019 - 17:49

Dan Pink in his book "Drive" says there are three motivators, assuming adequate (not lavish) compensation:
1/ acknowledgement - the workers must perceive that they are valued;
2/ meaning - it matters hugely that the workers see the value of what they do;
3/ competence - workers must know that they are well trained and kept up to date.
I'm seeing GP/FP problems especially with points 1 and 3. Even patients often ask, "Just a GP?"
Point 3# is more complex - so I had better stop. Kudos to how well we FPs do in an suboptimal environment. Improving there will require substantial if not transformative system changes, and ... that's another topic!

Charles T. Low, MD, CCFP (Ret'd.)

David Walters, Med '76. CCFP 78

Thu, 04/04/2019 - 19:03

Excellent discussion on vital issue that I would perhaps characterize as the future of the primary medical experience - finding fulfillment in a critical contribution to the community. Retiring after 40 years, there is no doubt that a varied FP training sustained me well. I worked 20 years in Canada and 20 years in the US where there is great demand for primary care experience. Throw in some research and behavioural science along the way and opportunities abound. I always kept a clinical practice but was able to work in occupational, public health, administrative, teaching and research, and as I aged, in post-acute and long term care settings. Pharmaceutical and industrial settings were turned down, international study and practice opportunities also existed. My last gig was on contract as staff physician in an excellent, large, long-term care facility in Hawaii - dream job with an outstanding multidiciplinary team.
My overall thought is never underestimate the potential of a good broad medical education and solid primary care experience- with a little imagination it can lead anywhere. Perhaps this variety of experience could be understood better, and integrated into teaching and career appeal.

David Walters, Med '76. CCFP 78

Thanks so much, David, your story underscores the tremendous diversity of possibilities of a career in family medicine. I'm so glad you commented on the blog and shared your experiences with us. 

Richard Reznick

Anonymous

Thu, 04/04/2019 - 22:36

Charles Low's #3 (above) is a very interesting point!
Queen's med school curriculum often features a specialist lecture followed by relevant group-work cases. As a recent graduate, I recall that a frequent opening motif for these cases was along the lines of "family doc misses diagnosis, proper management delayed - patient subsequently presents to hospital acutely unwell with classic presentation within lecturer's scope".

This left me with an early impression that family medicine is fraught with peril of frequently missing important diagnoses and thereby harming patients. As a risk-averse person, this did discourage me from family medicine (and I am now in an FRCPC program).

I will say, such vignettes seem to occur far more often in med school lectures than in real life! (Although there is something to be said for lecturers trying to teach us "what not to miss"). During clerkship and now residency, I rarely, if ever, encounter real examples of harmful GP-diagnostic error/mismanagement or anybody even hinting at such. On the contrary, I often hear specialists lamenting the shortage of GPs, particularly when faced with discharging a complex patient who doesn't have one!

My impression of the risk-reward balance of family medicine is now radically different. Just a reminder I suppose that junior medical students are very vulnerable and impressionable to even unintended whiffs of the "hidden curriculum", especially before they have sufficient clinical experience to contextualize or appraise it. Perhaps it would help to have more GPs teach the lecture-hall SGL cases, or a more heroic GP role in the existing cases? Note -the first year Intro to Fam Med course is terrific.
Thank you,
Anonymous MD PGY1
Queen's Medicine Class of 2018

Anonymous

Dear Colleague: thanks so much for highlighting one of the not-so hidden elements of this discussion. Your comment that we need to fortify the presence of family medicine in our curriculum is right on point. 

Richard Reznick

Jordan Sugie, QMED 2017, Queen's Family Medicine 2019

Thu, 04/04/2019 - 23:46

Dear Dr. Reznik,

Thank you very much for your thoughtful post. I first would like to commend Dr. Walker on his response to this incident and for the rest of the Queen's Medicine leadership for taking this as a serious matter.

During my six years at Queen's, I have become increasingly aware of this hidden curriculum. At first I was very naive and believed that at the end of the day health care professionals would treat each other with respect and find common ground in helping our patients. However, throughout my training and different rotations, I have consistently seen alarming levels of discrimination and lack of respect for each other, interprofessionally and between specialties. Health care workers have been treated poorly purely based on the perceived hierarchy of their specialty or job. It is very disheartening to realize that in a few months I am about to enter a field in with such deep seeded levels of discrimination.

