Teaching Opportunities for Postgraduate Trainees in Primary Care.

ABSTRACT: The purpose of this AM Last Page is to help faculty and postgraduate medical trainees (residents) identify resident teaching opportunities and foster teaching skill development. The Fundamental Teaching Activities (FTA) framework includes three domains in which physicians teach: Clinical Preceptor; Teacher Outside the Clinical Setting; and Educational Leader. Based on interviews with faculty and residents as well as our collective and diverse teaching experience, we adapted the FTA framework to be more applicable to resident teaching. The resultant domains are: Clinical Teacher; Teacher in Nonclinical Settings; and Educational Collaborator.

Longitudinal Study of Family Medicine Residents' Clinical Teaching After Participation in the Residents-as-Teachers Program.

BACKGROUND AND OBJECTIVE: Residents-as-teachers (RAT) programs provide opportunities for residents to gain teaching skills. Published studies have assessed RAT programs largely at a single point in time rather than longitudinally. To address this gap, we examined (a) longitudinal trends in RAT participants' interest, comfort, confidence, skill, and familiarity with aspects of clinical teaching; and (b) subsequent involvement in clinical teaching. METHODS: We conducted a longitudinal survey of one cohort of family medicine residents (N=56) who participated in the RAT program during residency. We collected data before and after the RAT program and at one and three years into practice (2016-2020). We measured outcomes including interest, comfort, confidence, skill, familiarity with aspects of clinical teaching and involvement in clinical teaching. We performed longitudinal analysis using repeated measures analysis of variance. RESULTS: Response rates at four data collections were 63% (n=35), 66% (n=37), 55% (n=31), and 34% (n=19), respectively. We observed consistent trends in interest, comfort, confidence, skill, and familiarity with aspects of clinical teaching; mean scores increased from before to after the RAT program and subsequently decreased in the early years in practice. At 1 and 3 years in practice, 71% and 74% of respondents, respectively, reported being involved in teaching, primarily teaching medical students. CONCLUSIONS: The RAT program appears to be a positive contributing influence on family medicine graduates' perceived preparedness to teach and their involvement in teaching after graduation from residency. A relatively high proportion of residents are involved in teaching in the early years in practice.

International medical graduates' experiences with caring for cross-cultural patient populations: Qualitative study in Alberta.

OBJECTIVE: To explore experiences of international medical graduate (IMG) FPs in providing cross-cultural patient care and to identify rewards and challenges they experienced when caring for patients of cultural backgrounds different from their own. DESIGN: Descriptive qualitative study. SETTING: Family medicine primary care practices in Alberta. PARTICIPANTS: Eighteen IMG FPs practising in the metropolitan areas of Edmonton or Calgary in Alberta as of May 2013. METHODS: Individual face-to-face or telephone interviews were conducted using a semistructured interview guide. Seventeen interviews occurred between July and August 2013 and 1 took place in August 2014. All interviews were audiorecorded and transcribed verbatim. Transcribed data were subject to thematic analysis. MAIN FINDINGS: International medical graduates identified several rewarding aspects of caring for patients with cultural backgrounds different from their own, including learning about different cultures, perceiving that appointments are more succinct, and advocating for patients whom they perceive to be at a disadvantage. Family physicians also identified several challenges associated with caring for patients of different cultural backgrounds, including encountering language barriers, perceiving that visits take longer, and experiencing patients' lack of acceptance of FPs with cultural backgrounds different from their own. CONCLUSION: Cultural differences between FPs and patients can enhance or undermine doctor-patient relationships. The results of this study speak to the need for cultural competency training for FPs practising in culturally diverse settings.

Psychological need fulfillment in virtual teaching: insights of residents and faculty.

