Achieving competencies in family medicine through continuing professional development

Virtually all health systems in low and middle income countries (LMICs) have a pool of generalist doctors with basic training (whom we will refer to here as DBTs, for lack of a better term validated in the literature) whose education and capacities span a wide spectrum. According to a survey of relevant literature we recently conducted through the Besrour Centre at the College of Family Physicians of Canada (CFPC),[1] the contributions of DBTs to these health systems have been substantial, but have been limited by their lack of specific preparation for most aspects of the vital functions they serve. There is good evidence that LMIC health systems and populations would greatly benefit from the contributions of a cohort of physicians who are specifically trained for, and supported in, the clinical, educational, and leadership roles that a highly functioning and responsive primary care sector demands. [2,3] Many LMICs are initiating family medicine residency training programmes in recognition and response to this reality. Is it possible that we could build on the experience and capacities of DBTs in LMIC health systems to augment the anticipated population benefits and system change achievable through family medicine residency training? We suggest that providing opportunities for some DBTs to acquire and demonstrate needed skills and knowledge through intensive and directed continuing professional development (CPD) could be a means of achieving these intended benefits much more quickly than relying on the residency route alone. We further suggest that engaging DBTs through CPD in a practice-eligible route that is connected to family medicine residency training would enrich both parallel streams and support the practices of future family doctors. What we concluded from our review was that validating and incentivising continuing learning by DBTs can be an important way for LMIC health systems to improve both the care given to patients and the efficiency of the system. Spreading innovation and optimal practice through CPD is complementary to the strategy of training a new cohort of highly trained generalists, and change engineered in this way can be achieved much more quickly than residency training of several generations of family doctors. As they emerge from residency, new family doctors will be practicing in parallel with the DBTs in their communities, so optimising the connections between family doctors and DBTs by providing opportunities and incentives to learn together will only improve system capacity and function. As the residency-trained cohort progress through their careers, there will continue to be advances in scientific knowledge and required skills that could, if taken up, allow for improved patient care and system function. A well developed and well supported CPD system, with connections to university training programmes, will continue to pay dividends through maintaining and enhancing the capacities of both DBTs and family doctors. For all these reasons, establishing and supporting high quality CPD for all generalists with basic training backgrounds could be as critical as residency training for family doctors for achieving system goals in LMICs. Having a dual focus – on residents and on practicing DBTs – could also improve and enrich these family medicine training programmes as they develop, and enhance the quality of learning and assessment for both groups. If the parallel training paths were developed specifically to take advantage of synergies, residents could have access to the deep reservoir of clinical experience and community connection possessed by DBTs, and these practicing generalists could take advantage of the academic skillsets and freshness of approach brought by residents. Training the two cohorts in parallel, moreover, would enable the