Investigating the barriers to teaching family physicians' and specialists' collaboration in the training environment: a qualitative study.
BACKGROUND
Collaboration between physicians in different specialties is often taken for granted. However, poor interactions between family physicians and specialists contribute significantly to the observed discontinuity between primary and specialty care. The objective of this study was to explore how collaboration between family physicians and specialists was conceptualised as a competency and experienced in residency training curricula of four faculties of medicine in Canada.


METHODS
This is a multiple-case study based on Abbott's theory of professions. Programs targeted were family medicine, general psychiatry, radiology, and internal medicine. The content of the programs' objectives was analyzed. Associate deans of postgraduate studies, program directors, educators, and residents were interviewed individually or in focus groups (47 residents and 45 faculty members).


RESULTS
The training objectives related to family physicians-specialists collaboration were phrased in very general terms and lacked specificity. Obstacles to effective collaboration were aggregated under themes of professional responsibility and questioned expertise. Both trainees and trainers reported increasing distances between specialty and general medicine in three key fields of the professional system: the workplace arena, the training setting, and the production of academic knowledge.


CONCLUSIONS
The challenges of developing collaborating skills between generalists and specialist physicians are comparable in many ways to those encountered in inter-professional collaboration and should be given more consideration than they currently receive if we want to improve coordination between primary and specialty care.
Beaulieu
Marie-Dominique
MD
Doctor Sadok Besrour Chair in Family Medicine, Department of Family Medicine, Universite de Montreal, Montreal, Canada. marie-dominique.beaulieu@umontreal.ca
Samson
Louise
L
Rocher
Guy
G
Rioux
Marc
M
Boucher
Laurier
L
Del Grande
Claudio
C
D000328:Adult; D002170:Canada; D003299:Cooperative Behavior; D003479:Curriculum; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010821:Physicians, Family / Q000193:education*; D012577:Schools, Medical; D013038:Specialization