Perspectives des médecins de famille en début de carrière sur leur expérience de résidence et leurs choix de pratique au Canada : une étude qualitative
DOI :
https://doi.org/10.36834/cmej.78363Résumé
Contexte : Bien qu'il y ait plus de médecins de famille au Canada que jamais auparavant et que les programmes de résidence continuent de se développer, des lacunes subsistent dans l'accès aux soins globaux. Cette étude visait à décrire et à comprendre le rôle que les expériences de formation en résidence ont joué dans l’orientation des choix de pratique, incluant la prestation de soins communautaires complets, parmi les médecins de famille en début de carrière.
Méthodes : Une analyse secondaire de soixante-trois (63) entrevues qualitatives a été effectuée sur les données d'une étude plus vaste à méthodes mixtes sur les modes et les choix de pratique des médecins de famille canadiens en début de carrière. Nous avons utilisé les six phases de l'analyse thématique réflexive de Braun et Clarke pour analyser les sections des transcriptions portant sur les expériences de formation en résidence.
Résultats : Les participants ont décrit des expériences positives de formation en résidence qui ont façonné leur choix de pratique en ce qui concerne les précepteurs et le mentorat, les expériences de soins longitudinaux, l'étendue de l'exposition et la préparation à la pratique clinique globale. Des « points de tension » et des « vérités cachées » sont apparus dans ces quatre domaines. Les points de tension comprenaient : i) la promotion d'une identité et d'une pratique professionnelles idéalisées qui étaient difficiles à maintenir, ii) le manque de représentation parmi les professeurs/précepteurs en ce qui concerne l'âge et le sexe, dans certains lieux, et iii) la frustration concernant le manque d'occasions de pratiques de collaboration interprofessionnelle qui reflétaient les expériences de formation. Les vérités cachées comprenaient : i) le manque de préparation à la gestion d'une entreprise, ii) la charge de travail administrative élevée, iii) les réalités des modèles de paiement, et iv) l'éventail des rôles disponibles pour les médecins de famille au-delà de la prestation de soins globaux.
Conclusions : Les résultats mettent en évidence les possibilités de réforme de l'enseignement pour soutenir la transition entre la résidence et la pratique, ainsi que l'importance d'aborder les facteurs systémiques au-delà de la formation qui ont un impact sur les choix des médecins en matière de soins globaux.
Références
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Millbank Quarterly. 2005;83(3):457-502. https://doi.org/10.1111/j.1468-0009.2005.00409.x
Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Services Res. 2003;38:831-65. https://doi.org/10.1111/1475-6773.00149
Kringos D. The strength of primary care in Europe [thesis]. Utrecht (The Netherlands): Nivel; 2012. Available from www.nivel.nl/sites/default/files/bestanden/Proefschrift-Dionne-Kringos-The-strength-of-primary-care.pdf [Accessed May 1, 2022].
Starfield B. Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012. Gaceta Sanitaria. 2012;26(S):20–26. https://doi.org/10.1016/j.gaceta.2011.10.009
Peckham A, Ho J, Marchildon GP. Policy innovations in primary care across Canada. Toronto: North American observatory on health systems and policies. Rapid review (No. 1), 2018. https://www.researchgate.net/publication/326210991
Aggarwal M, Hutchison B. Toward a primary care strategy for Canada. CFHI. 2012. Available at www.cfhi-fcass.ca [Accessed Oct 18, 2022].
Federal/Provincial/Territorial advisory committee on health delivery and human resources a framework for collaborative pan-Canadian human health resources planning. 2007.
Strumpf E, Levesque JF, Coyle N, Hutchinson B, Barnes M, Wedel RJ. Innovative and diverse strategies toward primary health care reform: lessons learned from the Canadian experience. J Amer Board Fam Med. 2012;25:S27-31. https://doi.og/10.3122/jabfm.2012.02.110215
College of Family Physicians of Canada. Family medicine interest groups. Strengthening the future of family medicine. 2017. Available from https://www.cfpc.ca/CFPC/media/Resources/Membership/FMIG-Future-fam-medicine-booklet-ENG.PDF. [Accessed Oct 18, 2022].
