Oral Papers

Diginal Tools and AI

May 13, 2025
11:00 AM - 12:15 PM

  • Presenter: Noah Crampton

    Background: Consistent adherence to Ontario Quality Standards for type 2 diabetes (T2D) remains challenging in time-pressured primary care, particularly in under-resourced community practices. Clinicians must rapidly synthesize large volumes of electronic medical record (EMR) data and act on care gaps, contributing to variability in care delivery.

    Objectives: To optimize care for patients with prediabetes and T2D and enhance provider experience by integrating artificial intelligence–enabled clinical decision support (AI-CDS) at the point of care that (1) stratifies patients by risk and (2) surfaces patient-specific, guideline-aligned recommendations.

    Methods: The Mid-West Toronto Family Practice Network is conducting a pragmatic pilot study in two community family practices involving approximately 15 primary care providers and 300 patients (November 2025–April 2026). KhureHealth’s AI-CDS platform analyzes EMR data on a monthly basis to identify patients at high risk of disease progression and generate actionable recommendations aligned with Centre for Effective Practice guidelines and the OHT’s care pathway. Recommended actions are displayed in a patient population dashboard and within a patient's EMR chart. OntarioMD provides change-management support to ensure data readiness and optimal workflow integration. Evaluation includes pre- and post-intervention comparisons of EMR-derived quality indicators (screening, monitoring, referrals, and clinical control), tool-usage analytics, and provider and patient experience surveys.

    Results: Preliminary findings demonstrate early guideline adherence, with 76% of AI-identified high-risk T2D recommendations actioned in Months 1-4 of the project. Prediabetes recommendations showed consistently high engagement, with all recommendations at least partially actioned. All high-risk patients received at least one early intervention. Full analyses will be completed for the May 13 conference.

    Conclusions/Implications: Early results suggest AI-CDS can support more consistent, high-quality diabetes care aligned with provincial Quality Standards through earlier detection, proactive management, and reduced risk of complications. Broader implementation may improve care consistency and long-term outcomes.

  • Presenters: Javier Silva-Valencia

    Background

    The COVID-19 pandemic accelerated telehealth adoption as a core modality of primary care. While virtual care was credited with preserving service continuity, its implications for equitable access across population groups and services remain uncertain. We aimed to synthesize evidence on how this transition reshaped access to inform post-pandemic hybrid health systems.

    Methods

    Following the PRISMA-ScR framework, MEDLINE, Embase, and Scopus were searched for English-language studies (April 2020 onwards). We included 32 studies that examined telehealth use in primary care and reported outcomes related to access. The findings were mapped to the Universal Health Coverage cube, encompassing population coverage, service coverage, and financial protection.

    Findings

    The rapid shift to telehealth enabled primary care volumes to rebound to 85–100% of pre-pandemic baselines within 6–12 months. Telehealth use stabilized at 8–35% of total consultations. However, service coverage narrowed: while continuity of mental health and chronic disease care was preserved, preventive services, screenings, new-patient visits, and routine pediatric services remained below baseline. Financial protection data showed modest reductions in out-of-pocket and travel costs. Crucially, digital exclusion persisted, with utilization consistently lower among adults aged over 75, rural residents, migrants, and individuals with low socioeconomic status. Evidence skewed toward high-income settings, limiting generalizability.

    Interpretation

    Telehealth bridged continuity gaps during the crisis but did not ensure equitable long-term access. The transition favoured established care over preventive services and widened disparities for structurally marginalized groups. Future hybrid care models must prioritize digital inclusion to prevent the permanent entrenchment of these health inequalities.

  • Presenters: Rajesh Girdhari, Sydney Pearce

    Background: Over 2 million Ontarians are not attached to primary care while Ontario physicians report spending over 19 hours/week on administrative tasks. This administrative burden takes time away from patient care, and artificial intelligence (AI) scribes may help alleviate this issue if effectively implemented.

    Objectives: This AI scribe distribution and evaluation initiative aimed to i) support Ontario primary care clinicians (physicians, nurse practitioners) to adopt AI scribes, ii) evaluate clinician experiences during AI scribe implementation, and iii) evaluate barriers and facilitators to uptake and sustained AI scribe-use.

