Physician training needs to evolve with changing health demands

May is an exciting time for the medical community as many future doctors will receive acceptances into medical programs across the country. It’s an opportunity for us already in the profession to reflect on our journeys.

Canadian physicians all have similarities in their training — a fairly uniform national medical school curriculum, and to some extent, a “generalized” first year of residency training.

But the way physicians communicate between each other requires a shared language and a similar framework of thinking. It also requires a strong understanding of roles, and what better way to accomplish that than to spend time working with a wide range of specialists during training. After all, patients admitted for psychiatric conditions can still get heart attacks, and in times of uncertainty, we might want a workforce that can be redeployed.

Prior to the rotating internship being abolished in the early 1990s, newly graduated medical students completed a one-year internship to obtain a “general licence” to practice medicine and were then free to pursue further specialty training if desired. With the general licence formally removed, family medicine became its own specialty, requiring a two-year focused residency, with most other specialties requiring four to five years.

Since 2018, residency programs have been transitioning from a “time-based” model to a competency-by-design (CBD) curriculum. While the length of time in residency is not expected to change, the new CBD curriculum aims to provide learners with more frequent feedback and specific exposure that will prepare them for independent practice in their chosen specialty.

In anatomical pathology, my cohort (expected to graduate in 2023) is the last group of residents who will train under the old curriculum. Compared to my 2024 colleagues, I will have spent 12 months of my total residency time rotating basic clinical services like internal medicine, psychiatry and family medicine. The new cohort will only spend six months on basic clinical services, and most of this will be time spent on pathology-related services like oncology and surgery.

What do these changes mean for our health care system?

There is no doubt that medicine is becoming increasingly complex. To adapt, it may be wise to have graduating physicians above all really be experts in their specialties. We don’t want jacksof-all-trades, but masters of none. Even generalist specialties like family practice or internal medicine will benefit from spending more time learning and working in their future-practice oriented environments.

As I put forth my name on a list for possible, albeit unlikely, redeployment to help with the COVID-19 response, I thought back on my “basic clinical year.” There were many on-call nights were I found myself involved in procedures like lumbar punctures on sick patients or suturing in the OR.

I probably won’t be involved in any of these procedures again, but that isn’t the point. This pandemic has taught me that things can change very rapidly. Our individual priorities and the priorities of hospitals are always changing.

In the next few months we will see a new cohort of both medical students and residents beginning the next phase of their training, and I want to leave junior students this to consider: You don’t know what you don’t know. Be open to learning things that may seem irrelevant. Embrace the learning process and know a lot can change before you’re out in practice — with the health care system and with your own priorities. We’re all in this together.