I do realize that there are larger systemic pressures that are leading to this behaviour and that this is not a Kingston isolated issue. I would also like to note that Dr. Walker's incident was not an outrageous one, but this is just the tip of the iceberg of a concern I have held throughout my training. If I cannot trust my leadership to uphold a high level of respect for one another, how can I expect my fellow colleagues to do any different.

It will be difficult to solve this long-standing issue. However, I would encourage you to use your place of leadership to make a necessary systemic change at Queen's. It is time that we work together to eliminate this discrimination from the workplace so we can concentrate on our main goal, caring for our patients. As a profession, I believe we need to take this discrimination as seriously as we do other forms of discrimination (i.e. discrimination against sexuality, age, ability, race, gender etc) and put similar policies and penalties in place to discourage this behaviour.

I look forward to your comments and results of your work group.

Thank you,

Jordan Sugie
QMED 2017, Queen's Family Medicine 2019

Jordan Sugie, QMED 2017, Queen's Family Medicine 2019

Well said, Jordan. I agree it should be taken seriously, viewed for what it is as discrimination in the workforce and dealt with as such.

Lyndsey Gott, QMed 2020

Dear Jordan, 

Thanks so much for your thoughtful remarks. As you suggest, this issue is in some ways "a canary in the coal mine." In that regard, you are correct that we need a more systematic approach to looking at all issues of bias and fortifying the interprofessional nature of how we should optimally deliver patient care. As you suggest, this is a longstanding issue and not one that's just germane to Queen's, but we are determined to make some progress through a direct effort at tackling this problem. 

Richard Reznick

Aaron Johnston, Director Distributed Learning and Rural UCalgary, QMEDS 03

Sat, 04/06/2019 - 11:02

Thanks for taking on this important work, I hope that you consider publishing or sharing your findings and solutions. Although there may be particular local factors at play this is a national issue and the work you do in this area will be a great jumping off point for others.

Leading organizational culture change is hard, both yourself and Queen's are showing strong leadership by taking this issue on.

Aaron Johnston, Director Distributed Learning and Rural UCalgary, QMEDS 03

Dear Aaron, 

 

Thanks for your comment. We will be sure to be mindful about monitoring our progress and sharing the results of our work. As previous comments have suggested, this is a national issue, one that's not easy to solve, and we will all benefit from sharing thoughts with each other. 

Richard Reznick

Jim Wilson Meds "77

Mon, 04/08/2019 - 10:19

An important project and I wish Tony, Mike and Ross all the best in trying to come to grips (finally) with an issue that has been ongoing at Queen's for as long as I have been around - and that is a long time. With the 50th anniversary of the establishment of Family Medicine at U of T this year, our Family Medicine department was met with active hostility in the 70's. Our CaRMS match rate to Family Medicine has been well below the national average for most of the time since then - despite having a superb group of family physicians locally and at the distributed sites and a traditionally very strong residency program. When I was actively involved from 1995 - 2008 Queen's regularly was well below the national average recruiting to Family Medicine- and also we were usually the lowest in retention of our own graduates in any program for that matter as well. . We clearly are not meeting out social contract obligations. I will be interested to read the report and the recommendations of this task group and I wish them well.

Jim Wilson Meds "77

Dear Jim, 

Thanks for providing your perspective and for highlighting some of the challenges here at Queen's. I certainly agree that we can definitely improve and am dedicated to sharing the results of our work in the future. 

Richard Reznick

Ramita Verma, Meds 2020

Mon, 04/08/2019 - 17:58

Dear Dr. Reznick,

Thank you for addressing this very prevalent issue in the medical community - at Queen's and also beyond the university.

I started clerkship this year and have been quite pleasantly surprised at the positive reactions from staff and residents when I say I want to be a family doctor. Unfortunately, a lot of initial reactions are "oh Family? Yeah that'll be chill" or "Family? Oh amazing, you'll have a life" and although comments about knowing that I will have work-life balance in the future are nice, these initial reactions aren't the same as what we hear when we say we want a surgical specialty or something with a longer residency program.

Perhaps some of the steps we can take as a faculty are the following (just thoughts): 1) increase research opportunities in family medicine for medical students by having more projects accessible for medical students to "pick up"; 2) increase formal mentorship between family doctors and med students by mandating that each mentorship group have at least 1 family doc (I'm not sure if this is already a requirement); and 3) increase didactic lectures given by family doctors. In the dermatology curriculum, a GP did the "intro" and "conclusion" lectures while the specialists tackled each specific disease/condition - can we do this for every block?