    Methods: A partnership between Ontario Health Teams, academia, eHealth experts, and an AI scribe vendor distributed over 100 AI scribe licenses. Change management resources were made available to participating clinicians. Clinicians also consented to a mixed-methods study informed by implementation science frameworks (RE-AIM and NASSS). Data collection included clinician and patient surveys, clinician and administrative staff focus groups, and EMR/AI scribe data. Data items focused on clinicians as the population of interest and will be used to understand AI scribe-use patterns, impact on burnout and administrative time, supportive implementation strategies, staff perspectives on implementation, and impact on patient experience.

    Preliminary Results: Data collection/analysis is ongoing. From the clinician pre-intervention survey (n=170), 84% reported that administrative tasks significantly detract from patient care (n=142), 81% find patient engagement compromises note detail (n=137), and 72% agree/strongly agree that they are overwhelmed by administrative tasks (n=111).

    Implications: This study may identify the impact of AI scribes and effective AI scribe implementation strategies.

  • Presenters: Rosamie Lall,

    AI tools, including clinical decision support, AI scribes, and AI-enabled inbox management, are increasingly available to community physicians. Little is known about how these technologies are adopted, implemented, and integrated in Ontario community clinics. Understanding usage, procurement, and barriers is essential to support effective AI adoption.

    Objectives:

    To assess AI use in Ontario community clinics by surveying clinics across Ontario. The intent is to identify adoption barriers and facilitators and evaluate digital literacy among clinicians. Secondary aims include understanding procurement processes, influencing vendor development, and informing future inter-provincial comparisons.

    Methods:

    A provincial cross-sectional survey was distributed to all community physicians, NPs, and clinic managers (Feb. 2026). Questions covered AI adoption, barriers, digital literacy, and experience with AI clinical decision support, AI scribes, and AI inbox technologies. Participation was voluntary. Data will be analyzed using descriptive statistics and subgroup comparisons by clinic type, size, and region.

    Expected Results:

    We anticipate identifying trends in AI adoption, common barriers, and gaps in digital literacy that influence uptake. Preliminary results will be shared at the presentation

    Conclusions/Implications:

    Findings will guide strategies to support AI integration, inform digital health policy, and optimize the use of AI tools in community clinics. The survey will also serve as a model for inter-provincial comparisons to promote evidence-based AI adoption in primary care

  • Presenters: Danyaal Raza, Sheryl Spithoff,

    This qualitative study reveals how new digital tools are leading to Canadian primary care medical records becoming commercial commodities. Researchers conducted 19 interviews with industry insiders and analyzed 22 documents, uncovering a complex ecosystem where patient data generates substantial revenue.

    The research identified two business models, with pharmaceutical companies accounting for over 90% of data requests.

    In the conventional model, data brokers obtain deidentified records from for-profit chains of primary care clinics. They then conduct analytics primarily for pharmaceutical companies.

    In a more concerning and emerging vertically integrated model, data brokers directly operate primary care chains as subsidiaries, using algorithms to identify patients potentially eligible for specific drugs, then message physicians with treatment recommendations.

    This represents a new structural pressure for family physicians. In this changing landscape, physicians must maintain professional autonomy, uphold legal responsibilities as custodians of patient data, ensure treatment decisions remain patient-centred rather than commercially influenced, and honour patient values regarding data use.

    JAMA Network Open

    Published Online: May 5, 2025

    2025;8;(5):e257688. doi:10.1001/jamanetworkopen.2025.7688

    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833520

May 13, 2025
11:00 AM - 12:15 PM

Opioid Use Disorder and Other Hard to Treat Conditions

  • Presenters: Alexandra Kubica, Aaron Orkin

    Introduction: Substance-related stigma is a prominent contributor to Canada’s ongoing crisis of opioid-related harms. The broad reach and digital capabilities of humanitarian organizations like the Canadian Red Cross can help combat stigma through opioid poisoning education, leading to improved health outcomes for people who use drugs.

    Methods: This project used an observational pre-post survey design to assess how participation in Canadian Red Cross Opioid Harm Reduction virtual courses impacts stigma held by individuals, compared with stigma held by instructors and the public. Stigmatizing attitudes were assessed using Health Canada’s 2021 public opinion survey on opioid awareness, knowledge, and behaviours.

    Results: Among 1,186 participants, stigmatizing baseline attitudes improved significantly for 21 of 22 survey items, particularly for those with initially more stigmatizing views. Participants and instructors demonstrated significantly lower stigmatizing baseline attitudes than a national sample.