Phillips JP, Wendling AL, Prunuske J, et al. Medical school characteristics, policies, and practices that support primary care specialty choice: a scoping review of five decades of research. Fam Med. 2022;54(7):542-54. https://doi.org/10.22454/FamMed.2022.440132
McKee ND, McKague MA. Ramsden VR, Poole RE. Cultivating interest in family medicine. Family medicine interest group reaches undergraduate medical students. Can Fam Phys. 2007;53:661-5.
Pham T-N, Kiran T. More than 6.5 million adults in Canada lack access to primary care. Healthy Debate. Mar 14, 2023. https://healthydebate.ca/2023/01/topic/ourcare-survey-primary-care/.
Kiran T. Keeping the front door open: ensuring access to primary care for all in Canada. CMAJ. 2022;194(48):E1655-E1656. https://doi.org/10.1503/cmaj.221563
Aggarwal M, Oandasan I, eds. Scope of practice of family physicians in Canada: an outcomes of training project evidence summary. Mississauga, ON: College of Family Physicians of Canada. 2022. https://www.cfpc.ca/CFPC/media/Resources/Education/AFM-OTP-Summary7-Scope-of-Practice.pdf
Hedden L, Banihosseini S, Strydom N, McCracken R. Modern work patterns of “classic” versus millennial family doctors and their effect on workforce planning for community-based primary care: a cross-sectional survey. Human Resources for Health, 2020;18:67. https://doi.org/10.1186/s12960-020-00508-5
Kabir M, Randall E, Mitra G, et al. Factors influencing focused practice: A qualitative study of resident and early-career family physician practice choices. Brit J Gen Pract. 2022; BJGP.2021.0512. https://doi.org/10.3399/BJGP.2021.051
Peterson LE, Fang, B, Puffer, JC, Bazemore, AW. Wide gap between preparation and scope of practice of early career family physicians. J Amer Board Fam Med. 2018;31(2):181-182. https://doi.org/10.3122/jabfm.2018.02.170359
Coutinho AJ, Cochrane A, Stelter K, Phillips RL Jr., Peterson LE. Comparison of intended scope of practice for family medicine residents with reported scope of practice among practicing family physicians. JAMA. 2015;314(22):2364- 2372. https://doi.org/10.1001/jama.2015.13734
Ringdahl, E, Delzell, JE Jr., Kruse, RL. Changing practice patterns of family medicine graduates: a comparison of alumni surveys from 1998 to 2004. J Am Board Fam Med. 2006;19(4):404-412. https://doi.org/10.3122/jabfm.19.4.404
Fowler, N, Oandasan, I, Wyman, R, eds. Preparing our future family physicians. An educational prescription for strengthening health care in changing times. A final report and recommendations of the Outcomes in Training Project. Mississauga, Ontario. College of Family Physicians of Canada. 2022. https://www.cfpc.ca/CFPC/media/Resources/Education/AFM-OTP-Report.pdf
Aggarwal M, Holtby A, Slade S. Comparing Practice Intentions and Patterns of Family Physicians in Canada. Fam Med. 2023;55(9):591-597. https://doi.org/10.22454/FamMed.2023.996183
Lavergne MR, Goldsmith LJ, Grudniewicz A, et al. Practice patterns among early-career primary care (ECPC) physicians and workforce planning implications: protocol for a mixed methods study. BMJ Open, 2019;9(9):e030477. https://doi.org/10.1136/bmjopen-2019-030477
Rudoler D, Peterson S, Stock D, et al. Do recent family physician graduates practice differently? A longitudinal study of primary care visits and continuity in four Canadian provinces. CMAJ. 2022;194:E1639-46. https://doi.org/10.1503/cmaj.220439
Grudniewicz A, Randall E, Lavergne MR, et al. Factors influencing practice choices of early-career family physicians in Canada: a qualitative interview study. Human Res Health, 2023;21(84). https://doi.org/10.1186/s12960-023-00867-9
Boyland, JR. A social constructivist approach to the gathering of empirical data. Austral Counselling Res J 2019;13(2). ISSN1832-1135 www.acrjournal.com.au
Mann K, MacLeod A. Constructivism: learning theories and approaches to research in researching medical education, (eds.) Jennifer Cleland, Steven J. Durning. 2015. https://doi.org/10.1002/9781118838983
Braun V, Clarke V. Thematic analysis - A practical guide. SAGE Publications Ltd. 2022.
