About NOSM Education Research Communities

Curriculum

Global Health Working Group

A curricular working group consisting of students, faculty, residents, and other interested parties is currently working towards developing a curricular thread in global health. Recognizing that global health is a part of any practice of medicine in Canada,  the group will be submitting a document to the UME office with proposed areas of curricular foci on global health issues.


Areas of Interest

  1. Epidemiology and Biostatistics
    This purely academic arm of global health is necessary as diseases increasingly cross borders and affect not only those working clinically abroad, but also those working in Canada with travellers or immigrant populations. Etiology of disease, transmission, and risk factors may vary significantly among different populations. An understanding biostatistical models and approaches informs policy and guides thoughtful engagement in global health, as we move towards a rethinking of the UN Millennium Development Goals. Through their involvement in this area of focus, our students develop as CanMEDS Scholars and Medical Experts. There are also many historical lessons related to the spread of pandemics and development of treatments and vaccines that direct important aspects of current clinical practice, and global and local public health policy.
  2. Travel Medicine
    Increasingly, our graduates will be faced with diagnosing and treating infections and diseases acquired abroad, irrespective of which area of medicine they chose to enter. Our Canadian patients are more likely than they were in the past to be planning trips to locations where infections are rampant and health care sub-optimal. Patients with chronic illnesses no longer shy away from international vacations. This area of curriculum also supports the CanMEDS focus on Medical Expertise. 
  3. Mental Health
    Conflict, poverty, and trauma all necessitate mental health interventions both locally and globally.4 Refugees arriving in Canada often have a history of traumatic experiences that Canadian doctors must identify and address. Aboriginal communities are in need of physicians with expertise in navigating the complexities of mental health care delivery in cultures with which they may not be completely familiar. Global health training helps form physicians who are up to the challenge of providing these services to the communities that so desperately need them. This supports the CanMEDS competency training as Medical Expert, Communicator, and Health Advocate. 
  4. Cultural Safety in a Global Context
    One of the primary benefits of working in a global context for our students is the development of the capacity to adapt to new cultural contexts, practice critical self-reflection and eventually to improve attainment of cultural safety. As medical practitioners - in Canada, in the North, and in a global world - cultural learning is critical to avoid cultural stereotyping and to improve the patient-doctor relationship. A grounding in this area supports the CanMEDS Communicator competency. An understanding of the state and context of global health combined with the praxis of honing skills to attain cultural safety are valuable learning experiences that lead to personal and professional growth. Grounded in an understanding of the historical context of cultural interactions, the association and fluidity between global, local, immigrant, Aboriginal, and circumpolar groupings is central to an effective, inclusive, and respectful medical practice in Northern Ontario, or anywhere in Canada.   
  5. Ethical and Bioethical Considerations of Global Medicine
    The field of global health is fraught with ethical and bioethical dilemmas. Challenging our students to consider these in a historical context and to work out solutions acceptable to them, and in concurrence with the precepts guiding ethical medical practice in Canada, would help foster a deeper understanding of the rights and responsibilities of practitioners and patients in Canada and abroad. Any education in global health would necessarily include this topic. As well, any consideration of this topic can only challenge students to become more aware of applying principles of justice and equity to our own medical system, and perhaps inspire them to continue practising in underserviced areas. This helps develop the CanMEDS competencies of Health Advocate and Communicator.
  6. History of Global Health
    Global health today is a collection of problems, institutions, people, initiatives, and diseases that are rooted in the past. Historical forces and events, from colonialism on, have shaped the current state of global health.  Thus, understanding the history of global health can help us to respond to the health challenges of today. Future practitioners need to understand the nature and significance of historical factors in contemporary global health challenges and opportunities. Physicians are necessarily lifelong learners, and the CanMeds competency of Scholar is developed in this area of focus. The proposed global health curricular thread is grounded in an understanding of the historical aspects of colonialism and medicine. This encourages our students to become informed about both the historical and evolving socio-political situations they encounter.
  7. Environment and Health
    The physical environment, both natural and developed, is an important determinant of health. Twenty-five percent (25%) of the disease burden in developing countries is attributed to environmental factors.5 Malaria, respiratory diseases, diarrheal diseases, newly emerging and re-emerging diseases are greatly influenced by environmental factors. Environmental factors interact in complex ways with other social determinants to differentially shape human health outcomes in various populations. To provide effective primary health care in such settings, physicians must understand the complex ways in which people interact with their surrounding environments, and how responding to such environmentally-mediated health problems spans beyond the health sector to include professional expertise from other disciplines. Learners will develop the core competency of the CanMEDs role of a physician as a Health Advocate as they become aware of the values and principles of sustainability, equity, and social justice in fostering the health of populations.
  8. Research and Service Learning Projects
    NOSM students have opportunities to develop and participate in service learning projects – these can easily be tied with global health issues. An example of an existing project is the student lead “Health Passport” initiative in Thunder Bay with the local immigrant community. Such projects should be encouraged and supported as they provide great learning opportunities for students, benefit to the community, research and publication options for the students, and positive exposure for the institution. They help develop NOSM students as CanMEDS Scholars and Health Advocates.
  9. International Clinical Electives
    These are important to student development and education at NOSM because our students are often preparing to work in culturally diverse and resource-challenged locations. An international elective provides exposure to diverse cultural perspectives and health inequalities. It helps students grow in the role of health advocate. If done in a developing nation, it provides a perspective on health inequalities and insights into how medicine is conducted in resource-challenged environments. It challenges students to evaluate standards of care and to think independently about the ethical and bioethical aspects of working in these environments. Students will gain an understanding of implementation gaps (the gap between the development of effective health solutions and the capacity to implement them) and formulate approaches to reduce these gaps. International clinical electives help to hone clinical skills and help students develop a notion of health care and populations in a global context. As well, it is an enriching personal experience that can foster a lifelong sense of altruism. Further, students who participate in international electives are more likely to work with underserviced populations in their home communities and in primary care. 6.7.8 The work of NOSM Global Health in this context is to develop and foster relationships with international partners to facilitate a positive, challenging, and educational experience for our students in international settings. It is also to prepare them for their experiences, help ensure their safety while away, and to offer debrief after they return. The CanMEDS competencies of Communicator, Professional, and Health Advocate are all developed in this area of focus.
  10. Clinical Work with Global Populations in Canada
    Students become aware that they are working in a global environment wherever they choose to work in Canada. Training in common and uncommon presentations of diseases found in immigrant and refugee populations, infectious diseases, and drug-resistant infections is paramount. Additionally, working with immigrant and refugee populations can further increase students’ knowledge and skills of working with culturally diverse populations by improving communications skills and understanding the cultural attitudes towards and manifestations of illness in the cultures in question. Issues particular to various populations are important (for example, atypical manifestations of heart disease in East Asian populations). As well, as immigrant populations adapt to life in Canada, they start acquiring diseases endemic to our population (for example, diabetes, obesity). The history of people’s migrations into Canada and their interactions with the medical system informs students’ practice and communication strategies. Work in this setting complements the 106 ICE placement in an Aboriginal community. Through such experiences, students acquire advocacy skills necessary for future practice. The CanMEDS competencies are supported as students grow as Medical Experts and Communicators.





 

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