Educating future physicians for francophone official language minority communities in Canada: A case study

Schrewe, Brett; Yeuchyk, Tatiana; El Hafid, Melanie; Nyhof-Young, Joyce

doi:https://doi.org/10.36834/cmej.75300

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Abstract

Background: Over one million Francophone Canadians live in official language minority communities (OLMC) outside of Québec. Availability and accessibility of linguistically appropriate care to these OLMCs is lacking, resulting in poorer quality of care. To help address this health equity gap, the FrancoDoc program was created in 2015 to identify Francophone/Francophile medical students enrolled at medical faculties that use English as their primary language of instruction and equip them with skills to increase their medical French abilities. Little is known, however, about the affordances and limitations of this educational endeavour.

Methods: Our qualitative instrumental single case study explored participants’ experiences with FrancoDoc, while also examining factors shaping the delivery of linguistically appropriate healthcare services to OLMCs. We conducted semi-structured interviews with medical students from across Canada and thematically analyzed these using a reflexive, inductive approach.

Results: Four main themes were derived from 12 interviews: factors facilitating French language learning; barriers to French language learning; contextual factors shaping linguistically appropriate healthcare provision; and recommendations to improve healthcare education to better prepare learners to provide care to OLMCs.

Conclusions: Medical student participants are highly motivated to engage in educational activities linked to FrancoDoc. Their efforts are nonetheless frequently impeded by barriers such as time constraints, irregular event programming, lack of regular clinical learning opportunities, and lukewarm support from faculties of medicine. If medical faculties are to realize their obligations to the OLMCs that they serve, recognition of language as a specific social determinant of health and more robust institutional supports for initiatives like FrancoDoc are paramount.

Résumé

Contexte : Plus d’un million de Canadiens francophones vivent dans des communautés de langue officielle en situation minoritaire (CLOSM) hors Québec. L’accessibilité de soins linguistiquement appropriés aux CLOSM est limitée. Par conséquent, la qualité des services qui leur sont offerts en souffre. Le programme FrancoDoc a été créé en 2015 pour aider à combler cette lacune sur le plan de l’équité en matière de santé. Il vise à offrir aux étudiants en médecine francophones ou francophiles dont l’anglais est la principale langue d’enseignement les moyens d’améliorer leurs compétences en français médical. Cependant, on sait peu de choses sur les possibilités et les limites de cette initiative éducative.

Méthodes : Notre étude qualitative instrumentale de cas unique a exploré les expériences des participants au programme FrancoDoc, tout en examinant les facteurs qui influencent la prestation de services de santé linguistiquement appropriés aux CLOSM. Nous avons mené des entrevues semi-structurées avec des étudiants en médecine de tout le Canada et nous en avons analysé le contenu thématiquement en utilisant une approche réflexive et inductive.

Résultats : Quatre thèmes principaux ont été dégagés des 12 entrevues réalisées : les facteurs facilitant l’apprentissage du français; les obstacles à l’apprentissage du français; les facteurs contextuels influençant la prestation de soins de santé linguistiquement appropriés; et les recommandations visant à améliorer l’enseignement en soins de santé de manière à préparer les apprenants à servir les CLOSM.

Conclusions : Bien que très motivés par le programme FrancoDoc, les étudiants participants se heurtent à des obstacles comme les contraintes de temps, la programmation irrégulière des activités, le manque d’occasions d’apprentissage clinique régulier et la réticence des facultés de médecine. Or, pour remplir leurs obligations envers les CLOSM qu’elles servent, il est essentiel que les facultés de médecine reconnaissent la langue comme un déterminant social spécifique de la santé et qu’elles offrent un soutien solide aux initiatives comme le programme FrancoDoc.