    Discussion: The social influence of this virtual education intervention is substantial, as there is little evidence of interventions that reduce social stigma. The observed improvements in stigmatizing attitudes suggest that participation in a nationally distributed digital education intervention is associated with reduced opioid-related stigma.

    Conclusion: The results of this study provide evidence that large-scale, virtual education campaigns can reduce stigmatizing attitudes and diminish the role of stigma in the opioid poisoning crisis. This study suggests that national humanitarian organizations can act as partners in community health crisis response, using their social and digital influence to address pressing public health challenges.

  • Presenters: Cristina de Lasa

    Individuals with serious mental illness (SMI) experience disproportionately high cancer mortality and lower uptake of preventive screening compared to the general population. Colorectal cancer (CRC), the fourth most common cancer in Canada, is highly preventable through screening, yet patients with SMI face barriers such as stigma, fragmented care, and competing health priorities.

    To address this equity gap, we implemented a quality improvement (QI) initiative at a Canadian mental health hospital to integrate fecal immunochemical testing (FIT)-based CRC screening into inpatient workflows. Using a co-design approach, clinicians identified barriers and facilitators, informed tailored workflows, and configured electronic health record (EHR) alerts. Over two years, screening rates among eligible long-stay inpatients improved from 4.9% (2/41) to 33.3% (14/42). Stakeholder engagement revealed key themes necessary for improved CRC screening including, care processes, role clarity, EHR configuration, and care continuity post-discharge.

    Building on these outcomes, we are launching a qualitative descriptive to explore patient and provider perspectives on CRC screening within psychiatric inpatient units. Semi-structured interviews with 10–15 patients and 10–15 providers will examine experiences, perceived barriers, facilitators, and recommendations. Findings will inform patient- and provider-centered strategies to enhance feasibility, acceptability, and sustainability of digitally integrated screening models.

    This work will demonstrate how reverse integration, embedding preventive care in mental health settings, can reduce CRC screening inequities. Insights from the qualitative study will guide scalable digital-enabled approaches to improve cancer screening for equity-deserving populations with SMI.

  • Presenters: Anna Maria Subic, Aaron Orkin

    Background: The COVID-19 pandemic worsened health inequities amongst people with opioid use disorder (OUD). This study quantified pandemic-related disparities through comparative analysis of COVID-19 morbidity and mortality rates, excess all-cause mortality, and COVID-19 vaccination coverage among the OUD population relative to the general population in Ontario.

    Methods: This population-based retrospective cohort study used linked administrative health data to compare the impact of COVID-19 on individuals with OUD to individuals without OUD. Inverse Probability of Treatment Weighting was applied to balance confounders, and Cox proportional hazards models estimated adjusted hazard ratios with 95% CI for primary and secondary outcomes. The primary outcome was COVID-hospitalisation; secondary outcomes were laboratory-confirmed COVID-19 infection, critical care admission, COVID-19 related-death, all-cause death, emergency-department use, and COVID-19 vaccination uptake.

    Results: This study included 105,733 individuals with OUD and 1,185,993 persons without. COVID-19 hospitalization occurred in 0.98 vs 0.43 per 100,000 person-years for OUD vs. non-OUD groups (adjusted HR 1.52, 95% CI 1.26–1.84). People with OUD had higher risks of critical care admission and all-cause mortality, but lower instances of infection and similar rates of COVID-19 death. Individuals with OUD had a lower hazard of receiving two vaccine doses (aHR: 0.75, 95% CI: 0.73–0.76) and ≥3 doses (aHR: 0.69, 95% CI: 0.67–0.70).

    Conclusion: Individuals with OUD experienced greater COVID-19 related health disparities compared to matched controls, suggesting the role of structural vulnerabilities and service disruption in differential health outcomes. Addressing disparities through targeted, low-threshold, and accessible interventions is crucial for equitable public health responses.

  • Presenters: Tokuharu Tanaka, Karen Tu

    Context

    Attention Deficit Hyperactivity Disorder (ADHD) is a common condition in children and youth, with varying levels of primary care involvement across countries. Primary care involvement in ADHD diagnosis and management has the potential to improve efficiency, cost-effectiveness and equity for ADHD care.

    Objectives

    This study examined policies with respect to primary care physicians (PCPs) ability to diagnose and prescribe ADHD medications and analyzed ADHD-related visits to primary care amongst 5-19 year olds across nine INTRePID countries: Australia, Brazil, Canada, Indonesia, Mexico, Norway, Peru, Sweden, and the US.

