The Northern Ontario School of Medicine (NOSM) is redefining the delivery of medical education. Its social accountability mandate, distributed learning model, and reliance on broadband technology are cornerstones of an innovative approach that is gaining world-wide recognition.
In this column, NOSM’s founding Dean, Dr. Roger Strasser, regularly apprises readers of ongoing advancements at the School, identifies challenges that inevitably arise from robust growth, and explores the unprecedented opportunities that emerge from a Pan Northern institution actively engaged with all Northern constituencies.
Latest column: Winter 2017- No missionaries, mercenaries or mad men
Catch up on past issue of the Dean’s Column bellow.
No missionaries, mercenaries or mad men
Many years ago, people used to say rural doctors were one of three things: missionaries, mercenaries or mad men.
Missionaries were on a crusade to change the community to match their own worldview.
Mercenaries were drawn to rural medicine by the financial incentives.
And mad men were eccentrics, who, due to personality characteristics, were unable to secure work in the city where medicine “really happens.”
I hope it goes without saying this notion is absurd. (After all, I’m a rural physician— surely, I don’t fit into any of those categories… although my wife may disagree about the last one).
In my time as dean of the Northern Ontario School of Medicine (NOSM), I am glad to say that I’ve seen these notions changed.
Many highly sought-after accolades have been awarded to NOSM faculty members. Our faculty are completing innovative research projects to provide better care for their patients and push medical knowledge, all while educating the next generation of health professionals.
Since 2011, more than 160 NOSMtrained family physicians have begun practising in the North.
This translates to better access to care for more than 190,000 Northern Ontarians—approximately 20 per cent of the population of our region.
Of the NOSM-trained physicians who have done both their MD and residency at NOSM, 94 per cent choose to practise in the North, with 33 per cent choosing to practise in rural and remote communities.
Reading this might give you one of two reactions. You might think, “Wow, that’s great news. I’m glad our community has more health professionals to provide health care to me and my family.”
But, if you live in a community that continues to struggle recruiting health professionals, I suspect you may think, “That must be nice for those communities, but we haven’t seen those benefits. Has NOSM forgotten about us?”
We have not forgotten about you. Just because graduates are now entering practice in the North, it doesn’t mean that our work at NOSM is done.
In years gone by, many physicians chose to work much more than a regular work week—commonly 80-hour weeks. Patients of those physicians are aging, and require more complex care. It is simply not feasible for graduates to provide care for this everincreasing need. So, as physicians retire, each one is being replaced by two or more recent graduates.
In addition, physicians are being expected to take on new roles beyond clinical service like clinical lead roles with the LHINs and, of course, academic (research and education) roles with NOSM.
Not only this, but recruiting a doctor is about the whole family. Physicians and their families need to feel at home in a community. Spouses need jobs, and children need recreational activities and educational opportunities. If a physician’s family isn’t happy, they won’t stay in a community for long.
So, what’s the answer?
There are many things that NOSM can and has done.
Knowing that health professionals need to feel at home in their communities, we partner with more than 90 communities across the North where learners live and receive hands-on education, so that they can get to know the community and hopefully see themselves practising there.
We also select medical students who have ties to Northern Ontario and who know the North and want to stay. We help our learners build professional networks in the North, so they feel comfortable practising independently in our context.
But there are also many recruitment factors that are outside of NOSM’s current education and research activities.
That’s why, in 2018, NOSM is hosting a Health Human Resources Summit. The summit will address the continuing struggle many communities face in recruiting and retaining health-care professionals.
We will bring together everyone with a role to play, and brainstorm what we can do collectively to improve recruitment in the North toward an action plan to assure health services for all Northern Ontario communities.
So, to all those communities feeling left out of the success in recruiting health professionals: we hear you.
Though we are not missionaries, NOSM is most certainly on a crusade to make shortages of health professionals in your communities a thing of the past.
Generalist medical education in Northern Ontario
Earlier this year (April 8-12), I attended the first World Summit on Social Accountability in Tunisia, a conference that brought together 450 participants, including 150 students, from all parts of the world.
This was also the annual conference of The Network: Towards Unity for Health (TUFH) focused on Improving the Impact of Educational Institutions on People’s Health.
Like all TUFH conferences, there was a strong emphasis on interactive sessions, including mini-workshops, thematic posters, TUFH talks and task force meetings, as well as outstanding keynote addresses.
A special feature of this conference was the active involvement of French language medical schools from around the world – not surprising, perhaps, as Tunisia is one of several former French colonies in North Africa. This was highlighted by a welcoming address delivered by the very distinguished Michaelle Jean, Canada’s former Governor General (2005-2010), now the secretary general of the Organization Internationale de la Francophonie.
There was a very large contingent from Canada, particularly from the Quebec schools, and the College of Family Physicians of Canada’s Besrour Centre. In addition, Dr. Danielle Blouin, secretary of the Committee on Accreditation of Canadian Medical Schools (CACMS) delivered a keynote address highlighting the way in which social accountability is woven into the Canadian MD accreditation standards. The Northern Ontario School of Medicine (NOSM) was well represented by Danielle Barbeau-Rodrigue, director Francophone Affairs, who presented two posters; Dr. David Marsh, deputy dean and associate dean of community engagement, who is also the North American member of the TUFH board; and Dr. Alex Anawati, NOSM board member and MD charter class graduate.
I presented a mini-workshop entitled “Generalism: A Key Competency for Socially Accountable Health Professionals.” It was truly exciting to be part of this first world summit which concluded with a strong declaration committing to global social accountability.
NOSM has had a very strong commitment to its social accountability mandate from our inception. It’s long been known that socio-economic factors are key determinants of health outcomes, and this is especially true in Northern Ontario.
In practice, this has meant special emphasis on Northern, remote and rural populations, including Francophones and Indigenous peoples who we have identified as being chronically underserviced.
In my workshop, I began by stressing the importance of identifying and defining medical generalism relative to one’s own culture and geographic region. Contextualizing is vital, and too often discounted, especially in the academic realm, where “scientific knowledge” is too often taken to be immutable, objective truth, without respect for the nuance of the individual and the culture of the “other.”
Here in Canada, the Royal College of Physicians and Surgeons defines generalism as “a philosophy of care that is distinguished by a commitment to the breadth of practice within each discipline and collaboration with the larger health-care team in order to respond to patient and community needs.”
Here at NOSM, we walk that talk through our distributed learning model, which sees our third-year learners dispatched to small communities across Northern Ontario. This “comprehensive community clerkship” is much longer than similar programs at other Canadian medical schools, allowing for more robust exposure to the urgent demands of generalist practice in rural and remote settings.
Our entire curriculum is designed to create generalists with a broadly based, holistic approach to medical practice.
How has this worked out in practice? Here’s a sampling of students’ reactions:
• “Rural medicine—that’s where you find the true generalists.”
• “I like how much variety there can be in the doctor’s role.”
• “We’re better off… we’ll learn more skills in a rural setting.”
How will all this improve the health of people in Northern Ontario? We’ve tracked the career path of our graduates and learned that 62 per cent have opted to pursue careers in family, mostly rural, medicine. An even higher percentage of NOSM residents – 69 per cent – opted to stay in Northern Ontario in mainly rural settings.
To sum up, since inducting our charter class students in 2005, NOSM has:
• Produced a remarkable number of practising generalists schooled as never before in the philosophy of medical generalism
• Enhanced access to health care across Northern Ontario with greater responsiveness to Indigenous, Francophone, and rural and remote communities
• Focused on interprofessional co-operation among all members of the primary health-care delivery team
• Fostered research geared toward the health needs of northerners and
• Contributed broadly to Northern economic development.
But, I hasten to emphasize, we couldn’t have done this without the people of Northern Ontario—the hundreds of Northern health professionals who served as clinical faculty members for students, and all the Northerners who have welcomed our learners into their communities and into their homes.
From the bottom of our hearts, all we here at NOSM can say is “Thank you, Merci, and Miigwetch.”
Health Science Library contributes to health care
This June, I participated in the Training for Health Equity network (THEnet) Evidence Group meeting in Sault Ste. Marie, Ontario. During the meeting, one of the speakers – Dr. Paul Grand’Maison from the Université de Sherbrooke – referred to an article in the journal Academic Medicine. Interested in learning more, I quickly hopped on the Internet, accessed the Northern Ontario School of Medicine’s (NOSM) Health Sciences Library, found, and downloaded the article. All of this took a few short minutes.
Sitting next to me was a friend and longstanding colleague from James Cook University (JCU) in Australia. Also interested in reading the article, she too tried to access it online, but with different results: “proxy denied.” After a few frustrating and failed attempts, she reverted to Google Scholar, where she was able to access only the 250-word abstract.
Now, imagine yourself as a rural doctor (in fact, some of you reading this may very well be rural doctors), teaching a student or resident in your clinic. You and the learner see a patient with some unusual symptoms. You suspect the patient has a rare condition. In a big city, you might refer this patient to a specialist, but in this case, you know the closest one is hundreds of kilometres away. To be sure of the course of treatment, you consult your Faculty of Medicine’s library to search for the best clinical practice guidelines for this illness. A relatively emergent case, your patient awaits you in the examination room, needing answers and treatment before they leave your office.
If you were this doctor (or the patient, for that matter), I bet you’d be hoping for the outcome I had in Sault Ste. Marie – the ability to seamlessly access the required resources. To me, this is one of the unsung ways that NOSM is contributing to the health of Northern Ontarians. Not only is the school training health professionals that stay and practice in the North, NOSM is also providing the ability for faculty members to retrieve up-to-date information and resources at the moment they need them – a fact that has a direct impact on patient care and teaching. Thanks to the school’s digital library service, patients in Northern Ontario are likely to be receiving the same evidence-informed care as patients in urban university health networks.
It’s not just the electronic access that sets NOSM’s library apart, but also its service. Many university librarians believe that they should never perform literature searches for their clients – library users must learn this skill for themselves. Of course, this is an important skill, but in Northern Ontario we also work under different circumstances.
With 1,400 clinical faculty in more than 90 communities across Northern Ontario (and with patient caseloads much higher than their urban counterparts), our faculty have great demands on their time. The staff in NOSM’s Health Sciences Library complete literature searches for faculty and researchers, and provide them with an expedited landing page to find all the resources they need. NOSM faculty members are able to quickly locate high quality research information, as well as the right types of services and support, depending on their needs.
Over the last few years, increasing operational costs and static governmental funding have caused rising financial pressure at the school. Because of the outstanding work of the Health Sciences Library, two very generous donors have committed to contributing a total of $50,000 in matching donations to ensure that the Health Sciences Library continues to support outstanding patient care, health research, and education in the North.
For every dollar donated to NOSM’s Health Sciences Library, your dollar will be matched by our committed donors to double the impact of your investment. If you’d like to support high-quality health care, research, and education throughout the North, contact NOSM’s Advancement Office at email@example.com or 1-800- 461-8777. I myself have recently made a personal financial commitment to our much-loved library, which has never failed to support me in my research and writing.
On behalf of the Northern Ontario School of Medicine, I wish you all the best for a happy and healthy holiday season. As for me over the holidays, I hope to spend time with my friends and family, and curl up with the most recent edition of Academic Medicine on my iPad, accessed via NOSM’s Health Sciences Library.
Continuing education supports rural health
Fifteen years of fame… and beyond
I have a proud confession. I, Dr. Roger Strasser, dean of the Northern Ontario School of Medicine (NOSM) have a famous friend. If you read my last column in the Northern Ontario Medical Journal, you may guess my famous friend to be George Clooney, but sadly I have no news to report on that front.
The origin of my friendship with this famous person dates back to 1997. At that time, I was Head of the Monash University School of Rural Health in Australia. I was approached by an eager physician looking to make positive change in medical education in Canada. He was interested in coming to Australia on sabbatical to research the best ways to teach procedural skills to rural physicians.
During his time “down under,” our guest searched broadly across the fields of health professions education and many others (adult sports education, for example) to create an approach for teaching clinical procedural skills that is now a household name for rural educators in the outback. More than just 15 minutes of fame, this educational strategy is still, to this day in Australia, called the Goertzen method. That’s right. My famous friend is Dr. James Goertzen, a rural family physician and clinical educator who many rural educators, learners and patients here in Northern Ontario know well.
In the 1990s when James was developing the Goertzen method, medical education in Canada was dominated by the urban academic health sciences centres. Given that rural health professionals have a broader scope of practice, many rural health professionals felt their education simply didn’t prepare them for practice in rural areas.
Since NOSM opened its doors, we’ve been working to change this. All of our educational programs – MD, dietetics, residency, rehabilitation studies – are offered with an eye to ensure our graduates feel confident providing rural service. But our role doesn’t stop upon graduation. To support clinicians in providing the best possible patient care to rural and Northern communities, NOSM provides Continuing Education and Professional Development (CEPD) – in the form of lectures, workshops, grand rounds, journal clubs, conferences and more – for health professionals across the North.
To achieve this, NOSM works closely with the Local Education Groups (LEGs), made up of physicians in scores of communities across Northern Ontario. Physicians come together in LEGs to identify their education, faculty development, and research needs to ensure that, as a team, they have the skills and knowledge to respond to the health needs of their community. NOSM’s role in this is to find, create, or customize education that meets the needs identified by the communities. CEPD’s education is offered in person, online, and archived for retroactive viewing, so that Northern Ontario health professionals don’t have to leave their busy practices and home communities in order to learn.
It’s not only continuing medical education that NOSM provides in communities across the North. The same support and training is required for the more than 1,300 faculty members who educate NOSM’s learners. CEPD’s faculty development education ensures that NOSM’s educators in the North have the skills and support they need to teach the next generation of health professionals.
As with anything, evaluation is important to ongoing success. This October, NOSM’s CEPD Office will undergo an accreditation visit to assess the quality of the continuing education the school offers. The accreditation visit will be managed by the outstanding CEPD team led by: Dr. Janice Willett, Anita Arella, and Heather Westaway, NOSM’s associate dean, director, and manager of faculty affairs and CEPD respectively, as well as Dr. Deb Smith, medical director of Continuing Medical Education, and last but certainly not least, the internationally famous Dr. James Goertzen, in the new role of assistant dean of faculty affairs and CEPD.
It’s hard to believe that more than 15 years have gone by since James arrived in Australia for his sabbatical. Though I’m sure he didn’t predict that he would become a household name in the rural Australian medical community, I doubt anything would have changed if he had. As a rural educator, James’ interest has never been recognition, but rather, improving the lives of rural clinicians and their patients – a dream that I know the CEPD team and many others here at NOSM share whole-heartedly.
“Given that rural health professionals have a broader scope of practice, many rural health professionals felt their education simply didn’t prepare them for practice in rural areas.”
A star is born: NOSM in the movies
I’m writing this from the shores of beautiful Lake Como in northern Italy, where I’ve come to participate in a workshop to develop a plan of action to achieve the goals of the Global Strategy on Human Resources for Health: Workforce 2030, sponsored by the World Health Organization.
When I explained all this to my long-time friend, Sudbury writer/author Mick Lowe, adding that George Clooney reportedly has a villa just up the shore from here, Mick teased me about having a hidden agenda: “You’re hoping to get him to play the role of a certain dashing med school founding dean in the film adaptation of “Hard Rock Medical!” Mick laughed.
While it is true that NOSM may be the only medical school in the world to have spun off its own TV series, tales of a feature film with George Clooney starring in the role of yours truly are wildly exaggerated. In fact, it would be fatuous to suggest the NOSM success story hinges on any one character.
In fact NOSM’s success is predicated quite literally on a cast of thousands of Northerners—our learners, faculty members including practising physicians and other clinical faculty, and staff, to say nothing of the 90 plus Northern communities— many of them Indigenous and Francophone—that have welcomed our learners with open arms. During their third year of undergraduate medical education, NOSM medical students fan out across Northern Ontario to 15 different communities for their Comprehensive Community Clerkship.
As a matter of fact, it was concern for the way those very key NOSM community partners might be depicted that gave us pause when show runner Derek Diorio first pitched us his concept about using the factual NOSM as a basis for a fictional dramatic television series about an innovative Northern medical school training its learners to become docs to cope with providing first rate primary health care despite the exigencies of rural and remote communities: would Francophones and First Nations, for example, remain subjected to the hoary old Hollywood stereotypes that have beset us for so long?
In the event, as we quickly discovered, our fears proved groundless. As a wing of the Ontario provincial government, TVO has a broad educational mandate that discourages racial and ethnic stereotyping in favour of diversity, inclusiveness and respect.
