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The rich potential for education research in family medicine and general practice

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Abstract

Medical education is a rapidly growing field of research, incorporating diverse disciplinary perspectives to assist physician trainees in developing the complex skills needed for practice. Education science is happening in many medical specialties; however, Family Medicine or General Practice settings have not seen a proportional share of theory-driven education research. The limited nature of education research in Family Medicine is surprising, given that there are several aspects of general practice that make it a particularly unique and interesting context to study issues of general importance to medical education, and there is a particular need for education research to further the discipline of Family Medicine. It is important that the community of medical education researchers in Family Medicine have a strong understanding and perspective on the breadth and potential impact of their work, and what this means for the training that occurs within and for the discipline. This Reflection aims to inform strategic thinking, collaboration, and innovation in medical education research as it pertains to Family Medicine. It does so by discussing four hallmarks of Family Medicine practice and outlining their independent and interactive potential for medical education research.

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References

  • Accreditation Council for Graduate Medical Education [ACGME]. (2014). Chicago, IL: Accreditation Council for Graduate Medical Education; 2013–2014 Annual report. Retrieved March 28, 2015, from www.acgme.org.

  • Alam, R., Cheraghi-Sohi, S., Panagioti, M., Esmail, A., Campbell, S., & Panagopoulou, E. (2017). Managing diagnostic uncertainty in primary care: A systematic critical review. BMC Family Practice, 18, 79. https://doi.org/10.1186/s12875-017-0650-0.

    Article  Google Scholar 

  • Allais, S. (2012). Will skills save us? Rethinking the relationships between vocational education, skills development policies, and social policy in South Africa. International Journal of Educational Development, 3, 632–642.

    Article  Google Scholar 

  • Beaulieu, M. D., Rioux, M., Rocher, G., Samson, L., & Boucher, L. (2008). Family practice: Professional identity in transition—A case study of family medicine in Canada. Social Science and Medicine, 67, 1153–1163.

    Article  Google Scholar 

  • Bernheim, S. M., Ross, J. S., Krumholz, H. M., & Bradley, E. H. (2008). Influence of patients’ socioeconomic status on clinical management decisions: A qualitative study. The Annals of Family Medicine, 6, 53–59.

    Article  Google Scholar 

  • Biesta, G., Allan, J., & Edwards, R. (2011). The theory question in research capacity building in education: Towards an agenda for research and practice. British Journal of Education Studies, 59, 225–239.

    Article  Google Scholar 

  • Brown, T. N. (2003). Critical race theory speaks to the sociology of mental health: Mental health problems produced by racial stratification. Journal of Health and Social Behavior, 44, 292–301.

    Article  Google Scholar 

  • Brown, J., Bearman, M., Kirby, C., Molloy, E., Colville, D., & Nestel, D. (2019). Theory, a lost character? As presented in general practice education research papers. Medical Education, 53, 443–457.

    Article  Google Scholar 

  • Buchman, S., Woollard, R., Meili, R., & Goel, R. (2016). Practising social accountability: From theory to action. Canadian Family Physician, 62, 15–18.

    Google Scholar 

  • Caulfield, M., Andolsek, K., Grbic, D., & Roskovensky, L. (2014). Ambiguity tolerance of students matriculating to U.S. medical schools. Academic Medicine, 89, 1526–1532.

    Article  Google Scholar 

  • Chan, B. T. (2002). Do family physicians with emergency medicine certification actually practise family medicine? CMAJj, 167, 869–870.

    Google Scholar 

  • College of Family Physicians of Canada [CFPC]. (2018). Family Medicine Professional Profile. Mississauga, ON: College of Family Physicians of Canada. Retrieved July 18, 2020 from fromhttps://portal.cfpc.ca/resourcesdocs/uploadedFiles/About_Us/FM-Professional-Profile.pdf.

  • College of Family Physicians of Canada [CFPC], Undergraduate Education Committee. (2007). Rethinking undergraduate medical education. A view from Family Medicine. Mississauga, ON: College of Family Physicians of Canada. Retrieved July 18, 2020 fromhttps://portal.cfpc.ca/resourcesdocs/uploadedFiles/Education/VIEW%20FROM%20FAMILY%20MEDICINE_Final%20April2008.pdf.

