Introduction
Koplan et al provide a definition of global health (GH) as: ‘an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide’.1 Family physicians are integral in addressing social determinants of health, as well as providing equitable care by advocating for marginalised and underserved populations. In Canada, rural healthcare coverage is an ongoing challenge.2 3 Furthermore, our First Nations, under-housed, refugee and immigrant populations frequently face healthcare inequities.4–8
Canadian family medicine (FM) trainees have identified a need for a stronger presence of GH education in the FM curricula.9 10 The advantages conferred to residents who participate in GH electives include cultural sensitivity, greater interest in working with underserved patients and less reliance on expensive diagnostic technology.11 Although data in Canada are limited, a previous study from the USA estimated that 22% of FM residency programmes contained a GH concentration.12 At the undergraduate medical level, there is increasing interest from students to study global health as well as from curriculum developers to restructure and standardise courses.13 This could lead to a surge of interest in residency programmes that offer GHAs and could displace the acquisition of certain global health competencies to earlier in the medical training.
The nature and scope of global health activities (GHAs) are very broad and include both didactic and experiential learning. In 2010, the Ontario Global Health Family Medicine Curriculum Working Group identified the need for increasing the emphasis on GH competencies under each CanMEDS role during residency training.9 14 In the same year, Gupta et al summarised some data from a biannual questionnaire completed by FM resident members of the Section of Residents Council of the College of Family Physicians of Canada.9 At that time, 88% of Canadian FM residency programmes had some formal GH curriculum, with most schools devoting <10 hours to the subject over 2 years of training. For further GH training, Canadian FM residents can apply to enhanced skills programmes, occurring during postgraduate year 3, offered at 6 of 17 Canadian medical schools. A literature review showed that elective courses are the most widely used method of teaching trainees in GH,15 with international electives being frequently described in the literature. The lack of standardisation of GH education is such that it is challenging to assess other methods of GH training, such as in research or formal course work within Canada.15
Although Redwood-Campbell et al began to map GH competencies in FM,10 to our knowledge, there has been no study surveying the entire landscape of GH education in Canadian FM residency programmes. Herein, we provide a snapshot of FM GH training across the country, with GHAs defined as any lectures, seminars, research or electives that focus on education around GH topics in local or international settings.16