My early doubts were quickly dispelled by meetings with Hard Rock Medical’s producers, who were very generous in allowing us to provide advice on scripts in advance, for example, and who also pledged to produce a fact-based documentary on the school if we agreed to allow the fictional show to proceed. That documentary, entitled “The Doctor Can See You Now,” and based on the work of NOSM alum (and one of my personal heroes) Dr. Doris Mitchell can be viewed here: http://tvo. org/video/documentaries/the-doctorcan-see-you-now
NOSM’s further attraction to filmmakers is also evident in this 10th anniversary tribute to the school lensed by the wonderful Dr. Hoi Cheu of Laurentian University. https://youtu.be/gU3LE3vPt_4 Entitled “The Rural Challenge,” this is one of the most artfully concise cinematic tributes to NOSM’s entire ethos ever produced.
But when it comes to spin-offs, even our spin-offs have spin-offs. As the third season of HRM was scheduled to begin shooting, it became necessary to move the entire production to North Bay because Sudbury’s busy film community was oversubscribed.
The main beneficiaries of the move were Film Production students at North Bay’s Canadore College, who staffed the production, thus earning course credits while gaining real life experience on a networkquality dramatic series.
By the time you read this I am back in Canada, and the third season of Hard Rock Medical should have wrapped production. Air dates for the show, which will appear once again on both TVO and the Aboriginal People’s Television Network (APTN) have yet to be announced, but I’m told it should be some time in the fall of 2016 or over the following winter.
And, also by the time you read this I will, or will not, have met Mr. Clooney. Stay tuned, as they say. You’ll be the first to know.
NOSM grads change the conversation
Ten years ago, a local newspaper published an editorial that really stuck with me. On September 14, 2005—the day after the Northern Ontario School of Medicine (NOSM), Canada’s newest medical school, opened its doors—it stated: “The idea for Northern Ontario School of Medicine was conceived, fleshed out, and championed by the North and was largely built by Northerners with the purpose of educating Northerners so that they could stay in their own communities. The basis of this solution is already here. We just need the tools to draw it together… Northerners are the solution, and the medical school will be our tool.”
A decade later, I am thrilled to say that thanks to the continued dedication and commitment of Northern Ontarians, NOSM’s model is really making a difference. Of our medical graduates, 62 per cent choose to pursue careers in family medicine, predominantly in rural areas. This is nearly double the national average, and speaks to the success of the school in producing family physicians who continue to be in demand in communities across the North. In addition, an incredible 94 per cent of NOSM grads who also complete their residency with NOSM have chosen to practice in Northern Ontario.
What’s the reason for this success? NOSM was built on three evidenceinformed principles that encourage learners to pursue rural practice. First, we select students from rural, remote, and Northern communities – the number one indicator for practice in a given region. Ninetytwo per cent of our MD classes come from Northern Ontario with substantial inclusion of Aboriginal and Francophone medical students. The other eight per cent come from remote and rural parts of the rest of Canada.
In fact, NOSM graduate Dr. Ben Quackenbush, now practising in his home town of Little Current, has said, “It was my connection with the town of Little Current and love for rural life that drew me to NOSM. I chose the school that made a promise to provide medical education that would best prepare me for rural medical practice and to best serve my community.”
The second factor that predicts a medical graduate choosing to practice in rural areas is positive clinical and educational experiences in rural settings as part of the MD program. NOSM partners with more than 90 communities across Northern Ontario to provide high quality clinical, educational, and cultural experiences for our learners. These experiences expose them to the personal and professional rewards and benefits of life as a rural practitioner.
Positive clinical experience is what made Dr. Paul Miron, NOSM Francophone alumnus and current faculty member, decide to practise in Timmins. “I chose Timmins after spending my third year of the NOSM program here,” he said. “I had an extremely positive experience with my colleagues, and I enjoyed providing care in French to a French-speaking community.”
The third and final factor that encourages rural practice is targeted training during residency that prepares the individual to practise in a rural setting. NOSM offers high-quality and community-based residency education in the types of general specialties that Northern Ontario communities need the most.
NOSM alumnus Dr. Nichole Currie helped to pioneer NOSM’s rural family medicine residency program, and, upon completion of her residency in Temiskaming Shores, decided to stay and practise. “I knew that I wanted to pursue family medicine with obstetrics. Temiskaming Shores is a great professional location for me. By the end of my residency here, I was practising independently and doing C-sections. Plus, I love living in a Northern, small town.”
The principles used to encourage physicians to stay in the North are also working with other disciplines. Northern Ontario communities have seen notable increases in recruitment of other NOSM-trained health professionals such as dietitians, physician assistants, physiotherapists, occupational therapists, and other allied health professionals.
Just recently, I received an email from Dr. Chris Nash, a friend and supporter of NOSM. She said: “The conversation has changed. Before NOSM, when seniors got together they talked about their aging physician, or their trouble finding a doctor. Now, they argue about who has the best NOSM trained doctor!”
NOSM has been successful in improving access to health care in the North, but truly, Northern Ontarians are the reason for the School’s success. Thank you, merci and miigwetch to all of you for creating and sustaining a medical school in the North, for the North.
The “no brainer”: dietetic internship in the North
Almost 10 years ago, I stood in the office of then assistant deputy minister (ADM) of the Ministry of Health, Dr. Josh Tepper, a physician I know quite well. In my hands, I held a proposal for a Northern Ontario dietetic internship at the soon-to-be-created Northern Ontario School of Medicine (NOSM).
After explaining the proposal—which outlined significant recruitment and retention needs for dietitians in the North, the capacity and passion for clinical teaching in Northern Ontario, and an insufficient number of dietetic internship positions in the province, I said: “Josh, this is a no brainer.”
Although this was true, we were working against a gross misconception. At the time, the standing assumption was that all knowledge and wisdom—really, anything worth knowing—came from big cities.
Luckily, Josh is not a man to be swayed by misconception. That day, he agreed to fund what is now known as the Northern Ontario Dietetic Internship Program (NODIP)—a program that many believed would be the key to increasing access to dietetic services in Northern Ontario. Since then, NODIP (perhaps NOSM’s most appropriate acronym—I suspect many dietitians would recommend eating less dip) has not only gone on to be successful, but has reached heights that even we hadn’t quite imagined.
Since the program accepted its first students in 2007, NODIP has trained 87 dietetic interns in more than 35 communities in the North. Of those, 74 per cent have developed a taste for Northern Ontario and have chosen to practise in rural or Northern communities. That means that 64 dietitians are now increasing access to dietetic services in rural and Northern settings that have faced historical shortages.
Thanks to its reputation for high quality education, NODIP was recently selected by the Dietitians of Canada (DC) to be the first post-degree internship of all Canadian dietetic education programs to be assessed using the new Partnership for Dietetic Education and Practice (PDEP) Accreditation Standards (2014). During their visit, the inspirational success story of the program led a couple individuals at the visit—an observer from DC included—to fight back tears. Moved by the outstanding progress that the program has made in just a few short years, the guests came to realize that the seemingly unbelievable reputation was true.
What’s the source of NODIP’s success? If you ask the graduates, they’ll each extol a different aspect of the program.
For Sandra Stirpe working in oncology, it’s the structure of the program. “The clinical rotations are long enough to prepare you, and diverse enough that you have lots of exposure to many areas of dietetics.”
For Lisa O’Brien in public health, it’s the focus on the North. “For me, the North is where I wanted to be. NODIP focuses on two of my passions: Northern Ontario and public health. Through NODIP, I was able to pursue them both.”
For Hannah Gilbertson in long-term care, it’s the emphasis on interprofessionalism. “During our training, we were always encouraged to pool our talents with other professionals for better patient care.”
For Gillian Nearing in diabetes education, it’s the cultural awareness. “Because of my experience with the program, I have developed cultural awareness for the residents of Ontario. I think that’s something you wouldn’t necessarily get in a program based in a big teaching hospital.”
Although the decision to fund NODIP was a “no brainer,” the success of the program has as much to do with the heart as the mind. In the words of registered dietitian Denise Raftis, NODIP’s manager, the power of NODIP comes from the passion of the many people— patients, community members, staff, preceptors, and more—who play “an important role in a registered dietitian’s journey, and teach them to strive to change the landscape of dietetic care in the North.”
Thanks to the incredible dedication of Denise, her colleagues Lee Rysdale, Teena McLaren, and the team of community clinicians with which they work closely—Heather Parsons, Kim Fisher and Lindsay Sutherland – NODIP isn’t just following in the footsteps of those who came before it. Rather, NODIP is blazing a new path of excellence in health education that others—urban and rural—now look to emulate.
Examining Hard Rock Medical, loosely based on NOSM
What “loosely-based” really means
Derek Diorio, the co-creator of TVO’s critically acclaimed series Hard Rock Medical, was in Sudbury several years ago making a French television program. One day, Derek was listening to CBC Radio, where he heard about the Northern Ontario School of Medicine (NOSM) for the first time. He heard that NOSM was looking for a different type of medical student: people who were from the North, and wanted to stay here.
That day, the idea for Hard Rock Medical was born.
Knowing that Hard Rock Medical is loosely based on NOSM, people often approach me to ask: “Is the Northern Ontario School of Medicine really like what you see in the show?”
Truly, NOSM’s curriculum does provide the basic story for Hard Rock Medical. Derek and his co-creator Smith Corindia take real events, anecdotes and experiences from learners at the school and apply them to dramatic situations. This means that there are some foundational similarities between NOSM and Hard Rock U, the medical school of Hard Rock Medical.
One major similarity is that Hard Rock U, like NOSM, has a philosophy of inclusiveness. The medical students, community members, patients and faculty at both schools are representative of the demographics of Northern Ontario— including Aboriginal and Francophone people.
Medical students at NOSM and Hard Rock U spend much of their time learning outside of the classroom. It is said that the students of Hard Rock Medical “learn to practice medicine in the bow of a canoe, or 5,000 feet underground.” Similarly, NOSM medical students might help deliver a baby one moment and amputate a toe the next. They become the ‘jack (or Jaqueline) of all trades doctors required in smaller communities.
Like NOSM, the students at Hard Rock U are engaged with Northern Ontario communities. Medical students are taken on moose hunting trips, into sweat lodges and on hiking excursions. From their first year in both the fictional and the real world of medicine in the North, students learn what it means to live and practise in a smaller community, where your friends become your patients and your patients become your friends.
Of course, there are some differences. Romeo and Juliet, the two cadavers that the students in Hard Rock Medical worked with during Season 1, provide one important distinction between NOSM and Hard Rock U. At NOSM, we use all sorts of anatomy learning aids, but our activities, heavily dependent on technology, do not involve dissecting cadavers.
Next, our admissions process doesn’t quite match the panel interview depicted in the first season. At NOSM, we use a system called Multiple Mini Interviews (MMI) which assess the non-cognitive qualities of the applicant, such as empathy and cultural sensitivity. Applicants meet with 10 different interviewers—often faculty, researchers, current students and community members—for one-on-one interviews that evaluate their candidacy.
Lastly, Hard Rock Medical applies some creative license to ensure that the stories are engaging to the viewer. You might notice that the boundaries of medical professionalism in the show are extended farther than they are here at NOSM. For example, I can assure you that none of our faculty are performing vasectomies in our anatomy labs!
All jokes aside, I believe that Hard Rock Medical is helping to shine a spotlight on health-care challenges in Northern Ontario. The series does a stellar job of demonstrating that training new doctors for rural practice in Northern Ontario quite literally “takes a village.” From patients to community partners and faculty, NOSM students wouldn’t receive the quality education they do without the support of many people across Northern Ontario.
That’s why NOSM is celebrating 2015, our 10th anniversary year, with thanks. We extend our sincere gratitude to the many people who provide invaluable support in educating the next generation of health professionals with an affinity for the North. We couldn’t do it without you.
I’d also like to extend my congratulations to the cast, crew, and creators for their exceptional work and success in creating the humorous and heartfelt Hard Rock Medical: a show loosely based on your medical school.
Northern Ontario benefits from global collaboration
In addition to being a highly respected physician, educator, and researcher, Professor Paul Worley, Dean of Flinders University School of Medicine in Australia (and a dear friend and colleague of mine), has a way with words. A few weeks ago, he spoke eloquently about an issue that is near and dear to my heart.
“When I grow old and frail, I know I will be in good hands if I find myself in the care of medical students with whom I currently have the pleasure of working,” he said.
“But, depending on where I choose to settle as I age, I may not be in good hands,” Paul continued. “Because there may not be any hands at all. This is the reality for many people around the world. There is no one in their community to provide them with the medical care that they need and deserve.”
Silence swept across a room of nearly 300 international health professionals, educators, and researchers after Paul’s words. He was speaking at Muster 2014, a conference on global, communityengaged medical education hosted jointly by Flinders University and the Northern Ontario School of Medicine (NOSM).
The individuals in this audience had gathered in the remote community of Uluru (known previously as Ayer’s Rock) in Australia to discuss the ways in which we can work together to ensure that all communities around the world have enough “hands” to provide quality health care to everyone—no matter where they live.
You might be thinking: “The Northern Ontario School of Medicine was designed in, of, and for the North. Why has NOSM partnered with a school in Australia?”
Canadians and Australians have much in common. Both countries share a vast geography with low population density outside of the major urban centres. In both countries, access to health care in rural, remote, and Aboriginal communities has historically been limited, leading to poorer health outcomes.
In order to make a positive change to the health of the people of their regions, both NOSM and Flinders have taken a similar and distinct approach to medical education. Both schools focus their education and research on the priority health needs of the people and communities that they serve, and collaborate with these communities to provide relevant education and research. This is what we call social accountability and community engagement.
NOSM and Flinders are not the only organizations interested in reforming health professional education for underserved populations. Our two schools are part of the Training for Health Equity Network (THEnet), a network of medical schools that operate in poorly resourced, rural, remote, and underserved regions of Africa, Asia, Australia, and the Americas. We also work with the Consortium for Longitudinal Integrated Clerkships (CLIC), a network that promotes education wherein students learn to provide comprehensive care to patients through longitudinal learning— an educational opportunity that is new to medical education and that supports learners in choosing to practise in rural, remote, and underserved areas.
The importance of our collaboration with Flinders, THEnet, CLIC, and many other organizations remains consistent: with so much in common, we almost can’t afford not to collaborate. The health of our people is what is at stake. That’s why, every two years, NOSM and Flinders jointly host conferences to bring together educators, researchers, and health professionals working towards the same goals.
The most recent in this series of conferences was Muster 2014, held from October 27-30. The conference focused on four themes that are relevant to all international organizations dedicated to improving health in rural and remote communities: community engagement, social accountability, longitudinal learning, Aboriginal and rural health.
In all, there were seven plenary sessions, nearly 200 workshops and parallel presentations, and 25 academic posters. There were hundreds of opportunities for international collaborators to discuss their strategies, successes, and challenges in delivering socially accountable and community-engaged medical education.
I feel confident that together, hand in hand, the many organizations with similar goals can work together to change the reality of health in their regions for the better. My sincere hope is that, in the years to come, there will be no one in the situation that Paul Worley described, where there are no hands to provide people in rural and remote areas with the care that they need.
NOSM and Northern Ontario communities develop strategic plan
A few months ago, I was very excited to welcome three physicians from Japan’s Nagasaki University – Drs. Ryota Nakaoke, Shunsuke Imadachi, and Naoki Harada – to the Northern Ontario School of Medicine (NOSM). Like Northern Ontario, Hirado Island in Japan has struggled with physician recruitment and retention due to its diverse geography and relative remoteness. Our guests came to see if our school’s model could be implemented in Japan to influence recruitment and retention as NOSM has in Northern Ontario.
During their visit, we asked the physicians about their impressions of NOSM’s non-traditional approach to medical education and research.
“All Japanese want to be the same, equal,” Dr. Nakaoke said. “I came here to learn how NOSM ensures that all community sites are uniform. Over the last few days, I have learned that none of NOSM’s sites are the same.”
For a moment, it almost seemed as though Dr. Nakaoke was disappointed— that NOSM’s model wouldn’t work in Japan.
“Since I’ve been here, NOSM has shown me that different is good,” Dr. Nakaoke said, with a slow smile. “Each site is unique, which adds to the value of the students’ experiences. At NOSM, you celebrate the differences of each community. That is very impressive to me.”
Needless to say, it was a welcome relief that Dr. Nakaoke and his colleagues hadn’t travelled to NOSM for naught! I believe that what he witnessed was social accountability and community engagement at work – two of the very qualities about the school that make it proudly different from its more traditional predecessors.
