Outcomes of Training Project (OTP) Communications Toolkit

In 2010 the CFPC introduced the Triple C to bolster comprehensiveness and continuity through improvements to training. There have been many positive results but our evaluation in 2018 highlighted the need for a better definition of comprehensiveness in training. This was a major objective of the OTP –  to define it as well as learn how training needs to change to prepare family physicians for the complex and evolving needs of people in Canada.

In May 2021 the College released the Residency Training Profile (RTP) in response to the outcomes of the Triple C and the need for educational changes in both core and enhanced skills residency training. This was supplemented with a full report and set of educational recommendation in January 2022 that enabled the RTP.

The CFPC developed the Patient’s Medical Home (PMH) as a vision for effective, compassionate, and evidence-derived and team-based care.  The OTP supports interprofessional teams practice as seen in the PMH vision. It is our intention and responsibility to ensure that the CFPC’s educational standards support this vision and are rigorous, subject to quality improvement, and changes in accordance with societal need as part of our commitment to social responsibility. 

Team Primary Care (TPC) launched in February 2023. This program, run by the FAFM, is funded by the Government of Canada’s Employment and Social Development Canada and co-led by the College of Family Physicians of Canada (CFPC) and the Canadian Health Workforce Network, in partnership with more than 65 health professional and educational organizations across Canada.

The initiative sets the foundation for education reform. It also aims to enhance and align the training of individual primary care practitioners, including family physicians, allowing  them to work together in team-based, comprehensive primary care models. By better preparing new and existing primary care practitioners, people in Canada will have better access to equitable care close to home.

• Improved interest in comprehensive family medicine as a career choice
• Improved preparedness and confidence in working within a full scope of practice
• Increased opportunities to work in team-based, comprehensive care models
• Increased growth in skill sets to work with underserved communities
• Increased professional well-being and satisfaction

• Increased ability to achieve the goals of training for comprehensiveness and preparedness
• Increased educational capacity (time) to make educational changes
• Improved ability to meet social accountability goals
• Enhanced well-being for learners

• Increased capacity for primary care providers, including family physicians, to manage more, complex health issues
• Improved family physician mobility and adaptability, keeping with national licensure
• Increased profession sustainability
• Improved integration of health equity, diversity, inclusion, and accessibility
• Improved access to comprehensive care and better patient experience

To help us address the crisis in family medicine, we need more comprehensive care family physicians with the skills and knowledge to work in interprofessional teams as seen in the PMH vision.

• These skills must respond to the pressing and increasingly complex health care needs
• The RTP defines the educational preparation needed to achieve these goals
• There is some urgency. If we want a different system in the future, we must invest in education now.   

• Evidence is from a mixed methods analysis using the CFPC’s Family Medicine Longitudinal Survey (FMLS) data combined with focus groups with early career family physicians  
  • FMLS data and expert panel consultations identified training gaps and societal trends that require new and/or higher levels of skill in specific defined areas  
• Canada has the broadest scope and shortest family medicine residency training period in the world, compared to other similar Organisation for Economic Co-operation and Development countries

Need for longer training (strengthened residency training)

• We have now defined comprehensiveness in training through the Residency Training Profile
• Residency program leaders state that “the curriculum is full” and there is no educational capacity to respond to needed changes or enhancements within the current period of training

• Added and enhanced educational experiences, including skills consolidation across different contexts
• Supported transition into practice, which can create and expand leadership, scholarship, and advocacy opportunities
• Increased autonomy and opportunities for meaningful mentorship support
• Easing the stress of highly compressed and fast-paced curriculum expectations
• Flexible learning trajectory to address individual learning plans

• No time increase
  • Rejected as leaders, residents, and early career family physicians lacked confidence that the status quo (two years) would allow for needed changes
• A flexible and customized time increase
  • Rejected because needed enhancements would become optional and highly customized
  • Extremely difficult and resource consuming to accomplish from an administrative feasibility standpoint
  • Would create difficulties in making stable and advanced service commitments to communities and hospitals
• A fixed increase in time to three years
  • Leaders preferred the fixed increase. Given their knowledge of resources coupled with their responsibility for meeting educational standards, priority was given to their preferences.

