Disclosure:This presentation has been funded by:

• Northern Ontario School of Medicine (NOSM)

which is funded by the Government of Ontario

I sit on the board of directors for the following organizations:

• NOSM (CEO of NOSM Corporation)

• Sudbury Regional Hospital

• Thunder Bay Regional Health Sciences Centre

Distributed Community

Engaged Learning:How Crazy is That?

Dr Roger Strasser Dean and Professor

Northern Ontario School of Medicine

Northern Ontario School of Medicine

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

In, by and for Northern Ontario

Northern Ontario

Southern Ontario

• Sioux Lookout

Recruitment Facilitators

for Rural Practice

• rural upbringing• positive undergraduate rural clinical

experiences• targeted postgraduate training for rural practice

Key Academic Principles

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

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

Organization / Deliveryof NOSM Curriculum

Phase 1 Phase 3

Year 1

101102103104105106

Residency

Year 2

107108109110111

Year 3

Comprehensive Community Clerkship

Year 4

Clerkship&

Electives

Licensure Examination

Years 5, 6and Beyond

IndividualSpecialtyChoice

Case Based Modules

Phase 2

Elective

All Placement Sites

Thunder Bay Sudbury

Toronto

Aboriginal Community SitesIntegrated Community Experience SitesComprehensive Community Clerkship Sites

Residency Programs

• Family Medicine Residents of the Canadian Shield (RoCS)

• 3rd year enhanced skills – emergency medicine, anesthesia, maternity care, etc

RC Specialty Programs

• General Internal Medicine• General Surgery• Pediatrics• Obstetrics & Gynecology• Psychiatry• Anesthesiology• Orthopedic Surgery• Community Medicine

Continuing Education Professional

Development• hundreds of events• many online sessions• CME/CPD• interprofessional• faculty development• leadership development

Health Professional Education

• rehabilitation sciences• interprofessional education - integrated clinical learning• communities of practice• dietetic internship program• physician assistants • digital library service

Research Programs

• building on existing strengths• broad canvas of research approaches• laboratory, clinical, community• Northern Ontario research questions• Northern Health Research Conferences

NOSM Charter Class

• CaRMS - 100% matched 1st round• 70% rural family medicine• 30% general specialties• 11 medical schools (of 17)• 40% residency with NOSM• “deep roots” in Northern Ontario• >60% of NOSM residents stay

FM RoCS Graduates

NOSM Charter Class

NOSM

Benefits of NOSM

• More generalist doctors• Enhanced healthcare access• Responsiveness to Aboriginal, Francophone, rural, remote• Interprofessional cooperation• Health research• Broader academic developments• Economic development

Socioeconomic Impact

• $67-82M new economic activity• 245 new jobs• economic development

• host universities’ status raised• improved HHR recruitment• communities feel empowered

Innovative Education and Research

for a Healthier North • Enhanced Education

• Strengthened Research

• Quality Learning Environment

• Excellent Faculty Relations

• Community Collaboration

“Community” inHealth Sciences

Education• community oriented - learning about the community• community based - learning in community context• community engaged - active community contribution

Community Engagement

• community active participant - interdependent partnership• ensures student “at home”• contributes to student’s educative experience• education and research activities• community development

Community Engagement

• individuals and organizations• partnerships and collaborations• Aboriginal and Francophone• Local NOSM Groups• education and training (DCEL)• research• community development

Partnerships & Relationships

• Communities of the North• Universities and Colleges• Hospitals and Health Services• OTN, KOTM and Contact North• Other Medical Schools

Membership of LNGs

• Faculty Members from community

• Community leaders

• Non-academic NOSM personnel

• Local academic and health service providers (i.e. Hospitals)

• Local Group Leader

Comprehensive Community Clerkship

• 30 weeks in large rural and small urban communities• Based in Family Practice • Learn clinical disciplines in parallel• Students learn and live in community

Principles for Longitudinal

Integrated Curricula• comprehensive patient care over time• continuing learning relationships with clinicians• achieve core clinical competencies across multiple disciplines simultaneously

Importance of Relationships

• student-teacher/student-student/ student-community• four levels: clinical, institutional, social and personal (Worley)• paying attention as part of curriculum improves learning

Clinicians

Patients

Personal Principles

ProfessionalExpectations

UniversityResearch

Health Service

Government

Community

MedicalStudents

Worley, 2006

Integrity Model

Rural Health Services

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

Rural Practitioners

• wide range of services• high level of clinical

responsibility• relative professional

isolation• specific community health

role

“Extended Generalists”

Rural Health Care

• specialists’ support role• partnership not putdown • consultant support to local

service• not assume patients will

travel

Information Technology

• greatly reduced isolation• education and information• clinical support - Telehealth

Key Considerations

• Context counts• Community participation• Standards and quality• Definition of success • Prevailing mindset• Vision and Mission

NOSM and OPOP

• Collaboration to enhance care

• Community engagement• Distributed learning• Telehealth• Research partnerships