Over the last few months, the associate dean of community engagement, Dr. David Marsh, and I—supported by our NOSM colleagues—have had the enormous pleasure of travelling across the North to speak with citizens of more than 50 unique communities. During the month of August alone, David and I travelled to Sundridge, Burks Falls, Huntsville, Bracebridge, Parry Sound, Espanola, Blind River, Thessalon, Sioux Lookout, Atikokan, Fort Frances, Emo, Kenora, Red Lake, and Deer Lake to discuss the future of the school. We also held five separate meetings in each of Thunder Bay and Sudbury. In itself, such an extensive process of community engagement is extremely unique for medical schools.
Our goal has been to collaborate with communities across the North in the development of our next strategic plan for 2015 to 2020 – our ‘2020 Vision’. During each community visit, we discuss the progress of the school to date and ask community members, including health professionals, to identify and rank the school’s priorities for the latter half of this decade. Each town has given us important insight into the unique needs of their community.
In Kapuskasing, community members emphasized the ongoing need for Francophone health-care professionals. Approximately 68 per cent of Kapuskasing’s population identify French as their first language, so the need for services in French is paramount.
In Marathon, physicians contemplated the future of health care in the North. There was great interest in the ways that NOSM could expand upon teaching health professionals to be positive agents of change in their communities. They discussed how health professionals could address social determinants of health through the practice of preventative, rather than reactive, medicine.
In Wawa, community members discussed the town’s aging population. More than 25 per cent of the citizens of Wawa are over the age of 65. Care of the elderly will become a matter of increasing importance in the years to come. Community members in Wawa were interested in hosting NOSM students with a specific interest in care of the elderly.
In Burks Falls, community members were concerned about access to health care. They said that there are people close by – north of Sundridge – who live without power. In their community, there was great interest in research that seeks to understand the challenges of health care delivery relative to one’s environment, particularly in remote areas.
In Chapleau at NOSM’s fourth Aboriginal Community Partnership Gathering, a passionate community member from Brunswick House First Nation discussed the importance of cultural competency – a priority of NOSM’s education since the school’s inception. As we continue to work toward eliminating barriers for Aboriginal peoples in accessing health care, cultural competency training must remain a priority.
These are but a very few examples of the community feedback we have recently heard. There have been countless other suggestions, all carefully recorded and considered as the plan develops.
As we refine our strategic priorities based on community feedback, I have been ever so grateful for the varied voices across the North that have helped us understand the diverse needs of Northern Ontarians with clarity. Like different and distinct brush strokes on a canvas, Northern Ontarians are painting a new picture of the future of health care that they hope becomes reality. As an equally unique organization here to serve you, NOSM’s role is to turn your hopes into plans.
In the words of our Japanese visitor, Dr. Nakaoke: different is good.
I am so excited to continue to work together with you for a healthier North. With so many heads together, I can’t wait to see what our future holds.
NOSM’s faculty inspire future health professionals to pursue rural practice
Rural medicine was considered urban medicine’s sad cousin for decades. To some urbanites, rural practitioners put their career out to pasture by choosing to practise in rural and remote settings, due in part to lack of involvement in health professional education. As a rural physician for over 30 years, I had witnessed first hand the excellence in those “pastures.”
When the Northern Ontario School of Medicine (NOSM), Canada’s first rural medical school, opened its doors, many of our rural colleagues welcomed the opportunity to teach in their own backyard. Today, NOSM learners – studying to become physicians, dietitians, physician assistants, physiotherapists, occupational therapists, audiologists and speech-language pathologists – are trained in more than 90 communities across Northern Ontario by more than 1,300 faculty members. Rural and Northern clinicians are showing themselves to be not only skilled clinicians, but also inspirational faculty members.
I’d like to share with you just a few of the countless tales I hear about the exceptional work of our faculty members.
NOSM graduate Dr. Ben Quackenbush recently fulfilled his dream of becoming a physician in his hometown of Little Current. Although it was his ties to Little Current that encouraged him to pursue rural medicine, it was his faculty who opened his eyes to both the challenges and rewards of rural medicine. “Medical education at NOSM was more than just a core education in a large, urban academic teaching centre with a few token, rural electives,” reports Ben. “I spent nearly 40 per cent of my time in rural communities such as Little Current, Blind River, Gore Bay and Parry Sound. My teachers and mentors during my education taught me the science of medicine, but also the fine art of rural family practice.”
Prior to his placement in the North, physiotherapist Tyler Moise from Cornwall, Ontario, had never been further north than Barrie. Through the expanded role of his preceptors, Tyler came to see the North as a place of exciting professional opportunity. “When you’re working in a smaller community, each person takes on a larger role than what you would see in southern Ontario,” Tyler says. “Seeing my preceptor’s expanded role and the huge impact she had on her patients inspired me to pursue a career in the North.” Upon graduation of his physiotherapy training, Tyler relocated to Sudbury to work at Health Sciences North.
NOSM resident Dr. Megan Bollinger, currently training in Sioux Lookout, speaks extremely highly of her exciting foray into rural residency. She likens her faculty to Swiss Army knives – compact bundles of widely diverse utility, with a variety of skills in obstetrics, anesthesia, orthopedics, emergency medicine and clinical care. “The rural clinicians I work with are incredible,” says Megan. “I have been taught to do procedures in the absence of a pre-labeled kit… MacGyverstyle medicine. I know that I will not be alone when I step into practice; that in rural settings, I can feel well supported.”
Serving the Francophone community of Sturgeon Falls, NOSM assistant professor and past recipient of the Excellence Award in Teaching Dr. Jean Anawati has been a long-standing advocate for training physicians sensitive to the needs of Francophone communities. Working one-on-one with learners, Jean combines patient consults with book learning to ensure learners get the most out of their clinical training. “As a physician and a Francophone, I feel it is my role to promote training and retention,” he says. “If we can train, we will retain.”
NOSM assistant professor Dr. Rick Senior was recently named the 2014 recipient of North Bay Regional Health Sciences Centre’s Jean Rochefort Award for his involvement with NOSM medical students and residents. NOSM learner Mélanie Patrie grins as she describes Rick’s influence on her: “Forty years from now when I look back at my favourite teachers, I’ll be thinking of Dr. Senior. If I am to become a great family physician in my life, I will owe much of that to him.”
If education is not the filling of a pail, but the lighting of a fire, it gives me great excitement to see NOSM’s passionate and award-winning faculty creating the sparks that are inspiring meaningful rural practice and education all across Northern Ontario.
I extend my sincerest gratitude to NOSM’s passionate faculty – absolutely indispensable agents of inspiration to our future generation of health-care professionals.
2020 Vision – NOSM’s next strategic plan
There was once a traveller in the Irish countryside looking to find his way to Dublin. “Excuse me,” said the traveller to a farmer. “I am lost. Could you tell me how to get to Dublin from here?” The farmer looked at the man, turned to gaze out over the fields, scratched his chin and said, “If you want to get to Dublin, I wouldn’t start from here.”
This Irish anecdote has been on my mind a lot lately. The farmer provides the traveller with an important truth. Success in reaching your goals depends on where you start. If our “Dublin” is equitable, quality access to health care for all Northern Ontarians, the Northern Ontario School of Medicine (NOSM) must continue to look at Northern Ontario as our starting point.
As we near the end of NOSM’s 2010 to 2015 Strategic Plan, we are beginning to assess next steps for reaching our Dublin. To achieve this, we are spending this year cultivating a rich dialogue within the school and with the people and communities we serve, particularly focused on educational excellence, outstanding research, relationship development, organizational effectiveness and expanded resources.
In January 2014, NOSM issued a call for expressions of interest to oversee the strategic planning process for the 2015 to 2020 Strategic Plan. To our great excitement, we were flooded with responses and established the Strategic Planning Advisory Committee (SPAC) – a group of 28 people that includes the perspectives of board members, Academic Council members, physicians, staff, faculty, learners, academics, administrators and community members. Those who were not selected to join SPAC have been invited to participate as Strategic Planning Reference Group members.
One aspect of our strategic planning involves learning from our experience. At NOSM, we emphasize continuous quality improvement, evaluating our work and recording our findings to ensure we continue to build on lessons learned.
We are also undertaking an environmental scan. Over the last few years, the Association of Faculties of Medicine of Canada (AFMC), the World Health Organization (WHO) and many other organizations have challenged medical schools to transform health professional education and research to meet changing societal needs. NOSM is the only Canadian medical school with a social accountability mandate. In order to continue to be a leader, we must accurately assess national and global issues and developments in our field. For these perspectives, we have already begun reaching out to other Canadian medical schools, international health professional institutions and others who may provide insight.
The most important aspect of our strategic planning will be to seek the perspectives of our collaborators so that we can advance together. Aboriginal communities, Francophone communities, health service partners, host universities, funders, local and provincial government officials, LHINs and many others will have a say in the future of the school. These collaborators share the dream of equitable, responsive health care for all Northern Ontarians, and their feedback ensures that we develop a plan for NOSM that will continue to meet their needs.
With a grin, I often say that our acronym NOSM stands for “No Ordinary School of Medicine.” Even though our history is relatively short, NOSM started in Northern Ontario, for Northern Ontario and has grown into something extraordinary. Our many successes – positive influence on recruitment and retention, innovative use of technology, unique distributed community engaged learning model and our long list of national and international awards – have created a global reputation that has only been possible because of the contributions of so many. With the new NOSM Strategic Plan, we hope to continue to work with Northern Ontarians to reach beyond extraordinary, charting our future with 2020 vision of the road before us.
Your input is so very important in setting the priorities for NOSM in the second half of this decade. Over the coming months, I invite you to visit nosmsp2020.ca to learn more, and to join the conversation about NOSM’s future. Please, make your voice heard, and ensure that the Northern Ontario School of Medicine continues to be accountable to you.
Postgraduate accreditation in NOSM’s non-traditional model
Traditions: they’re often something we cherish. Every year at this time, I think about the differences in holiday traditions between Canada and my native Australia. For some Canadians, December is associated with snowy landscapes, ice-skating, and hot chocolate. For some Australians, this is the time of year for the hot summer sun, surf, and the proverbial “shrimp on the barbie.” Whether the jolly, bearded, present-bearing man is wearing traditional winter boots or modern beach sandals, the spirit of the holiday season doesn’t change. We still celebrate with friends and family, and ponder our dreams for the following year.
Similarly, the Northern Ontario School of Medicine (NOSM) has demonstrated that there are many paths to the same metaphorical destination. Our model of distributed, community-engaged education and research may be unique, but it serves a very important purpose.
In order to ensure that medical learners across the nation are receiving quality education, medical schools undergo accreditation reviews. Accrediting bodies visit medical schools and examine their programs – from administration to educational material – to ensure that learners will be successful health professionals upon completion of their training.
In May 2014, NOSM will be the first new Canadian medical school in more than 30 years to undergo a full accreditation review for our postgraduate education (residency) programs. After completing the four-year MD program, Canadian physicians must undertake a residency program in order to be licensed for independent practice. During residency, they develop necessary skills and competencies through supervised practice, formal learning, and independent study.
Like all of NOSM’s programs, our postgraduate training is unique. No other Canadian medical school is a joint initiative between two universities. No other Canadian medical school provides training in more than 70 communities across a geographic area of 800,000 square kilometres.
NOSM’s postgraduate programs are also relatively new. Rather than taking the off-the-shelf approach and delivering residency programs directly modeled after those of other Canadian medical schools, NOSM has developed novel post-graduate education strategies to meet the needs of Northern Ontarians. All of our nine postgraduate programs – one in family medicine and eight in other major, general specialties like psychiatry and pediatrics – are offered because Northern Ontario communities need those types of physicians the most.
At other medical schools, residents complete their required clinical rotations in a big city teaching hospital – only steps away. In fact, accreditation standards were developed based on residency programs that are delivered in a single teaching hospital. But NOSM takes a different approach. We send our residents hundreds of kilometers across the province for their rotations. From Haileybury to Kenora, our residents are literally all over the map.
Our unique strategy accomplishes many important things. First, variety in practice location exposes residents to patients who require different types of care. Second, residents become versatile by adapting to new facilities and equipment, while also networking with different NOSM residents and faculty members. Third, through their educational licenses, residents provide a significant amount of patient care in communities across the North – in aged-care facilities, hospitals, family health teams, and more. Fourth, residents broaden teaching opportunities for community physicians, who would not otherwise have opportunity to interact with residents. And last, but certainly not least, our model weaves residents into the fabric of more than three dozen communities throughout the North in the hopes that a positive experience may win over the residents’ hearts and minds, and encourage them to return upon completion of their training.
For me, holiday traditions provide a light-hearted metaphor for varied approaches to medical education. Whether we reach for ear muffs or sunscreen, we protect ourselves from the elements. Whether metropolis or rural based, medical education should strive to graduate high-quality health professionals. In May 2014, NOSM staff, faculty, and community partners will showcase the exciting, non-traditional road of medical education that we are paving in the North. We may be on the road less travelled, but we’re proud to train the type of health professionals that Northern Ontarians need.
On behalf of NOSM, I wish you, your family, and your friends a happy and healthy holiday season.
Unsung health-care heroes: a spotlight on NOSM’s researchers
Our culture has a fascination with alter egos and hidden identities. With the name “Northern Ontario School of Medicine” (NOSM), the most obvious thing the School does is educate future physicians. Physicians, by the nature of their work, are seen as people who make a difference. They help the sick; they save lives. To some, physicians may even be seen as everyday heroes for the work they do.
Yes, NOSM certainly educates doctors and other health professionals. But what you may not know is that NOSM has another identity. We have a population of affiliates who are working hard to significantly impact the health of the people and communities in the North. NOSM’s (often) unsung health-care heroes are our researchers.
NOSM is the only school in Canada established with a social accountability mandate – a mandate of which we are very proud. The school must be responsive to the needs and priority health concerns of the people and communities of Northern Ontario. NOSM’s research initiatives are designed and implemented to do just that, to contribute to improving the health of Northern Ontarians. And this is a goal that could not be achieved without collaboration.
NOSM has reciprocal agreements with Sudbury’s Health Sciences North (HSN), Thunder Bay Regional Health Sciences Centre (TBRHSC), Lakehead University and Laurentian University, and with other hospitals/health services, colleges and universities in the North. The research equipment in our labs exists in complement to our partners – all of NOSM’s equipment was purchased with the vision of housing resources to supplement the equipment of our partners and to encourage a team approach to improving health outcomes. Our researchers are welcome in labs across the North, and researchers from other facilities are welcome at NOSM.
At NOSM, we seek meaningful collaboration amongst our many stakeholders. Each year, we grant the Dean’s Summer Medical Student Research Awards to encourage medical students to get involved in research. This benefits three distinct populations: students, who are able to hone their research skills and interact on a different level with NOSM’s faculty; faculty, who enjoy fresh perspectives and varied opportunities for teaching; and most importantly, the people of Northern Ontario, for whom research initiatives at NOSM are intended.
Post-doctoral fellow Dr. Eli Nix and principal investigator Dr. Marina Ulanova have been researching Haemophilus influenzae type A, a strain of bacteria that can cause permanent disability, including brain damage and deafness. According to their research, this bacteria has higher incidence in aboriginal communities in northwestern Ontario, and Nix has set his sights on uncovering why. Nix is currently working with the Meno Ya Win Health Centre, the Métis Nation of Ontario, and many other communities and health care centres across the North to try to address this serious health concern while at the same time developing meaningful relationships between NOSM researchers and First Nation communities in the region.
In the northeast, another type of bacteria is causing concern: cyanobacteria, commonly known as blue-green algae. NOSM researcher Dr. Joe Eibl is working to develop a new, faster method of screening lakes and waterways for blue-green algae blooms. Exposure to cyanobacteria can cause a wide array of significant health effects, which range from nausea and vomiting to kidney toxicity. Eibl’s goal is to be able to circulate information about affected waterways to the public faster, to avoid exposure to the bacteria by the people who use Northern Ontario lakes for drinking water and recreation.
Across the whole of the North, chronicdisease prevention and management are substantial issues faced by patients and health-care service providers. Unfortunately, this is to a larger extent than in other geographic locations. In order to address this priority health concern, I am thrilled to announce the addition of Dr. Sheldon Tobe to our complement of researchers. Tobe is the new NOSM/Heart and Stroke Foundation Research Chair in Aboriginal and Rural Health. His research focuses on improving cardiovascular outcomes, with the primary goal of preventing heart attack and stroke – initiatives that I am very excited about.
In the words of NOSM researcher Dr. Carita Lannér, “we have ground-breaking, innovative work happening in Northern Ontario. It doesn’t all have to happen in Toronto or Ottawa at the big universities. Up here, people have innovative ideas that we can bring to fruition.” With a vision of expanding the research culture of Northern Ontario, we have further strengthened our team with the addition of a new assistant dean of research, Dr. David MacLean. A well-respected researcher himself, MacLean will be responsible for aspects of planning, development, and implementation of a research strategy that supports NOSM’s ever-expanding work in socially accountable research.
