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New NOSM University Francophone Curricular Initiative addresses health inequities in the North

Posted on September 14, 2023
New NOSM University Francophone Curricular Initiative addresses health inequities in the North

Medical learners who want to study in French can now do so, thanks to the pilot of the Francophone Curricular Initiative at NOSM University.

“It’s been a long road to offering learning activities for the mandatory curriculum in French,” says Dr. Nicole Ranger, Francophone Curricular Lead at NOSM University. Also an alumna and Assistant Professor, Dr. Ranger says this initiative has been in the works since the University was founded in 2005. “Francophone learners have always been encouraged to come to NOSM University, but there haven’t been a lot of opportunities for learners in French, until now.”

For many years, NOSM University’s Francophone Affairs Unit had worked with Francophone communities to coordinate clinical opportunities for students in French, but these experiences did not contribute towards the mandatory curriculum. It required Francophone learners to complete extra work on top of their MD program studies.

The new initiative enables students to complete some of their mandatory MD curriculum in French. It immediately saw high uptake, and the vast majority of Francophone students in the 2022 incoming class chose to participate. Out of 18 students admitted through NOSM University’s Francophone stream, 16 opted to pursue studies in French. An additional three self-identified Francophone students who were not admitted through the Francophone stream also chose to participate, bringing the total number of students to 19.

“The high uptake is a reflection of the need for this curricular initiative,” Dr. Ranger says. “Learners come out of high school and university fluent in French, but they don’t have the medical terminology regarding patient care. Being able to learn in French helps them develop skills, build on the skills they have, and more importantly express themselves in French and have patients understand.”

She adds, “These students knew that they would benefit extraordinarily from learning in French, and they were excited to be the first participants for our initiative. This cohort will be strong ambassadors to help learners participate in this initiative in the future.”

The pilot will roll out over four years, with additional years of the MD curriculum added as the pilot cohort progresses through their studies. While not all educational activities are offered in French, Francophone students currently participate in small-group learning in French throughout their first two years of medical school. While on campus, they also interact with Francophone Standardized Patients in some of the clinical skills sessions. They have the opportunity to undertake clinical placements in French, and every effort is made to pair them with Francophone preceptors.

Simon Paquette, a second-year medical student, is participating in the pilot cohort. “I wanted to gain a better appreciation for linguistic and cultural diversity in health care,” he says. “I also wanted to meet people like me—individuals embarking in English medical education after completing their past studies in French. Additionally, I wanted to make connections with Francophone doctors and communities. By participating in this initiative, I will enhance my ability to serve Francophone communities and contribute to the promotion of equitable health-care access for Franco-Ontarians.”

French language health services are a critical component of health equity in Northern Ontario. Since its inception, NOSM University has identified Francophones as a key population, and a group that is critical to achieving the University’s mandate of improving care across the region.

“Our university’s special mission is to be responsive to the unique health-care needs of the people of Northern Ontario, including Francophone communities, by providing innovative medical and health education programs. This is tied to our social accountability mandate,” says Dr. Céline Larivière, Provost and Vice President Academic. “The Francophone Curricular Initiative aligns very well with the university’s mission and mandate and is supported by our admission strategies. The initiative will further strengthen the positive impact our graduates and future health care providers will have within Francophone communities.”

Dr. Ranger sees the benefits of French-language health services in her day-to-day work as a Family Physician at the Centre de santé communautaire (CSC) du Grand Sudbury. This CSC is specifically mandated to serve the Francophone population exclusively. She is also a member of the Francophone Reference Group at NOSM University, and continues a second mandate as the Francophone representative on the Admissions Committee and as Chair of the Francophone Admissions Sub-Committee. She is continuing her role as the Francophone Curricular Initiative Lead.

“Language is one of the social determinants of health,” Dr. Ranger explains. “If patients are able to undertake the care in a language they’re familiar with—their mother tongue—that’s a key aspect to improving the communication between providers and patients and improving patient safety. Patients can better understand medical instructions and what they are consenting to.”

Physicians in the North have a responsibility to support patients and to communicate in a way that is understood, whether they are serving Anglophone patients, Indigenous patients, members of the original population of Franco-Ontarians, or an emerging and growing population of immigrants who speak French as their first official language, says Dr. Ranger.

NOSM University aims to embed training about culturally competent care throughout the medical school curriculum. Dr. Ranger hopes that the Francophone students can become role models and mentors for their Anglophone colleagues, and that the two groups can work together to provide better care.

That’s a lesson Paquette has already gained from his first year of medical studies. “My biggest takeaway so far is the importance of actively offering to speak French in health-care encounters. Offering French-language services to patients and never assuming English is the default language is now my standard practice. If I wait for patients to tell me they would prefer their health care in French, some might never do it,” he says.

The Francophone Curricular Initiative is still in the pilot stage but has big potential to improve health care in the North. In the long-term, Dr. Ranger sees opportunities for all Francophone physicians in Northern Ontario to mentor medical students, and for senior students to mentor new learners.

She also notes a significant research gap: “There’s not a lot of research into Francophone medical education, outside of Québec. That could be an important role for NOSM University to play.”

Ultimately, the initiative can help keep Francophone physicians in the North.

“If we send Francophone students elsewhere due to a lack of opportunity to learn in French, they may stay where they study,” Dr. Ranger says. “If we integrate initiatives in French and develop confidence in delivering French language health services, many will go back home and practice where they’re needed.”

NOSM University is recruiting Francophone Standardized Patients to support the Francophone Curricular Initiative. Looking for casual work? Help train Northern Ontario’s future doctors by portraying a patient.