  • Cooke, G., Tapley, A., Holliday, E., Morgan, S., Henderson, K., Ball, J., et al. (2017). Responses to clinical uncertainty in Australian general practice trainees: A cross-sectional analysis. Medical Education, 51, 1277–1288. https://doi.org/10.1111/medu.13408.

    Article  Google Scholar 

  • Danczak, A., & Lea, A. (2018). Developing expertise for uncertainty; Do we rely on a baptism of fire, the mills of experience or could clinicians be trained? Education for Primary Care, 29, 237–241.

    Google Scholar 

  • Entwistle, V. A., & Watt, I. S. (2006). Patient involvement in treatment decision-making: The case for a broader conceptual framework. Patient Education and Counseling, 63, 268–278.

    Article  Google Scholar 

  • Epstein, R. M. (2013). The ambiguity of personhood. The American Journal of Bioethics, 13, 42–44.

    Article  Google Scholar 

  • Epstein, R. M., & Street, R. L. (2011). The values and value of patient-centered care. Annals of Family Medicine, 9, 100–103.

    Article  Google Scholar 

  • Evans, L., & Trotter, D. R. (2009). Epistemology and uncertainty in primary care: An exploratory study. Family Medicine, 41, 319–326.

    Google Scholar 

  • Ford, C. L., & Airhihenbuwa, C. O. (2010). Critical race theory, race equity, and public health: Toward antiracism praxis. American Journal of Public Health, 100, S30–S35.

    Article  Google Scholar 

  • Future of Family Medicine Project Leadership Committee. (2004). The future of Family Medicine: A collaborative project of the Family Medicine community. Annals of Family Medicine, 2, S3–S32.

    Article  Google Scholar 

  • Gibbs, T., Durning, S., & van der Vleuten, C. P. M. (2011). Theoriesin medical education: Towards creating a union between educational practice and research traditions. Medical Teacher, 33, 183–187.

    Article  Google Scholar 

  • Gibson, C., Arya, N., Ponka, D., Rouleau, J., & Woollard, R. (2016). Approaching a global definition of family medicine: The Besrour Papers a series on the state of family medicine in the world. Canadian Family Physician, 62, 891–897.

    Google Scholar 

  • Glasser, M., Stearns, J., & McCord, R. (1995). Defining a generalist education: An idea whose time is still coming. Academic medicine: journal of the Association of American Medical Colleges, 70(1 Suppl), S69–S74.

    Article  Google Scholar 

  • Green, L. A., Graham, R., Bagley, B., Kilo, C. M., Spann, S. J., Bogdewic, S. P., et al. (2004). Task Force 1: Report of the task force on patient expectations, core values, reintegration, and the new model of family medicine. Annals of Family Medicine, 2(Suppl 1), s33–s50.

    Google Scholar 

  • Grumbach, K. (2003). Chronic illness, comorbidities, and the need for medical generalism. Annals of Family Medicine, 1, 4–7.

    Article  Google Scholar 

  • Guenter, D., Fowler, N., & Lee, L. (2011). Clinical uncertainty: Helping our learners. Canadian Family Physician, 57, 120–122.

    Google Scholar 

  • Haggerty, J., Burge, F., Lévesque, J. F., Gass, D., Pineault, R., Beaulieu, M. D., et al. (2007). Operational definitions of attributes of primary health care: Consensus among Canadian experts. The Annals of Family Medicine, 5, 336–344.

    Article  Google Scholar 

  • Han, P. K. J., Klein, W. M. P., & Arora, N. K. (2011). Varieties of uncertainty in health care: A conceptual taxonomy. Medical Decision Making, 31, 828–838.

    Article  Google Scholar 

  • Hutten-Czapski, P., Pitblado, R., & Slade, S. (2004). Scope of family practice in rural and urban settings. Canadian Family Physician, 50, 1548.

    Google Scholar 

  • Kent, A., & De Villiers, M. R. (2007). Medical education in South Africa–exciting times. Medical Teacher, 29(9–10), 906–909.

