Educating future physicians for francophone official language minority communities in Canada: a case study
DOI:
https://doi.org/10.36834/cmej.75300Abstract
Background: Over one million Francophone Canadians live in official language minority communities (OLMC) outside of Québec. Availability and accessibility of linguistically appropriate care to these OLMCs is lacking, resulting in poorer quality of care. To help address this health equity gap, the FrancoDoc program was created in 2015 to identify Francophone/Francophile medical students enrolled at medical faculties that use English as their primary language of instruction and equip them with skills to increase their medical French abilities. Little is known, however, about the affordances and limitations of this educational endeavour.
Methods: Our qualitative instrumental single case study explored participants’ experiences with FrancoDoc, while also examining factors shaping the delivery of linguistically appropriate healthcare services to OLMCs. We conducted semi-structured interviews with medical students from across Canada and thematically analyzed these using a reflexive, inductive approach.
Results: Four main themes were derived from 12 interviews: factors facilitating French language learning; barriers to French language learning; contextual factors shaping linguistically appropriate healthcare provision; and recommendations to improve healthcare education to better prepare learners to provide care to OLMCs.
Conclusions: Medical student participants are highly motivated to engage in educational activities linked to FrancoDoc. Their efforts are nonetheless frequently impeded by barriers such as time constraints, irregular event programming, lack of regular clinical learning opportunities, and lukewarm support from faculties of medicine. If medical faculties are to realize their obligations to the OLMCs that they serve, recognition of language as a specific social determinant of health and more robust institutional supports for initiatives like FrancoDoc are paramount.
Metrics
References
The Association of Faculties of Medicine of Canada. Social accountability. Ottawa: AFMC; 2021 Available from: https://www.afmc.ca/resources-data/social-accountability/ [Accessed on Mar 22, 2023].
Health Canada. Social accountability—A vision for Canadian medical schools. Ottawa: Minister of Public Works and Government Services Canada: Ottawa; 2001.
Government of Canada. Canada Health Act (R.S.C., 1985, c. C-6). Ottawa: Government of Canada.
Romanow RJ. Building on values: the future of health care in Canada—final report. Commission on the future of health care in Canada. Ottawa: Government of Canada; 2002. DOI: https://doi.org/10.12927/hcpap.2003.17376
Molina RL, Kasper, J. The power of language-concordant care: a call to action for medical schools. BMC Med Educ 2019; 19:378. https://doi.org/10.1186/s12909-019-1807-4 DOI: https://doi.org/10.1186/s12909-019-1807-4
Jacobs E, Chen AHM, Karliner LS, Agger-Gupta N, Mutha S. The need for more research on language barriers in healthcare: a proposed agenda. Milbank Quarterly 2006; 84(1):111-133. https://doi.org/10.1111/j.1468-0009.2006.00440.x DOI: https://doi.org/10.1111/j.1468-0009.2006.00440.x
Health Canada. Language barriers in access to healthcare Ottawa: Minister of Public Works and Government Services Canada; 2001 Available from: https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2001-lang-acces/2001-lang-acces-eng.pdf [Accessed on Mar 22, 2023].
Bowen S. The impact of language barriers on patient safety and quality of care. Prepared for la Société Santé en français. 2015 Available from: https://www.santefrancais.ca/wp-content/uploads/2018/11/SSF-Bowen-S.-Language-Barriers-Study-1.pdf [Accessed on Mar 22, 2023].
Statistics Canada. English, French and official language minorities in Canada. Ottawa: Government of Canada; 2017 Available from: https://www12.statcan.gc.ca/census-recensement/2016/as-sa/98-200-x/2016011/98-200-x2016011-eng.cfm. [Accessed on Mar 22, 2023].
Government of Canada. Innovation, Science and Economic Development Canada—CommunAction. What is an official language minority community? Ottawa: Government of Canada; 2013, Available from: https://www.ic.gc.ca/eic/site/com-com.nsf/eng/h_01223.html [Accessed on Mar 22, 2023].
