A global picture of family medicine: the view from a WONCA Storybooth.

BACKGROUND: Family Medicine is a novel discipline in many countries, where the motivation for training and value added to communities is not well-described. Our purpose was to understand the reason behind the choice of Family Medicine as a profession, the impact of Family Medicine on communities, and Family Medicine's characterizing qualities, as perceived by family doctors around the world. METHODS: One-question video interviews were conducted using an appreciative inquiry approach, with volunteer participants at the 2016 World Organization of Family Doctors conference in Rio de Janeiro. Qualitative data analysis applied the thematic, framework method. RESULTS: 135 family doctors from 55 countries participated in this study. Three overarching themes emerged: 1) key attributes of Family Medicine, 2) core Family Medicine values and 3) shared traits of family doctors. Family Medicine attributes and values were the key expressed motivators to join Family Medicine as a profession and were also among expressed factors that contributed to the impact of Family Medicine globally. Major sub-themes included the principles of comprehensive care, holistic care, continuity of care, patient centeredness, and the patient-provider relationship. Participants emphasized the importance of universal care, human rights, social justice and health equity. CONCLUSION: Family doctors around the world shared stories about their profession, presenting a heterogeneous picture of global Family Medicine unified by its attributes and values. These stories may inspire and serve as positive examples for Family Medicine programs, prospective students, advocates and other stakeholders.

Contrasting current challenges from the Brazilian and Canadian national health systems: The Besrour Papers: a series on the state of family medicine in Canada and Brazil.

OBJECTIVE: To compare the national health systems of Canada and Brazil and how both countries have addressed similar challenges in their primary care sectors. COMPOSITION OF THE COMMITTEE: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades. METHODS: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil. REPORT: The Brazilian and Canadian primary care systems are faced with similar challenges, including geography, demographic changes, population health inequities, and gaps in universal access to comprehensive primary care services. Although the approaches to addressing these challenges are different in both settings, they highlight the central importance of family physicians in both systems. Both countries continue to face considerable challenges in the context of mental health services in primary care. It remains important for Canada to draw lessons from the primary care systems and reforms of other countries, such as Brazil.

Cervical Cancer Screening by Refugee Category in a Refugee Health Primary Care Clinic in Calgary, Canada, 2011-2016.

Newly arrived refugees and refugee claimants experience low cervical cancer screening (CCS) rates in Canada. We investigated CCS at a dedicated refugee clinic. We completed a retrospective cohort study among patients at the Mosaic Refugee Health Clinic in Calgary, Canada, between 2011 and 2016. We investigated CCS offers and completion by refugee category. We then used multivariable logistic regression to estimate the association of CCS screening and refugee category, accounting for sociodemographic and clinical factors. We included 812 refugees. Most were married (71%) and had limited English proficiency (57%). Overall, 88% and 77% of patients were offered and completed screening, respectively. Compared to government assisted refugees, privately sponsored refugees completed CCS more often (OR 1.60, 95% CI [1.02-2.49]). A dedicated refugee clinic may provide effective CCS to newly arrived refugees irrespective of refugee category, insurance status or other barriers.

Syndromic surveillance of respiratory infections during protracted conflict: experiences from northern Syria 2016-2021.

OBJECTIVE: Northern Syria faces a large burden of influenza-like illness (ILI) and severe acute respiratory illness (SARI). This study aimed to investigate the trends of Early Warning and Response Network (EWARN) reported ILI and SARI in northern Syria between 2016 and 2021 and the potential impact of SARS-CoV-2. METHODS: We extracted weekly EWARN data on ILI/ SARI and aggregated cases and consultations into 4-week intervals to calculate case positivity. We conducted a seasonal-trend decomposition to assess case trends in the presence of seasonal fluctuations. RESULTS: It was observed that 4-week aggregates of ILI cases (n = 5,942,012), SARI cases (n = 114,939), ILI case positivity, and SARI case positivity exhibited seasonal fluctuations with peaks in the winter months. ILI and SARI cases in individuals aged ≥5 years surpassed those in individuals aged <5 years in late 2019. ILI cases clustered primarily in Aleppo and Idlib, whereas SARI cases clustered in Aleppo, Idlib, Deir Ezzor, and Hassakeh. SARI cases increased sharply in 2021, corresponding with a severe SARS-CoV-2 wave, compared with the steady increase in ILI cases over time. CONCLUSION: Respiratory infections cause widespread morbidity and mortality throughout northern Syria, particularly with the emergence of SARS-CoV-2. Strengthened surveillance and access to testing and treatment are critical to manage outbreaks among conflict-affected populations.

The impact of urban-based family medicine postgraduate rotations on rural preceptors/teachers.

BACKGROUND: The use of rural rotations within urban-based postgraduate programs is the predominant response of medical education to the health needs of underserved rural populations. The broader impact on rural physicians who teach has not been reported. METHODS: This study examined the personal, professional, and financial impact of a rural rotations for urban-based family medicine (UBFM) residents on Canadian rural teaching physicians. A survey was created and reviewed by community and academic rural physicians and a cohort of Canadian rural family physicians teaching UBFM residents was sampled. Survey data and free-text responses were assessed using quantitative and qualitative analyses. RESULTS: Participants with rural residency backgrounds perceived a negative impact of teaching UBFM (p = 0.02 personal and professional) and those in a primary rural environment (as defined below) perceived impact as positive (p < 0.001). Rural preceptors often held contrasting attitudes towards learners with negative judgements counter-balanced by positive thoughts. Duration in practice and of teaching experience did not have a significant impact on ratings. CONCLUSION: Being a rural preceptor of UBFM residents is rewarding but also stressful. The preceptor location of training and scope of practice appears to influence the impact of UBFM residents.

