Dr. Upender (Upe) Mehan has been a family physician for nearly 35 years, starting in Cambridge and now at the Center for Family Medicine in Kitchener. Dr. Mehan has always recognized the benefits of the FMPE Practice-Based Learning (PBLP) Program, particularly when it came to resident training. His focus has been to promote the value of active engagement and reflection, fostering skills in identifying knowledge gaps and applying practical knowledge, beneficial across all medical fields.
Q: Can you describe your career journey as a family physician, including your involvement with the Practice-Based Learning (PBLP) Program and the impact it has had on your practice and professional development?
I’ve been a family physician for nearly 35 years, beginning my practice in 1988 in Cambridge. Initially, I was part of a small group practice with four members, within a call group of about 10-12 physicians. After practicing in Cambridge for 22 years, I transitioned in 2010 to the Center for Family Medicine in Kitchener, a family medicine residency training program affiliated with McMaster University. Our team is an academic family health team, primarily involved in training family medicine residents and, occasionally, medical students. I’ve been with this program for 14 years.
My interest in PBLP began early in my career. In fact, I believe the group I started within Cambridge was one of the founding groups of the program. I might be one of the only remaining original members still practicing. Another doctor in my current group, who retired years ago, still joins us for PBLP, but I am the last active practitioner from that initial group.
Being part of one of the founding PBLP groups has always been a highlight for me. When I joined the Cambridge practice, I took over from a doctor who later returned and initiated our group’s involvement with PBLP. Over time, I took on the role of facilitator after he stepped down and eventually became a facilitator trainer. With the residency program, I facilitated many sessions for residents and trained new facilitators to expand the program’s reach.
One of the benefits of being part of a PBLP group outside my daily work environment is the exposure to different resources and perspectives. Collaborating with physicians from other clinics helps broaden my knowledge and approach to patient care. This diversity in experience and resources enriches our discussions and enhances our ability to provide quality care.
Q: How do resident and community member engagements differ in PBLP sessions, and how do you convey the program’s true value to residents?
I recall that initially, the residents held sessions perhaps every other week. When we started, the residents typically formed groups of eight to ten people, sometimes splitting into two groups due to the high number of participants. The program operates more effectively with smaller groups because larger groups make it difficult for everyone to participate and for the facilitator to manage discussions.
Over time, I noticed significant differences between running these sessions with residents and in the community. Residents often approach the program as just another academic requirement, focusing on the informational sections rather than the practical discussions. In contrast, community members bring diverse practice experiences, which enriches the discussion and learning process.
Residents, especially those fresh out of medical school, might not relate to all the cases since they lack practical experience. They tend to view the modules as didactic sessions rather than interactive learning opportunities. My goal was to convey the true value of PBLP through my experience as both a facilitator and a group member. I emphasized that the key to the program is not to pre-read the case commentaries, but to engage actively with the material during sessions.
I stressed the importance of the introductory section, which explains the practice care gap that led to the module’s creation. Understanding this helps frame the discussion, making it more relevant and practical. I also highlighted that the goal isn’t to rush through all the cases within the allocated time but to focus on meaningful discussions. If we didn’t cover all the cases, that was fine; the primary objective was the quality of the discussion, not the quantity of cases covered.
Another crucial aspect I emphasized was reflection. Many learners tend to skim through evaluations or reflection prompts without deep consideration. I encouraged residents to reflect genuinely on what they learned, what surprised them, and how they might apply new knowledge in practice. This reflection is vital for real learning and professional growth.
Q: How are PBLP modules valuable for residents?
PBLP modules are highly valued for exam preparation as they are current, evidence-based, and Canadian-focused, which is crucial since many residents rely on American resources like UpToDate that may not be entirely relevant in the Canadian context. The PBLP modules provide practical, locally applicable information.
Residents often enter the program with the mindset of acing exams and impressing preceptors, but through PBLP, they learn that the discussions and thought processes are more important than simply having the right answers.
Over time, I observed that residents’ thinking evolved. They became more comfortable with not knowing everything upfront and more willing to engage in discussions, reflecting on their knowledge gaps and seeking to fill them thoughtfully. This change was particularly evident as they progressed through their residency.
Q: How have former residents continued to engage with PBLP after their residency, and why are its principles valuable across various medical fields?
Many residents continued to engage with PBLP after finishing their residency, joining community groups or forming their own. Some even became facilitators, contributing back to the program. For instance, one of my former residents, now a colleague, split my practice with me and still participates in our PBLP group, benefiting from the diverse perspectives it offers.
Family medicine residents often don’t remain in traditional family practice, moving into specialties like ER or palliative care. Even though PBLP is family medicine-oriented, its principles of identifying and addressing knowledge gaps, learning through discussion, and applying knowledge in practice are valuable across all medical fields.
For new facilitators, I emphasize that PBLP offers high-quality, cost-effective continuing medical education. The program consolidates current, evidence-based information into manageable modules, making it a practical alternative to more comprehensive but less relevant resources like UpToDate. The modules’ point-form structure and practical appendices, including talking tips, enhance the learning experience, helping physicians communicate effectively with patients.
Q: How do the modules help you in identifying and addressing knowledge gaps in your medical practice, and how does this process evolve as you progress from your first year to your second year?
At first, this might seem like just a bunch of information to take in, but trust me, there’s a lot more to it. What this really teaches you is how to identify knowledge gaps. No matter what field of medicine you go into, you’ll always encounter gaps in your knowledge. This process helps you recognize those gaps, in whichever field you choose to focus on.
Even if you don’t end up using these specific modules daily, the skills you gain from them are invaluable. You’ll learn how to gather the information you need to fill those gaps, and more importantly, how to communicate that information to your patients. This is a crucial part of the learning journey.
As you move from your first year to your second, you’ll notice a shift in your thinking. It’s not just about knowing the information anymore; it’s about understanding its relevance to each unique case. For instance, with a Crohn’s patient, it’s not just about ticking off a list of symptoms, tests, and treatments. Every patient is different, and you’ll learn to tailor your care to each individual situation.
So, essentially, these modules help you apply what you’ve learned to real-life scenarios. You gather the information, understand its relevance to the specific patient in front of you, and then use that knowledge to manage their care effectively.
PBLP teaches the importance of reflection, discussion, and application of knowledge. It transforms how physicians approach learning and patient care, fostering continuous professional development.