Figuring this out is our current focus of OTP (phase two), occurring over the next 18 to 24 months. By spring 2024 each school will have developed a curriculum renewal plan and the national picture of what this will look like will be clearer.

• Curricular changes should be integrated across all three years
• Curricular changes need to better support the transition into practice with a focus on greater autonomy, leadership and teaching, and skills consolidation according to individualized learning plans
• There is a need to address gaps regarding health care for low resource and underserved communities and Indigenous people
• Residents should be taught to work sustainably within an interprofessional practice model where they can work in PMH-type practices upon graduation
• Residents should have the opportunity to cultivate community attachments and related areas of interest

• Practice anywhere in Canada
• Have new and strengthened skills
• Make a meaningful difference in the lives of their communities

• Attract individuals with an extraordinary blend of skills who can make a difference in various communities, including the lives of underserved, rural, or Indigenous populations
• Support learner wellness and effectiveness by enhancing opportunities for meaningful support such as mentorship
  • Help individuals to meet the increasingly complex needs of patients and hit the ground running once they transition to practice

• Treat diverse patients and communities
• Respond to unexpected or uncertain situations
• Learn as you go

• Field research
• Hundreds of family physicians studying their discipline and scope of work
• Consultation with expert panels of family physicians and experienced educators

The RTP also takes into consideration what is essential for residency versus what can be learned in practice.

• Universities
• Certifying bodies (Collège des médecins du Québec and Royal College)
• Medical regulatory authorities
• Learner groups
• Other national partner organizations

• New training sites
• New medical schools
• Clinical resources
• Teaching capacity

As with any big change, it happens in stages accompanied by a range of reactions that require listening, learning, communication, and adjustment. These are things we are working hard on at present.  

We hope to have a clearer national picture of what is possible—related to feasibility, risk and threat, opportunity, and support—by spring 2024.

• Advanced practice skills
• Leadership and scholarship in a particular domain of family practice
• The ability to support colleagues (through consultation and teaching) within the framework of comprehensive care close to home

As we look at curriculum changes to core training, the question arises about what this means for enhanced skills training and the Certificate of Added Competence (CAC) certification pathway.

• The CFPC supports our members with CACs and values their role in the health care system as they act as leaders and a resource to their communities
• The CFPC has not yet determined how the changes to core training will impact enhanced skills  training in terms of overall length of education
• Examining enhanced skills training will be part of the educational redesign currently under way
• Changes to core training should result in residents being more prepared and functioning at an advanced level from the outset
• The main changes to enhanced skills training and CACs focus on achieving skills in:
  • Health system leadership
  • Consultancy
  • Supporting comprehensive care as part of the interprofessional care team

The OTP brings about complex but exciting and transformative change. That said, the CFPC is committed to a responsible, collaborative, flexible, iterative, and system-based approach. No changes have been made to the CFPC’s educational standards and will not be made until there is a clear way forward, so no earlier than 2027.  

Spring 2024 is our next major project milestone based on two current project work streams:

Curriculum Renewal Plan

Family medicine residency programs have been asked to create a Curriculum Renewal Plan based on the RTP and following OTP recommendations:

• Each school’s plan will look a little different, reflecting local realities and context
• This work is supported by the CFPC and schools are working collaboratively with us and each other to determine their plans
• By spring 2024 we anticipate knowing much more about how curriculum changes could be implemented

Change Stewardship

• Departments of family medicine have been asked to create a Change Readiness Assessment
  • This will indicate what is possible in terms of beginning to implement the recommended changes starting in 2027
  • It will give the CFPC a national snapshot of progress and change readiness from the school’s perspective
• The CFPC is also convening a change stewardship process at the systems level. This work includes:
  • Engaging system partners
  • Working collaboratively to examine a range of issues related to capacity, resources, feasibility, risk, and opportunity
• By spring 2024 we expect to have a snapshot of change readiness and what is possible  

Results from these will inform next steps and the CFPC’s decision regarding our approach to implementing the OTP recommendations.