Faculty Members Ensure Medical Students Have Better Appreciation of Family Medicine
Medical students will now graduate with a better understanding and appreciation of the contributions family physicians make for their patients, communities and the healthcare system every day, thanks in part to the work of faculty from the Department of Family and Community Medicine’s (DFCM) Undergraduate Program on a new curriculum for MD students.
Developed by the University of Toronto’s (UofT) MD Program and launched in 2016, the Foundations Curriculum is delivered to first and second-year medical students at the University of Toronto and is considered the most significant change made to the way UofT delivers medical education in over two decades.
While developing the new curriculum, representatives of the MD program requested that faculty from DFCM’s Undergraduate program review the content from a family medicine perspective to ensure it accurately portrays the role and work of family physicians.
“We wanted to ensure that everyone who comes out of medical school, including those who become specialists, is grounded and has a good sense of what family medicine is,” says Dr. Ruby Alvi, DFCM’s Pre-Clerkship Director. “At an even more basic level, we also wanted to make sure the curriculum reflected generalist principles as well.”
Generalism, according to the Royal College of Physicians and Surgeons of Canada, is a philosophy of care wherein medical practitioners are committed to a wide breadth of practice and collaboration with the larger health care team in order to respond to patient and community needs. Family doctors, many contend, are the ultimate generalists: most treat a variety of illnesses and see patients from all age groups and demographics, as well as have roles in areas such as health promotion and disease prevention.
Generalists are vital to the health care system: with an aging population and an increasing number of patients dealing with multiple medical issues, it is necessary to have physicians who are focused on treating the patient as a whole. Generalists, particularly family doctors, assist in preventing, diagnosing and treating a wide breath of medical, physical and emotional ailments while collaborating with a larger health care team – ensuring that patients receive comprehensive care.
“There is a lot of confusion around generalism both inside and outside of medical schools but it’s the groundwork for all physicians, and medical school is where MD students learn generalism principles,” says Dr. Alvi.
DFCM faculty, building off existing work in generalism, developed a tool that systematically assesses for the presence or absence of generalism principles in the curriculum. For instance, the curriculum largely uses case-based learning that is intended to mimic real-life clinical encounters; however, DFCM faculty sometimes found that the cases didn’t reflect their own experiences as family physicians.
“As an example, sometimes the referral time for a specialist was not accurate based on our own experience or the location where care was received was not typical, whereby a problem dealt with commonly in primary care was referred to a specialist,” says Alvi. “We were concerned because students might not be receiving a true sense of what really happens on the ground.”
When DFCM faculty completed their review, they provided feedback to the Faculty of Medicine MD program. The feedback was well received and much of it has been incorporated into the current curriculum and other areas are being considered for potential future curriculum changes. Other departments and offices within U of T’s Faculty of Medicine inspired by DFCM have also followed suit and have begun their own reviews, including the theme leads of LGBTQ health education and black health.
“The response to our work from those involved in the creation of the curriculum has been positive and encouraging,” says Dr. Melissa Nutik, DFCM’s Undergraduate Education Scholarship lead. “We believe we have made an impact on the curriculum that includes more exposure to generalist principles and positive messages about family medicine.”
The initiative’s success expands beyond the University of Toronto’s borders. DFCM faculty members have presented their scholarly work at the national Family Medicine Forum 2016 and 2017 and the international Society of Teachers of Family Medicine (STFM) conferences in 2017 and 2018. Other medical schools that are looking to review their curriculums with a family medicine and generalist lens are interested in their work.
“It’s a really exciting time to be in family medicine and see all these new medical students graduating with a deeper appreciation of family physicians and a good sense of what we do,” says Dr. Alvi. “Our work has been valued by everyone involved, and it’s really just the first step.”