I would not consider myself a budding vocalist. So when I say that NOSM’s unsung health-care heroes are our researchers, I am exceptionally thankful that the Northern Ontario Medical Journal is a print publication. As you can imagine, the initiatives I have outlined here are just the tip of NOSM’s research iceberg. The next time you hear about new drug technologies, new screening methods, new curriculum developments, think of the unsung health-care heroes, and give thanks for researchers who made health promotion their life’s work.
I know I do.
Communities and students collaborate across the North
Allow me to introduce an unlikely pairing: Canada’s national sport and an Australian. Since my time as dean of the Northern Ontario School of Medicine (NOSM), I have received my fair share of surprising news. But, I have to admit that the story of the grass-roots naming of the Strasser Cup will be one of my foremost NOSM memories.
Since the school’s inception, students from NOSM’s Sudbury and Thunder Bay campuses have come together to play a casual game of shinny hockey. But in 2008, the students decided to incorporate two new elements to the tradition. First, they created a trophy for the game (“for bragging rights,” they admitted afterwards) and second, they named the tournament the “Strasser Cup.”
When I heard this news for the first time, it triggered an intense emotional response in me that, as an Australian, hockey had yet to produce. I felt surprised, honoured, and humbled by their decision to name the tournament after their “fearless and ever-influential dean,” as they described me. After the shock of the news subsided, I thought with a laugh, “This has to be a first – an ice hockey tournament named after an Aussie!”
Although I was still bashful about the name, I realized that the name, the students and the school had one important quality in common: they were all unique.
Our students’ first exposure to the unique qualities of NOSM is likely in discovering our admissions criteria. Our school was the first Canadian medical school to adopt non-traditional recruiting that focuses on holistic, well-rounded students with connections to rural and remote communities. We wanted to shift the recruitment focus away from traditional admissions tests that have not been validated for rural, remote, aboriginal and francophone students. The logic behind our unusual strategy was to recruit students with a natural capacity for empathy and community engagement. This, we felt, was much more difficult to teach than the science and math required in the medical profession.
Often, what draws students to NOSM is the experience-driven nature of our education. Students in all of our programs are dispersed throughout clinics across Northern Ontario very early in their education at NOSM. Our learners quickly become integrated into their host communities by being involved in sweat lodges, smudging ceremonies, family dinners, community barbeques, hunting parties and recreational sport leagues across the North. Our learners are invited to become part of the fabric of their host communities with a sincerity that is rare in many urban centres.
While in these communities, NOSM learners are encouraged to be so much more than traditional students. NOSM believes strongly in ‘service learning,’ an exciting element of the school’s curriculum that incorporates student volunteerism in their communities across the North. Whether it is volunteering with at-risk youth or engaging with high school students, NOSM learners discover that in order to improve the health of the community, you must understand the community.
But it’s not just the learners who benefit from NOSM’s deviation from the traditional model of education. Since the integration of the school throughout the North, many preceptors have excitedly explained that hosting NOSM learners ensures that they keep up-to-date with best practices, newly-released medical information and constantly-evolving innovations in medical technology. Learner engagement drives a culture of academic inquiry that challenges preceptors to remain on the leading edge of medical developments – a culture that many professionals thought was only possible in urban centres. In addition, recent years have demonstrated a particular rise in physician recruitment throughout the North due to the opportunities in academia and research that NOSM provides. As we dreamed, NOSM’s presence has become a powerful recruiting tool.
During graduation season, I can’t help but be reminded of the awe that I often experience at the hands of NOSM’s students. As he addressed his peers at last year’s graduation ceremony, Dr. Sean Sullivan, student representative, said, “A common phrase is that ‘it takes a village to raise a child.’ At NOSM, it takes half a province to raise a medical student.” This year, as with every year, I am honoured to be part of an organization that values collaboration so wholeheartedly that it involves half a province in the education of future health providers. I am honoured to be chosen as the namesake of the annual MD hockey tournament. And, I am honoured to be involved in an institution that marries the needs of the students with the distinct needs of their communities.
My sincerest congratulations to all 2013 graduates.
NOSM residents serving and learning across the North
When I arrived in Northern Ontario a decade ago to undertake the founding of Canada’s first new medical school in 30 years, I’m sure many wondered if we weren’t overreaching when we set a goal to improve “the health of the people of Northern Ontario.” But now, barely 10 years later, I believe we have, in fact, met that goal.
Consider that if you or a loved one have ever been a patient in your local hospital, known a labouring mother giving birth to a child, had a family member undergo orthopaedic surgery or taken your child to a pediatrician, chances are you’ve had a direct experience with a Northern Ontario School of Medicine (NOSM) resident. After receiving their MD degree, all physicians must undertake further education in a specialty before they can practise independently. Post-MD education is called residency. Thus a NOSM resident with a medical degree and an educational licence practises medicine under the supervision of a fully-licenced physician, a NOSM faculty member who is part of a vast network of support for NOSM residents across the North.
Many NOSM residents are graduates of the NOSM MD program. Other residents come to Northern Ontario from medical schools across Canada and around the world. At any given time throughout the year, NOSM has approximately 130 residents working in more than 40 partner communities in the North.
Recognized most often by their enthusiasm to learn and the long hours they spend caring for patients in clinics, doctors offices and hospital wards, our residents across Northern Ontario are working hard to learn how to provide high quality medical care in a system that remains plagued by doctor shortages.
These new physicians are training to be specialists with either the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada. As part of their medical training, physicians who have completed undergraduate medical school are required to choose an area of specialization for continued training before completing their certification examination.
Residency programs are available across the country at each of Canada’s 17 medical schools. NOSM’s nine residency programs now include: family medicine, anesthesiology, public health and preventive medicine, internal medicine, general surgery, obstetrics and gynecology, orthopedic surgery, pediatrics and psychiatry.
To secure residency positions, all final-year medical students – from Newfoundland to British Columbia – apply through the Canadian Resident Matching Service (CaRMS). This service provides students an electronic format to apply for residency programs in all the disciplines offered at all medical schools across the country. Interviews with medical student applicants are held in January and February. Medical students then rate their program of choice, and residency program representatives rate their candidates of choice. These choices are then electronically computed by a CaRMS algorithm to deliver a match between student and program.
In highly competitive residency programs, this can mean that an applicant’s match is less likely to occur on the first attempt. Since the school’s first graduation in 2009, three graduating classes of NOSM learners have matched 100 per cent to their residency program on the first attempt, showing that our NOSM MD graduates are highly sought after by some of the country’s most competitive residency programs.
CaRMS matches are officially announced in early March. This is a much-anticipated event for NOSM students, as well as staff and faculty at the school. The successful match rate of NOSM students is one which has not been seen by another institution in over a decade – a feat of which we are very proud!
For some residents, specialty training that is not yet available to them at NOSM or in Northern Ontario means having to leave home to become certified in more highly specialized disciplines of medicine such as Plastic Surgery, Dermatology and Ophthalmology and other subspecialty disciplines. NOSM focuses on the generalist, foundational specialities which are more suited to the Northern needs.
Residency training lasts a minimum of two years in duration and can last up to five to six years, or more, depending on the chosen discipline. Residents are remunerated based on their years of training, increasing with each year in their respective program.
Spring is always an exciting time of year for medical students at NOSM. I want to publicly extend my best wishes to all CaRMS applicants and hope that they are successful in matching to a program that best fits their goals and professional aspirations.
“NOSM’s nine residency programs now include: family medicine, anesthesiology, public health and preventive medicine, internal medicine, general surgery, obstetrics and gynecology, orthopedic surgery, pediatrics and psychiatry.”
Rendez-Vous 2012 participants recommend changes
After two years of preparation by many, Rendez-Vous 2012, five world conferences in one, proved to be one of this year’s most exciting international conference opportunities for health professional education. Hosted by the Northern Ontario School of Medicine (NOSM) from October 9 to 14, Rendez-Vous 2012 welcomed more than 850 delegates from nearly 50 countries and six continents, including 486 delegates from North America, 124 delegates from Africa, 100 delegates from Australia, 80 delegates from Asia, 51 delegates from Europe and 37 delegates from South America. This conference truly brought the world to Northern Ontario.
Rendez-Vous 2012 began with an exciting keynote presentation by Dr. Timothy Evans titled, Does Praxis make perfect? Evans, dean of the James P. Grant School of Public Health at BRAC University and International Centre for Diarrhoeal Disease Research, Bangladesh, discussed the long history of medical professional shortages around the world, and how global public health education must be transformed to address these shortages.
In addition to Evans’ presentation, there were many notable highlights throughout the conference, including 14 plenary speakers, a student-led panel discussion, and even a special Improv session (titled Lessons in Regaining Humanity through Improv Theatre) put on by NOSM’s own faculty member Dr. Bryan Macleod—to name but a few. The mix of over 400 oral presentations, poster presentations, Personally Arranged Learning Sessions (PeArLS), and interactive workshops was outstanding. Every session engaged participants in thought-provoking discussions relative to a shared commitment to the conference’s theme of “Community Participation in Education, Research and Service.”
If you were unable to attend RendezVous 2012, you are still able to watch many archived presentations by visiting www. rendez-vous2012.ca. I encourage you to take a look!
During their stay, some of the delegates chose to participate in the Conference on the Move portion of Rendez-Vous 2012. Conference on the Move featured four bus excursions that allowed participants to discover the distributed communities and NOSM’s community partners throughout the North. On the way to the final destinations of Marathon, Sioux Lookout and Sudbury, participants were able to visit a variety of health-care providers, community organizations, and cultural and historical sites. For some, it was also their first opportunity to see snow falling from the sky, a moose in the back of a pick-up truck, or the breathtaking display of leaves turning colour for which Northern Ontario is known during that time of year.
Those who stayed in Thunder Bay while Conference on the Move was under way had the opportunity to explore and meet some of NOSM’s Thunder Bay and area community partners on the Portage Express. Delegates were able to experience aboriginal and francophone culture, take part in interactive historical displays, and trek in the wilderness, as well as witness health education, research, technology and even search and rescue in action. More than 30 locations in Thunder Bay and the surrounding areas received Rendez-Vous 2012 delegates, with some locations such as Thunder Bay Regional Health Sciences Centre (TBRHSC) and St. Joseph’s Care Group welcoming delegates to various departments across the organization.
One very important outcome of the Rendez-Vous 2012 conference is a series of recommendations prepared by the participants of the conference titled the Thunder Bay Communiqué: New Ways of Thinking. This communiqué is being disseminated by the Rendez-Vous 2012 co-hosting organizations as a challenge to individuals, organizations and governments for implementation. A synopsis of their recommendations includes:
• Supporting underserved communities to grow in their ability to identify and voice their health needs and work to guide institutions educating health practitioners in providing targeted training that will address these needs
• Communities must be part of generating solutions to their own health-care needs and enabled to be actively involved in implementing these solutions
• The Melbourne Manifesto and subsequent World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel should be implemented and reported on by governments
• Health systems should be strengthened through universal coverage leading to improved access
• The effectiveness of systems such as capitation, fee-for-service and pay-for-performance should be rigorously assessed as the basis for an evidence based approach to health-care financing
• Health services should be delivered wherever possible by locally-based health-care teams that include generalist practitioners who are empowered to deliver and co-ordinate comprehensive care and to integrate the implementation of disease based programs where they exist, and
• The improvement of the health of communities requires the empowerment and involvement of women and improving their safety and social, educational and economic standing.
A full version of the Thunder Bay Communiqué can be found on the Rendez-Vous 2012 website at www.rendez-vous2012.ca.
I can’t say enough about the people and our partners who contributed to this important conference. On behalf of Sue Berry, conference co-chair, and myself, congratulations, well done, and thank you.
World medical experts converge on Northern Ontario
This Dean’s Column has a venerable tradition— dating back to 2004, in fact, but for me, this one is particularly exciting because it’s the first one I’ve written as a Canadian citizen!
We first arrived in Canada from our native land, Australia, exactly 10 years ago, and I must admit that, as a life-long Australian, it took some time to begin thinking of Canada as “home.”
But on Canada Day, I travelled to Ottawa with my wife Sarah and our three youngest children to take the Affirmation of Canadian Citizenship. Just hours later, we were joining the Canada Day celebrations with thousands of other Canadians on Parliament Hill. All of it – from the concerts to the fireworks – was quite spectacular, breathtaking, really. For many reasons, it was a Canada Day we’ll never forget. Now, truly, Canada is the Strassers’ new “home and native land!”
All of which makes me even prouder to welcome the 800 or so experts in health professional education who will converge on Thunder Bay this coming October. It’s no exaggeration to say that, for the better part of five days in October, Northern Ontario will become the global centre for medical education, research, and clinical practice in the emerging science of rural and remote medical education.
To have the world at our doorstep is truly a once-in-a-lifetime event, and I want to take this opportunity to invite all Northern Ontario health professionals to join us at Rendez-Vous 2012. I guarantee that you’ll enjoy an unforgettable learning experience! For registration info (and specifics on attending virtually via the internet) visit our special website at www. rendez-vous2012.ca
As one of Canada’s newest citizens, I’m quite keen to show off our beautiful Northland. In keeping with our School’s commitment to distributed learning and our Social Accountability mandate (two precepts for which NOSM is becoming quite famous, actually) we won’t be content to let our distinguished guests sit on their – ah – laurels for the entire five days.
Instead, we’ll bundle them all into buses for the trip to our Sudbury campus, with numerous stops in First Nations, towns and villages along the way—NOSM’s true campus.
It’s quite an experience, as anyone who has ever made the trip well knows. (And what a shame that it’s no longer possible to go by rail, VIA Rail having elected to bypass Thunder Bay years ago.)
This bus trip, challenging by its very length, is one of the very first group experiences shared each year by our incoming undergraduate learners and, with any luck at all, we’ll get a glimpse of spectacular fall colours as we journey over the top of Lakes Superior and Huron in one group, while a second contingent of hardy travellers is on the more northerly route across Northern Ontario.
We’ve dubbed this gathering, which is also reflective of NOSM’s international dimension, Rendez-Vous 2012. It is, in fact, five international gatherings rolled into one, making it an unprecedented opportunity for the world’s foremost thinkers in the field to assemble in one place to exchange ideas and best practices from medical schools the world over.
The popularity of this idea is already apparent. While we had anticipated 200 or so abstracts (synopses for papers that might be presented) at Rendez-Vous 2012, we in fact received 440!
A NOSM peer review group narrowed this number down to the 412 papers from 43 different countries (including submissions from 60 students) that will actually be presented.
Each day of the conference will feature a plenary session, follow-up workshops, hands-on clinical sessions, telemedicine sessions, and much, much more.
Rendez-Vous 2012 coincides with NOSM’s own academic week, enabling our undergraduate learners to attend, and we’re also encouraging our residents to do so.
This opportunity to engage with the world’s best will, I am certain, influence Northern Ontario’s future medical professionals in the ineffable way that good teaching always does, resonating through the decades to come, improving clinical practice and technique that will, in the words of NOSM’s original mandate “improve the health of the people of Northern Ontario.”
See you in Thunder Bay!
“Rendez-Vous 2012 is, in fact, five international gatherings rolled into one, making it an unprecedented opportunity for the world’s foremost thinkers in the field to assemble in one place to exchange ideas and best practices from medical schools the world over.”
NOSM signs of success abound
In September 2012, we will mark the seventh anniversary since the Northern Ontario School of Medicine (NOSM) opened its doors. From that time, NOSM has grown from being recognized as Canada’s newest medical school to one of the world’s medical schools to watch. Guided by a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario, the school’s distinct model of distributed, community-engaged learning and research is working as intended. NOSM-trained health professionals are now practising across the North.
Signs of NOSM’s success are appearing in communities across the region. One such community is the City of Dryden, where three alumni from NOSM’s MD and family residency programs have chosen to begin practising. Drs. Adam Moir, Bruce Cook, and Dan Cutfeet are three of Dryden’s newest family physicians. Not unlike other places experiencing physician shortages, Dryden suffered a predicament in 2000 when a number of family physicians retired. Soon after, the City hired Chuck Schmitt as physician recruiter for the community. “The creation of the Northern Ontario School of Medicine is the best thing to happen to the community of Dryden,” explained Schmitt. “It has raised the profile of our community, allowed us to showcase opportunities to medical students, and increased the number of locums wishing to work in Dryden.” Schmitt also explained that although financial incentives and support assist in physician recruitment, it is also more sustainable to attract physicians who already have an affinity for rural medicine and living in the North. According to Schmitt, this is why the NOSM model of community-engaged learning has worked so well for recruitment in Dryden.