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Bibliography

The Association of Faculties of Medicine of Canada. Social accountability. Ottawa: AFMC; 2021 Available from: https://www.afmc.ca/resources-data/social-accountability/ [Accessed on Mar 22, 2023].
Google Scholar
Health Canada. Social accountability—A vision for Canadian medical schools. Ottawa: Minister of Public Works and Government Services Canada: Ottawa; 2001.
Google Scholar
Government of Canada. Canada Health Act (R.S.C., 1985, c. C-6). Ottawa: Government of Canada.
Google Scholar
Romanow RJ. Building on values: the future of health care in Canada—final report. Commission on the future of health care in Canada. Ottawa: Government of Canada; 2002.
Google Scholar
Molina RL, Kasper, J. The power of language-concordant care: a call to action for medical schools. BMC Med Educ 2019; 19:378. https://doi.org/10.1186/s12909-019-1807-4
Google Scholar
Jacobs E, Chen AHM, Karliner LS, Agger-Gupta N, Mutha S. The need for more research on language barriers in healthcare: a proposed agenda. Milbank Quarterly 2006; 84(1):111-133. https://doi.org/10.1111/j.1468-0009.2006.00440.x
Google Scholar
Health Canada. Language barriers in access to healthcare Ottawa: Minister of Public Works and Government Services Canada; 2001 Available from: https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2001-lang-acces/2001-lang-acces-eng.pdf [Accessed on Mar 22, 2023].
Google Scholar
Bowen S. The impact of language barriers on patient safety and quality of care. Prepared for la Société Santé en français. 2015 Available from: https://www.santefrancais.ca/wp-content/uploads/2018/11/SSF-Bowen-S.-Language-Barriers-Study-1.pdf [Accessed on Mar 22, 2023].
Google Scholar
Statistics Canada. English, French and official language minorities in Canada. Ottawa: Government of Canada; 2017 Available from: https://www12.statcan.gc.ca/census-recensement/2016/as-sa/98-200-x/2016011/98-200-x2016011-eng.cfm. [Accessed on Mar 22, 2023].
Google Scholar
Government of Canada. Innovation, Science and Economic Development Canada—CommunAction. What is an official language minority community? Ottawa: Government of Canada; 2013, Available from: https://www.ic.gc.ca/eic/site/com-com.nsf/eng/h_01223.html [Accessed on Mar 22, 2023].
Google Scholar
Government of Canada, Justice Laws Website. Constitution Act, 1982: Part I—Canadian Charter of Rights and Freedoms. Ottawa: Government of Canada; 1982 Available from: https://laws-lois.justice.gc.ca/eng/Const/page-12.html. [Accessed on Mar 22, 2023].
Google Scholar
Government of Canada, Justice Laws Website. Official Languages Act. Ottawa: Government of Canada; 1988. Available from: https://laws-lois.justice.gc.ca/eng/acts/o-3.01/page-1.html. [Accessed on Mar 22, 2023].
Google Scholar
Government of Canada, Office of the Commissioner of Official Languages. Official languages in the provinces and territories. Ottawa: Government of Canada; 2020. Available from: https://www.clo-ocol.gc.ca/en/language_rights/provinces_territories?wbdisable=true. [Accessed on Mar 22, 2023].
Google Scholar
Alimezelli HT, Leis A, Denis W, Karunanayake C. Lost in policy translation: Canadian minority Francophones and health disparities. Can Public Policy. 2015; 41(Suppl 2):S44-S52. https://doi.org/10.3138/cpp.2014-073
Google Scholar
Gagnon-Arpin I, Bouchard L, Leis A, Bélanger M. Accès et utilisation des services de santé en langue minoritaire. In : Landry R, editor. La vie dans une langue officielle minoritaire au Canada. Sainte-Foy: Presses de l’Université Laval; 2014. p. 195-222.
Google Scholar
Warnke J, Bouchard L. Validation de l’équité d’accès des CLOSM aux professionnels de la santé dans les régions sociosanitaires du Canada. Rev Can Sant Pub 2013; 104(6)(Suppl. 1):S49-S54. https://doi.org/10.17269/cjph.104.3490
Google Scholar
Consultative Committee for French-Speaking Minority Communities. Towards a new leadership for the improvement of health services in French—report to the federal Minister of Health. Ottawa: Government of Canada; 2007. Available from: https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/ahc-asc/alt_formats/hpb-dgps/pdf/olcdb-baclo/cccfsm/2007-cccfsm/2007-cccfsm-eng.pdf. [Accessed on Mar 22, 2023].
Google Scholar
