Oral Papers
Digital Technology: Innovation and Evaluation
May 13, 2025
11:00 AM - 12:15 PM
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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.
In conclusion, participants will be able to:
Describe a pragmatic approach to embedding AI-CDS (NLP + ML risk stratification + guideline prompts) into EMR workflow.
• Select and operationalize diabetes quality indicators aligned with Ontario Quality Standards and the Quintuple Aim for evaluation.
• Identify common barriers/enablers to AI-CDS adoption in community practices (data quality, workflow fit, clinician trust) and mitigation tactics.
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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.
In conclusion of this activity, participant will be able to:
Describe how the rapid expansion of telehealth during the COVID-19 pandemic affected access to primary care across population groups, services, and financial protection domains.
Identify key sociodemographic factors (including age, socioeconomic status, and digital literacy) that contributed to inequities in primary care access during the pandemic.
Apply evidence from the Universal Health Coverage framework and evaluate the limitations of virtual care modalities to inform the design of more inclusive hybrid health systems.
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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.
In conclusion of this activity, participants will be able to:
1. Describe what an AI scribe is.
2. Understand the potential benefits of AI scribe use, with a focus on its impact on administrative burden.
3. Identify barriers and enablers to the implementation of AI scribes in practice.
4. Determine whether they would like to trial an AI scribe in their practice.
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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
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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
In conclusion of this activity, participants will be able to:
1. Describe how commercially funded clinical tools created by Health IT companies may affect physician and patient behaviours.
2. Understand how Health IT companies act as intermediaries between pharmaceutical companies and primary care
3. Critically appraise new digital tools in order to minimize commercial influence of patient care
May 13, 2025
11:00 AM - 12:15 PM
Health Interventions for Vulnerable Populations
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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.
In conclusion, participants will be able to:
1. Discuss how opioid use stigma can affect the health and care of people who use drugs.
2. Explore the public and individual implications of a digital, nationally available, humanitarian-led opioid poisoning education and naloxone distribution program.
3. Discuss how family medicine practices and large humanitarian organizations can work together to address substance use stigma and other public health challenges.
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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.
In conclusion, participants will be able to:
1. Identify barriers individuals with opioid use disorder face in accessing healthcare and vaccination.
2. Discuss why people with OUD experienced greater COVID-19 related health disparities in comparison to the general population.
3. Propose how these findings can lead to tailored public health interventions for people with opioid use disorder.
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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.
In conclusion of this activity, participants will be able to:
1. Describe a community-engaged process for developing transgender and gender diverse (TGD) health curricula that meaningfully incorporates TGD community members alongside medical educators and trainees.
2. Identify key priority content areas and learning objectives for TGD health education across medical training and continuing professional development.
3. Apply principles of trauma-informed, gender-affirming, and socially responsive medical education when designing or adapting curricula in their own training or practice settings.
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Presenters: Ijeoma Itanyim, Karen Tu
Background: The identification and management of patients with severe asthma is challenging in primary care, leading to missed opportunities for early detection and referral to specialists.
Objectives: This study sought to establish consensus on the criteria for entering patients into a primary care severe asthma registry and the components of a Clinician Behavior Index (CBI) to evaluate the quality of care in the management of severe asthma.
Methods: The research team, composed of experts in severe asthma clinical management and research, conducted an e-Delphi process in four iterative rounds. Registry criteria consisted of disease severity indicators, such as emergency department visits. CBI criteria consisted of care-related indicators, such as asthma control monitoring or medications prescribed.
Results: After three e-Delphi rounds, consensus was achieved on 10 registry entry and 14 CBI criteria. In the fourth round, four registry entry criteria – objective documentation of asthma diagnosis, exacerbations, emergency department visits, and hospitalisations for asthma – and nine CBI criteria, including documentation of severe asthma diagnosis, medication management, asthma control questions, personalised asthma action planning, variable airflow obstruction, exacerbations and severity, inhaler review, smoking habits, and referral to specialists, were voted as essential data elements, and were deemed feasible for extraction from primary care electronic medical records.
Conclusion: Developing a severe asthma registry in primary care is crucial to early identification of these patients so that life-altering therapies are not needlessly delayed. The CBI will help evaluate the quality of care in severe asthma management.
In conclusion of this activity, participants will be able to: 1. Describe the essential and feasible primary care electronic medical record data elements for a primary care severe asthma registry and clinician behaviour index, as established through expert consensus using a four-round e-Delphi process.