Objective: To explore benefits and challenges experienced by residents and faculty when teaching in virtual settings. Methods: This was a qualitative descriptive study employing one-on-one semi-structured interviews with 10 residents and 12 faculty in the Department of Family Medicine at the University of Alberta, Canada, from May 2021 to May 2022. Participants were recruited via social media, resident and department events and email lists. Interview transcripts were analyzed descriptively and thematically employing the Self-Determination Theory (SDT) framework to map the identified benefits and challenges as facilitators and barriers to fulfilling teacher's basic psychological needs for autonomy, competence, and relatedness in virtual settings. Results: Resident and faculty participants used virtual technology not only to deliver education, but also leveraged various platform features to support their needs in virtual settings. The emerging themes within benefits and challenges of virtual teaching were amenable to mapping onto three basic psychological needs of the SDT framework - autonomy (e.g., increased accessibility; lack of control over teaching environment), competence (e.g., increased self-confidence; technological limitations hindering skill development), and relatedness (e.g., timely exchange of information; difficulty with professional identity formation). Conclusions: Despite the inherent challenges, teaching in virtual settings can support teachers' psychological needs. Recommendations for the future delivery and facilitation of virtual learning include: giving high priority to engagement and active participation; nurturing autonomy and greater individual responsibility for learning; and creating an environment of emotional support. The SDT-informed strategies shown to be effective in in-person teaching need to be examined for their applicability in virtual settings.

Yellowknife: Canada's First Circumpolar Family Medicine Residency Site.

PROBLEM: Canada's Northwest Territories (NWT), like other regions in the circumpolar north primarily inhabited by Indigenous peoples, faces challenges in recruiting and retaining physicians. Communities in this vast, diverse region depend largely on external medical professionals for health care. Consequently, these communities receive discontinuous medical care from physicians who lack local knowledge and are available only temporarily. The shortage of physicians for people residing in northern Canada requires a sustainable, long-term solution. APPROACH: The authors describe establishing Canada's first circumpolar family medicine residency training site in Yellowknife, NWT. The site was launched in 2020 as a partnership between the University of Alberta, Alberta Health Services, and 3 local health authorities in the NWT. The residency site, which bases residents in the local community, is expected to positively impact family physician recruitment and retention by allowing residents to build connections with local communities and identify as a northern physician. OUTCOMES: As of fall 2022, 4 residents had trained with the Yellowknife family medicine residency site. Two of these 4 residents graduated in 2022, both of whom plan to continue practicing medicine in the NWT. Residents have positively influenced medical care in the NWT, providing care in close to 20 small and remote communities. The presence of residents decreased appointment wait-times for some teams by as much as 60%, improved primary care screening, and enabled the provision of medical services at critical times. Furthermore, their presence has fostered academic spirit in the medical communities and had a positive impact on the communities as a whole. NEXT STEPS: The authors provide key insights and lessons learned from the establishment of the remote residency site. To develop and improve the site, continuous program evaluation is planned.

Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians' perspectives.

BACKGROUND: There is a lack of understanding of the team processes and factors that influence teamwork and medication management practices in the care of patients with type 2 diabetes mellitus (T2DM). The purpose of the study was to explore physicians' perspectives of barriers and facilitators to interprofessional care of patients with T2DM within team-based family practice settings. METHODS: This was a qualitative, descriptive study. Participants included physicians affiliated with a primary care network providing care to patients with T2DM in an interprofessional team-based primary care setting in Edmonton, Alberta, Canada. Participants' contact information was obtained from the publicly available College of Physicians and Surgeons of Alberta and respective primary care network websites. Interview questions addressed physicians' perspectives on factors or processes that facilitated and hindered the care and medication management of adult patients with T2DM in primary care team-based clinical practice. Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis and a constant comparative approach. RESULTS: A total of 15 family physicians participated in individual interviews. Family physicians identified facilitators of interprofessional team-based care and medication management of patients with T2DM in three theme areas-access to team members and programs, knowledgeable and skilled health professionals, and provision of patient education by other health professionals. Two themes emerged as barriers to interprofessional care - lack of provider continuity and the loss of skills from delegation of tasks. CONCLUSION: Family physicians perceive both benefits and risks to interprofessional team-based care in caring for patients with T2DM. Successful functioning of team-based care in family practice will require overcoming traditional professional roles.