    Methods

    A document review and key informant survey was conducted in PCPs in each country. ADHD-related visit rates (2018–2023) were calculated as a percentage of total visits. Negative binomial regression estimated rate ratios (RRs, 95% CI) across pre-pandemic (2018–2019), pandemic (2020–2021), and recovery (2022–2023) periods, adjusting for sex, seasonality, and offsetting by total visits. Sex-specific RRs were derived from stratified analysis.

    Results

    The ability for PCPs involvement in ADHD varied by country, with Canada and the US having full abilities, Australia recently introducing reforms, and all other countries having significant restrictions. Overall, North America had the highest ADHD-related visit rates: US (8.15%), Mexico (1.99%), and Canada (1.31%), while Indonesia had the lowest (0.03%). During the pandemic, rates increased in all countries with significant increases ranging from rate ratio (RR) 1.87; (95% CI: 1.61–2.17) to RR:1.16; (95% CI: 1.05–1.27) compared to the pre-pandemic. Rates remained higher than in the pre-pandemic during the recovery period in all countries, although differences were non-significant in Indonesia and Mexico. Across all countries, visit rates were 1.66 to 5.86 times higher in males than females. However, relative increases during the pandemic and recovery periods were more pronounced in females in over half of the countries.

    Discussion

    ADHD-related primary care visits varied across countries, likely reflecting differences in care models and cultural factors. However, rates increased over time, particularly among females in all countries.

    Conclusion

    Better integration of ADHD care in primary care could help reduce care gaps globally.

  • Presenter: Andrea Bowra

    Background: Opioid agonist therapy (OAT) is a key component of Canada’s response to opioid-related harms and is commonly delivered in family medicine settings, yet access remains constrained by regulatory and monitoring requirements. The COVID-19 pandemic disrupted service delivery, prompting rapid policy adjustments across jurisdictions.

    Objective: To better understand how OAT policy changes varied across jurisdictions, a comparative policy analysis was conducted of federal, provincial, and territorial OAT policies implemented during and after the COVID-19 pandemic.

    Methods: Policy documents (n=88) were sourced from grey literature, targeted website searches, and recommendations from relevant knowledge experts. A combined content and thematic analysis approach was employed to organize and compare identified policy changes (n=300) across eight policy areas: expanded prescribing permissions, take-home dosing, medication delivery, urine drug screening and monitoring, witnessed dosing, virtual care, slow-release oral morphine, and injectable OAT.

    Results: Provinces introduced extensive but uneven OAT policy changes including expanded prescribing authorities (particularly for pharmacists), broader delivery options, and increased flexibility in take-home dosing, witnessed dosing, urine drug screening, and virtual care. While provinces such as British Columbia, Ontario, Quebec, Nova Scotia, and Newfoundland and Labrador adopted the most permissive and client-centered approaches, others like Manitoba, Saskatchewan, and Alberta implemented more limited shifts. Emerging OAT modalities, including slow-release oral morphine and injectable OAT, were gradually integrated into provincial and federal frameworks by 2024.

    Conclusions: These findings demonstrate how crisis-driven reforms can advance longer-term change and highlight the need for coordinated, equitable approaches to sustain and expand access to OAT across Canada.

Education

May 13, 2025
3:00 PM - 4:15 PM

  • Presenters: Jackie Bellaire, Lindsay Herzog

    Introduction: Over the last twenty-five years, we have witnessed the rise of Interprofessional Primary Care Teams in Canada. Team-based primary care offers a wide variety of services that both improve patient access and promote the health of the community. As Interprofessional Healthcare Providers (IHPs) increasingly engage as Health Professional Educators (HPEs) in teaching Family Medicine residents, there are limited formal examples of co-teaching with IHPs and Family Physicians. We sought to explore family medicine residents’ experiences participating in an interprofessional teaching session.

    Methods: An interactive Poverty and Health workshop, grounded in the transformative paradigm of education, was co-facilitated by Family Physicians and IHPs (eg. social workers, pharmacists, nurses) and offered at six Greater Toronto Area University of Toronto Family Medicine teaching sites during the 2024-2025 academic year. Qualitative semi-structured interviews were conducted 4 to 6 months after participating in the workshop.

