The demographic characteristics of the FM resident and PD respondents are shown in Table 1. A total of 19 family medicine PDs were identified from the 17 Canadian medical schools and 17 completed the PD survey (response rate = 87%). They represented 16 of the 17 medical schools with FM training programs. The 17 program directors agreed to distribute the resident survey link to a total of 902 FM residents, of which 150 completed the survey (response rate = 17%). Figure 1 shows the geographic distribution of respondents across Canada. A total of 17 FM programs were represented with responses from PDs and/or residents from all areas of Canada. Although it was not possible to disseminate the survey to one Western Canadian FM training program, due to logistic barriers, we were still able to obtain survey responses from this institution’s program directors.
Table 2 summarizes key findings with regards to the current state of oncology teaching in Canadian FM training programs (all raw response data from residents and program directors are available in Additional File 1 and Additional File 2, respectively). Based on these survey results, it appears that none of the FM training programs currently have a mandatory oncology rotation. Five PDs (29%) report having oncology learning objectives and competencies, but many residents are unaware that these exist. More PDs than residents report that there is currently adequate oncology education (18% vs 7%, respectively), and residents are being adequately prepared for their role in caring for cancer patients (13% vs 7%, respectively).
The most common instructional method was informal clinical teaching around cases on rotation (e.g. bedside teaching) by family physicians, as reported by 88% of PDs (Table 3). However, only 49% of residents reported receiving formal oncology teaching (e.g. lecture-based, problem-based learning) in their family medicine clinics. Oncology teaching through didactic lectures and small group/case-based learning were reported by 76% of PDs. Yet, only 36% to 37% of residents reported learning oncology through these teaching methods. PDs and residents agreed that the optimal methods for teaching oncology to FM residents is preferentially through clinical exposure, followed by didactic teaching, and also small group/case-based learning (Table 4).
Table 5 shows that based upon the survey results, the most important oncology topics for FM residents to learn in descending order of mean perceived importance, accompanied by the perceived prevalence of current teaching of each topic. The topics thought to be most important by residents with a mean rating of 4.5 out of a 5-point Likert scale or higher were: performing pap smears, cancer screening, breaking bad news, cancer prevention, approach to a patient with increased risk of cancer and palliative care. The PDs generally agreed that these topics are most important, but also included providing psychosocial support and performing a skin biopsy as areas of importance. There was general consensus between PDs and residents that all of these topics are being taught to residents (ranging between 87% - 100% frequency, per item). However, other important topics, including appropriate referral to cancer specialists, post-treatment surveillance for recurrence, managing common cancer complications, and managing common treatment side effects were only taught with frequency rates of 73%, 47%, 40% and 47%, respectively, according to PDs.
According to PDs, five cancer disease sites viewed to be of greatest educational importance for FM residents are breast (100%), lung (93%), colorectal (80%), prostate (73%), and cutaneous (73%). Residents stated that breast (93%), lung (90%), colorectal (83%), prostate (73%), and cutaneous (30%) cancers were of greatest interest to them.
When asked whether a set of standardized national oncology learning goals, objectives and competencies for family medicine would be useful 62% of residents and 53% of PDs agreed. Only 3% and 12%, respectively, disagreed while the others were unsure.