Government of Canada, Justice Laws Website. Constitution Act, 1982: Part I—Canadian Charter of Rights and Freedoms. Ottawa: Government of Canada; 1982 Available from: https://laws-lois.justice.gc.ca/eng/Const/page-12.html. [Accessed on Mar 22, 2023].
Government of Canada, Justice Laws Website. Official Languages Act. Ottawa: Government of Canada; 1988. Available from: https://laws-lois.justice.gc.ca/eng/acts/o-3.01/page-1.html. [Accessed on Mar 22, 2023].
Government of Canada, Office of the Commissioner of Official Languages. Official languages in the provinces and territories. Ottawa: Government of Canada; 2020. Available from: https://www.clo-ocol.gc.ca/en/language_rights/provinces_territories?wbdisable=true. [Accessed on Mar 22, 2023].
Alimezelli HT, Leis A, Denis W, Karunanayake C. Lost in policy translation: Canadian minority Francophones and health disparities. Can Public Policy. 2015; 41(Suppl 2):S44-S52. https://doi.org/10.3138/cpp.2014-073 DOI: https://doi.org/10.3138/cpp.2014-073
Gagnon-Arpin I, Bouchard L, Leis A, Bélanger M. Accès et utilisation des services de santé en langue minoritaire. In : Landry R, editor. La vie dans une langue officielle minoritaire au Canada. Sainte-Foy: Presses de l’Université Laval; 2014. p. 195-222.
Warnke J, Bouchard L. Validation de l’équité d’accès des CLOSM aux professionnels de la santé dans les régions sociosanitaires du Canada. Rev Can Sant Pub 2013; 104(6)(Suppl. 1):S49-S54. https://doi.org/10.17269/cjph.104.3490 DOI: https://doi.org/10.17269/cjph.104.3490
Consultative Committee for French-Speaking Minority Communities. Towards a new leadership for the improvement of health services in French—report to the federal Minister of Health. Ottawa: Government of Canada; 2007. Available from: https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/ahc-asc/alt_formats/hpb-dgps/pdf/olcdb-baclo/cccfsm/2007-cccfsm/2007-cccfsm-eng.pdf. [Accessed on Mar 22, 2023].
Gauthier AP, Timony PE, Wenghofer EF. Examining the geographic distribution of French-speaking physicians in Ontario. Can Fam Phys 2012; 58:e717-24. https://www.cfp.ca/content/cfp/58/12/e717.full.pdf
Timony PE, Gauthier AP, Serresse S, Goodale N, Prpic J. Barriers to offering French language physician services in rural and northern Ontario. Rural Remote Health 2016; 16(3805):1-13. https://doi.org/10.22605/RRH3805 DOI: https://doi.org/10.22605/RRH3805
De Moissac D, Bowen S. Impact of language barriers on access to healthcare for official language minority Francophones in Canada. Healthcare Management Forum 2017; 30(4):207-212. https://doi.org/10.1177/0840470417706378 DOI: https://doi.org/10.1177/0840470417706378
Government of Canada, Office of the Commissioner of Official Languages. Active offer—a culture of respect, a culture of excellence. Ottawa: Government of Canada; 2013 Available from: https://www.clo-ocol.gc.ca/sites/default/files/active-offer-tool.pdf. [Accessed on Mar 22, 2023].
Office of the Commissioner of Official Languages. 2020-2021 annual report. Fredericton: Office of the Commissioner of Official Languages for New Brunswick; 2021. Available from: https://officiallanguages.nb.ca/wp-content/uploads/2021/10/ANNUAL-REPORT-2020-2021.pdf. [Accessed on Mar 22, 2023].
De Moissac D, Bowen S. Impact of language barriers on quality of care and patient safety for official language minority Francophones in Canada. J Patient Experience 2019; 6(1):24-32. https://doi.org/10.1177/2374373518769008 DOI: https://doi.org/10.1177/2374373518769008
Fédération des communautés francophones et acadienne du Canada. French-language healthcare: improving access to French-language health services. Ottawa: Fédération des communautés francophones et acadienne du Canada; 2001. Available from: https://web.archive.org/web/20220627152213/https://fcfa.ca/wp-content/uploads/2018/03/Pour-un-meilleur-acces-a-des-services-de-sante-en-francais-EN.pdf [Accessed on Mar 22, 2023].