In the coming months, for the first time in nearly seven years, the community of Chapleau will no longer depend mostly on medical services provided by travelling locum physicians. NOSMtrained physicians Drs. Doris Mitchell, Kendra Saari, and Stephen Saari will be practising in the community of more than 2,000 people. Their inspiring story is profiled in this journal.
Other NOSM alumni are starting practices in communities such as Atikokan, Sault Ste. Marie, and Bracebridge – and the list is growing. Sixteen NOSM-trained family medicine physicians have recently set up or joined practices in Sudbury, and another 18 have done the same in Thunder Bay. All of these physicians have either trained at NOSM in the MD program and then have undertaken residency at either NOSM or at another medical school, or have come to Northern Ontario as recent MD graduates to train in NOSM’s Family Medicine program. And already, NOSM-trained health professionals are becoming leaders, researchers, and clinical teachers who are changing the future of health care in our communities.
Signs of success can be seen in other NOSM programs. Thirty-one alumni from the school’s Northern Ontario Dietetic Internship Program are now practising across Northern Ontario. For example, Marla Parker, a NOSMtrained dietitian, is now calling the community of Moose Factory home. She practises at the Weeneebayko Area Health Authority, where she is responsible for the dietary needs of all in-patients at the hospital. She is also very actively involved in community nutrition, an interest she developed when she was training at NOSM. Parker’s arrival in Moose Factory is a significant step towards an increase in preventative medicine.
This June, the first class of physician assistants graduates from the Consortium of Physician Assistant Education, which is a Physician Assistant (PA) degree program delivered collaboratively by NOSM, the University of Toronto, and the Michener Institute for Applied Health Sciences. Britton Sprules, a PA graduate, has chosen to practise in Thunder Bay. She is currently working at the Superior Family Health Organization, which is comprised of four physicians, and provides a wide variety of medical services to the community alongside two of the physicians.
Rising to the challenge
If NOSM alumni are blazing the trail, our current learners are certainly rising to the challenge. For the third time, this year’s graduating class of NOSM MDs has matched 100 per cent in the first round of the Canadian Resident Matching Service (CaRMS). Each medical student is required to continue his or her training through a residency program upon graduation from the MD program. The annual CaRMS match identifies which program each physician will attend. Having each of our MD graduates matched in the first round of CaRMS speaks to the fact that NOSMtrained physicians are sought after by residency programs across the country.
As another academic year comes to a close, I extend congratulations to NOSM’s fourth-year MD students, residents and dietetic interns who are completing their training, and also to those applicants who have received acceptance letters for the 2012 entry class to NOSM. Thanks to the hard work of learners, staff, and faculty, the Northern Ontario School of Medicine is realizing its vision of Innovative Education and Research for a Healthier North.
For more information about NOSM and the school’s signs of success, please visit www.nosm.ca/signsofsuccess.
Exceptional research projects undertaken across the North
When the Northern Ontario School of Medicine (NOSM) buildings were constructed at Laurentian University (NOSM’s East Campus) in Sudbury and at Lakehead University (NOSM’s West Campus) in Thunder Bay, they were designed to accommodate state-of-the-art research laboratory facilities that complemented equipment and other laboratories in their respective communities. Research is an integral part of NOSM, and is included as an essential component of the school’s vision: Innovative Education and Research for a Healthier North.
As with NOSM’s education programs, the school’s research program is guided by social accountability. The key theme of NOSM research is tackling the questions of importance to improving the health of the people of the North. Dr. Greg Ross, NOSM’s associate dean of research, notes that, “We have researchers looking at rates of diabetes, heart disease, and some cancers that are much higher in Northern Ontario, compared to the rest of the country. We also have researchers who are looking at pollution from local industry, and its effects on the Exceptional research projects undertaken across the North Roger Strasser Founding Dean, Northern Ontario School of Medicine health of our populations.”
When you think of research, it may be easy to conjure up a room full of test tubes, beakers, and lab coats. While some research does take place in laboratories, for many of NOSM’s more than 1,000 distributed faculty members, research is conducted in communities across Northern Ontario.
Drs. Aaron Orkin and David VanderBurgh, for instance, have researched and developed a collaborative process to deliver and evaluate a culturally-specific first aid education program for members of Sachigo Lake First Nation, a remote Aboriginal community in northwestern Ontario. This research was conducted with input from members of the Sachigo Lake First Nation, and focused on scenarios that affect the members of this remote community. Collaboration is a key component to successful partnerships in research for NOSM.
In the past, the school has collaborated with researchers from its host universities, members from the Academic Health Sciences Centres, industries, and communities across the North. NOSM faculty member Dr. Ashley Scott and Dr. Greg Ross are working with the mining company Xstrata Nickel to produce microalgae at the company’s Falconbridge site. Harvesting the microalgae is exploratory work for producing carbonneutral fuels for the biofuel industry.
Research projects underway at NOSM are not only potentially beneficial to the people of Northern Ontario, but also to the medical students currently enrolled at NOSM. Each year, the Dean’s Summer Medical Student Research Awards are given to NOSM medical learners, and provide the opportunity for learners to work on research projects with NOSM faculty members. In the past, recipients have worked on projects identifying groups at risk for community acquired pneumonia in Northern Ontario, evaluating the risk of invasive Haemophilus influenzae disease in patients with chronic renal failure, and looking at pain management strategies for knee surgery patients in a hospital setting.
Each year NOSM hosts the Northern Health Research Conference (NHRC), which encourages NOSM learners, staff, and faculty across Northern Ontario to share their research work and progress. This year, the NHRC will be held on May 10 and 11, 2012, in Thunder Bay. Simultaneously, Thunder Bay will host the seventh Canadian Oxidative Stress Consortium (COSC) conference, which will bring together Canada’s leading researchers in the vast field of oxidative stress. Dr. Greg Ross notes that “hosting both the NHRC and COSC conference in Thunder Bay is an exciting opportunity for NOSM and Northern Ontario. It is solidifying Northern Ontario as the go-to place for innovation and exciting research opportunities.”
NOSM is not the only organization taking a proactive approach to encouraging an environment fuelled by research. Most recently, you may have noticed both the Sudbury and Thunder Bay hospitals are now recognized as academic health sciences centres. These organizations are enhancing their culture to better emphasize patient care, research, community support, and networks. Dr. Michael Wood, vice president of research at the Thunder Bay Regional Health Sciences Centre (TBRHSC), explains that “Research contributes to the bettering of patient care in that it potentially provides additional options for the prevention, diagnosis and treatment of conditions that affect patients.”
Developing a network of research partners, and creating hubs of research excellence encourages collaboration and enriches learning through an evidence-based approach to medicine. “Collaborative research is recognized widely as the appropriate way to address the biggest problems that confront health care. The most important problems in health care are simply too complex, and impact so many different aspects of society. Collaborative research promises to have the most impact,” says Dr. Wood.
At NOSM, the close integration of clinical experience, education and research allows our learners to approach patient care in a way that is beneficial in the everyday practice of medicine.
NOSM to host major world conference next year
The year 2012 is quickly approaching, and it promises to be an exciting one for the Northern Ontario School of Medicine (NOSM). Next October, NOSM will host Rendez-Vous 2012, a major joint world conference in Thunder Bay. Rendez-Vous 2012 will attract more than 500 delegates from around the world to reflect on and share experiences relevant to a common interest in the conference’s theme: Community Participation in Education, Research and Service.
Leading Rendez-Vous 2012 are the organizing committee co-chairs, Kaat De Backer, executive director of The Network: Towards Unity for Health (TUFH), and Sue Berry, assistant dean, integrated clinical learning at NOSM. Organizers have named this conference “Rendez-Vous” in homage to the pioneering voyageurs who once travelled the rivers and lands across Northern Ontario. This conference will combine the Wonca World Rural Health Conference and The Network: Towards Unity for Health annual conference, as well as the next NOSM-Flinders Conference on Community Engaged Medical Education, the Consortium for Longitudinal Curricula (CLIC) and the Training for Health Equity Network.
These six partnering organizations and groups share an appreciation for innovation in medical and health professional education. TUFH is a global network of health professional schools and health service agencies with a focus on integrating the population and individual health and approaches to education and service. NOSM is a member of this international network that strives to promote higher education for health professionals, collaborative health services, educational institutions and research.
In 2005, NOSM was opened in Northern Ontario to address physician shortages in rural locations across the North. The NOSM model draws on the collective experience and policy statements of the Working Party on Rural Practice of Wonca, the World Organization of Family Doctors. The Wonca Working Party includes rural practitioners from each of the world’s regions – Europe, Asia, Africa, North America, South America, Australasia/ Pacific – who are committed to improving rural health care around the world.
NOSM partnered with Flinders University School of Medicine in 2008 to host the International Conference: Community Engaged Medical Education in the North (ICEMEN) in Northern Ontario, and then again in 2010 to host the Global Community Engaged Medical Education Muster in the Barossa Valley of South Australia. Rendez-Vous 2012 will be the third conference in the NOSMFlinders series with a focus on community engaged medical education.
NOSM adheres to the World Health Organization’s (WHO) definition of the Social Accountability of Medical Schools as “the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region and the nation that they have a mandate to serve.” NOSM is a member of THEnet: Training for Health Equity Network (THEnet), which is a collaboration of medical schools in under-resourced, rural and remote regions of Africa, Asia, Australia and North and Latin America. All of THEnet’s members share a core mission to increase the number, quality, retention, and performance of health professionals in underserved communities.
NOSM is also a member of the final hosting organization, the Consortium for Longitudinal Curricula, also known as CLIC. The faculty members from medical schools around the world comprising this group are currently, or are in the process of developing, implementing and studying the clerkship model wherein medical students undertake clinical clerkships which involve comprehensive care of patients over time; continuing learning relationships with the patients’ clinicians; and achieving core clinical competencies across multiple disciplines simultaneously. Rendez-Vous 2012 will mark the first time a health conference of this magnitude is held in Northern Ontario.
This is an opportunity for NOSM and its partners to showcase the school’s distinct model of distributed community engaged learning to the rest of the world.
I encourage all health professionals across the North to plan to attend and consider submitting abstracts to Rendez-Vous 2012 on October 9-14. Visit www.rendez-vous2012.ca for details. I hope to see you there!
O-Week charts direction for 64 new M.D. students
Orientation Week—or “O-Week” as we affectionately call it—for incoming M.D. students at the Northern Ontario School of Medicine (NOSM) provides a unique beginning to a distinctive program. We have just welcomed our seventh class of incoming undergraduate medical students. These learners recently participated in the specially-designed orientation, where they experienced meeting their fellow classmates for the first time, were introduced to NOSM, and began to familiarize themselves with many of the school’s staff and faculty who will contribute to their success over the next four years of their M.D. education.
During O-Week, students become aware of their obligations and the expectations of professionalism that come with their new roles as medical learners. It is during this time that the learners begin to grasp the full significance of the journey that will follow, and the role that, as physicians, they can and will have in the health care of others. Former NOSM associate dean of learner affairs, Dr. Gerry Cooper, commented that, “even upon graduation, our medical learners have looked back and reminisced about their Orientation Week, and what an important marker it was in their time at NOSM.”
The weeklong event began on Monday, August 22, when learners participated in a “meet and greet” at their respective campuses at Lakehead University in Thunder Bay and Laurentian University in Sudbury. On the first evening, the new medical students enjoyed receptions hosted by the school’s Aboriginal Affairs Unit, where they learned more about the school’s social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario. Students heard about their upcoming placements in rural and remote Aboriginal communities, as well as how elders and the school’s Aboriginal Affairs Unit are available to support all learners throughout their time at NOSM.
On the Tuesday (August 23), all of the students of the incoming M.D. class travelled to North Bay, where the East Campus and West Campus students met each other in person. The entire group visited the new North Bay Regional Health Centre, and enjoyed meeting with community partners. A dinner was hosted by the school’s Francophone Affairs Unit, which continued the exploration of social accountability and the importance of medical education that addresses the needs of the North’s diverse cultural groups.
Beginning with the charter class in 2005, the oath ceremony remains an integral portion of O-Week. This ceremony introduces learners to the Hippocratic Oath, its meaning and importance, and inspires the learners to successfully complete their four years of medical education with the ethical principles of the oath in mind. The learners recite the Hippocratic Oath upon successful completion of their M.D. education at a hooding ceremony during convocation.
There are many people who help make O-Week possible for incoming medical students. Community members, organizations, municipal leaders, returning students, faculty members and staff all contribute to the weeklong event, with the school’s Learner Affairs Unit and Community Engagement portfolio taking leadership roles.
This year’s incoming M.D. class, like all previous M.D. classes admitted to NOSM, reflects the school’s commitment to recruiting students who have a strong aptitude for practising medicine in Northern urban, rural and remote communities. More than 90 per cent of the students in this class come from Northern Ontario. Eight per cent of the learners have selfidentified as Aboriginal people and 20 per cent have self-identified as Francophone. In addition, this year’s incoming class has seven students who have completed their Masters degree and one who has completed a Ph.D.
Orientation Week provides a jampacked introduction into the demanding life of a medical learner and the unique characteristics of a medical school guided by the vision of Innovative Education and Research for a Healthier North. On behalf of everyone at the Northern Ontario School of Medicine, I welcome our new and returning medical students to an exciting new academic year of scholarship, camaraderie, and success.
A time for celebration
This time of year is particularly electric at the Northern Ontario School of Medicine (NOSM). For the third time, we have celebrated the graduation of medical students from NOSM’s M.D. program, and the completion of training from NOSM’s family medicine residency program. A real sense of excitement surrounds the ceremonies commemorating these joyful occasions.
Adding to the sense of celebration this year is the achievement of several additional special milestones by our learners. For the first time, NOSM M.D. charter class graduates who have been undertaking family medicine residency at NOSM are now completing their training and are fully licensed physicians. In other words, there are now individuals who have successfully completed the full spectrum of medical education at NOSM, a journey that began with entry into NOSM’s M.D. program in 2005, and has now finished with the completion of NOSM’s family medicine residency training six years later in 2011.
There are also graduates of NOSM’s M.D. program who have completed their family medicine residency training at other institutions, while still others continue their training in other specialty programs at NOSM and elsewhere. And there are still others who came to NOSM’s postgraduate program two years ago from other medical schools, and who are now ready to begin practicing family medicine.
We not only celebrate the completion of programs by our students and residents, but also the excellence of, and dedication to medicine made by our learners. In May, NOSM was advised that our residents – comprised of the charter class graduates and those who came to NOSM from other medical schools across Canada – ranked first among Canada’s 17 medical schools in overall performance on their Medical Council of Canada (MCC) Part II qualifying examinations. What an achievement! This group of NOSM residents achieved a 100 per cent pass rate and ranked first in the category of legal, ethical and organizational aspects of the practice of medicine, with above average standing in the categories of patient interaction and data acquisition. Additionally, the entire group of NOSM’s charter class M.D. graduates – whether they chose residency at NOSM or went on to pursue residency at other medical schools across Canada – did remarkably well. Ranking fourth nationwide compared to other medical schools, this group of graduates from 2009 also achieved a 100 per cent pass rate. NOSM’s learners are excelling nationally, and all of Northern Ontario should be proud.
Please join me in congratulating all of these residents, and wish them continued success as they prepare to open their practices, many in hospitals and health centres across Northern Ontario.
Excellence is also demonstrated by the graduating M.D. class of 2011. Early this year, there was much excitement when the School received notice that all undergraduate medical students in this year’s graduating class successfully matched to Canadian residency programs on their first attempt. This is the second time in more than ten years that NOSM is the only Canadian medical school to have all students matched in the first round of matches of the Canadian Residency Matching Service (CaRMS).
Please join me in congratulating the class of 2011 on their achievements, and wish them well as they move on to the next stage of becoming fully-trained physicians.
The exceptional accomplishments of NOSM’s learners underscore their commitment to excellence, the effectiveness of the School’s medical education programs, and the high quality of clinical training received from health-care professionals across Northern Ontario. NOSM’s distinct model of education and research is not only working, but the outstanding quality of education received by our learners in a curriculum that combines classroom and community learning is indisputable. Our learners are leaders.
In my first dean’s column eight and a half years ago, I promised Northerners that we were about to create “a medical school like no other.” In less than 10 years, I am happy to say that bold promise has come true. Physicians, health-care professionals, faculty, staff, donors, and supporters across the North – all of us who believe in NOSM’s vision of Innovative education and research for a healthier North – can today celebrate our learners. Congratulations one and all.
