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Comparative Study
. 2025 Jul-Aug;71(7-8):500-510.
doi: 10.46747/cfp.710708500.

Comparison of horizontal and traditional block family medicine curricula: Canadian study

Miriam Lacasse  1 , Jean-Sébastien Renaud  2 , Batya Grundland  3 , Maria M Hubinette  4 , Fok-Han Leung  5 , Theresa van der Goes  6
Affiliations
Comparative Study

Comparison of horizontal and traditional block family medicine curricula: Canadian study

Miriam Lacasse et al. Can Fam Physician. 2025 Jul-Aug.

Abstract
in English, French

Objective: Longitudinal curriculum model outcomes in postgraduate medical education are not well documented. The authors aimed to compare satisfaction, learning, clinical exposure, and practice intentions between longitudinal family medicine (FM) curricula and traditional rotational ("block") curricula.

Design: This curriculum structure evaluation used a retrospective quasi-experimental study design using data from the College of Family Physicians of Canada Family Medicine Longitudinal Survey.

Setting: The project used data from 3 FM residency programs for the entry years 2014 to 2017.

Participants: A total of 1283 residents across 49 teaching sites were invited to participate at program entry (T1) and residency completion (T2).

Main outcome measures: Data were categorized by horizontal curriculum or block curriculum. The authors used the Kirkpatrick taxonomy to compare satisfaction with the curriculum, learning, behaviour (ie, clinical exposure), and results (practice intention). One-way analyses of variance (ANOVAs) tested the effect of curriculum model on satisfaction and clinical exposure. Analyses of covariance (ANCOVAs) tested the effect of curriculum model on the other outcomes.

Results: Residents from 40 teaching sites provided answers to T1 and T2 surveys (N=385: 81 in the horizontal curriculum and 304 in the block curriculum). The average satisfaction score was lower in block curricula (4.28/5 [SD=0.47]) than in horizontal curricula (4.46 [SD=0.42]) (F 1,382=9.39, P=.002, η2=.02). The curriculum structure had no significant impact on learning and on most items in the clinical exposure or practice intention categories.

Conclusion: Longitudinal curriculum models in residency might be associated with better resident experience. However, curriculum models do not have a significant impact on most educational outcomes, and residents from all curriculum models feel similarly prepared for practice.

Objectif: Les résultats du modèle longitudinal des cursus en éducation médicale postdoctorale ne sont pas bien documentés. Les auteurs avaient pour but de comparer la satisfaction, l’apprentissage, l’exposition clinique et les intentions de pratique dans les cursus longitudinaux par rapport à ceux des cursus traditionnels par stages (« blocs ») en médecine familiale.

Type d’étude: Cette évaluation de la structure des cursus est fondée sur un modèle d’étude rétrospective quasi expérimentale à l’aide des données du Sondage longitudinal en médecine familiale du Collège des médecins de famille du Canada.

Contexte: Le projet a utilisé les données de 3 programmes de résidence et portait sur les années d’entrée de 2014 à 2017.

Participants: Au total, 1283 résidents dans 49 sites d’enseignement ont été invités à participer au moment d’entrer dans le programme (T1) et de terminer la résidence (T2).

Principaux paramètres à l’étude: Les données ont été classées selon qu’il s’agissait d’un cursus horizontal ou par blocs. Les auteurs se sont servis de la taxonomie de Kirkpatrick pour comparer la satisfaction à l’égard du cursus, l’apprentissage, le comportement (p. ex. exposition clinique) et les résultats (intentions de pratique). Les analyses à sens unique de la variance (ANOVA) examinaient les effets du modèle de cursus sur la satisfaction et l’exposition clinique. Les analyses de la covariance (ANCOVA) se penchaient sur les effets du modèle de cursus sur les autres paramètres.

Résultats: Des résidents de 40 sites d’enseignement ont répondu aux sondages T1 et T2 (N=385 : 81 dans le cursus horizontal et 304 dans le cursus par blocs). Le score moyen de satisfaction était plus faible dans le cursus par blocs (4,28/5 [ET=0,47]) que dans le cursus horizontal (4,46 [ET=0,42]) (F1 382=9,39, p=,002, η2=,02). La structure du cursus n’a pas eu d’impacts significatifs sur l’apprentissage ni sur la plupart des éléments dans les catégories liées à l’exposition clinique ou aux intentions de pratique.

Conclusion: Les modèles de cursus longitudinaux durant la résidence pourraient être associés à une meilleure expérience des résidents. Toutefois, les modèles de cursus n’ont pas exercé une influence significative sur la plupart des résultats éducatifs, et les résidents, quel que soit le modèle de cursus, se sentaient similairement préparés à la pratique.

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Figures

Figure 1.
Figure 1.
Continuum of horizontalization and integration in curriculum models: Continuum of horizontalization and integration of 4 typical Canadian family medicine curriculum models and 1 hypothetical block model without continuity clinics, based on the concepts of horizontalization* and integration.†
Figure 2.
Figure 2.
Frequency of continuity clinics in block vs longitudinal models: In a block curriculum, residents have intensive exposure to continuity clinics during their FM rotations, and keep 1 half-day back per week as a horizontal experience, even when they are on other specialty rotations. In longitudinal models, scheduling allows for more consistent availability of these continuity clinics (often 3-4 half-days per week depending on the sites).
Figure 3.
Figure 3.
Items from the Family Medicine Longitudinal Survey used in the program evaluation
Figure 4.
Figure 4.
Training outcomes of Canadian family medicine residency programs from 3 different universities, by curriculum structure: Summary of the study results for the 4 levels of training outcomes (Kirkpatrick and Kirkpatrick).
See this image and copyright information in PMC

References

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