CONTEXTE: L'introduction de stages en milieu rural pour les résidents qui effectuent leur formation postdoctorale dans un centre urbain constitue la solution principale adoptée en matière d'éducation médicale pour répondre aux besoins des populations rurales mal desservies. L'impact plus large de ces stages sur les médecins enseignants en milieu rural n'a pas été documenté. MÉTHODES: Cette étude examine les répercussions personnelles, professionnelles et financières du stage réalisé en milieu rural par les résidents de médecine familiale en milieu urbain (MFMU) sur les médecins enseignants en milieu rural au Canada. Un sondage a été créé et revu par des médecins universitaires et communautaires en milieu rural et une cohorte de médecins de famille ruraux enseignant à des résidents de médecine familiale en milieu urbain a été échantillonnée. Les données du sondage et les réponses ouvertes obtenues ont fait l'objet d'analyses quantitative et qualitative. RÉSULTATS: Tandis que les participants possédant une expérience de résidence en milieu rural ont perçu l'effet négatif du fait d'enseigner aux résidents de MFMU (p = 0,02 personnel et professionnel), ceux qui exercent dans un environnement rural primaire (tel que défini ci-dessous) en ont une perception positive (p<0,001). Les superviseurs en milieu rural avaient souvent des attitudes contrastées envers les apprenants, des aspects positifs compensant certains jugements négatifs. La durée d'exercice et l'expérience en l'enseignement n'ont pas eu d'impact significatif sur les évaluations. CONCLUSION: Être un superviseur en milieu rural de résidents en MFMU est gratifiant, mais aussi stressant. Le lieu de formation et le champ d'exercice du superviseur semblent déterminer l'effet qu'ont les stages de résidents de MFMU sur ces superviseurs.

Weaponizing water as an instrument of war in Syria: Impact on diarrhoeal disease in Idlib and Aleppo governorates, 2011-2019.

OBJECTIVES: Investigate the weaponization of water during the Syrian conflict and the correlation of attacks on water, sanitation, and hygiene (WASH) infrastructure in Idlib and Aleppo governorates with trends in waterborne diseases reported by Early Warning and Response surveillance systems. METHODS: We reviewed literature and databases to obtain information on attacks on WASH in Aleppo and Idlib governorates between 2011 and 2019. We plotted weekly trends in waterborne diseases from two surveillance systems operational in Aleppo and Idlib governorates between 2015 and early 2020. RESULTS: The literature review noted several attacks on water and related infrastructure in both governorates, suggesting that WASH infrastructure was weaponized by state and non-state actors. Most interference with WASH in the Aleppo governorate occurred before 2019 and in the Idlib governorate in the summer of 2020. Other acute diarrhea represented >90% of cases of diarrhea; children under 5 years contributed 50% of cases. There was substantial evidence (p < 0.001) of an overall upward trend in cases of diarrheal disease. CONCLUSIONS: Though no direct correlation can be drawn between the weaponization of WASH and the burden of waterborne infections due to multiple confounders, this research introduces important concepts on attacks on WASH and their potential impacts on waterborne diseases.

Being a resident of family medicine in Africa in 2019: a picture from the 6th WONCA Africa Conference in Kampala / Ser residente em medicina de família na África em 2019: um retrato da sexta conferência WONCA África em Kampala / Ser residente en medicina familiar en África en 2019: un retrato de la sexta conferencia WONCA África en Kampala

Training young doctors in family medicine is challenging in any setting and many variables can influence the success or failure of a residency program. This article is the end result of a collaborative work that started in June 2019 at the WONCA Africa Regional Conference in Kampala, during a workshop lead by the Besrour Centre for Global Family Medicine at the College of Family Physicians of Canada. We present here the perspective of a small group of young African family physicians on the experience of being a resident in family medicine in Africa in 2019, hoping that the picture we depict here helps to promote the necessary improvements in the training programs in Africa for the near future.

Formar novos médicos de família é um desafio em qualquer cenário e muitas variáveis podem influenciar o sucesso ou o fracasso de um programa de residência. Este artigo é o resultado final de um trabalho colaborativo iniciado em junho de 2019, na Conferência Regional WONCA África em Kampala, Uganda, durante um workshop liderado pelo Centro Besrour do Colégio Canadense de Medicina de Família. Apresentamos aqui a perspectiva de um pequeno grupo de jovens médicos de família africanos sobre a experiência de ser residente em medicina de família na África em 2019, esperando que a imagem que representamos aqui ajude a promover as melhorias necessárias nos programas de residência na África em um futuro próximo.

La formación de nuevos médicos de familia es un desafío en cualquier lugar y muchas variables pueden influir en el éxito o el fracaso de un programa de residencia. Este artículo es el resultado final del trabajo colaborativo iniciado en junio de 2019 en la Conferencia Regional de África WONCA en Kampala, Uganda, durante un taller dirigido por el Centro Besrour del Colegio Canadiense de Medicina Familiar. Presentamos aquí la perspectiva de un pequeño grupo de jóvenes médicos de familia africanos sobre la experiencia de ser residente en medicina familiar en África en 2019, con la esperanza de que la imagen que representamos aquí ayude a promover mejoras en los programas de residencia en África en un futuro próximo.