Professor Maria Palacios Mackay with UKZN’s
Professor Richard Scott.

UKZN’s Department of Telehealth recently hosted University of Calgary’s Assistant Professor in Family Medicine and Medical Education Specialist, Professor Maria Palacios Mackay, who provided great insight during a public lecture on the recently introduced Triple C programme which is a new competency-based curriculum for Family Medicine Residency training in Canada.

The Triple C programme provides an interesting insight into the re-engineering of the medical curriculum.

The College of Health Sciences (CHS) is currently focused on re-engineering its curriculum to ensure UKZN produces healthcare professionals competent and prepared for the changing dynamics of healthcare in a developing world.

The new CHS curriculum is centred on a community-based training model embedded in primary healthcare.

In 2009, the College of Family Physicians in Canada requested that the Family Medicine Residency training programmes in Canada become a comprehensive, competency-based curriculum in family medicine focused on continuity of care and education. This resulted in the Triple C programme which is based on Comprehensive Care and Education, Continuity of Patient Care and Education and Centred in Family Medicine.

Comprehensive Care and Education focuses on a curriculum that is centred on the Social Responsibility of Family Medicine Residency Programmes (FMRPs) to educate physicians to meet community needs through the delivery of comprehensive care.

The FMRPs must model comprehensive care and train their residents to this standard. Continuity of care is key in the development of physicians whose practice is truly comprehensive. It is a fundamental component of family medicine which improves physician and patient satisfaction, and more importantly, patient outcomes.

The Continuity of Education is the teaching and assessment by a small core of primary preceptors that contributes to the authentic assessment of learners over time. As trust builds between learner and teacher, the independence and autonomy of the learner increases in a safe, supportive environment.

The continuity of the learning environment fosters both patient and learner centeredness.In July 2012, the new Triple C Competency-based Curriculum was initially implemented in the University of Calgary (UC) and seven other universities then joined the pilot project.

 UC currently has 167 residents in the rural stream based in 15 academic sites and 27 residents in the urban stream based in 38 rural sites. Palacios Mackay is deeply involved in evaluating the program locally and nationally.

The Triple C programme has resulted in a significant increase of Family Medicine blocks in year one and year two of the residency programme from the traditional programme where there were four blocks to seven in year one and from four blocks to nine in year two.

These blocks are now led by Family Medicine practitioners and not specialists, supporting the ‘Centred in Family Medicine’ aspect of the new curriculum. The Programme is currently in phase two of assessment but thus far, according to Palacios Mackay, feedback is very positive. ‘The focus of the assessment is qualitative.

We have managed to move away, as much as we can, from summative assessments at the end of rotations to an assessment system that monitors progress of a resident’s learning over two years, leading to the  development of competence and readiness for entry into early professional independent practice at the end of the training period.

‘The residents accepted that they were in a new programme and fully embraced the concepts. There was wide agreement that the learning experiences in different sites differed with the main challenge being how one provides for the continuity of care when the preceptors spent too little time in the clinics,’ said Palacios Mackay.

Her advice to the lecture audience of mainly family medicine and rural health experts was: ‘Don’t introduce a huge number of tools in your assessment unless you’ve evaluated them. Also take note that continuous support for the Faculty is essential in delivering a successful programme.’