    Results: Three interrelated themes were identified: (1) a collaboratively facilitated teaching model that enacted collaborative practice; (2) enabling design and relational conditions, including structured preparation and psychological safety; and (3) learner outcomes suggestive of perspective shift and early practice change. Together, these elements appeared to support transformative learning related to poverty and health.

    Discussion: A collaborative model of teaching emphasizes the unique expertise among colleagues, reinforcing the benefits of interdisciplinary primary care. The creation of a safe and supportive learning environment allowed residents to lean into discomfort and engage in critical self-reflection - an essential process needed for intervening in and addressing the social determinants of health in practice.

  • Presenters: Jordan Goodridge, James Owen

    Background/Purpose: Transgender and Gender Diverse (TGD) patients face significant barriers in accessing healthcare. Medical education must equip learners and practicing physicians with skills to provide safe, trauma-informed care. We describe a process to inform an open access TGD curriculum for medical students, residents, and practicing physicians available on thehub.utoronto.ca that involved community members from early stages of updates and development.

    Methods: Nine advisory committee members including five TGD community members, two faculty, one resident physician, and one project manager developed a list of topics and objectives based on existing literature and curricula. Objectives were reviewed over three meetings and a survey was completed by TGD community members to prioritize them and collect qualitative feedback. This feedback was incorporated and the final objectives were reviewed by selected faculty and students.

    Results: 41 objectives were proposed, all of which were deemed high or medium priority by the five TGD community members. These objectives were grouped into seven modules covering topics such as language and terminology, social determinants of health, sexual and reproductive health, mental health, TGD youth, gender-affirming hormone therapy, and transition-related surgeries.

    Discussion: This process identified TGD curricular objectives with significant community involvement and practitioner expertise. The objectives were used to create seven modules, the initial feedback for which has been positive. Our hope is that this curriculum increases the knowledge, skills, and attitudes of trainees and healthcare providers across Canada and globally to improve the delivery of gender-affirming care.

  • Presenters: Lindsay Herzog, Jackie Bellaire,

    The space in which learning takes place impacts the learning itself. However, most clinical teaching research has focused on what is taught and how it is taught, with little attention to where it is taught. This study explored how the physical space of the Mount Sinai Academic Family Health Team’s clinical supervision room influences the teaching and learning that occurs within it.

    Participants included family medicine residents and supervising family medicine teachers. As part of our ongoing study, we have conducted fourteen participant-led walking interviews of the teaching unit, allowing participants to reflect in situ on the intricate relationships between materials, practices, and experiences during clinical supervision. Drawing on constructivist approaches and sensitized by a sociomaterial lens, we qualitatively analyzed interview audio-recordings, field notes, and photographs through open, inductive, thematic coding.

    Our analysis identified five interconnected themes, revealing how the supervision room influences teaching and learning. (1) It enables relational, dialogical, and peer-to-peer pedagogical practices. (2) It fosters professional identity formation, shaping norms, values, and ways of being. (3) It cultivates a climate of psychological safety and trust. These roles are supported by (4) conditions including a separate, intentional, and collective space, and (5) material elements such as furniture, technology, and room layout.

    This study illustrates how the supervision room is not a passive backdrop, but an active participant in clinical education. These findings have broad implications and encourage a reimagining of learning environments, underscoring how physical space can be leveraged as a powerful pedagogical tool in medical education.

  • Presenter: Abigail Ramdawar

    Description:

    Introduction:

    With 6.5 million Canadians lacking a family physician (FP), primary care is in crisis.1-3 Despite efforts to define and measure comprehensive care (CC), consensus remains elusive, fueling tensions around what constitutes as a “good FP.”4 Furthermore, with recent reports of 30% of FPs opting not to practice CC,5 questions about residency training influences have been raised. Thus, this study explores how ideas of CC within FM residency training shape residents’ perceptions of CC and influence practice intensions.

    Methods:

    We explored how CC was operationalized across multiple postgraduate medical education (PGME) sites at one university. Data collected included 24 semi-structured interviews with FM residents (PGY1-3) and a survey (N =23). Using a Governmentality and Hidden Curriculum (HC) lens, we analyzed both datasets inductively and deductively to explore how ideas of CC shaped perceptions, practice, values, education experiences, and their relationship to practice intentions. 6-8

    Results:

    Preliminary analysis of data suggests that: (1) exposure and perceptions of FM begin during undergraduate medical training. (2) Beliefs about CC were shaped by HC factors during residency, while (3) perceptions around systemic challenges such as: unpaid administrative labour, inadequate compensation, and time constraints in managing complex patients, strongly influence FM residents’ future practice intentions.