Simulation innovation at NOSM
The Northern Ontario School of Medicine (NOSM) is known for its many firsts. NOSM is the first new medical school in Canada in over 35 years, the first medical school in Canada to be established with a social accountability mandate, and the first medical school in the world in which all medical school students undertake a community based, longitudinal, integrated clerkship. Perhaps another lesser known first is that NOSM was also the first medical school in Canada to have “Harvey,” a cardio-respiratory mannequin. This full-sized mock patient simulates 25 heart diseases at the touch of a button. But already, Harvey seems “old hat” in light of more recent developments in simulation. In the short six years that the School has been open, researchers and educators in simulation-based learning have devised new programs, devices and techniques that are attracting the attention of educators across the world.
Simulation in health professional education involves representing a real-world situation in enough detail to train students. It does not require the simulation to create the illusion of reality; rather, it requires that those who are involved know that it is not real, but still behave as if it were. Simulation is used increasingly in health professional education for a number of reasons, the most important of which is that it creates educational opportunities without placing real patients at risk.
There are various types of simulation used at NOSM, including our Standardized Patient (SP) program. SPs are community volunteers trained to provide the medical history, physical symptoms, and the behaviours and reactions of real patients. NOSM involves SPs throughout the first two years of its M.D. program as well as for Objective Structured Clinical Examinations (OSCE) and, increasingly, in other programs, such as the Medical Council of Canada (MCC) exams.
Task trainers are models of a particular part of the human body that allow students to learn specific clinical skills such as suturing, airway management and chest tube insertion. A third type of simulator used by the School are mannequins, ranging from basic airway life support (ALS) models to the Laerdal SimMan 3G that can exude blood, sweat and tears, as well as talk and represent a wide range of patient management scenarios. NOSM also uses onscreen simulators such as virtual patients and laparoscopic surgery trainers.
NOSM’s most extensive use of simulation training so far was in January 2010 when third-year NOSM students and Canadore College’s first-year nursing students shared a weekend of simulationbased learning sessions. Hosted at the West Parry Sound Health Centre, the student groups rotated through a series of simulation stations dealing with practical issues associated with disaster management. Stations provided experiences with triage, shock, airway management, and managing difficult fractures, to name a few. By using simulation, all stations allowed students to develop practical and hands-on skills in the scenarios they encountered.
Last year also saw NOSM teaming up with Sudbury Regional Hospital to host an Anesthesia Boot Camp for third-year Family Practice Anesthesia residents. This was the longest continuous use of simulation at NOSM to date. Running all day for five days, it provided residents with an opportunity to develop skills in recognizing and appropriately responding to situations in and around anesthesia. The boot camp also allowed learners to develop skills in dealing with stressful and difficult situations, and to acquire crisis resource management and leadership skills in a dynamic team environment. The course will be held again in the summer of 2011, but with twice the number of participants from our region and beyond. Such is the interest in this innovative program that we are already turning away some applicants from outside of Northern Ontario.
The next major simulation event will be during the medical student academic week on March 22, 2011 and after that, the Northern Lights MiniSUN conference May 13-14, 2011, both in Sudbury. The latter will bring presenters and participants together from the Northern Ontario Simulation in Healthcare Network (NOSHN), as well as experts from across North America. NOSHN is another innovative undertaking supporting collaboration between all of the universities, colleges and, increasingly, hospitals that use some form of simulation-based learning in Northern Ontario.
Simulation research is also unfolding with Dr. Rachel Ellaway’s team developing the OpenLabyrinth virtual patient system that is now being used by institutions across the globe, and the Health Services Virtual Organization (HSVO) Integrated Simulation platform that allows simulation activities to be run across multiple simulators in multiple locations. NOSM medical students have been working collaboratively with their counterparts at McGill University in Montreal, the University of Ottawa, and the University College Cork in Ireland. This platform is attracting interest from institutions such as the United States Veterans Administration and CAE Systems (the world’s and Canada’s largest simulator manufacturer).
Medical education is about preparing high quality health professionals for practice. Simulation allows us to create training scenarios without having to use real patients, while retaining all of the essential elements to support the graduation of world-class physicians and health professionals. NOSM is making increasing and innovative use of simulation to address core goals of patient safety and quality care for people of Northern Ontario. The simulation team encourages all those interested to come and see what simulation is doing at NOSM!
“In the short six years that the School has been open, researchers and educators in simulation-based learning have devised new programs, devices and techniques that are attracting the attention of educators across the world.” – Roger Strasser Founding Dean, Northern Ontario School of Medicine
NOSM Hosts the Medical Council of Canada, Part II
There are many steps involved in becoming a fully qualified doctor. Many years of education – a bachelor’s degree, medical school and residency – must be completed before becoming licensed to practice as a physician. The Northern Ontario School of Medicine (NOSM) undergraduate medical curriculum lasts four years and includes classroom learning, clinical education and community placements. Learners graduate with an M.D., making them licenced doctors, but they still need to complete their residency before they can open their own practice. NOSM offers residency training in family medicine and eight other major general specialties.
Any medical graduate seeking to practice in Canada must pass the Medical Council of Canada (MCC) qualifying examination in order to be licensed for unsupervised practice. The MCC examination is divided into two parts. Last year, NOSM became an examination site for the MCC Part I. The MCC Part I is taken in the last year of medical school and is a one-day, computer-based test that learners must pass in order to be accepted into residency and begin their supervised clinical practice in a postgraduate training program.
Part II of the MCC is a three-hour long exam taken in the second year of residency that evaluates the residents’ skills, knowledge and attitudes essential for starting their own clinical practice. I am happy to announce that NOSM recently reached another milestone of achievement by becoming an official exam site for Part II of the MCC.
The MCC Part II consists of a series of five- and ten-minute clinical testing stations. At each station, the examinee (resident) receives an introduction to a case and examines a standardized patient. These standardized patients are community volunteers who are trained prior to the exam to act out or relay specific health information. The resident then reviews their medical history, conducts a physical examination, and addresses the patient’s issues. Residents may be asked to answer specific questions about the patient, interpret x-rays, and/ or make a diagnosis for issues related to pediatrics, obstretics and gynecology, preventative medicine and community health, psychiatry, and surgery, as well as other areas that are essential for competence in general medicine and health care.
Recently held in Sudbury, the exam had residents move through 14 stations with a different clinical case at each location. The patient encounters were supervised by faculty members who observe the residents and grade them on an evaluation form. This particular exam required 22 examiners, all of whom were NOSM faculty from both Sudbury and Thunder Bay.
Two MCC Part II exams were held on one day. The morning exam consisted mostly of NOSM residents, including some of the NOSM Charter Class graduates. The exam in the afternoon was for residents of other programs, including several from the University of Toronto Faculty of Medicine. It will be approximately six weeks before the results of the exam are known.
“I am happy to announce that NOSM recently reached another milestone of achievement by becoming an official exam site for Part II of the MCC.” – Roger Strasser Founding Dean, Northern Ontario School of Medicine
Once requirements are met and both exam parts are passed, the newly-minted physician receives a qualification in medicine known as the Licentiate of the Medical Council of Canada (LMCC). The LMCC is required for doctors to open a practice in Ontario and across Canada.
The MCC Part II exam that NOSM recently held at the Cancer Centre of Sudbury Regional Hospital was an outstanding success. This exam is particularly complex, involving physician faculty members as examiners, trained volunteers as standardized patients in various scenarios, volunteers to coordinate staff, and many examinees from NOSM and beyond. Congratulations and job well done to Dr. Laura Piccinin, deputy registrar, Dr. Mike Anol, chief examiner, and the many faculty, physicians, and community members involved in the smooth running of the exam.
What a year it’s been!
It is hard to believe a full year has passed since the Northern Ontario School of Medicine (NOSM) celebrated the first graduation of M.D. students, and the completion of its first group of family medicine residents from the Family Medicine Residents of the Canadian Shield program. And what a year it has been! A second M.D. class has just been hooded, a new group of residents is now ready to practice medicine and a third class of dietetic interns are about to complete their internship. The school continues to have many reasons to celebrate.
Over the past academic year, NOSM has received considerable accolades for its leadership in distributed, communityengaged learning and health research. In February, the Ontario Library Association bestowed two awards in recognition of NOSM’s Health Science Library’s innovative programming and collaborative approach to adopting an open source library system. In April, NOSM was the recipient of the 2010 Rural Medical Education Award granted by the Society of Rural Physicians of Canada in recognition of its success in graduating physicians heading toward a career in rural medicine. And last, but not least (drum roll, please!), NOSM recently received top international honours with three 2010 Global Best Awards granted by the International Partnership Network for the successful relationships the school has built with Aboriginal community partners.
These accolades and the achievement of many other milestones are the result of the vision, commitment, teamwork, and leadership of NOSM’s many contributors – including three exceptional individuals who are leaving senior posts at the school.
Dr. Marc Blayney, who has served as senior associate dean at the East Campus in Sudbury, and as associate dean of community engagement, will be retiring from NOSM in June 2010. Since his arrival in 2005, Dr. Blayney has been a passionate advocate for medical education in the North, and the partnerships he has worked hard to develop with the diverse communities of Northern Ontario have been key to the school’s mandate to be socially accountable to the people and communities of the North.
Dr. Joel Lanphear, who has provided leadership in the role of associate dean of undergraduate medical education since 2005 and senior associate dean for NOSM’s West Campus in Thunder Bay, is also retiring from his posts this June. Dr. Lanphear has worked tirelessly in the planning, development and implementation of NOSM’s distinctive undergraduate curriculum and its accreditation.
Finally, Dr. Wayne Bruce, the associate dean of continuing health professional education, will soon be retiring from NOSM. Dr. Bruce has demonstrated exceptional leadership in bringing together people involved in a wide variety of programs, projects and educational initiatives across Northern Ontario.
I personally extend a heartfelt thank you to these three special, ground-breaking associate deans for their significant contributions to Canada’s first medical school for the 21st Century.
With these departures come vacancies, and I am pleased to say that NOSM has successfully appointed three well-suited individuals to assume these vacant associate dean positions.
Dr. David Marsh, a provider of clinical leadership and strategic planning as a medical director for addiction, HIV/AIDS, and Aboriginal health services for the Vancouver community, has been appointed to serve as the new associate dean of NOSM’s community engagement portfolio. Dr. Marsh’s Aboriginal ancestry, coupled with a firsthand engagement with distinct populations, ideally positions him to respond to the needs of Northern Ontario’s diverse cultural groups.
Dr. Lisa Graves will be taking up the post of associate dean of undergraduate medical education. Dr. Graves comes to NOSM from McGill University with a full understanding of medical education programming. Her interests in vulnerable populations, medical education and research, as well as her fluency in the French language, will support the many components of NOSM’s distributed community-engaged learning model of instruction among the region’s distinct cultural and linguistic groups.
Finally, I am pleased Ms. Sue Berry will be taking up the post of interim associate dean of the continuing health professional education portfolio. Ms. Berry, a physiotherapist who grew up in Kenora, and whose previous position was director of health sciences and interprofessional education at NOSM, will be responsible for delivering integrated and comprehensive continuing education and professional development for health professionals.
It is a pleasure to welcome Dr. David Marsh, Dr. Lisa Graves, and Sue Berry to their new positions. The range of skills, breadth of experience and level of commitment to NOSM’s distributed, community-engaged learning and health research demonstrated by each of these individuals will undoubtedly contribute to the continued success and global leadership demonstrated by the school.
Please join me in acknowledging both the departing and incoming associate deans – I am profoundly grateful for the dedication demonstrated by all.
NOSM contributes to knowledge economy
Since taking up the post of Dean of the Northern Ontario School of Medicine (NOSM), I have been greatly impressed by the spirit of co-operation of so many who support and assist the school through its many stages of growth. Much has been accomplished since NOSM opened its doors to the first class of students entering the M.D. program in 2005. In previous columns I have highlighted the school’s significant academic achievements, program successes and innovative education model—all of which have raised the profile and recognition of NOSM across Canada and around the world.
These successes have risen from the power of participation. From the very beginning, physicians, the host universities, politicians, and community supporters of every kind lobbied for the creation of a made-in-the-North medical school that would respond to the unique health challenges of the region. The result is an innovative, distributed, and communityengaged school with a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario.
The rewards of fulfilling the dream of a medical school for Northerners are far-reaching. A report recently released by the Centre for Rural and Northern Health Research (CRaNHR) at Lakehead University in Thunder Bay and Laurentian University in Sudbury tells of the multiple benefits resulting from the school in health care, education, and in communities across Northern Ontario.
The findings of the impact study, entitled, Exploring the Socio-Economic Impact of the Northern Ontario School of Medicine, were summarized in a public release of the report on February 9, 2010 by the principal researchers, CRaNHR directors Dr. Raymond Pong and Dr. Bruce Minore, and Laurentian University Economics Professor, Dr. David Robinson.
Among the key findings is the multimillion dollar annual impact NOSM has on the economy of Northern Ontario. In the 2007-2008 fiscal year, for example, the school spent $37 million, and, according to the report, the recirculation of these funds generated between $67 million and $82 million of economic activity. Communities across Northern Ontario, particularly those with teaching sites where NOSM learners receive clinical training, benefit financially from their participation in the school.
These contributions, say the researchers, are important as they mark qualitative shifts in the economy. Employment opportunities in health care, education, teaching and administration lead to less reliance on a traditional resource-based economy toward one that is more knowledge-based.
The widespread movement to bring a medical school to Northern Ontario has also impacted job growth. NOSM funds over 230 full-time equivalent (FTE) positions, and it is estimated that the school supports a total of 420 – 510 FTE positions in Northern Ontario through various economic effects. Stipendiary fees are also paid to more than 670 physician teachers in multiple teaching and research sites in over 70 Northern Ontario communities where NOSM learners undertake clinical training in hospitals, health centres and family practices.
Beyond the numbers, important as they are as a measure of economic growth, is the pride in NOSM that exists across the region, and other social indicators that are part and parcel of NOSM’s story. Community leaders, and others who participated in interviews for the report, share the belief that the school exists because they fought for it. Individuals in practically every community visited for this study anticipate that NOSM graduates will relieve the chronic shortage of physicians across Northern Ontario, and that Francophone and Aboriginal medical learners will respond to the needs of these important cultural groups. There has been much heart-felt investment made in NOSM and its commitment to health care and research in the North.
The Northern Ontario School of Medicine has impacted the region in other significant, though perhaps less tangible, ways. Interviewees in the study reported that NOSM has had a positive impact on the school’s host universities -Lakehead and Laurentian -and affiliated health-care institutions. The recruitment and retention of physicians, health providers and specialists has also increased in community hospitals and health centres across the region, they report, thanks in part to the expanded teaching and research opportunities available with the medical school. Health practitioners also benefit from the infrastructure upgrades and improved telecommunications systems at NOSM community learning sites.
The Exploring the Socio-Economic Impact of the Northern Ontario School of Medicine report demonstrates that, in a few short years, NOSM has impacted health care, contributed to job growth and aided economic development. In addition, it has also served as an example of how Northern communities, when empowered by a shared goal, can make dreams come true.
I invite you to read CRaHNR’s full report by visiting the school’s website at www.nosm.ca.
The making of a medical school
Starting a new medical school doesn’t just happen. The Northern Ontario School of Medicine (NOSM) became a reality as a result of the commitment, determination, and hard work of many individuals and organizations over many years. On the heels of celebrating NOSM’s milestone achievements of full accreditation and first graduations, it is time to tell the story of the school’s beginning. A peer reviewed McGill Queen’s University Press publication, The Making of the Northern Ontario School of Medicine, does just that. Written by 12 contributing authors, this highly readable collection provides a diversity of viewpoints about the challenges and rewards faced by those who insisted on creating a school for the North, by the North and in the North.
NOSM is not an ordinary medical school. In fact, most things about NOSM are atypical and extraordinary. The new medical school came about because of the need to address the chronic doctor shortages in Northern Ontario. Northern mayors, physicians, university administrators, academics, community leaders and political representatives lobbied the provincial government to fund a custom-made medical school. This would be a medical school that responds to the particular health challenges of the region. The model of medical education required to fulfill this vision would call for new thinking and a pioneering approach.
The timing of the social, political and academic forces underway in Northern Ontario that led to the government decision to establish NOSM coincided with other developments occurring in medical education around the world. The concepts of community-based learning (learning in context) and social accountability in medical education gained momentum in the latter part of the 20th century. Developments in both information and medical technology occurred. These innovations were woven into a distinctive model of distributed medical education and health research designed to contribute to improving the health of the people and communities of the North. NOSM’s governance and organizational structure, admissions process and curriculum have been specifically created to address the particular health demands of smaller, rural and diverse populations.