Gauthier AP, Timony PE, Wenghofer EF. Examining the geographic distribution of French-speaking physicians in Ontario. Can Fam Phys 2012; 58:e717-24. https://www.cfp.ca/content/cfp/58/12/e717.full.pdf
Google Scholar
Timony PE, Gauthier AP, Serresse S, Goodale N, Prpic J. Barriers to offering French language physician services in rural and northern Ontario. Rural Remote Health 2016; 16(3805):1-13. https://doi.org/10.22605/RRH3805
Google Scholar
De Moissac D, Bowen S. Impact of language barriers on access to healthcare for official language minority Francophones in Canada. Healthcare Management Forum 2017; 30(4):207-212. https://doi.org/10.1177/0840470417706378
Google Scholar
Government of Canada, Office of the Commissioner of Official Languages. Active offer—a culture of respect, a culture of excellence. Ottawa: Government of Canada; 2013 Available from: https://www.clo-ocol.gc.ca/sites/default/files/active-offer-tool.pdf. [Accessed on Mar 22, 2023].
Google Scholar
Office of the Commissioner of Official Languages. 2020-2021 annual report. Fredericton: Office of the Commissioner of Official Languages for New Brunswick; 2021. Available from: https://officiallanguages.nb.ca/wp-content/uploads/2021/10/ANNUAL-REPORT-2020-2021.pdf. [Accessed on Mar 22, 2023].
Google Scholar
De Moissac D, Bowen S. Impact of language barriers on quality of care and patient safety for official language minority Francophones in Canada. J Patient Experience 2019; 6(1):24-32. https://doi.org/10.1177/2374373518769008
Google Scholar
Fédération des communautés francophones et acadienne du Canada. French-language healthcare: improving access to French-language health services. Ottawa: Fédération des communautés francophones et acadienne du Canada; 2001. Available from: https://web.archive.org/web/20220627152213/https://fcfa.ca/wp-content/uploads/2018/03/Pour-un-meilleur-acces-a-des-services-de-sante-en-francais-EN.pdf [Accessed on Mar 22, 2023].
Google Scholar
Alimezelli HT, Leis A, Karunanayake, C, Denis W. Determinants of self-rated health of Francophone seniors in a minority situation in Canada. Minorités linguistiques et société/Linguistic Minorities and Society 2013; 3(3):144–70. https://doi.org/10.7202/1023804ar
Google Scholar
Bouchard L, Desmeules, M. (2013). Les minorités linguistiques du Canada et la santé. Healthcare Policy 2013; 9:38-47.
Google Scholar
Société Santé en Français. Les réseaux de santé en français du Canada. Ottawa: SSF; 2021. Available from: https://www.santefrancais.ca/reseaux/. [Accessed on Mar 22, 2023].
Google Scholar
The Association of Faculties of Medicine of Canada. FrancoDoc. Ottawa: AFMC; 2021. Available from: https://www.afmc.ca/resources-data/education/franco-doc/. [Accessed on Mar 22, 2023].
Google Scholar
Baxter P, Jack S. Qualitative case study methodology: study design and implementation for novice researchers. Qualitative Report 2008; 13(4):544–59. https://doi.org/10.46743/2160-3715/2008.1573
Google Scholar
Malterud K, Siersma VD, Dorrit Guassora A. Sample size in qualitative interview studies: guided by information power. Qual Health Res 2016; 26(13): 1753-1760. https://doi.org/10.1177/1049732315617444
Google Scholar
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006; 3(2):77-101. https://doi.org/10.1191/1478088706qp063oa
Google Scholar
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health 2019; 11(4):589-597. https://doi.org/10.1080/2159676X.2019.1628806
Google Scholar
Lacaze-Masmonteil T, Leis A, Lauriol E, Normandeau J, Moreau D, Bouchard L, Vaillancourt C. Perception du contexte linguistique et culturel minoritaire sur le vécu de la grossesse. Revue Canadienne de Santé Publique 2013; 104(6)(Suppl.1):S65-S70. https://doi.org/10.17269/cjph.104.3515
Google Scholar
Schrewe B, Ruitenberg CW. Offering welcome in the kingdom of the sick: a physician guide to hospitality. J Eval Clinical Practice 2021; 27(3):571-577. https://doi.org/10.1111/jep.13410
Google Scholar
Espinoza J, Derrington S. How should clinicians respond to language barriers that exacerbate health inequity? AMA J Ethics 2021; 23(2):E109-116. https://doi.org/10.1001/amajethics.2021.109
Google Scholar
Mikkonen J, Raphael D. Social determinants of health: the Canadian facts. Toronto: York University School of Health Policy and Management; 2010.
Google Scholar
Northern Ontario School of Medicine. The NOSM challenge: strategic plan 2021-2025. Sudbury/Thunder Bay: NOSM; 2021 Available from: https://strategicplan.nosm.ca [Accessed on Jan 20, 2023].