    Conclusion:

    Our preliminary findings highlight not only HC factors embedded within FM residency, but also broader systemic influences shaping future practice decisions among FPs. These insights may inform workforce planning by illuminating how operationalized ideas of what constitutes CC within FM residency impact residents’ future practice intentions.9

  • Presenters: Alissa Tedesco, Naheed Dosani

    There is an increasing call for socially accountable medicine and for physicians to serve as advocates, yet there is limited understanding of how best to achieve this within the confines of medical education. Aiming to foster a transformative educational experience, in 2019 the Palliative Education and Care for the Homeless (PEACH) program in Toronto, Ontario developed a clinical rotation in equity-oriented palliative care. PEACH is a mobile palliative care team that aims to meet the complex social and medical needs of people experiencing advanced illness and structural vulnerability. During this rotation, learners provide care within an interdisciplinary team guided by principles of harm reduction, trauma-informed care, intersectionality and anti-oppression. The objective of this qualitative study was to develop an understanding of the impact of this rotation on the perspectives and practices of the palliative care physicians who previously completed it. Semi-structured interviews were conducted with graduates of palliative care residency programs at the University of Toronto who completed the PEACH rotation between 2019 and 2025. De-identified transcripts from the interviews (n=9) will be analyzed using abductive thematic analysis. Results will be available by May 2026. In addition to exploring the impact of the rotation on learners’ perspectives and practices, pending results will also explore the barriers and enablers of transformation within this specific medical education experience. We will explore how these results can support us in optimizing our educational and experiential offerings as well as further our collective understanding of how to foster transformative learning experiences in clinical settings.

May 13, 2025
3:00 PM - 4:15 PM

Social Determinants of Health

  • Presenter: Ezekiel Garuba

    Hypertension disproportionately affects Black Canadians, yet culturally relevant dietary counseling is rarely integrated. The CHOICES pilot at TAIBU Community Health Centre demonstrated feasibility and potential benefits of culturally adapted nutrition seminars. The project is now expanding to the Sunnybrook Academic Family Health Team to evaluate delivery and early outcomes in primary care.

    Black adults ≥30 with hypertension ≥1 year and grade 9+ English literacy are recruited through Sunnybrook. Participants attend four weekly virtual seminars on hypertension education and a culturally adapted DASH diet. Data collection includes the University of Kansas Nutrition Literacy Assessment Instrument, ASA24 dietary recall, and baseline chart abstraction (BP, BMI, comorbidities, medications). Supplemental self-report surveys on blood pressure self-monitoring and grocery cost perceptions are collected at baseline and 8 weeks. Focus groups at 3 months explore barriers and sustainability.

    The first cohort (n=4; 2 males, 2 females) had typical cardiometabolic comorbidities. Baseline surveys indicated broadly similar dietary self-management, though one participant had discontinued hypertensive medication due to side effects. Following the seminars, participants demonstrated modest, individualized gains in nutrition knowledge and skills. Dietary recalls showed small, variable changes. Feedback was generally positive: three reported increased confidence in dietary changes and label interpretation; one reported limited benefit.

    These early findings suggest culturally adapted nutrition education is feasible and acceptable for Black patients with hypertension in primary care. Modest improvements in knowledge and individualized dietary changes are consistent with early-stage behavior change. Ongoing recruitment will allow evaluation of sustainability, response variability, and links to clinical outcomes.

  • Presenter: Sherylan Young

    Background/Purpose:

    At the University of Toronto, there are 14 sites that participate in teaching students their core clinical family medicine (FM) clerkship program, including rural sites. There are many factors that make each site unique, including location, number of preceptors, resident mentorship, delivery of seminars, and many more. This project aims to determine if any factors affect student performance in order to optimize learning and inform resources.

    Methods:

    We used Qualtrics to survey all clinical clerks (~500) during their core FM clerkship rotation during the 2023-2024 and 2024-2025 academic years to gather information about factors of their specific clinical rotations and their experiences. We then used performance data from their mastery evaluation exercises (ME) and clinical evaluation scores for our analysis to determine which factors, if any, made a difference on student performance.