Again, thank you for opening this topic up. I would love to get involved more with a focus group if it is an opportunity in the future.

Ramita, MEDS 2020

Ramita Verma, Meds 2020

Dear Ramita, 

Thanks for commenting on the blog and more importantly for your very thoughtful suggestions. I'm going to pass them on to our working group. I think they are all viable, and will certainly help in addressing this issue. 

Richard Reznick

Maggie Hulbert Qmed 2020

Mon, 04/08/2019 - 18:32

Hi Dr Resnick,

I think this is a really important issue. I support the points above, and agree that we could have more exposure to family docs throughout the preclerkship curriculum. As well, I found that the attitude towards family doctors within specialist teams at KHSC was disheartening and frankly, often disparaging.

One thought that I’ve had while currently on my family block is that the rural family medicine experience is not for everyone. Unfortunately, this is the only exposure we get to family as clerks. Often, you don’t work with residents, who are closer to peers and allow students to picture what the next couple years of their life will be like. There is little formal teaching, and students are isolated. The clinics can be strapped for resources, overflowing with patients, and as a clerk you can feel more like an assistant. These can contribute to negative feelings surrounding family medicine especially when compared to hospital rotations. The range of rural family experience can be what draws some students to family medicine, so it’s hard to say if changing this would work for everyone. But I have found it frustrating that Queen’s has such an excellent family medicine program and we get little exposure to it.

I’m sure others will feel differently about the rural experience, and it is absolutely a division of medicine that needs to be promoted. But as a student who never saw herself in a rural centre, I always felt our curriculum excluded me from family medicine.

Thanks for taking this initiative!

Maggie

Maggie Hulbert Qmed 2020

Dear Maggie, 

Thanks for your comments. You make an important point that there is an enormous difference between rural and urban experiences. In my view, our students should be exposed to both, which is implicit in your comment. I also agree that we have an excellent Department of Family Medicine at Queen's and we need to maximize the exposure of our students to this department. 

Richard Reznick

Bill Moore, Meds '62

Mon, 04/08/2019 - 19:31

Family Medicine is Essential. Thanks for introducing this topic and sorry I couldn't comment earlier while so many others have. My wife had a medical emergency but thankfully is doing well.
I recall when there were few mentors who might inspire medical students into GP/FM. I hope there is or will be a Family Medicine department at Queen's that attracts the best-qualified and motivated community doctors.
Many things have changed since my father's and my time at Queen's Meds but hopefully the tradition of being well prepared for taking care of most health problems before referring to a Hospitalist or Specialist assumes control -- and relatives do or don't understand or know the implications of their decisions.
Bill...

Bill Moore, Meds '62

Dear Bill, 

Glad to hear your wife is doing well. As always, thanks for your thoughtful comments. We are certainly working hard at recruiting and retaining top talent to our Department of Family Medicine, and you are correct that our goal is to equip our trainees with a broad suite of competencies necessary for generalist practitioners. 

All the best,

Richard Reznick

Stephen Kaladeen Meds 88

Wed, 04/10/2019 - 12:40

I applaud your efforts to correct the imbalance in family medicine enrolment.
One of the problems that I see as a doc working with a bunch of mid career FPs is that there is often no real career progression. This ultimately leads to burnout.
One of the things that might help is to offer a novel FP program that incorporates some management training.
Currently what I see is that just about every other health discipline wants to get involved in health care decision making while at the same time leaving doctors carrying the bulk of risk.
A 3rd year FP program designed to help people move into management and leadership programs at hospitals and other organizations might actually help this. This might also help the profession at large.

This is quite different from the clinical based training. It seems that more and more of what we do (and can do is) determined by economics. Direct doctor involvement with a new generation of doctors who understand all of this might help all f us.
Thank you so much.

Stephen Kaladeen Meds 88.

Stephen Kaladeen Meds 88

Dear Stephen, 

This is an excellent idea and I will certainly bring up the notion of a third year that includes education in health leadership. It is certainly become evident in the last decade that there is an important and ever growing role for clinicians at the coal face to get materially involved with our health system. Improvements are more likely to come from the ideas of those on the ground than from those in purely administrative capacities. 

Richard Reznick

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