    Article  Google Scholar 

  • Kiguli-Malwadde, E., Olapade-Olaopa, E. O., Kiguli, S., Chen, C., Sewankambo, N. K., Ogunniyi, A. O., et al. (2014). Competency-based medical education in two Sub-Saharan African medical schools. Advances in Medical Education and Practice, 5, 483.

    Article  Google Scholar 

  • Kinsella, E. A. (2010). Professional knowledge and the epistemology of reflective practice. Nursing Philosophy, 11, 3–14.

    Article  Google Scholar 

  • Légaré, F., Labrecque, M., Cauchon, M., Castel, J., Turcotte, S., & Grimshaw, J. (2012). Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: A cluster randomized trial. CMAJ, 184, E726–E734.

    Article  Google Scholar 

  • Lemire, F. (2018). Enhanced skills in family medicine: Update. Canadian Family Physician, 64(2), 160.

    Google Scholar 

  • Lemire, F., & Fowler, N. (2017). Comprehensiveness revisited: Family medicine responsibility profile. Canadian Family Physician, 63, 416.

    Google Scholar 

  • Lerner, J. (2018). Wanting family medicine without primary care. Canadian Family Physician, 64, 155.

    Google Scholar 

  • Lingard, L., Garwood, K., Schryer, C. F., & Spafford, M. M. (2003). A certain art of uncertainty: Case presentation and the development of professional identity. Social Science and Medicine, 56, 603–616.

    Article  Google Scholar 

  • Mangin, D., Stephen, G., Bismah, V., & Risdon, C. (2016). Making patient values visible in healthcare: A systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity. British Medical Journal Open, 6, e010903.

    Google Scholar 

  • Mash, R. J., De Villiers, M. R., Moodley, K., & Nachega, J. B. (2014). Guiding the development of family medicine training in Africa through collaboration with the Medical Education Partnership Initiative. Academic Medicine, 89, S73–S77.

    Article  Google Scholar 

  • Mash, R. B., & Reid, S. (2010). Statement of consensus on family medicine in Africa. African Journal of Primary Health Care & Family Medicine, 1, 132–134.

    Google Scholar 

  • McInnes, S., Peters, K., Bonney, A., & Halcomb, E. (2017). The influence of funding models on collaboration in Australian general practice. Australian Journal of Primary Health, 23, 31–36.

    Article  Google Scholar 

  • Mercuri, M., & Gafni, A. (2018). Reflecting on Evidence Based Medicine, Person Centered Medicine and Small Area Variations: How contemporary frameworks for medicine address (or not) the needs of the individual patient. European Journal for Person Centered Healthcare, 6, 454–461.

    Article  Google Scholar 

  • Mezzich, J., Snaedal, J., Van Weel, C., & Heath, I. (2010). Toward person-centered medicine: from disease to patient to person. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine: A Journal of Translational and Personalized Medicine, 77, 304–306.

    Article  Google Scholar 

  • Mizen, L. A., Macfie, M. L., Findlay, L., Cooper, S. A., & Melville, C. A. (2012). Clinical guidelines contribute to the health inequities experienced by individuals with intellectual disabilities. Implementation Science, 7, 42.

    Article  Google Scholar 

  • Moesch, K., Hauge, M. L. T., Wikman, J. M., & Elbe, A. M. (2013). Making it to the top in team sports: Start later, intensify, and be determined! Talent Development & Excellence, 5(2).

  • Mylopoulos, M., Brydges, R., Woods, N. N., Manzone, J., & Schwartz, D. L. (2016). Preparation for future learning: A missing competency in health professions education? Medical Education, 50, 115–123.

    Article  Google Scholar 

  • Mylopoulos, M., Kulasegaram, K., & Woods, N. N. (2018). Developing the experts we need: Fostering adaptive expertise through education. Journal of Evaluation in Clinical Practice, 24, 674–677.

    Article  Google Scholar 

  • Ng, S. L., Kinsella, E. A., Friesen, F., & Hodges, B. (2015). Reclaiming a theoretical orientation to reflection in medical education research: A critical narrative review. Medical Education, 49, 461–475.