2. Explain how the consensus-derived registry entry criteria and clinician behaviour index can be used to assess the quality of severe asthma care in primary care settings.
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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.
Optimizing Family Medicine Education
May 13, 2025
3:00 PM - 4:15 PM
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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.
In conclusion of this activity, participants will be able to:
1. Appreciate the components of a successful model of interdisciplinary teaching that can contribute to developing or enhancing new and existing post-graduate Family Medicine curriculum.
2. Understand the components that lead to a psychologically safe learning environment for the Family Medicine Residents.
3. Consider how to incorporate interdisciplinary teaching to further promote team-based, comprehensive primary care.
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Presenters: Lindsay Herzog
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.
In conclusion of this activity, participants will be able to:
1. Appreciate the role of physical space in shaping teaching and learning in family medicine clinical supervision.
2. Explore sociomateriality as a way of understanding the relationship between space, materials, and practices.
3. Consider how intentional design choices can support and align with the pedagogical purposes of clinical learning spaces.
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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.
In conclusion of this activity, participants will be able to:
1. Demonstrate which factors of the family medicine clinical clerk rotation effect student performance on their rotation evaluation.
2. Identify key aspects of the clerk family medicine clinical rotation that are recommended to be included (or not) when creating new education sites for learners.
3. Reflect on how this information can be used for quality improvement of training sites.
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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
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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.
In conclusion of this activity, participants will be able to:
2. Interpret the barriers and facilitators of transformative approaches in medical education
3. Build and improve on how we can collaboratively support one another in better meeting the needs of our teachers and learners in empowering socially accountable practice
May 13, 2025
3:00 PM - 4:15 PM
Equitable and High Quality Care for our Communities
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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 for successful CRC screening, including, care processes, role clarity, elctronic health record (EHR) configuration, and care continuity post-discharge.
Building on these outcomes, we are launching a launching a digitally enabled “Smart Zone” EHR alert to prompt screening eligibility identification and task completion. In parallel, we are conducting a qualitative descriptive study to explore patient and provider perspectives on CRC screening within psychiatric inpatient units. Semi-structured interviews will examine experiences, perceived barriers and facilitators, and recommendations to inform patient- and provider-centered strategies that enhance the feasibility, acceptability, and sustainability of digitally integrated screening models.
This work demonstrates how digital implementation strategies within routine inpatient psychiatric care can measurably improve preventive screening delivery and illustrates how reverse integration, embedding preventive care in mental health settings, can reduce CRC screening inequities. The findings highlight scalable, data-driven approaches to advance equity-oriented cancer screening for populations with SMI.
In conclusion of this activity, participants will be able to: 1. Describe a co-designed, EHR-enabled workflow that increased FIT-based colorectal cancer screening among long-stay psychiatric inpatients with SMI (4.9% → 33.3%).
2. Identify patient- and provider-level barriers and facilitators to CRC screening in inpatient psychiatry and articulate how qualitative methods surface contextual factors affecting feasibility and acceptability.
3. Apply implementation strategies including role clarity, digital prompts, FIT logistics, and discharge linkage to primary care to inform scalable, sustainable reverse-integration models that reduce cancer screening inequities in mental health setting.
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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.
In conclusion of this activity, participants will be able to: 1. Explain how cultural adaptation was operationalized within a DASH-based nutrition intervention for Black adults with hypertension in a primary care context.
2. Appraise early feasibility, acceptability, and participant-level response variability observed during initial implementation of the CHOICES pilot.
3. Discuss implications of early-stage findings for the design, evaluation, and scaling of culturally relevant dietary interventions in primary care.
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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.
In conclusion of this activity, participants will be able to: 1. Understand the process to prepare directives, including barriers and facilitators, that enable peer workers to deliver essential clinical services.
2. Learn how peer worker programs in primary care and community settings can expand access to preventive care for people experiencing homelessness in Toronto.
3. Discuss potential clinical tasks that can be shared with peer workers to reach underserved communities.
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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.
In conclusion of this activity, participants will be able to:
Better understand the photovoice methodology and the benefits of participatory research
Consider the effectiveness of a social prescribing program such as SEED
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Presenter: Aaron Orkin
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.
In conclusion of this activity, participants will be able to: 1. Describe how early sociodemographic data collection in Canadian public health, urban planning, and social medicine was shaped by assumptions about race, and moral fitness.
2. Reflect on parallels between historical social medicine and contemporary uses of demographic data in family and community medicine.
3. Apply historical insight to support more critically informed, equity-oriented primary care practice.