Alimezelli HT, Leis A, Karunanayake, C, Denis W. Determinants of self-rated health of Francophone seniors in a minority situation in Canada. Minorités linguistiques et société/Linguistic Minorities and Society 2013; 3(3):144–70. https://doi.org/10.7202/1023804ar DOI: https://doi.org/10.7202/1023804ar
Bouchard L, Desmeules, M. (2013). Les minorités linguistiques du Canada et la santé. Healthcare Policy 2013; 9:38-47. DOI: https://doi.org/10.12927/hcpol.2013.23589
Société Santé en Français. Les réseaux de santé en français du Canada. Ottawa: SSF; 2021. Available from: https://www.santefrancais.ca/reseaux/. [Accessed on Mar 22, 2023].
The Association of Faculties of Medicine of Canada. FrancoDoc. Ottawa: AFMC; 2021. Available from: https://www.afmc.ca/resources-data/education/franco-doc/. [Accessed on Mar 22, 2023].
Baxter P, Jack S. Qualitative case study methodology: study design and implementation for novice researchers. Qualitative Report 2008; 13(4):544–59. https://doi.org/10.46743/2160-3715/2008.1573 DOI: https://doi.org/10.46743/2160-3715/2008.1573
Malterud K, Siersma VD, Dorrit Guassora A. Sample size in qualitative interview studies: guided by information power. Qual Health Res 2016; 26(13): 1753-1760. https://doi.org/10.1177/1049732315617444 DOI: https://doi.org/10.1177/1049732315617444
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006; 3(2):77-101. https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health 2019; 11(4):589-597. https://doi.org/10.1080/2159676X.2019.1628806 DOI: https://doi.org/10.1080/2159676X.2019.1628806
Lacaze-Masmonteil T, Leis A, Lauriol E, Normandeau J, Moreau D, Bouchard L, Vaillancourt C. Perception du contexte linguistique et culturel minoritaire sur le vécu de la grossesse. Revue Canadienne de Santé Publique 2013; 104(6)(Suppl.1):S65-S70. https://doi.org/10.17269/cjph.104.3515 DOI: https://doi.org/10.17269/cjph.104.3515
Schrewe B, Ruitenberg CW. Offering welcome in the kingdom of the sick: a physician guide to hospitality. J Eval Clinical Practice 2021; 27(3):571-577. https://doi.org/10.1111/jep.13410 DOI: https://doi.org/10.1111/jep.13410
Espinoza J, Derrington S. How should clinicians respond to language barriers that exacerbate health inequity? AMA J Ethics 2021; 23(2):E109-116. https://doi.org/10.1001/amajethics.2021.109 DOI: https://doi.org/10.1001/amajethics.2021.109
Mikkonen J, Raphael D. Social determinants of health: the Canadian facts. Toronto: York University School of Health Policy and Management; 2010.
Northern Ontario School of Medicine. The NOSM challenge: strategic plan 2021-2025. Sudbury/Thunder Bay: NOSM; 2021 Available from: https://strategicplan.nosm.ca [Accessed on Jan 20, 2023].
University of Ottawa. Leading innovation for a healthier world—2020-2025 strategic plan. Ottawa: University of Ottawa; 2020. Available from: https://med.uottawa.ca/sites/med.uottawa.ca/files/fm_2020-2025_strategic_plan_en_web.pdf. [Accessed on Mar 22, 2023].
University of Manitoba. Rady Faculty of Health Sciences—Max Rady College of Medicine: applicant information bulletin 2022-2023. Winnipeg: University of Manitoba; 2021 Available from: https://umanitoba.ca/explore/sites/explore/files/2021-03/medicine-bulletin.pdf. [Accessed on Mar 22, 2023].