    Article  Google Scholar 

  • Noël, P. H., Lanham, H. J., Palmer, R. F., Leykum, L. K., & Parchman, M. L. (2013). The importance of relational coordination and reciprocal learning for chronic illness care within primary care teams. Health Care Management Review, 38, 20.

    Article  Google Scholar 

  • Norman, G. (2011a). Fifty years of medical education research: Waves of migration. Medical Education, 45, 785–791.

    Article  Google Scholar 

  • Norman, G. (2011b). Chaos, complexity and complicatedness: Lessons from rocket science. Medical Education, 45, 549–559.

    Article  Google Scholar 

  • Olopade, F. E., Adaramoye, O. A., Raji, Y., Fasola, A. O., & Olapade-Olaopa, E. O. (2016). Developing a competency-based medical education curriculum for the core basic medical sciences in an African Medical School. Advances in Medical Education and Practice, 7, 389.

    Article  Google Scholar 

  • Ontario Ministry of Health and Long-Term Care [MOHLTC]. (2015). Patients first: A proposal to strengthen patient- centred health care in Ontario. Discussion paper, December 17, 2015. Toronto, ON: Queen’s Printer for Ontario.. Retrieved April 4, 2017, from http://www.health.gov.on.ca/en/news/bulletin/2015/docs/discussion_paper_20151217.pdf.

  • Østbye, T., Yarnall, K. S., Krause, K. M., Pollak, K. I., Gradison, M., & Michener, J. L. (2005). Is there time for management of patients with chronic diseases in primary care? The Annals of Family Medicine, 3, 209–214.

    Article  Google Scholar 

  • Payne, L., Moaveni, A., & Handford, C. (2019). Family medicine residents’ perspectives on curricular messaging surrounding enhanced skills fellowship programs. Canadian Family Physician, 65, e207–e213.

    Google Scholar 

  • Perkins, D. N., & Salomon, G. (1992). Transfer of learning. International Encyclopedia of Education, 2, 6452–6457.

    Google Scholar 

  • Proot, I. M., Abu-Saad, H. H., Crebolder, H. F., Goldsteen, M., Luker, K. A., & Widdershoven, G. A. (2003). Vulnerability of family caregivers in terminal palliative care at home; balancing between burden and capacity. Scandinavian Journal of Caring Sciences, 17, 113–121.

    Article  Google Scholar 

  • Rees, C. E., & Monrouxe, L. V. (2010). Theory in medical education research: How do we get there? Medical Education, 44, 334–339.

    Article  Google Scholar 

  • Regehr, G. (2010). It’s NOT rocket science: Rethinking our metaphors for research in health professions education. Medical Education, 44, 31–39.

    Article  Google Scholar 

  • Rodríguez, C., Bartlett-Esquilant, G., Boillat, M., Dove, M., Grad, R., Lalla, L., et al. (2015). Manifesto for family medicine educational research. Canadian Family Physician, 61, 745.

    Google Scholar 

  • Rodríguez, C., Pawlikowska, T., Schweyer, F. X., López-Roig, S., Bélanger, E., Burns, J., et al. (2014). Family physicians’ professional identity formation: A study protocol to explore impression management processes in institutional academic contexts. BMC Medical Education, 14, 184.

    Article  Google Scholar 

  • Saba, G. W., Wong, S. T., Schillinger, D., Fernandez, A., Somkin, C. P., Wilson, C. C., et al. (2006). Shared decision making and the experience of partnership in primary care. The Annals of Family Medicine, 4, 54–62.

    Article  Google Scholar 

  • Sadovsky, R. (1987). Urban family practice: Breadth and scope. In Urban family medicine (pp. 6–10). Springer, New York, NY.

  • Sharma, M., Pinto, A. D., & Kumagai, A. K. (2018). Teaching the social determinants of health: A path to equity or a road to nowhere? Academic Medicine, 93, 25–30.

    Article  Google Scholar 

  • Shaw, E., Oandasan, I., & Fowler, N., (Eds.). (2017). CanMEDS-FM 2017: A competency framework for family physicians across the continuum. Mississauga, ON: The College of Family Physicians of Canada. Retrieved July 18, 2020, from: https://portal.cfpc.ca/resourcesdocs/uploadedFiles/Resources/Resource_Items/Health_Professionals/CanMEDS-Family-Medicine-2017-ENG.pdf.