Barnhoorn PC, Nierkens V, Numas ME, Steinert Y, Kramer AWM, van Mook WNKA. General practice residents’ perspectives on their professional identity formation: a qualitative study. BMJ Open. 2022;12:e059691. https://doi.org/10.1136/bmjopen-2021-059691
Beaulieu M-D, Dory V, Pestiaux D, et al. General practice as seen through the eyes of general practice trainees: a qualitative study. Scand J Prim Health Care 2006;24:174–180. http://doi.org/10.1080/02813430600795498
Beaulieu M-D, Rioux M, Rocher G, Sampson L, Boucher L. Family practice: professional identity in transition. A case study of family medicine in Canada. Soc Sci Med. 2008;67:1153-1163. https://doi.org/10.1016/j.socscimed.2008.06.019
Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69(11):861–871.https://doi.org/10.1097/00001888-199411000-00001
Hafferty FW. Beyond curricular reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73(4):403-7. https://doi.org/10.1097/00001888-199804000-00013
Doja A, Bould MD, Clarkin C, Eady K, Sutherland S, Writer H. The hidden and informal curriculum across the continuum of training: a cross-sectional qualitative study. Med Teach 2016;38(4):410–8. https://doi.org/10.3109/0142159x.2015.1073241
Philibert I, Elsey E, Fleming S, Razack S. Learning and professional acculturation through work: examining the clinical learning environment through the sociocultural lens. Med Teach. 2019;41(4):398-402. https://doi.org/10.1080/0142159X.2019.1567912
Mulder H, ter Braak E, Chen HC, ten Cate O. Addressing the hidden curriculum in the clinical workplace: a practical tool for trainees and faculty. Med Teach. 2019;41(1):36-43. https://doi.org/10.1080/0142159X.2018.1436760
Pourbairamia G, Bigdeli S, Kamran S, et al. Hidden curriculum in residency programs: a scoping review. J Advan Med Educ Profess. 2022;10(2):69-82.https://doi.org/10.30476/JAMP.2021.92478.1486
Murakami M, Kawabata H, Maezawa M. The perception of the hidden curriculum on medical education: an exploratory study. Asia Pacific Med. 2009;8(1):9. https://doi.org/10.1186/1447-056X-8-9
Rothlind E, Fors U, Salminen H, Wändell P, Ekblad S. The informal curriculum of family medicine – what does it entail and how is it taught to residents? A systematic review. BMC Fam Pract. 2020;21(1):49. https://doi.org/10.1186/s12875-020-01120-1
Mahood, SC. Medical education. Beware the hidden curriculum. Commentary. Can Fam Phys. 2011;57(983-5).
Beaulieu M, Dory V, Pestiaux D, et al. What does it mean to be a family physician? Exploratory study with family medicine residents from 3 countries. Can Fam Phys 2009;55:e14-20. http://www.cfp.ca/content/cfp/55/8/e14.full.pdf
Philipott, J, Sanfilipop, T, Schultz, K. What are we really telling our medical students? The story of the hidden curriculum. Dean’s blog. Queen’s University, Faculty of Health Sciences. March 11, 2021. https://healthsci.queensu.ca/stories/blog/what-are-we-really-telling-our-medical-students-story-hidden-curriculum
Woloschuk W, Wright B, McLaughlin K. Debiasing the hidden curriculum. Academic equality among medical specialties. Can Fam Phys. 2011;57(e26-30).
