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Family medicine residents' perspectives on curricular messaging surrounding enhanced skills fellowship programs
Lauren Payne1, Azadeh Moaveni2, Curtis Handford3
1Family physician with the Toronto Western Family Health Team and Lecturer in the Department of Family and Community Medicine at the University of Toronto in Ontario. lauren.payne@uhn.ca.
Objective:
To better understand the messages that family medicine residents receive about enhanced skills fellowship programs throughout their training.
Design:
Phenomenologic approach using structured qualitative interviews.
Setting:
Postgraduate family medicine program in Ontario.
Participants:
Eleven family medicine residents (5 first-year and 6 second-year residents) from 4 separate training sites.
Methods:
Interviews were audiotaped and codes were developed by the study investigators. Themes arose from the data via the immersion and crystallization technique.
Main Findings:
Themes emerged in 3 categories: perception of purpose, sources of messaging, and formal or informal versus hidden curricular messages. Fellowship programs were viewed by residents in terms of their personal and professional benefits. Residents learned about fellowship programs through word of mouth and from role models. The formal curriculum remained neutral about fellowship training. The hidden curriculum highlighted a number of messages: a) to maximize chances of acceptance into some fellowship programs, one should focus most of his or her elective time in that clinical area; b) many fellowships graduate subspecialists to the exclusion of family medicine; c) a fellowship is required to practise in a large urban centre but is not required to practise in rural communities; and d) those without fellowship training are less well regarded.
Conclusion:
Residents receive mixed messages regarding fellowship training. This might be a phenomenon isolated to a larger urban centre in Ontario. Decision making at the individual level in terms of career path seems to be affected and might have implications at the larger system level.