  • Stille, C. J., Jerant, A., Bell, D., Meltzer, D., & Elmore, J. G. (2005). Coordinating care across diseases, settings, and clinicians: A key role for the generalist in practice. Annals of Internal Medicine, 142, 700–708.

    Article  Google Scholar 

  • Tannenbaum, D., Konkin, J., Parsons, E., Saucier, D., Shaw, L., Walsh, A., & Organek, A. (2011). Triple C competency-based curriculum. Report of the Working Group on Postgraduate Curriculum Review—part 1. Retrieved July 18, 2020, from https://portal.cfpc.ca/resourcesdocs/uploadedFiles/Education/_PDFs/WGCR_TripleC_Report_English_Final_18Mar11.pdf.

  • Taylor, R. B. (2003). Family medicine: The discipline, the speciality, and the physician. In A. K. David, D. M. Philips, & J. E. Scherger (Eds.), Family medicine: Principles and practice (pp. 1–18). New York: Springer.

    Chapter  Google Scholar 

  • Towle, A., Greenhalgh, T., Gambrill, J., & Godolphin, W. (1999). Framework for teaching and learning informed shared decision making COMMENTARY: Competencies for informed shared decision making commentary: Proposals based on too many assumptions. British Medical Journal, 319(7212), 766–771.

    Article  Google Scholar 

  • Urbaniak, J. R. (1990). Certificates of added qualifications in orthopedic surgery. Clinical Orthopaedics and Related Research, 257, 52–56.

    Google Scholar 

  • Van Berckelaer, A., DiRocco, D., Ferguson, M., Gray, P., Marcus, N., & Day, S. (2012). Building a patient-centered medical home: Obtaining the patient’s voice. The Journal of the American Board of Family Medicine, 25, 192–198.

    Article  Google Scholar 

  • Wald, H. S., Anthony, D., Hutchinson, T. A., Liben, S., Smilovitch, M., & Donato, A. A. (2015). Professional identity formation in medical education for humanistic, resilient physicians: Pedagogic strategies for bridging theory to practice. Academic Medicine, 90, 753–760.

    Article  Google Scholar 

  • Webster, F., Krueger, P., MacDonald, H., Archibald, D., Telner, D., Bytautas, J., et al. (2015). A scoping review of medical education research in family medicine. BMC Medical Education, 15, 79.

    Article  Google Scholar 

  • Williams, B. C., Warshaw, G., Fabiny, A. R., Lundebjerg, M. P. A. N., Medina-Walpole, A., Sauvigne, K., et al. (2010). Medicine in the 21st century: Recommended essential geriatrics competencies for internal medicine and family medicine residents. Journal of Graduate Medical Education, 2, 373–383.

    Article  Google Scholar 

  • WONCA, Europe. (2002). The European definition of general practice/Family Medicine. Barcelona: WONCA Europe.

    Google Scholar 

  • World Health Organization. (2003). Family medicine. Report of a regional scientific working group meeting on core curriculum. Colombo, Sri Lanka. WHO Project # ICP OSD 002. Retrieved July 18, 2020 from https://apps.who.int/iris/bitstream/handle/10665/205046/B3426.pdf?sequence=1&isAllowed=y.

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Acknowledgements

We are grateful for the generative dialogue from colleagues within McMaster University’s Department of Family Medicine and the members of NAPCRG who participated in our 2018 and 2019 workshops. We would also like to acknowledge Raquel Burgess and Dr. Allyn Walsh for their invaluable contributions to the gatherings, and the subsequent synthesis and analysis. Dr. Andreanne Wassef informed our understanding of clinical uncertainty and the current state of the scholarly literature on this topic.

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  1. Department of Family Medicine, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, USA

    Lawrence Grierson & Meredith Vanstone

  2. McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, USA

    Lawrence Grierson & Meredith Vanstone

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Correspondence to Lawrence Grierson.

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Grierson, L., Vanstone, M. The rich potential for education research in family medicine and general practice. Adv in Health Sci Educ 26, 753–763 (2021). https://doi.org/10.1007/s10459-020-09994-7

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