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Background and Objectives: Despite a record of excellence, Canadian family medicine residency programs must respond to the changing face of health care and the needs of the population. A working group was established by the College of Family Physicians of Canada to review the current curriculum and make recommendations for change., Methods: Literature reviews of current evidence regarding strategies in postgraduate medical education were carried out, and recent developments in medical education internationally were studied. After recommendations for curriculum change were drafted, workshops, presentations, and peer consultations were conducted over a 4-year period to test ideas and obtain stakeholder feedback., Results: The core recommendation of the working group is: Residency programs in family medicine are to establish a competency-based curriculum that is comprehensive, focused on continuity, and centered in family medicine--The Triple C Competency-based Curriculum. The working group developed a new framework for family medicine competency in Canada, CanMEDS-FM, to support the transition., Conclusions: The Triple C Competency-based Curriculum was developed to redesign Canadian family medicine residencies based on a solid rationale. Recommendations for curricular change, as well as the competency framework, CanMEDS-FM, have been accepted enthusiastically by stakeholders. Implementation and evaluation phases are underway.

Objective: To describe primary health care professionals' views on barriers and facilitators for implementing the Ottawa Decision Support Framework (ODSF) in their practice., Methods: Thirteen focus groups with 118 primary health care professionals were performed. A taxonomy of barriers and facilitators to implementing clinical practice guidelines was used to content-analyse the following sources: reports from each workshop, field notes from the principal investigator and written materials collected from the participants., Results: Applicability of the ODSF to the practice population, process outcome expectation, asking patients about their preferred role in decision making, perception that the ODSF was modifiable, time issues, familiarity with the ODSF and its practicability were the most frequently identified both as barriers as well as facilitators. Forgetting about the ODSF, interpretation of evidence, challenge to autonomy and total lack of agreement with using the ODSF in general were identified only as barriers. Asking about values, health professional's outcome expectation, compatibility with the patient-centered approach or the evidence-based approach, ease of understanding and implementation, and ease of communicating the ODSF were identified only as facilitators., Conclusion: These results provide insight on the type of interventions that could be developed in order to implement the ODSF in academic primary care practice., Practice Implications: Interventions to implement the ODSF in primary care practice will need to address a broad range of factors at the levels of the health professionals, the patients and the health care system.

Objective: To investigate family physicians' views on factors that make health care decisions difficult for patients, interventions family physicians use to support patients making decisions, and interventions proposed by the Ottawa Decision Support Framework (ODSF)., Design: Thirteen group discussions., Setting: Five family practice units., Participants: One hundred twenty family physicians., Interventions: The multifaceted implementation intervention consisted of feedback from participants, a reminder at point of care, and an interactive workshop. During the workshop, family physicians were asked about their views on 2 videos both showing the concluding phase of a simulated clinical encounter with a woman facing a decision about hormone therapy. One video showed usual care; the other showed use of the ODSF process and related tools. Content was analyzed using observations by non-participants, field notes, material collected from participants during workshops, evaluation forms completed at the end of workshops, and comments written on exit questionnaires from the implementation trial., Main Outcome Measures: Family physicians' views on the types of difficult decisions their patients face, the factors that make decisions difficult for patients, the interventions family physicians use to support patients' decisions, and the interventions proposed by the ODSF., Results: The 2 most frequently cited factors making decisions difficult for patients were experiencing uncertainty and fears about adverse outcomes. Before being introduced to the ODSF, participants had used mostly information-related strategies to provide decision support. After learning about the ODSF, participants overwhelmingly identified assessing patients' values as a priority. At the end of the workshop, the 5 changes in practice participants most frequently intended to make were, in order of importance, to assess patients' values, to ask about patients' preferred role in decision making, to screen for decisional conflict, to assess support or undue pressure on patients, and to increase patients' involvement in decision making., Conclusion: The ODSF process and related tools have the potential to broaden family physicians' views on supporting patients facing difficult decisions.

During the initial Partners Meeting of the Association of Faculties of Medicine of Canada (AFMC), the Canadian Association for Medical Education (CAME), the College of Family Physicians of Canada (CFPC), the Medical Council of Canada (MCC), and the Royal College of Physicians and Surgeons of Canada (RCPSC) in May 2005, a plenary discussion and debate focused on the tensions that exist between generalist and subspecialty education within both the undergraduate and postgraduate educational programs in Canadian medical schools. Key issues identified in the debate included medical student selection, generalist representation on medical school faculty and in learning experiences, and the need for a greater teaching role and respect for generalism to be developed.

Objective: To determine the nature of inaccuracies likely to occur when standardized patients (SPs) are used to measure physician behaviour and to evaluate the potential impact of these inaccuracies on estimates of physician performance., Design: Secondary analysis from a randomized controlled trial., Setting: Family physicians' offices., Study Participants: Eighteen individuals, each portraying one of two patient scenarios, made a total of 179 visits to 92 family physicians who were participating in a separate randomized controlled trial to evaluate the impact of an educational workshop on implementation of preventive guidelines., Main Outcome Measures: Accuracy of SPs' portrayal of the assigned scenarios and accuracy of their coding of physician performance, determined on the basis of audiotapes of the visits and correlated with indicators of physicians' preventive practices., Results: Accuracy of portrayal of the patient scenario was 84.8% for the male SPs and 93.5% for the female SPs. Inaccuracies in portrayal had no impact on physician performance scores. Accuracy of coding of physician performance was 90.5% for the female SPs (kappa = 0.66) and 90.1% for the male SPs (kappa = 0.68). Coding inaccuracies occurred most frequently for assessment of alcohol consumption and advice against smoking., Conclusion: SPs can provide valid information about physicians' professional performance. However, standardization of their activities must not be taken for granted. It may be more difficult to obtain standardized coding for counselling activities, an aspect of physician visits for which SPs are particularly appropriate.