{'fraction_non_alphanumeric': 0.01967005076142132, 'fraction_numerical': 0.0031725888324873096, 'mean_word_length': 4.840740740740741, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Blending Community and Big Hospital Experiences for Residents-Does It Add Value?

My first visit to North America was last century when I was a youngish family physician on sabbatical in Canada. I spent a wonderful year reading and thinking about education. One of the articles I read was the interesting study on the ecology of medical care by White and colleagues,1 which told us what we all suspected, that most patient interactions with the health care system did not happen in the hospital. During that sabbatical, my Canadian colleagues reminded me that “you can't teach forestry in the lumber yard.” This metaphor was somewhat lost on me, coming from Scotland, where centuries of felling, burning, and overgrazing had reduced the native forest to a few forlorn fragments. This metaphor makes more sense now that I live in British Columbia near pulp and saw mills and surrounded by forest. During this time we taught medical students and residents primarily in the hospital and in tertiary care settings—tantamount to the lumberyard in our analogy—which meant they were largely missing experiences in the community settings, where illness arises and is often managed, and from where some patients are sent to the tertiary institutions, often for very specific services. Even though the study of White and colleagues1 was conducted more than 50 years ago, it was repeated by Green et al2 more recently with similar results. If I ask myself whether things have changed much with respect to how and where we train our future physicians, my thoughts would be “maybe, a bit.”