Holmes D, Tumiel-Berhalter LM, Zayas LE, Watkins R. “Bashing” of medical specialties: students’ experiences and recommendations. Fam Med. 2008;40(6):400-6.
Hearst N, Shore WB, Hudes ES, French L. Family practice bashing as perceived by students at a university medical center. Fam Med. 1995;27(6):366-70.
Campos-Outcalt D, Senf J, Kutob R. Comments heard by US medical students about family practice. Fam Med 2003;35(8):573-8. PMID: 12947520
Alston M, Cawse-Lucas J, Hughes LS, Wheeler T, Kost A. The persistence of specialty disrespect: student perspectives. PRiMER. 2019;3:1. https://doi.org/10.22454/PRiMER.2019.983128
Manor, S, Holland, R. Ageism and intergenerational gaps between senior physicians and young residents in the health care system. J Intergenerational Rel. 2023. https://doi.org/10.1080/15350770.2023.2166639
Bogler T, Lazare K, Rambihar V. Female family physicians and the first five years. In pursuit of gender equity, work-life integration, and wellness. Can Fam Phys. Aug 2019;585-88.
First five years family practice committee (website). College of Family Physicians of Canada. 2024. https://firstfiveyears.ca
Jewell K, Newton C, Dharamsi S. Length of family medicine training and readiness for independent practice: residents’ perspectives at one Canadian university. UBC Med J. 2015;15-19. https://med-fom-ubcmj.sites.olt.ubc.ca/files/2015/02/ubcmj_6_2_2015_15-19.pdf
Resident Doctors of Canada. 2018 National resident survey. 2018. https://residentdoctors.ca/areas-of-focus/career-planning/career-intention-and-practice-management/
Grudniewicz A, Randall E, Lavergne MR, et al. Factors influencing practice choices of early-career family physicians in Canada: a qualitative interview study. MedRxiv preprint https://doi.org/10.1101/2023.05.07.23289626.
EQUIP Health Centre, University of British Columbia, Western University, University of Northern British Columbia. Equity Health Care Action Kit. 2023. https://equiphealthcare.ca/equity-action-kit/
Téléchargements
Publié-e
Versions
- 2024-11-12 (2)
- 2024-06-26 (1)
Comment citer
Numéro
Rubrique
Licence
© Catherine Moravac, Agnes Grudniewicz, Ian Scott, Ellen Randall, Laurie J Goldsmith, Emily G Marshall, Lori Jones, M Ruth Lavergne 2023
Cette œuvre est sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.
La soumission d’un manuscrit original à la revue constitue une indication qu’il s’agit d’un travail original, qu’il n’a jamais été publié et qu’il n’est pas envisagé pour publication dans une autre revue. S’il est accepté, il sera publié en ligne et ne pourra l’être ailleurs sous la même forme, à des fins commerciales, dans quelque langue que ce soit, sans l’accord de l’éditeur.
La publication d’une recherche scientifique a pour but la diffusion de connaissances et, sous un régime sans but lucratif, ne profite financièrement ni à l’éditeur ni à l’auteur.
Les auteurs qui publient dans la Revue canadienne d’éducation médicale acceptent de publier leurs articles sous la licence Creative Commons Paternité - Pas d’utilisation commerciale, Pas de modification 4.0 Canada. Cette licence permet à quiconque de télécharger et de partager l’article à des fins non commerciales, à condition d’en attribuer le crédit aux auteurs. Pour plus de détails sur les droits que les auteurs accordent aux utilisateurs de leur travail, veuillez consulter le résumé de la licence et la licence complète.