There are many parts to NOSM’s story. The development of NOSM owes much to the strong history of physician training in Northern Ontario provided by the Northwestern Ontario Medical Program (NOMP) and the Northeastern Ontario Medical Education Corporation (NOMEC). These programs, attached to the medical schools at McMaster University and the University of Ottawa, respectively, provided medical residents with clinical learning opportunities to work alongside practicing physicians in Northern communities.
The success of NOSM’s community-based model is contingent on the participation of physicians and health-care providers, many of whom participated in the NOMP and NOMEC models, and continue to provide a high standard of clinical training to NOSM learners. In The Making of the Northern Ontario School of Medicine, Dr. John Mulloy, a family physician and contributing author, provides insight into how distributed family medicine programs across Northern Ontario developed a broad base of physician-teachers who would provide the foundation for NOSM’s clinical placements. Today, NOSM’s unique model includes the participation of over 70 learning and research sites across Northern Ontario. In communities across the region, NOSM medical students, residents, dietetic interns and other health science students are living and learning in context as part of the school’s distinctive curricula.
The Making of the Northern Ontario School of Medicine tells the story of Canada’s first new medical school of the 21st century. This is a story in which the people and communities in Northern Ontario are an integral part. It is also a story of a made-in-Northern Ontario solution, which is garnering international recognition for its pioneering approach to addressing rural health needs. Health organizations and medical educators around the world are looking at NOSM as an effective solution to increase the number of highly qualified practitioners in under-serviced areas. Key features of NOSM—community engagement, a diversity of learning experience, incontext clinical training opportunities and a social accountability mandate—are now leading developments in medical education internationally.
In November, at book launches in Sudbury and Thunder Bay, and in December in Toronto, co-editor Dr. Geoffrey Tesson and I were very fortunate to publicly announce The Making of the Northern Ontario School of Medicine. It is extremely rewarding to celebrate the collective achievement of the book and NOSM with so many who have contributed to the school’s beginning.
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English copies of The Making of the Northern Ontario School of Medicine are available at Chapters, Chapters Online, directly from McGill Queen’s University Press, and through NOSM’s website. A French version of the book will be available in early 2010. Ten percent of all book sales will be donated to NOSM’s Student Bursary Fund.
Celebrating a shared dream
This past academic year has been a particularly special year for the Northern Ontario School of Medicine (NOSM). In May and June, I was pleased to witness and take part in the first graduation of students from the M.D. program, and the first completion of residency training by 20 residents from NOSM’s Family Medicine Residents of the Canadian Shield (FMRoCS) program. These celebrations, which unfolded over the course of a week (May 28 to June 5, 2009), clearly demonstrated the level of interest and depth of commitment Northerners have for their new medical school and the men and women who are our learners.
Hundreds of people gathered in Thunder Bay and Sudbury to commemorate these firsts during public celebrations; many more participated in welcoming students and staff to various community events across Northern Ontario.
Of special note were the hooding ceremonies. This time honoured-tradition acknowledged the achievements of our M.D. students and, through the administration of the Hippocratic Oath, reminded them of the obligations and high standard of behaviour of their chosen profession. Following opening remarks by guest speakers Dr. Peter Neelands in Thunder Bay and Dr. Bill McMullen in Sudbury, students were called before the Associate Dean of Undergraduate Medical Education, Dr. Joel Lanphear, to receive their hoods. In one of my most rewarding moments as NOSM Dean, I had the honour of congratulating each and every new graduate, the very first physicians to complete the M.D. program at the Northern Ontario School of Medicine.
In addition to the planned ceremonies, numerous touching and occasionally unexpected moments enriched the extraordinary distinction of these milestones.
One pleasant surprise came when one of the two buses travelling to learner-hosting communities made an impromptu visit to Sacred Heart School in Espanola. Why the stop? Charter Class graduate Todd Spencer, who was travelling on the bus, wished to say hello to his two sons studying there and draw them into the excitement of the celebrations. This stop delighted his boys, and the students and the staff of the school, especially when it was discovered that a picture of Todd was included on the side of the bus, which was branded with a montage of NOSM images. This stop also attracted local media attention when a reporter, shopping at a local corner store, saw the NOSM bus come through town!
Meanwhile, along the northern Highway 11 bus route, NOSM students and staff also visited communities to show their appreciation for learning opportunities during clinical placements in the M.D. program. In Kapuskasing, the NOSM contingent was deeply impressed by the generosity extended by the family of one of our physician teachers. In yet another surprise, this second bus, also branded with images of NOSM and Northern Ontario, toured the streets of Kirkland Lake and stopped at the front door of another graduate’s family home. Graduate Tracey Ross’ mother was delighted at the sight of her daughter accompanied by a retinue of friends and colleagues descending onto the lawn. In each and every community, in Thunder Bay to Sudbury, and all stops in between, NOSM visitors were extended the warmest welcome and hospitality, and presented with delicious meals, gifts and words of congratulation.
As dean of NOSM, I personally took great joy in receiving, on behalf of the Northern Ontario School of Medicine, two works of original art from the Charter Class. These metal works each depict lone trees reaching out into the Northern sky, and to me, they capture the spirit of the first M.D. graduates. The unique individuals making up NOSM’s Charter Class have been true leaders and established the way for future physicians with a particular understanding of the North’s health determinants and its distinct populations. And now these individuals are themselves reaching new heights as they continue their education in postgraduate programs in Northern Ontario and across the country.
Of course, milestone celebrations would not have been complete without the direct participation of our students and residents. Graduating physicians Safiya Adam and Jonathon DellaVedova, and completing residents of the Family Medicine program, Aaron Orkin and Michael Bodnar gave moving, passionate, and sometimes hilarious accounts of their medical education and training in communities across Northern Ontario.
The accolades from public officials at all levels of government underscore the widespread support for NOSM. Via video messages delivered throughout the milestone celebrations, Premier Dalton McGuinty, and Minister of Health and Long-Term Care David Caplan joined a host of mayors, ministers, and the presidents of Laurentian and Lakehead Universities to pay tribute to NOSM’s first graduates and residents.
The week of NOSM’s milestone celebrations saw family, friends, staff, faculty, clinical physician teachers, allied health professionals, community partners, politicians, donors, and others from across Northern Ontario come together in a chorus of congratulations. The collective optimism for the future of these pioneering physicians and the health of people and communities across the North was unmistakable and exceptionally inspiring to all who participated. These celebrations, including many special moments and numerous generous acts of support, were a fitting realization of the NOSM dream shared by so many.
A Year of Milestones at the Norther Ontario School of Medicine
It is truly a year of milestones at the Northern Ontario School of Medicine (NOSM).
The multiple successes taking place at this time signal important developments in the school’s evolution. In achieving these benchmarks, NOSM moves closer to its mandate of contributing to improving the health of the people and communities of Northern Ontario by graduating physicians with a unique understanding of Northern health challenges.
This spring, NOSM celebrates the firstever graduation of medical students from it’s M.D. program. Our charter class members have been true pioneers by breaking ground for the ongoing graduation of physicians who are innovative, resourceful, sensitive, and who understand the rigours and rewards of medical practice in Northern, rural, and culturally diverse settings. These newly minted M.D. graduates will go on to postgraduate training for two or more years before entering medicine as independent practitioners.
Standing alongside the graduation of our charter class students is the first completion of residents from NOSM’s Family Medicine Residents of the Canadian Shield (FM RoCS) program. Twenty fully qualified physicians trained in Northern communities are now preparing to practice family medicine or undertake additional training. From this time forward, a similar number of fully qualified physicians, with an understanding of Northern health challenges, will complete their training from this newest family medicine program in the country.
Another cause for celebration is the achievement of full accreditation status. The Northern Ontario School of Medicine now takes its place among all other accredited medical schools in North America. This has been a multi-year process that involved the participation of many faculty members, staff and students.
As we prepare for the upcoming graduation celebrations, I extend a heartfelt thank you to clinical physician teachers, health professionals, staff, faculty, and our many community partners and supporters. It is your contribution to the advancement of the school that ensures that we all benefit from a model of medical education committed to improving the health of the people of the North. Please join NOSM in celebrating a historic year of milestones for which all of Northern Ontario can be proud.
The realization of a dream
You have to give credit to the Charter Class of the Northern Ontario School of Medicine (NOSM) M.D. program. These students are a remarkably courageous group of people who signed on for a brand new medical school, with brand new faculty members, a brand new curriculum, and buildings which, when the students started, were still construction projects. Over the last four years, these students have been trailblazers every step of the way. As we enter spring 2009, their goal is in sight as they prepare for their final set of exams and then for graduation.
The first M.D. graduations will be historic occasions for all of us in Northern Ontario. Many people across the North came together and worked hard, first to attain government support, and then to turn the dream of a Northern Ontario School of Medicine into a reality. We are all looking forward to celebrating this groundbreaking achievement – the graduation of our Charter Class members from the NOSM M.D. program.
In fact, we will have a double celebration this May/June. We will be celebrating the completion of training of the first NOSM residents from the Family Medicine Residents of the Canadian Shield (FM RoCS) program as well.
This is truly exciting. We are planning a whole series of special events and celebrations to mark these very important milestones.
The Northern Ontario School of Medicine serves as the faculty of medicine of Lakehead University in Thunder Bay and the faculty of medicine of Laurentian University in Sudbury. Each class of students in the M.D. program has a mix of students registered with Lakehead and students registered with Laurentian. NOSM medical students will graduate with a joint M.D. Degree from Lakehead and Laurentian Universities. The Lakehead registered students will graduate at a Lakehead convocation and the Laurentian registered students will graduate at a Laurentian convocation.
This year, the entire Charter Class will be present for the Lakehead convocation, which will take place on the morning of Saturday, May 30, and the whole class will be present for the Laurentian convocation on Friday, June 5. In addition, there will be public celebrations in the afternoon following each morning convocation. These public celebrations will provide an opportunity for the involvement of everyone who contributed so much to the establishment and the success of the Northern Ontario School of Medicine.
The celebrations will continue during the intervening week. Two thirds of the Charter Class members have indicated their desire to undertake the journey between Thunder Bay and Sudbury by bus. There will be two routes: “Bus A” will travel to Sudbury via Marathon, Wawa, Sault Ste. Marie, Manitoulin Island, and Parry Sound; while “Bus B” will make the journey via Geraldton, Kapuskasing, Timmins, Kirkland Lake, Timiskaming Shores and North Bay. These are communities in which the students have undertaken some of their clinical learning during the M.D. program.
Each visit will give the students an opportunity to express their appreciation, recognizing the contribution to their learning experiences of the physician clinical teachers and other health-care professionals, as well as the wider community. These visits will give each community the opportunity to be part of the Northern Ontario first graduation celebrations.
Of course, these communities are only a sample of the over 70 communities in which NOSM students and residents may undertake part of the clinical learning. Unfortunately, we have only a week, which means that opportunities are being taken at other times to recognize these other communities and to hold celebrations across the North.
The FM RoCS program has five base sites across the North; however, all family medicine residents will be together for their last academic session of the year in Marathon on May 28 and 29. We will take the opportunity to celebrate completion of training for the first group of NOSM family medicine residents in Marathon on May 28.
Another source of celebration for NOSM is the recent notification that the School has been accorded unconditional Full Accreditation. This is a crowning achievement in a multi-year process aimed at meeting all expected standards. The Committee on Accreditation of Canadian Medical Schools (CACMS) and the Liaison Committee on Medical Education (LCME) both approved NOSM’s status. From here on in, NOSM can proudly stand alongside other medical schools in North America. Congratulations and thank you to everyone who over the last six years worked so hard to achieve this milestone. The timing is perfect for the Charter Class who will graduate from a fully accredited medical school.
As we prepare to celebrate these historic milestones, I am ever mindful of the role of physician-teachers, faculty members, staff, and community contributors who have helped us achieve the fulfillment of our pan-Northern dream: the first graduation of Northern–trained M.D. graduates and family physicians who are skilled and able to pursue their medical careers anywhere, but who have a special knowledge of and desire to provide health care here in Northern Ontario.
As Founding Dean, I extend a profound thank you to all who contributed in blazing the way for the ongoing graduation of physicians who are innovative, culturally sensitive, and fully acquainted with the rigours and rewards of health care in Northern, rural and culturally diverse settings.
NOSM’s commitment to continuing ed
The Northern Ontario School of Medicine (NOSM) has created a unique model of medical education that seeks to address the specific health-care needs of all Northerners. One cornerstone is our community-engaged distributed model of medical education. Another is the commitment the School has made to continuing professional education for faculty, physician teachers in the communities, health professionals and the general public. Inter-professional education is premised on the notion that education spans the entire life cycle of health professionals practicing in Northern Ontario.
NOSM engages with communities and health practitioners in order to develop and deliver education initiatives with a panNorthern perspective, one which serves the diverse needs of medical practitioners and educators, and promotes healthy living programs.
The recent publication of the 2008-2009 Continuing Education and Professional Development Calendar encompasses a diversity of presentations, workshops, seminars, and symposia, all moderated by experts in their respective fields and designed to enhance clinical skills, improve teacher training and broaden understanding of health issues. The diversity of listed topics reflects the range of health determinants in Northern Ontario that require attention.
The School also partners with community organizations in hosting conferences on health matters critical to Northerners. Recently, NOSM collaborated with the Northeastern Ontario Stroke Network in hosting its annual conference. A multidisciplinary group of health professionals explored the latest developments in stroke research, management and rehabilitation. The School also hosted this year’s Annual Retreat for the Ontario Psychiatric Outreach Program (OPOP) at which mental health experts discussed mental health services, support, and education for remote and rural communities with populations to which NOSM is mandated to be accountable.
In keeping with its social accountability mandate of engaging communities in the School’s development, this year’s Continuing Education and Professional Development Calendar represents the effort of over 11 planning groups that worked collaboratively with NOSM Continuing Education Professional Development staff. A combination of feedback and an open request for topics and speakers were important additions to the success of the continuing education and professional development itinerary. Wideranging participation ensured that the program would reflect the needs of faculty members and community-based health professionals in their various capacities as teachers, health-care providers, and administrators.
New features in this year’s calendar include more professional development courses and events which are delivered live, via video-conference and accessed through the School’s website (nosm.ca). Regular online updates will be made to the calendar as changes arise.
This year’s breadth of programming builds on previous efforts to address the North’s cultural diversity and specific health challenges. Examples of additions to the calendar include:
• Fourth year NOSM medical student, Jeremie Larouche, will discuss the results of his research addressing the primary health-care issues of Franco-Ontarians in Thunder Bay.
• NOSM’s Dr. Anne Robinson will discuss how practitioners can make best use of an interpreter to overcome language barriers, and explore techniques to improve communication and enhance the therapeutic relationship when an interpreter is required.
• As part of a series on Aboriginal Activities, social worker Cristine Rego will facilitate a session that explores the interface between traditional understandings and Western medicine.
Progressive programming in all areas of education are developed in accordance with NOSM’s key academic principles, which guide the School’s academic programs. Collectively, these embrace the participation of stakeholders, the pursuit of common goals, the creation of meaningful partnerships, the distribution of educational resources, the acknowledgement of cultural diversity, and an approach that regards health care and education as a continuum.
These values will continue to guide NOSM in its efforts to deliver an integrated and comprehensive professional development and education program relevant to the health-care needs of all Northerners.
A year of milestones for medical school
The Northern Ontario School of Medicine (NOSM) has been extremely fortunate to attract participants from communities across Northern Ontario to assist in delivering our unique model of distributed medical education. In fact, the ongoing enthusiasm and participation of our many partners has been essential for the school’s success. Support has also been demonstrated through the commitment of hundreds of clinical faculty and staff, generous donations to student bursaries and volunteerism via our Local NOSM Groups at 12 Comprehensive Community Clerkship sites.
Thanks to the significant contribution of our many supporters, the school is now about to embark on an exciting year of milestones and accomplishments of which all Northern Ontario can be proud.
This academic year marks the first time that NOSM has had a full complement of learners; a combined total of 224 medical students are now studying in the four-year MD program. Hereafter, students will graduate from the undergraduate medical education program every year.
This year’s incoming class profile follows previous entry classes of students that mirror the cultural diversity of Northern Ontario. Of this year’s 58 students chosen from 1,892 applicants, 91 per cent come from Northern Ontario, 40 per cent are from rural and remote communities, five per cent are self-identified as Aboriginal, and 26 per cent are selfidentified as Francophone. Consistent with standards of all medical schools, these students demonstrated academic capability by achieving a mean weighted grade point average (WGPA) of 3.67 on a four-point scale.
