Oak Valley Health – Markham Stouffville Hospital

• Manage your own practice in a beautiful Family Medicine Teaching Unit with an electronic medical system.
• Learn to be a skilled family physician through a flexible and thorough curriculum.
• Deliver comprehensive care to a diverse patient population in an office and hospital setting.
• Enjoy a learning environment that provides one-on-one mentorship with family physician preceptors.
• Focus on health equity and global health

The Markham site offers an innovative, value-added feature to the family medicine residency with a longitudinal focus including:

Comprehensive and Continuous Care

The Markham Family Medicine Teaching Unit (MFMTU) takes pride in providing comprehensive and continuous care to a diverse population of patients from cradle to grave. We acknowledge that Family Medicine is a special discipline which is unique for its foundation and mandate to deliver a broad basket of primary care services. We support a range of clinical resources and care for health promotion, illness screening and prevention, diagnosis and management of differentiated and undifferentiated medical conditions.

We provide:

• prenatal, delivery and post-partum care, including maternal and newborn care
• care of adolescents and the elderly
• palliative care
• care for patients with complex diseases or mental health conditions
• home visits for home-bound and frail patients

MFMTU seeks to emulate the Patient-Centred Medical Home (PMH) model which advocates for strong primary care teams to support the central pillars of comprehensiveness and continuity. Our team is represented by family physicians, some with added competencies and special practice interests, inter-professional healthcare providers and administrative staff working together to meet the primary and speciality care needs of our patients. We strive for continuity of care so that our patients have the opportunity to develop long-term, trusting relationships with their primary care providers. We use quality improvement and patient safety methodologies to enhance access and continuity for the provision of comprehensive care.

Procedures Clinic

Markham Family Medicine Teaching Unit (MFMTU) supports the practice and teaching of minor office procedures for patients, including:

• Daily routine procedures such as injections, pap tests, and cryotherapy
• Special gynecological procedures such as endometrial biopsies and intra-uterine contraceptive device insertions
• Minor surgical procedures such as shoulder and knee injections, skin biopsies and excisions, e.g. removal of nevi, epidermal or sebaceous cysts, or suspected malignancies such as basal or squamous cell carcinomas
• Infection prevention and control (IP&C)

For minor surgical procedures, resident physicians use the Minor Surgical Procedures Manual to educate themselves in performing and recording procedures in which they participate. Primary care practitioners, including faculty, residents and nurses refer their patients to one another in recognition of the consultation and procedural skills that each contributes to comprehensive team-based care for our patients at MFMTU.

Global Health and Health Equity Focus

Our global health program offers additional educational features as follows:

• Monthly social determinants of health teaching and global health lunch rounds at the teaching unit which is a unique two-year curriculum addressing a wide variety of global health, health advocacy and intercultural health topics.
• Support in completing the requirements for a certification from the Global Health Education Institute of the University of Toronto. This innovative modular program is completed over a two-year period and provides a broad introduction to global health.
• The residency research project can focus on a topic of relevance to global health or intercultural health.
• Lecturers and other leaders of teaching sessions of the academic half-day curriculum at this site devote a portion of their teaching to considering the international and cultural features of the given topic.
• Throughout the two years of residency trainees will be preparing for a global health or health equity elective. This site is developing long-term partnerships with universities and health care institutions in international settings. Residents will prepare throughout the two years of their program for an education elective of one or two-month duration in one of these settings.

Many residents and staff physicians have chosen Markham-Stouffville Hospital’s family medicine teaching unit in which to train and practice because of their interest in global and intercultural health. This has allowed trainees and faculty to build a culture within the program which fosters ongoing learning about such issues.

Research Program

MFMTU is currently expanding its research program to cater for growing research interest of its faculty. Faculty at MFMTU have diverse research interests that include but not limited to:

• Global Health & Health Equity
• Harnessing Electronic Medical Records (EMR ) and other administrative data for various research purposes
• Medical education, role modelling and professionalism
• Patient safety
• Choosing Wisely Initiatives

Patient Safety in Primary Care

Patient safety in family medicine addresses harm reduction in our primary healthcare system so that patients accessing care are as safe as possible. Patient safety is one of the most important dimensions within the six that comprise the envelope of healthcare quality, as defined by the Institute of Medicine.

By studying patient safety in family medicine / primary care we learn that the greatest risks for our patients are associated with missed or delayed diagnoses, medication management and the transfer of large amounts of information between acute and primary care. At the Markham Family Medicine Teaching Unit (MFMTU) / Health for All Family Health Team (HFAFHT), we strive to improve patient safety through innovations such as:

• incident management, e.g. Significant Event Analysis (SEA)
• infection prevention and control, e.g. minor office procedures
• medication reconciliation, e.g. post-hospital discharged patients
• reducing unnecessary tests, e.g. Choosing Wisely mandate

At MFMTU, we integrate patient safety into our QI infrastructures through the responsibilities of our Quality Improvement Committee, accountabilities of our Board and inter-professional team meetings, education and Patient Advisory Council. We practice and teach safe care on our journey to a “safe” or “just” culture where we celebrate providers who want to talk about uncomfortable incidents and how to turn them into opportunities for improvement in our systems of care and management. As a special focus at MFMTU, we are learning to SEE a lot more because of SEA and its consequent prioritization of system improvement.

The FMTU at Markham Stouffville Hospital follows the horizontal model in which residents will spend three half days per week in the Family Medicine Teaching Unit managing their own practice. Residents will also spend one-half day per week in academic seminars.

Core rotations include:

• Emergency Medicine
• GP Hospitalist
• Internal Medicine
• Obstetrics, Gynecology and Women’s Health
• Palliative Care, Complex Chronic Care and Rehabilitation
• Paediatrics
• Mental Health
• Care of the Elderly
• Surgery
• Musculoskeletal and Sports Medicine
• Teaching Practice
• Health Equity / Global Health Elective

1st Year:

2nd Year: