Education for Rural Practice through Distributed Medical Education

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Education for Rural PracticethroughDistributed
Medical Education

• Dr. Roger Strasser
• Founding Dean and Professor
• Northern Ontario School of Medicine

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Rural Health Around the World

• access is the rural health issue
• resources concentrated in cities
• communication and transport difficulties
• rural health workforce shortages

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Rural Practitioners
Extended Generalists

• wide range of services
• high level of
• clinical responsibility
• relative professional isolation
• specific community health role

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Rural Health Services

• access is the major issue
• safety net
• local services preferred
• limited resources
• workforce shortages
• different from cities

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Sustainable Rural Health Services

• health service authority/agency
• health care providers
• community participation

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Rural Health Care

• specialists support role
• partnership not putdown
• consultant support to local service
• not assume patients will travel

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Sustainable Improvementsin Rural Health

• ground up health service models
• investment in infrastructure
• recognition and support for RPs
• education, training and research

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Recruitment Facilitators

• rural upbringing
• positive undergraduate
• rural clinical experiences
• targeted postgraduate training
• for rural practice

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20th Century Trends in Medicine

• specialization
• the cult of the expert
• hospitals and technology
• workforce maldistribution

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20th Century Medical Education

• Flexner and Johns Hopkins
• Problem Based Learning
• community oriented
• medical education
• community based
• medical education

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Community Based Medical Education

• Not just learn about
• - experience for themselves
• Maximum hands on experience
• Students part of health team

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Rural Medical Education

• response to workforce shortages
• specific knowledge and skills
• high quality learning environment

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Rural Clinical Education

• more hands-on experience
• greater procedural competence
• more common conditions

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Technology Medicine

• always good
• draws attention away
• from patients experience
• except pregnancy ultrasound

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Information Technology Distance Education

• printed and posted
• film, radio and television
• telephone and fax
• electronic communications

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Electronic Communications

• proliferation of computers
• e-mail, WWW and CD ROM
• potential to reduce rural isolation
• clinical educational applications

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Electronic Distance Education

• positive teacher-student and student-teacher
  relations
• greater flexibility - teaching materials -
  assessment procedures
• improved communications - e-mail chat
  groups
• learning network rather than teaching
  hierarchy

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Rural Distributed Medical Education

• high quality clinical
• and educational experiences
• electronic access to information
• and educational resources
• maximum human contact

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Faculty Development

• inclusive of all teachers
• involved in curriculum development
• electronic distance education
• case based learning
• role modeling

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Northern Ontario School of Medicine

• Faculty of Medicine of Lakehead U
• Faculty of Medicine of Laurentian U
• Social Accountability mandate
• Commitment to innovation

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• Sioux Lookout

• In, by and for Northern Ontario

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Recruitment Facilitators

• rural upbringing
• positive undergraduate
• rural clinical experiences
• targeted postgraduate training
• for rural practice

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Physicians Life Cycle

• high schools program
• local premed programs
• undergraduate program
• postgraduate programs
• CME/professional development
• graduate studies

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Admissions

• Selection criteria target
• northern students
• Background living in northern urban,
• rural and/or remote communities
• Admissions process eliminates many
• barriers for northern students

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NOSM MD Program

• Four years
• Clinically driven
• Integrated curriculum
• Distributed learning
• Consultative process in
• developing curriculum

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Six Key Academic Principles

• Interprofessional
• Integration
• Community Oriented
• Distributed
• community engaged learning
• Generalism
• Diversity

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Distributed CommunityEngaged Learning

• An instructional model that allows widely
  distributed human and instructional resources to
  be utilized independent of time and place in
  community partner locations across the North

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Comprehensive Community Clerkship (CCC)

• 32-week attachment in large rural
• and small urban communities
• Based in Family Practice
• Learn specialty disciplines in parallel
• Students live learn in community

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Organization / Deliveryof NOSM Curriculum
Phase 1
Phase 3
Residency
Phase 2
Year 1 101 102 103 104 105 106
Year 2 107 108 109 110 111
Year 3 Comprehensive Community Clerkship
Year 4 Electives Selectives Licensure
Examination
Years 5, 6 and Beyond Individual Specialty Choice
Case Based Modules
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Thunder Bay
Sudbury
Aboriginal Community Sites
Toronto
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Thunder Bay
Sudbury
Integrated Community Experience Sites
Toronto
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Thunder Bay
Sudbury
Comprehensive Community Clerkship Sites
Toronto
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Thunder Bay
Sudbury
All Placement Sites
Toronto
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NOSM Residency Training

• family medicine from 2007
• major general specialties
• postgraduate specialty positions part of McMaster
  and U Ottawa programs
• NOSM accreditation for 2009

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NOSM Specialty Programs

• General Internal Medicine
• General Surgery
• Pediatrics
• Obstetrics Gynecology
• Psychiatry
• Anesthesia
• Orthopedics
• Community Medicine

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Benefits of NOSM to the Health System

• More generalist physicians
• Enhanced healthcare access
• Responsiveness to Aboriginal,
• Francophone, rural, remote
• Interprofessional cooperation
• Health research

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