University of Saskatchewan College of Medicine. Health training in French. Saskatoon: University of Saskatchewan; 2022. Available from: https://medicine.usask.ca/social-accountability/training/health-training-in-french.php. [Accessed on Mar 22, 2023].
Boelen C, Heck JE. Defining and measuring the social accountability of medical schools. Genève: World Health Organization; 1995. Genève.
Rourke J. Social accountability in theory and practice. Annals Fam Med 2006; 4(S1):S45-S48. https://doi.org/10.1370/afm.559 DOI: https://doi.org/10.1370/afm.559
Government of Canada, Canadian Heritage. English and French: towards a substantive equality of official languages in Canada. Ottawa: Government of Canada; 2021. Available from: https://www.canada.ca/en/canadian-heritage/corporate/publications/general-publications/equality-official-languages.html. [Accessed on Mar 22, 2023].
Tesson G, Curran V, Pong R, Strasser R. Advances in rural medical education in three countries: Canada, the United States and Australia. Educ Health (Abingdon) 2005;18(3):405-15. https://doi.org/10.1080/13576280500289728 DOI: https://doi.org/10.1080/13576280500289728
Bates J, Frost H, Schrewe B, Jamieson J, Ellaway R. Distributed education and distance learning in postgraduate medical education. Ottawa: Members of the Future of Medical Education in Canada Postgraduate Consortium; 2011.
Wenghofer EF, Hogenbirk JC, Timony PE. Impact of the rural pipeline in medical education: practice locations of recently graduated family physicians in Ontario. Hum Resour Health 2017; 15(1):16. https://doi.org/10.1186/s12960-017-0191-6 DOI: https://doi.org/10.1186/s12960-017-0191-6
Rourke J, Asghari S, Hurley O, Ravalia M, Jong M, Parsons W, et al. From pipelines to pathways: the Memorial experience in educating doctors for rural generalist practice. Rural Remote Health 2018; 18(1):4427. https://doi.org/10.22605/RRH4427 DOI: https://doi.org/10.22605/RRH4427
Battarbee K. Languages Canada: the paradoxes of linguistic inclusivity—colonial/founding, Aboriginal, and immigrant language rights. London J Can Studies 2019; 34(1):79-102. https://doi.org/10.14324/111.444.ljcs.2019v34.005 DOI: https://doi.org/10.14324/111.444.ljcs.2019v34.005
Government of the Northwest Territories. Official Languages Act (RSNWT 1988, c.O-1). Yellowknife: Government of the Northwest Territories; 1988. Available from: https://www.justice.gov.nt.ca/en/files/legislation/official-languages/official-languages.a.pdf. [Accessed on Mar 22, 2023].
Government of Nunavut. Official Consolidation of Official Languages Act (C.S.Nu.,c.O-20). Iqaluit: Government of Nunavut; 2021. Available from: https://www.nunavutlegislation.ca/en/consolidated-law/official-languages-act-official-consolidation. [Accessed on Mar 22, 2023].
Office of the Languages Commissioner of Nunavut. If you cannot communicate with your patient, your patient is not safe. Iqaluit: Government of Nunavut; 2015. Available from: https://langcom.nu.ca/sites/langcom.nu.ca/files/QGH%20-%20Final%20Report%20EN.pdf. [Accessed on Mar 22, 2023].
Statistics Canada. While English and French are still the main languages spoken in Canada, the country’s linguistic diversity continues to grow. Ottawa: Government of Canada; 2022 Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/220817/dq220817a-eng.htm?indid=32989-1&indgeo=0. [Accessed on Mar 22, 2023].
Zhou JS, Chen R, Feng YY, Lu Y, Nyhof-Young J. Who wants to translate? Evaluation of a novel medical Mandarin education program for and by pre-clerkship medical students [version 1]. MedEdPublish 2020; 9:262. https://doi.org/10.15694/mep.2020.000262.1 DOI: https://doi.org/10.15694/mep.2020.000262.1
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Brett Schrewe, Tatiana Yeuchyk, Melanie El Hafid, Joyce Nyhof-Young
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.
