Implementation of virtual primary care: a comparative study of family medicine residents’ experiences

Udoka Okpalauwaekwe; Cathy MacLean; Angela Baerwald

doi:10.36834/cmej.81983

Authors

Udoka Okpalauwaekwe University of Saskatchewan
Cathy MacLean University of Saskatchewan
Angela Baerwald University of Saskatchewan

DOI:

https://doi.org/10.36834/cmej.81983

Abstract

Background: Virtual care (VC) was rapidly adopted during the COVID-19 pandemic to ensure continuity of primary care. In this study, we explored Family Medicine (FM) residents’ evolving experiences with VC across early (2020), late (2022), and post-pandemic (2024) phases in Saskatchewan, focusing on satisfaction, preparedness, supervision, and perceived impact on training and well-being.

Methods: FM residents across eight distributed sites were surveyed at three time points using a standardized tool. Responses were analyzed using chi-square, Kruskal-Wallis, and post hoc Mann-Whitney U tests (p < 0.05).

Results: Seventy-eight residents participated (2020: n = 26; 2022: n = 19; 2024: n = 33). Satisfaction with VC tended to decline over time (p = 0.074), while requests for additional VC training did not change (p = 0.269). Confidence to use VC post-residency dropped significantly from 100% (2020) to 60.6% (2024; p < 0.001), despite a consistent and moderate amount of supervision. The negative impact of COVID-19 on training declined by 2024 (p = 0.008), while trust in the provincial response to the COVID-19 pandemic also decreased (p < 0.0001).

Conclusions: Although FM residents adapted to VC during the pandemic, long-term sustainability to use VC requires improved training, structured supervision, and curricular integration. Embedding VC competencies into postgraduate education is essential to support hybrid models of care in the evolving primary care landscape.

Downloads

Download data is not yet available.

Author Biographies

Udoka Okpalauwaekwe, University of Saskatchewan

Dr. Udoka Okpalauwaekwe is a Primary Care Researcher and currently serves as a Research Officer in the Department of Academic Family Medicine at the University of Saskatchewan. He holds a Bachelor of Medicine, Bachelor of Surgery (MBBS) from the University of Nigeria, as well as a Master of Public Health (MPH) and a PhD in Health Sciences (Primary Care/Family Medicine) from the University of Saskatchewan. He also completed a Primary Care Research Fellowship at Western University in Ontario. Udoka’s research interests focuses on primary health care, primary care, health systems strengthening, disease prevention, and wellness promotion, particularly in underserved and Indigenous communities, using participatory and collaborative methodologies.

Cathy MacLean, University of Saskatchewan

Professor, Department of Family Medicine and Director, Faculty Development; College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7M 3Y5, Canada

Angela Baerwald, University of Saskatchewan

Associate Professor and Director, Women’s Health Research Laboratory, Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.

References

1. Shaver J. the state of telehealth before and after the COVID-19 pandemic. Prim Care. 2022 Dec;49(4):517-530. Epub 2022 Apr 25. https://doi.org/10.1016/j.pop.2022.04.002.

2. Wong A, Bhyat R, Srivastava S, Boisse Lomax L, Appireddy R. Patient care during the COVID-19 pandemic: use of virtual care. J Med Internet Res. 2021;23(1):e20621. https://doi.org/10.2196/20621

3. Bokolo Anthony J. Use of telemedicine and virtual care for remote treatment in response to COVID-19 pandemic. J Med Syst. 2020;44(7):132. https://doi.org/10.1007/s10916-020-01596-5

4. Lurie N, Carr BG. The role of telehealth in the medical response to disasters. JAMA Intern Med. 2018;178(6):745-746. https://doi.org/10.1001/jamainternmed.2018.1314

5. College of Family Physicians of Canada. Patient medical home. Available from: https://www.cfpc.ca/en/policy-innovation/health-policy-goverment-relations/the-patient-s-medical-home. [Accessed on Sep 15, 2025].

