Are the practices and culture of the medical profession in Quebec unique from the rest of Canada(ROC), as some studies have shown, or do they mirror other parts of the country? Canada’s major medical newspapers in both markets, the Medical Post and our sister publication L’actualité médicale in Quebec, have teamed to create a six-part series, starting here, to compare and contrast physicians’ lives: those who live in and work in Quebec with those in other provinces. Are there true differences? What are the similarities? Are there models to emulate, best practices to adopt? Or frustrating policies that best be taken to the trash? In the coming weeks we’ll look at resources and remuneration packages, working conditions, professional representation, public vs. private medicine issues, and overall attitudes in a colourful and revealing analysis. Here, we begin with a look at what it takes to become a doctor, and what QROC trends reveal.

Med students are being trained to work in interdisciplinary groups; courses promote awareness, respect of other health professionals

Having completed his medical degree only last May, Dr. André Bernard can be counted among the first generation of Canadian physicians for whom the idea of working in an inter-professional team was as central to his studies as learning how to accurately assess a patient’s presentations.

As a graduate of the Dalhousie University medical program, Dr. Bernard, who is now an anesthesiology resident in Halifax, said considerable emphasis was placed on collaborating with allied health professionals throughout his education.

The importance, however, only truly gelled near the end of his four years at the East Coast medical school, during a geriatric-medicine rotation. He and several students from allied health professions were working in a small team in which each person took a turn leading the group.

It was the first time he was practising what had until that point been little more than theory. Dr. Bernard felt a surge of elation as they all “played a role in benefiting the patient,(and)orchestrated(the teamwork)in such a way that it actually changed care. . . . We saw demonstrated the incredible role of the physiotherapist and the occupational therapist and all members of the team.”

Dr. Bernard, who is also president of the Canadian Federation of Medical Students, observed that “acculturation to interprofessionalism” will go a long way toward helping advance the work on primary care reform underway in the different provinces. “Because when we get out(of residency), this is the type of team we will be working in and it is not an obligation because we have a health human-resource shortage, it is an obligation because that is the model that provides the best care for patients.”

Medical educators across the country are slowly but surely moving toward educating future doctors about how to work co-operatively in small teams. As Dr. Marcel D’Eon(PhD), director of educational support and development and an associate professor at the University of Saskatchewan college of medicine, pointed out: “We are not looking at doing the whole curriculum like this but interspersing—where appropriate and where there are distinct advantages—opportunities for students(from different professions)to learn with, from and about each other,” he said.

At the Saskatchewan medical school, teams frequently include “medical, nursing, physical therapy, pharmacy and kinesiology students in a number of different ways.” They are learning to work together as they simultaneously learn about how to manage various health issues, such as HIV, aboriginal health and palliative care.

The experience allows them “to research the best approaches to managing those particular situations, and learning what the different professions can offer and how they can support and compliment each other,” added Dr. D’Eon.

Dr. Wayne Weston agreed interprofessional education has its benefits. “That is the theory: that people will have greater awareness of what the other professionals do, have more respect for them, be more willing to collaborate with them,” said the professor emeritus and department of family medicine’s director of undergraduate education at the Schulich School of Medicine and Dentistry at the University of Western Ontario in London.

However, Dr. Weston stressed it is a challenge for educators to implement. “I think it is more talk than action(currently)—we need to do a much better job. It is very complicated to design one curriculum, but to integrate the medical school curriculum with, let’s say, the nursing school curriculum, so that several hundred students can participate in the same sort of thing at the same time, boggles the mind sometimes.”

Dr. Weston, who is also a consultant to the dean of medicine on faculty development, said the change is necessary “because more and more physicians are working in teams and we(professionals)need to understand each other better and to communicate with one another more effectively. And if we don’t do it as students, it will be a whole lot harder to do it after getting out and into practice.”

The University of Laval faculty of medicine is among the coterie of schools that have begun the process of integrating the concept of interprofessional education. With $67.5 million in hand, the faculty will by 2007 complete an overhaul of its curriculum(as well as some infrastructure work)that will see student groups of no bigger than 20 members, and stress inter-professional co-operation, said Laval’s vice-dean of medicine, Dr. Joan Glenn.

Quebec’s four medical schools—Laval, as well as McGill, Sherbrooke and the University of Montreal—are in discussions to develop a conjoined curriculum that will align their programs to help put a renewed focus on issues such as interprofessionalism.

With files from Denis Méthot