Abstracts
Abstract
Background: Though there are more family physicians in Canada than ever before, and residency programs are expanding, gaps in access to comprehensive care remain. This study aimed to describe and understand the role residency training experiences played in shaping practice choices, including the provision of comprehensive community-based care, among early career family physicians.
Methods: A secondary analysis of sixty-three (63) qualitative interviews was conducted on data from a larger mixed method study on practice patterns and choices of early career Canadian family physicians. We utilized Braun and Clarke’s six phases of reflexive thematic analysis on portions of transcripts concerning residency training experiences.
Results: Participants described positive residency training experiences that shaped practice choice with respect to preceptors and mentorship, experiences of longitudinal care, breadth of exposure, and preparedness for comprehensive clinical practice. Woven through these four domains were “points of tension” and “hidden truths”. Points of tension included: i) the promotion of an idealized professional identity and practice that was difficult to uphold, ii) lack of representation among faculty/preceptors with respect to age and gender, at some sites, and iii) frustration about the lack of opportunities for interprofessional collaborative practices that reflected training experiences. Hidden truths included: i) lack of preparation to run a business, ii) high administrative workload, iii) realities of payment models, and iv) the range of roles available for family physicians beyond the provision of comprehensive care.
Conclusions: Findings highlight opportunities for educational reform supporting the transition from residency to practice alongside the importance of addressing systemic factors beyond training which impact physicians’ choices regarding comprehensive care.
Résumé
Contexte : Bien qu'il y ait plus de médecins de famille au Canada que jamais auparavant et que les programmes de résidence continuent de se développer, des lacunes subsistent dans l'accès aux soins globaux. Cette étude visait à décrire et à comprendre le rôle que les expériences de formation en résidence ont joué dans l’orientation des choix de pratique, incluant la prestation de soins communautaires complets, parmi les médecins de famille en début de carrière.
Méthodes : Une analyse secondaire de soixante-trois (63) entrevues qualitatives a été effectuée sur les données d'une étude plus vaste à méthodes mixtes sur les modes et les choix de pratique des médecins de famille canadiens en début de carrière. Nous avons utilisé les six phases de l'analyse thématique réflexive de Braun et Clarke pour analyser les sections des transcriptions portant sur les expériences de formation en résidence.
Résultats : Les participants ont décrit des expériences positives de formation en résidence qui ont façonné leur choix de pratique en ce qui concerne les précepteurs et le mentorat, les expériences de soins longitudinaux, l'étendue de l'exposition et la préparation à la pratique clinique globale. Des « points de tension » et des « vérités cachées » sont apparus dans ces quatre domaines. Les points de tension comprenaient : i) la promotion d'une identité et d'une pratique professionnelles idéalisées qui étaient difficiles à maintenir, ii) le manque de représentation parmi les professeurs/précepteurs en ce qui concerne l'âge et le sexe, dans certains lieux, et iii) la frustration concernant le manque d'occasions de pratiques de collaboration interprofessionnelle qui reflétaient les expériences de formation. Les vérités cachées comprenaient : i) le manque de préparation à la gestion d'une entreprise, ii) la charge de travail administrative élevée, iii) les réalités des modèles de paiement, et iv) l'éventail des rôles disponibles pour les médecins de famille au-delà de la prestation de soins globaux.
Conclusions : Les résultats mettent en évidence les possibilités de réforme de l'enseignement pour soutenir la transition entre la résidence et la pratique, ainsi que l'importance d'aborder les facteurs systémiques au-delà de la formation qui ont un impact sur les choix des médecins en matière de soins globaux.
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