    Results:

    Analysis of data from 2023-2024 revealed that although students’ experiences were positive on the rotation, these experience scores did not correlate with student performance. We found a limited number of factors weakly correlated with performance on the ME, including clinical and non-clinical health professional educator experiences, exposure to residents and long commutes. Notably, things like timing of clerkship rotation, number of preceptors and exposure to preceptors that did focused practice did not make a difference in performance.

    Discussion:

    Findings from the completed 2-year study will be presented and we hope that the results will serve as a template for new undergrad sites and be used to inform quality improvement for both undergrad and post-grad education.

  • Presenter: Sherry Hao

    Background: Peer workers are uniquely positioned to deliver health services and draw clinical programs closer to their community. However, peer work is often limited to case navigation or health education rather than administering essential clinical tasks.

    Intervention: Our team is collaborating with two community organizations and a primary care clinic in Toronto to co-design an expanded peer worker program where peers with lived experience deliver essential health interventions to people experiencing homelessness. We co-developed directives for peer workers to deliver smoking cessation, administer vaccines, distribute HIV self-tests and harm reduction supplies. We interviewed 23 peer workers, staff, and people experiencing homelessness to understand how existing peer worker programs could deliver on the Quintuple Aim and inform the development of an expanded peer worker role. Interviews were analyzed using the Framework Method and coded using NVivo software.

    Implications: Partners were initially hesitant about liability and adverse events but were willing to make the changes needed to widen the role of peer workers. Integrating peer workers in clinical care models improves social accountability and access to care. Essential interventions get to the people who need them by involving the most underserved as partners in care. Medical directives are underutilized, thus taking advantage of directives and delegation can strengthen and restructure primary care to be more community-based and address resource constraints.

  • Presenter: Han Yan

    Background:

    Social isolation and loneliness increase the risk of long-term health problems. The St. Michael’s Hospital Academic Family Health Team (SMHAFHT) cares for more than 17,000 adults aged 50 or older, and we estimate that thousands of these older adults are experiencing social isolation or loneliness. A new Enhanced Social Prescribing program (SEED) was recently launched to tackle these challenges by assessing social needs and linking individuals to community services and resources.

    Objectives:

    To evaluate the impact of SEED through photography and personal narratives

    Methods:

    We conducted a qualitative study engaging people accessing this program as coresearchers, using ‘photovoice’. Recruitment occurred among members of the SEED program who were at least 50 years of age and able attend two English-facilitated workshops. The first session allowed them to co-develop the research question on how SEED helped them learn through community access. The second session focused on the development of narratives for the photographs taken.

    Results:

    Thirteen coresearchers generated photographs that were shared and discussed in two groups of six. The common themes about how SEED can enhance learning are i) the positive effects of nature on mood and ii) the benefits of urbanism and diversity. Coresearchers generally demonstrated an appreciation of the SEED program.

    Conclusion:

    Social prescribing, as it is operationalized by the SMHAFHT through SEED, is well received by the participants or coresearchers of this study. The photovoice methodology allowed for the visual representation of important buildings, items, and ideas from the community. Group discussion generated valuable story-sharing and theme development.

  • Presenter: Aaron Orkin

    Dr. Charles Hastings’ 1911 investigation of Toronto’s slum conditions is often cited as a foundational moment in Canadian social medicine. His detailed documentation of housing, sanitation, and infectious disease has been celebrated as an early, equity-oriented effort to protect marginalized populations and improve community health. Hastings’ work is frequently invoked as an origin story for population-based, socially responsive medical practice and public health.

    This paper argues that this narrative is incomplete. Hastings’ investigation relied on an early form of sociodemographic data collection, undertaken to guide equitable public health intervention. His analysis consistently emphasized that the Ward was a predominantly Jewish neighbourhood, and this identification shaped how disease, overcrowding, and poverty were interpreted. Hastings reported ill health both in structural slum conditions, and drew on contemporary ideas of racial hygiene, moral reform, and eugenics, framing Jewish communities as sites of health risk.

    Re-reading Hastings’ work through this lens reveals how social medicine functioned simultaneously as care and social control. While Jewish residents of the Ward organized their own health, labour, and welfare initiatives, public health authorities used epidemiological and demographic data to justify surveillance, moral regulation, and ultimately displacement in the name of a “healthy” city.

    For family and community medicine, this history raises clinically relevant questions. Contemporary primary care similarly relies on sociodemographic data to advance equity and population health. This case invites reflection on how data-driven approaches can either challenge or reproduce assumptions, and why critical awareness of medicine’s past is essential to ethical, equitable practice today.