6. Canadian Institutes of Health Research Natural Sciences and Engineering Research Council of Canada and Social Sciences and Humanities Research Council of Canada. Tri-Council Policy statement: ethical conduct for research involving humans - TCPS 2 (2022). Government of Canada. Available from https://ethics.gc.ca/eng/policy-politique_tcps2-eptc2_2022.html. Published 2022. [Accessed Mar 19, 2023].

7. Calton B, Abedini N, Fratkin M. Telemedicine in the time of Coronavirus. J Pain Symptom Manage. 2020;60(1):e12-e14. https://doi.org/10.1016/j.jpainsymman.2020.03.019

8. Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: Evidence from the field. J Am Med Inform Assoc. 2020;27(7):1132-1135. https://doi.org/10.1093/jamia/ocaa072

9. Wosik J, Fudim M, Cameron B, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020;27(6):957-962. https://doi.org/10.1093/jamia/ocaa067

10. Smith N, Newton C, Barbacuta D, Tseng OL. An unexpected transition to virtual care: family medicine residents' experience during the COVID-19 pandemic. BMC Prim Care. 2022;23(1):127. https://doi.org/10.1186/s12875-022-01728-5

11. Touchie, C. AFMC Entrustable Professional Activities for Medical School to Residency Transition. The Association of Faculties of Medicine of Canada. Canada. Retrieved from https://coilink.org/20.500.12592/qgtj2q. COI: 20.500.12592/qgtj2q. Published 2021. [Accessed on Sept 17, 2025].

12. College of Family Physicians of Canada. Triple C Competency-based curriculum: report of the working group on postgraduate curriculum review – Part 1. Mississauga, ON: CFPC; 2020.

https://www.cfpc.ca/CFPC/media/Resources/Education/WGCR_TripleC_Report_English_Final_18Mar11.pdf Accessed on Sept 17, 2025].

13. College of Family Physicians of Canada. Virtual care in the Patient’s Meical Home. Mississauga, ON: CFPC; 2021. https://patientsmedicalhome.ca/files/uploads/PMH_Virtual-Care-Supplement_ENG_FINAL_REV.pdf [Accessed on Sept 17, 2025].

14. College of Family Physicians of Canada. Priority topics and key features for the assessment of competence in family medicine. Mississauga, ON: CFPC; 2020.

https://www.cfpc.ca/CFPC/media/Resources/Certificate-of-Added-Competence/Priority-Topics-and-KFs-with-skills-and-phases-Jan-2011.pdf [Accessed on Sept 17, 2025].

15. Lawrence K, Cho J, Torres C, Alfaro-Arias V. building virtual health training tools for residents: a design thinking approach. Front Digit Health. 2022 Jun 13;4:861579. https://doi.org/10.3389/fdgth.2022.

16. Shanafelt TD, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020;323(21):2133–2134. https://doi.org/10.1001/jama.2020.5893

17. Bhatia RS, Jamieson T, Shaw J, et al. Virtual care use before and during the COVID-19 pandemic: regional variation and implications for equity in access. CMAJ Open. 2021;9(1):E22-E28. https://doi.org/10.9778/cmajo.20200311

18. Ho JSS, Leclair R, Braund H, Bunn J, et al. Transitioning to virtual ambulatory care during the COVID-19 pandemic: a qualitative study of faculty and resident physician perspectives. CMAJ Open. 2022 Aug 16;10(3):E762-E771. https://doi.org/10.9778/cmajo.20210199.

19. College of Family Physicians of Canada. A new vision for Canada: family practice—the patient’s medical home 2019. 2019. Available from: https://patientsmedicalhome.ca/files/uploads/PMH_VISION2019_ENG_WEB_2.pdf. [Accessed Feb 04, 2025].

20. Nakagawa K, Yellowlees P. Inter-generational effects of technology: why millennial physicians may be less at risk for burnout than baby boomers. Curr Psychiatry Rep. 2020 Jul 13;22(9):45. https://doi.org/10.1007/s11920-020-01171-2.

21. Powell RE, Henstenburg JM, Cooper G, Hollander JE, Rising KL. Patient perceptions of telehealth primary care video visits. Ann Fam Med. 2017 May;15(3):225-229. https://doi.org/10.1370/afm.2095.