Google Scholar
University of Ottawa. Leading innovation for a healthier world—2020-2025 strategic plan. Ottawa: University of Ottawa; 2020. Available from: https://med.uottawa.ca/sites/med.uottawa.ca/files/fm_2020-2025_strategic_plan_en_web.pdf. [Accessed on Mar 22, 2023].
Google Scholar
University of Manitoba. Rady Faculty of Health Sciences—Max Rady College of Medicine: applicant information bulletin 2022-2023. Winnipeg: University of Manitoba; 2021 Available from: https://umanitoba.ca/explore/sites/explore/files/2021-03/medicine-bulletin.pdf. [Accessed on Mar 22, 2023].
Google Scholar
University of Saskatchewan College of Medicine. Health training in French. Saskatoon: University of Saskatchewan; 2022. Available from: https://medicine.usask.ca/social-accountability/training/health-training-in-french.php. [Accessed on Mar 22, 2023].
Google Scholar
Boelen C, Heck JE. Defining and measuring the social accountability of medical schools. Genève: World Health Organization; 1995. Genève.
Google Scholar
Rourke J. Social accountability in theory and practice. Annals Fam Med 2006; 4(S1):S45-S48. https://doi.org/10.1370/afm.559
Google Scholar
Government of Canada, Canadian Heritage. English and French: towards a substantive equality of official languages in Canada. Ottawa: Government of Canada; 2021. Available from: https://www.canada.ca/en/canadian-heritage/corporate/publications/general-publications/equality-official-languages.html. [Accessed on Mar 22, 2023].
Google Scholar
Tesson G, Curran V, Pong R, Strasser R. Advances in rural medical education in three countries: Canada, the United States and Australia. Educ Health (Abingdon) 2005;18(3):405-15. https://doi.org/10.1080/13576280500289728
Google Scholar
Bates J, Frost H, Schrewe B, Jamieson J, Ellaway R. Distributed education and distance learning in postgraduate medical education. Ottawa: Members of the Future of Medical Education in Canada Postgraduate Consortium; 2011.
Google Scholar
Wenghofer EF, Hogenbirk JC, Timony PE. Impact of the rural pipeline in medical education: practice locations of recently graduated family physicians in Ontario. Hum Resour Health 2017; 15(1):16. https://doi.org/10.1186/s12960-017-0191-6
Google Scholar
Rourke J, Asghari S, Hurley O, Ravalia M, Jong M, Parsons W, et al. From pipelines to pathways: the Memorial experience in educating doctors for rural generalist practice. Rural Remote Health 2018; 18(1):4427. https://doi.org/10.22605/RRH4427
Google Scholar
Battarbee K. Languages Canada: the paradoxes of linguistic inclusivity—colonial/founding, Aboriginal, and immigrant language rights. London J Can Studies 2019; 34(1):79-102. https://doi.org/10.14324/111.444.ljcs.2019v34.005
Google Scholar
Government of the Northwest Territories. Official Languages Act (RSNWT 1988, c.O-1). Yellowknife: Government of the Northwest Territories; 1988. Available from: https://www.justice.gov.nt.ca/en/files/legislation/official-languages/official-languages.a.pdf. [Accessed on Mar 22, 2023].
Google Scholar
Government of Nunavut. Official Consolidation of Official Languages Act (C.S.Nu.,c.O-20). Iqaluit: Government of Nunavut; 2021. Available from: https://www.nunavutlegislation.ca/en/consolidated-law/official-languages-act-official-consolidation. [Accessed on Mar 22, 2023].
Google Scholar
Office of the Languages Commissioner of Nunavut. If you cannot communicate with your patient, your patient is not safe. Iqaluit: Government of Nunavut; 2015. Available from: https://langcom.nu.ca/sites/langcom.nu.ca/files/QGH%20-%20Final%20Report%20EN.pdf. [Accessed on Mar 22, 2023].
Google Scholar
Statistics Canada. While English and French are still the main languages spoken in Canada, the country’s linguistic diversity continues to grow. Ottawa: Government of Canada; 2022 Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/220817/dq220817a-eng.htm?indid=32989-1&indgeo=0. [Accessed on Mar 22, 2023].
Google Scholar
Zhou JS, Chen R, Feng YY, Lu Y, Nyhof-Young J. Who wants to translate? Evaluation of a novel medical Mandarin education program for and by pre-clerkship medical students [version 1]. MedEdPublish 2020; 9:262. https://doi.org/10.15694/mep.2020.000262.1
Google Scholar

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