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- Page navigation anchor for RE: Six years later, three year training still doesn't make senseRE: Six years later, three year training still doesn't make sense
To the editor:
It’s funny that six year later, I have been afforded a new opportunity to engage again on the topic of whether base family medicine residency in Canada should be extended to three years. I recall responding to Dr. Buchman’s original article in Canadian Family Physician on the topic in 2012. (1) Many of the issues that led me to disagree with a three-year family medicine residency remain salient or even more convincing today.
In the intervening time since 2012, current cohorts of family medicine residents are graduating with even more historic debt loads, and are also graduating even older, due to the four-year undergraduate degree entry requirement and unprecedented levels of competition that see many complete a graduate degree prior to or during medical training. This means that an extra year weighs that much more heavily in financial and family planning – and likely would also impact the desirability of family medicine as a potential specialty choice.
Additionally, as in 2012, the concern expressed by Dr. Buchman that family doctors are restricting their practices or not providing various aspects of care may well be explained by other factors besides training length and exposure. Home care, cited in the article, is a great example—typically not well remunerated, resource intensive, and with significant impacts on work-life balance; an extra year of training simply will not address these disincentives to providing full-scope care.
...Show MoreCompeting Interests: None declared. - Page navigation anchor for Comparing the family medicine residency trainings in Canada and the UKComparing the family medicine residency trainings in Canada and the UK
This CMAJ article mentions that the United Kingdom has longer family medicine residency training and outperforms Canada.<1> I wonder where the evidences are to support that claim. Although family medicine training in the UK takes a minimum of three years, the UK trainees work shorter hours compared to the Canadians, owing to the European Working Time Directive (EWTR) which restricts a maximum working week of 48 hours.<2> It does not mean the UK trainees have more relaxed training, as EWTR causes inadequate work coverage and burnout among physicians.<3> Physicians are overstretched and thus have minimal time to develop their knowledge and skills.<4> Moreover, each rotation in a UK training program takes 4-6 months, compared to 4 weeks in Canada, and thereby limiting the trainees exposure to only a few specialties.<5> A UK GP trainee can finish training without having worked in psychiatry, obstetric, and pediatric, all of which are core rotations in the Canadian training system.
The UK specialty training programs have a "winnowing" process,<6> with a 50% pass rate in the Royal College examinations.<7> Some applicants to family medicine are dropouts from specialty programs, with years of experience in hospital training. But this creates a negative image for family physicians, who are mislabelled as failures off the specialty consultant ladder.<8> Is this how Canadian family physicians want to be labelled?
...Show MoreCompeting Interests: I have been paid for working as a resident physician in Canada and Britain, but not for writing this letter.