Exploring the experience of residents during the first six months of family medicine residency training

Background: The shift from undergraduate to postgraduate education signals a new phase in a doctor’s training. This study explored the resident’s perspective of how the transition from undergraduate to postgraduate (PGME) training is experienced in a Family Medicine program as they first meet the reality of feeling and having the responsibility as a doctor.Methods: Qualitative methods explored resident experiences using interpretative inquiry through monthly, individual in-depth interviews with five incoming residents during the first six months of training.  Focus groups were also held with residents at various stages of training to gather their reflection about their experience of the first six months. Residents were asked to describe their initial concerns, changes that occurred and the influences they attributed to those changes.Results: Residents do not begin a Family Medicine PGME program knowing what it means to be a Family Physician, but learn what it means to fulfill this role. This process involves adjusting to significant shifts in responsibility in the areas of Knowledge, Practice Management, and Relationships as they become more responsible for care outcomes.Conclusion: This study illuminated the resident perspective of how the transition is experienced. This will assist medical educators to better understand the early training experiences of residents, how these experiences contribute to consolidating their new professional identity, and how to better align teaching strategies with resident learning needs

Development of accreditation standards for interprofessional education: a Canadian Case Study

Background: Academic institutions worldwide are embedding interprofessional education (IPE) into their health/social services education programs in response to global evidence that this leads to interprofessional collaborative practice (IPC). The World Health Organization (WHO) is holding its 193 member countries accountable for Indicator 3–06 (‘IPE Accreditation’) through its National Health Workforce Accounts. Despite the major influence of accreditation on the quality of health and social services education programs, little has been written about accreditation of IPE. Case study: Canada has been a global leader in IPE Accreditation. The Accreditation of Interprofessional Health Education (AIPHE) projects (2007–2011) involved a collaborative of eight Canadian organizations that accredit pre-licensure education for six health/social services professions. The AIPHE vision was for learners to develop the necessary knowledge, skills and attitudes to provide IPC through IPE. The aim of this paper is to share the Canadian Case Study including policy context, supporting theories, preconditions, logic model and evaluation findings to achieve the primary project deliverable, increased awareness of the need to embed IPE language into the accreditation standards for health and social services academic programs. Future research implications are also discussed. Conclusions: As a result of AIPHE, Canada is the only country in the world in which, for over a decade, a collective of participating health/social services accrediting organizations have been looking for evidence of IPE in the programs they accredit. This puts Canada in the unique position to now examine the downstream impacts of IPE accreditation.Medicine, Faculty ofNon UBCFamily Practice, Department ofPhysical Therapy, Department ofReviewedFacult

Advancing team-based primary health care: a comparative analysis of policies in western Canada

Background: We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. Methods: We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. Results: The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Conclusions: Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.Other UBCNon UBCReviewedFacult

Collaborative Practice in a Global Health Context: Common Themes from Developed and Developing Countries

This paper reports on a study commissioned by the World Health Organization (WHO) to explore common themes of collaborative practice. The WHO requested global clarification of (1) the nature of collaborative practice, (2) its perceived importance, and (3) strategies for systematizing collaborative practice throughout national health systems. While there are many interpretations of collaborative practice around the world, there was a need to ascertain common underlying themes that illustrate good practice in both developed and developing countries to inform an international Framework for Action. A multiple case study design was used to examine collaborative practice in primary health care and commonalities across countries. Staff at each of WHO's six regional offices invited key informants in one or two primary health care organizations where collaborative practice was the model of care to complete case studies. Ten case studies were received from ten different countries, representing all six WHO regions. The results are described according to the study's three areas of focus: describing collaborative practice globally, the shared importance of collaborative practice, and systematizing collaborative practice. Collaborative practice requires a strong political framework that encourages interprofessional education and teamworking. Shared governance models and enabling legislation are required. At a practical level, interprofessional health care teams function most efficiently with shared clinical pathways and a common patient record. © 2010 Informa UK Ltd

Additional file 1: of Advancing team-based primary health care: a comparative analysis of policies in western Canada

Contains a full list of policy documents reviewed in this study. (DOCX 21 kb

Additional file 2: of Advancing team-based primary health care: a comparative analysis of policies in western Canada

Contains an diagram of the health policy triangle (DOCX 27 kb