Curricular structure and its association with family medicine career interest in Canada
Background
The issue: Primary care is the cornerstone of the Canadian healthcare system. Studies have shown that health systems with strong primary care have improved health outcomes, more efficient use of healthcare resources, and more equitable access to healthcare. Despite the importance of primary care for population health, a recent international study has found that Canada lags far behind other high-income countries in access to a primary care provider. At the same time, the College of Family Physicians of Canada has declared a crisis in family medicine, highlighting inadequate support for family physicians in Canada, leading to early retirement, burnout, and practitioners leaving the profession altogether. Compounding this problem is that medical student interest in pursuing family medicine is at an all-time low. The number of unmatched family medicine positions for the Canadian Resident Matching Service (CaRMS) main residency match has been trending upwards for the past 5 years, and the highest ever in 2023 at 18%. While this decreased interest is certainly multifactorial and can be linked to lower anticipated remuneration and higher administrative burden in family medicine, there is evidence that the culture of medicine itself, including the subconscious and unintentional messages received by medical students, shapes their values, attitudes, and perceptions of different medical specialties, and influences medical student career choice. This informal culture that medical students internalize during their education is called the informal, or “hidden”, curriculum.
Research questions
1. Do Canadian medical schools with a longitudinal family medicine clerkship, compared to schools without a longitudinal clerkship, have a higher proportion of students who rank family medicine as their first-choice discipline, and/or have a higher family medicine match rate?
2. After introduction of a longitudinal family medicine clerkship, does the proportion of students ranking family medicine as a first-choice discipline, and/or the family medicine match rate, increase?
3. Is the presence or addition of longitudinal family medicine pre-clerkship experiences associated with an increased proportion of medical students ranking family medicine as their first-choice discipline and/or associated with a higher family medicine residency match rate?
Methods
Program search: We will catalogue clerkship designs for each Canadian medical school. We will begin with a search of each medical school’s website. To obtain further detail as to the structure of a school's longitudinal clerkship and the years in which it was implemented as well as pre-clerkship family medicine experiences, we will contact the schools by email to confirm this information and follow up with schools as required. Contact information will be obtained from publicly available information on the respective medical school websites.
Once dates for the introduction of the longitudinal integrated clerkships have been gathered, we will ask for anonymized school-level data from CaRMS, containing residency match rates for family medicine and the proportion of students who ranked family medicine as first choice discipline. We plan to gather data for 8 years prior to the introduction of the longitudinal integrated clerkship and as many available years after its introduction.
Principal Investigators:
- Zhubo (Drew) Zhang
- Maria Mathews
CoInvestigators:
- Amit Garg
