High quality educational experience keeps graduates in Barrie

In 2009, the University of Toronto (U of T) Department of Family and Community Medicine (DFCM) founded a community-based Family Medicine Residency Program (FMRP) at the Royal Victoria Regional Health Centre (RVH) in Barrie, Ontario. The establishment of this program at RVH was part of a response to a government request to address physician shortages in underserved communities, as research has shown that physicians are more likely to settle in the communities they were educated and trained in. But how have the educational experiences of the RVH FMRP graduates influenced their decision to return to the community to practice and what does it suggest for the successful growth of community-based residency programs in an underserviced community?

A new study in PRiMER aimed to tackle this question by looking into what factors contributed to graduates choosing to train and continue practicing in Barrie after completing their training. While rural recruitment and retention is an area that has been fairly well studied, the implemented programs are not often evaluated for their efficacy.

“We needed to evaluate our program to ensure we're providing the highest quality educational program we can and see what improvements we can make,” says Dr. Stuart Murdoch, the Academic Chief of Family Medicine at RVH and the director of the Postgraduate Education Program at DFCM. “We also wanted to prove that expansion into a community hospital can provide quality education. The study found that the quality of our teaching is consistently high. We’re training good family doctors, and it will help communities recruit and retain their primary care providers.”

Of course, there are a variety of factors that can influence an individual’s decision to do their residency in Barrie, but the study found that many participants were drawn to the program’s structure.The horizontal curriculum - which gave residents the opportunity to have comprehensive responsibility for their own small roster of patients – was often cited as a notable aspect of the program that attracted them to RVH. 

“I liked the horizontal training … the opportunity to have my own roster. To be doing comprehensive care and looking after my patients the entire time was much more attractive versus the block system,” says one of the participants of the study.

After graduation, two-thirds of the 2011-2016 graduates continued to work in the RVH region. Personal reasons such as being near family or friends factored into several participants’ decisions to continue practicing in the region, but for those individuals who did not have a natural connection with the city, their decision to return was influenced by the sense of attachment to the local community that had developed during their training.

“Research shows that when you provide educational experiences in rural and non-urban areas, the communities are able to establish relationships with the physicians, support them while they’re there, and show them what a great lifestyle they can have,” says Mary-Kay Whittaker, one of the lead authors on the study. “Then you will find that after they graduate, the residents will often stay and set up their practice in those communities.”

A limitation of the study is that it only looked at the first five years of graduates as they entered practice. Future studies may include tracking graduate’s practices on a longer-term basis to see if they decide to stay in Barrie beyond their early career.