While these new students begin their education in a distributed communityengaged model of medical education, and begin living and learning in Northern communities, NOSM’s charter class members are preparing to graduate from the MD program next spring. For the first time in the history of Northern Ontario, physicians will graduate in the North. They are expected to have an affinity for the north and an understanding of Northern health challenges.
In addition to our first MD graduates, the first cohort of fully qualified physicians will graduate in the spring of 2009 from NOSM’s two-year, fully accredited Family Medicine Residents of the Canadian Shield (RoCS) program – the newest Family Medicine program in Canada. Building on previous successful programs in the northwest and the northeast, this program was developed to provide residency training with particular attention to the needs of the people and communities of Northern Ontario. Learners are based in primary residency sites in Sudbury, North Bay, Timmins, Sault Ste. Marie and Thunder Bay, and supported by clinical rotations throughout rural, remote, Aboriginal and Francophone communities. These physicians will choose to enter family practice or pursue further thirdyear enhanced skills training in fields like emergency medicine and anaesthesia. In fact, all six graduates of the first year of NOSM’s emergency medicine training are practising in Northern Ontario.
The Northern Ontario School of Medicine celebrated the beginning of this milestone year on August 22, 2008 when the first dietitian interns graduated from the Northern Ontario Dietetic Internship Program (NODIP). This comprehensive internship program provides opportunities for community-based learning as well as practice-based research. Based at one of four principal sites (Sudbury, Timmins, Sault Ste. Marie and Thunder Bay), the dietetic interns worked with, and learned from, preceptors in hospitals, health units, long term care facilities, and clinics in their base community and in rural, remote, Aboriginal and Francophone settings. As with medical students and residents, these new dietitians graduate with an appreciation for the unique health-care needs of Northerners, as well as for the cultural diversity of the region.
The upcoming academic year will follow with milestones of truly historic proportions as the Northern Ontario School of Medicine graduates its charter class of undergraduate medical students and first class of postgraduate residents. I enthusiastically invite you and all our community partners, physician-teachers, donors and many supporters to join the celebrations of all that we have achieved together.
Physicians across North contribute to NOSM success
If you ask medical students, they will tell you that what makes their medical education so great is the enthusiasm and vitality of the physician clinical teachers. In Northern Ontario, we are blessed with an outstanding group of physicians who have stepped up to help make the Northern Ontario School of Medicine such a great success.
Dr. Richard Denton is one such physician who drew on his 30 years of family practice experience in Kirkland Lake to lead the early development of the flagship theme in the NOSM MD program curriculum: Northern and Rural Health. This theme explores the social and cultural diversity of the North, as well as highlighting occupational and environmental health issues which are specific to Northern and rural settings, like mercury poisoning in water systems.
Another early contributor to NOSM is Dr. David Boyle, an anaesthetist in Sudbury who took the lead in the early days with planning and project management for the School. Dr. Boyle is still very active with NOSM, not only as a clinical teacher of residents and medical students, but also as Chair of the NOSM Academic Council.
It was Dr. Boyle who recruited Dr. Sarah Newbery, a family physician in Marathon, to coordinate curriculum development for years one and two of the MD program. Dr. Newbery and Dr. Denton proved that physicians in distributed small rural communities could have significant roles with the School without moving to Sudbury or Thunder Bay.
Of course, clinicians in the larger centres like Drs. Saleem Malik and Trevor Bon have been key contributors as well by leading the development of the internal medicine teaching service at Thunder Bay Regional Health Sciences Centre.
NOSM’s distributed model was embraced early on as the best way to reach out to and include all Northerners in the School’s development. At the outset, physicians were enthusiastic about being involved, and their steadfast support of this unique approach is enabling the School to fulfill its goal of graduating resourceful physicians who have a particular understanding of people in Northern and remote settings. The support of physicians unites faculty, health-care centres, and communities to create a well-functioning platform for medical education that addresses the health needs of Northerners.
Designing a medical education program that was both inclusive and responsive began early, and contributors like Dr. Christine Rossi were there from the start, bringing years of resident teaching experience with her from the Northeastern Ontario Medical Education Corporation (NOMEC). Dr. Rossi has since taken on the dual role of coordinator for NOSM’s Postgraduate Family Medicine Program and the Comprehensive Community Clerkship.
Unique to medical education, the Comprehensive Community Clerkship, also known by its acronym, CCC, is a curriculum requirement where third-year students learn in hospitals and health-care centres in one of 12 communities across Northern Ontario. Under the guidance of physician teachers, learners receive practical training in the delivery of health care during this eight-month placement. The length of clinical training enables students to participate in various stages of patient care and exposes them to the integration of all allied health professions.
A full academic year, while revealing the challenges of family medicine to students, also exposes them to medical care administered by experienced physicians well seasoned by the daily challenges and diversity of medical practice in the North.
In addition to their responsibilities as instructors, many physicians also function as members of Local NOSM Groups (LNGs). These are pivotal positions that link the School, clinical teachers, students and communities into pan-Northern “classrooms” supported by broadband technology.
Dr. Jason Shack, site clinician in Fort Frances, highlights the benefits of the community engaged learning model made possible by the work of the LNGs:
“The importance of students coming to the communities and following a family medicine role model is that they don’t start off learning medicine piece by piece. They begin by integrating all aspects of medicine in their daily responsibilities. And the idea of bringing the students out to the communities enables them to experience the diversity of the North.”
In reflecting upon the contribution of NOSM’s participating physicians, I extend my heartfelt thanks to everyone whose collective contribution to the advancement of the School is ensuring NOSM’s success as a pioneering model of delivering medical education.
A busy spring for Northern health professionals
As I write this, I am quite literally half a world away from Northern Ontario – in Calabar, Nigeria – attending the 8th Wonca World Rural Health Conference.
It is partly from attending global events such as these that I can make the claim, without exaggeration or fear of contradiction, that NOSM is leading the world in educational programs that prepare our graduates to meet the needs of their patients and the wider community, particularly in rural and northern settings.
One of the ways we do this is by organizing conferences and events of our own. Nearly two years ago in this column I noted how NOSM had created a new Rite of Spring for many in Northern Ontario – the annual admissions interview weekend held in Thunder Bay and Sudbury for hundreds of short-listed applicants to the School.
This year, it’s North Bay’s turn to host another annual NOSM event that has come to mark the start of summer for health professionals across the North. I refer to the Third Annual Northern Health Conference, or NHRC, which was held in early June in Sault Ste. Marie for the first two years of its existence.
An outstanding success both times, this year’s conference will be co-hosted by Nipissing University and will take place on the Nipissing campus May 30 and 31. The NHRC is geared towards showcasing the research activities of Northern Ontario research scientists and health professionals.
I personally take great pleasure in attending the NHRC, not least because of the delightful mix of subjects presented. At one session, conference goers may hear from a bench scientist reporting on the identification of pharmacologically active molecules in plants, followed directly by a researcher who has studied the health effects of traditional drumming in aboriginal communities.
Where else but in Northern Ontario could one experience first hand such tremendous diversity in health research? In keeping with NOSM’s founding precepts, the NHRC is committed to inclusivity and in maintaining focus on research activities within Northern Ontario arising from community-based activities.
The NHRC highlights research projects undertaken by students, residents and community-based researchers while providing opportunities for collaboration and community networking. Registration is still open, and all Northern health professionals, researchers, and interested individuals are welcome.
To learn more, visit our website at www.normed.ca
Another major event we are looking forward to early this coming summer is the International Conference Community Engaged Medical Education in the North (ICEMEN), which will be co-sponsored by NOSM and Flinders University, Australia.
This five-day conference on community-based medical education will be held in communities across the North from June 9 to 14. The conference will open in Sudbury, with two days devoted to the exploration of program delivery, curriculum, program management, faculty development, research and evaluation.
On the third day, conference participants will be distributed to the 10 host communities in Northern Ontario where NOSM third-year students spend their entire academic year. (These are: North Bay, Huntsville, Bracebridge, Sault Ste. Marie, Sioux Lookout, Fort Frances, Timmins, Parry Sound, Kenora and Temiskaming Shores.)
On the final two days, ICEMEN attendees will travel to Thunder Bay, where discussion will centre on clinical education sessions for students, residents and physicians. These CME-accredited sessions will discuss, among other subjects, how to teach clinical skills in a community environment.
ICEMEN will also include the third annual meeting of a group of Medical Schools that have introduced longitudinal integrated clerkships into their undergraduate curricula.
Dubbed the Consortium on Longitudinal Integrated Clerkship or CLIC, this group includes representatives from medical schools at the Universities of Minnesota, Washington, North Dakota, South Dakota, British Columbia, UC San Francisco, and Harvard, as well as Flinders and other Australian universities.
One of the highlights of ICEMEN will be a presentation by Dr. Paul Worley, now Dean of Medicine at Flinders University in Australia. Very little documentation had been done on the practice of ruralbased longitudinal community clerkships until Paul wrote a ground-breaking thesis on the subject.
Another high-profile participant will be Dr. Molly Cooke, a Senior Scholar with the Carnegie Foundation for the Advancement of Teaching, and Professor of Medicine at the University of California, San Francisco.
Dr. Cooke has conducted an intensive study of innovative Third Year Medical School programmes, and is now charged with reviewing the whole of North American Medical School Education, most of which is still based on the Flexner Report, which was published in 1910.
It is my personal belief that the sort of Comprehensive Community Clerkship offered at NOSM and at the handful of other schools in CLIC may soon help galvanize sweeping changes to medical education across North America.
But whatever that long term outcome may be, there is no doubt that the next few months will be exciting – and busy ones – for NOSM, and for those health professionals here in the North who elect to take part in these important upcoming events.
Putting Northern Ontario on the global medical map
A couple of years ago, Dr. Dan Hunt, who was then NOSM Vice Dean, Academic Activities, was invited to attend a gathering of North American medical educators in Miami Beach. Specifically, he was invited to make a presentation about our new Medical School, only to discover, to his chagrin, that his talk had been scheduled for 8 a.m. on a Sunday morning!
“I expected to find at most a few dozen bleary-eyed attendees on deck to hear my presentation,” he recalled with a smile. “So you can imagine my surprise when some 600 people, representing well over half of all the conference-goers, showed up to hear what we’re doing here in Northern Ontario.”
His experience was symptomatic of the intense interest and increasing recognition that NOSM is receiving from medical educators all over the world. Modern medicine is truly a global endeavour, and even though still in its infancy, NOSM is fast becoming a must-see location on the world map for medical educators.
Here are just a few examples of the national and international recognition that NOSM has received this year alone:
• In early October, a delegation from the medical school at Tromso, Norway, including Norway’s National Centre for Rural Medicine, spent several days visiting NOSM. Tromso is the world’s northernmost medical school owing to its location well north of the Arctic Circle, and Canada has long enjoyed a special relationship with the school.
When it was first established in 1969, the founders of Tromso Medical School visited McMaster School of Medicine in Hamilton, which was itself then a new, pioneering Faculty of Medicine.
A delegation from Northern Ontario in turn visited Tromso seeking guidance when NOSM was just a long-standing dream, and the Dean of the Tromso School attended a conference in Sudbury that presaged the establishment of NOSM.
The 18 members of the recent Tromso delegation arrived seeking assistance with a thorny problem: though the school has been an outstanding success in training physicians who remain in the northernmost parts of Norway, they nevertheless gravitate towards the larger centres and towns, leaving more remote, smaller communities in the north still under-serviced.
After they spent a day on one of NOSM’s main campuses, we elected to split them up and distribute them around the North, just as we do with our students, to smaller centres. The Norwegians concluded that NOSM’s inter-dependent community partnership model could be the very element that’s lacking in their pedagogical approach and one reason that their graduates opt to remain in larger urban centres in the north.
• In September at a NOSM Symposium broadcast around the world on the Internet, Sister Elizabeth Davis told our students, faculty and staff that “You are the leaders …you are helping to draw the new maps … for new realities” in modern medical education.
“Your way is the most noted, most advanced and most articulated,” Sister Davis said in reference to NOSM’s curriculum, our model for distributed community engaged learning and the School’s use of new technology to advance medical education.
Coming from no less an authority than Sister Davis, this is high praise indeed. She is president of the Medical Council of Canada, a board member of the Royal College of Physicians and Surgeons of Canada and a noted medical administrator.
• Yet another indication that the school’s innovative, distributed community engaged education and research programs are being recognized as world-leading came in November, when a delegation from the University of Sherbrooke Faculty of Medicine arrived for a visit.
“You have been able to implement in a relatively short period of time a school of medicine that puts in practice most of the recent and future trends of medical education for the 21st century. Lessons for our school and our curriculum are numerous,” wrote Dr. Paul Grand’Maison, Sherbrooke’s Vice Dean for Undergraduate Medical Education, at the conclusion of his visit.
• Finally, in mid-October, NOSM hosted a seminar led by Dr. Charles Boelen. A distinguished physician with a long history of association with such institutions as the World Health Organization and Harvard, Stanford and McGill universities, Dr. Boelen is considered to be the father of the social accountability concept of medical education.
NOSM is the first new medical school in Canada to open its doors under an outright social accountability mandate, meaning that we must be fully committed to the health and well-being of the communities we serve.
After learning about NOSM’s efforts to incorporate this mandate into virtually everything we do, Dr. Boelen said that he was “seeing for the first time concretely implemented ideas which I have talked about for years and years, particularly around the medical school focusing on making a difference to people’s health.”
I’m immensely proud of the staff, faculty and students here at NOSM and of the people of Northern Ontario for helping to make Canada’s first new medical school for the 21st century a place that is already garnering so much recognition on the global stage of medical education.
Shaping our own future: a pan-northern vision
When I arrived in Northern Ontario nearly five years ago, I encountered two perplexing psychological obstacles in my assignment of helping to establish Canada’s first new medical school in 30 years. The first has been put to rest. But the second roadblock haunts us still.
That first challenge was in overcoming deep-seated doubts that a Medical School would ever be built in Northern Ontario. But the Northern Ontario School of Medicine is now here for all to see. And, it’s turned out to be a highly desirable place to get an education; for the third year in a row we’ve received more than 2,000 applications for the 56 positions available.
But I must admit the second difficulty is proving far more intractable. It’s the oft-repeated prophecy that NOSM could never succeed because of its two-campus model. Two Northern cities and two Northern Universities, I was told again and again, could never cooperate constructively on such a venture.
Sadly, this observation was most often made by Northerners themselves. I won’t tell you that it has always been easy, or that there aren’t challenges still to be resolved, but the fact is, NOSM is living proof of what can happen when the people of Northern Ontario think and act collaboratively rather than regard one another with suspicion and a competitive spirit.
As a matter of fact, the Medical School might never have existed had not the mayors of the North’s five largest municipalities banded together to lobby Queen’s Park. One of the School’s founders told me, when a single mayor walked the halls of the provincial legislature building, he or she might or might not receive a hearing.
But the first time that all five Northern mayors showed up to press home a single issue, the reaction from key Ministers of the day was noticeably different, and the outcome speaks for itself.
And so it is with many other Northern issues: we must begin to shape our own future, and the way we do that is by working together, rather than against each other.
I came to Canada from the Latrobe Valley in Australia. It is comprised of three principal towns of about 20,000 people each, located at intervals of 15 kilometers apart. Each community had its own small hospital, and we had become so accustomed to fighting each other for resources that the centre finally stopped allocating those resources, so weary were they of the infighting and the endless energy being expended.
In the end, it was determined that we should build and share a single, much larger centrally located hospital. Yes, some of the doctors in the outlying communities have to drive a bit further to work, but I can assure you that the health needs of the Valley are far better served by the new facility.
I know it’s hard here in the North, where the distances separating us are so great that it’s often difficult for people to identify the interests we share in common. But it’s imperative that we begin to do exactly that. Considered separately, Northern municipalities pale very nearly into total insignificance when compared to their far larger counterparts in southern Ontario. But put together, we have a critical mass of population that actually counts for something.
In the fall of 2005, the Medical School published a commissioned report entitled Creating a Sustainable Health Research Industry in Northern Ontario. Its authors concluded that many of the factors long considered liabilities in the North could actually become a strong advantage in the creation of a health research cluster of national and even international stature.
The challenges of distance and isolation, for example, could be exploited through the development of information technology that can then be exported to other parts of the world facing similar issues.
Our sizeable Franco-Ontarian and aboriginal communities offer us special research opportunities, as does Sault Ste. Marie’s Group Health Centre, which has a patient record database of some 30,000 individuals.
But, as the report emphasized, it was imperative that Northern Ontario see itself as one cohesive whole to leverage every ounce of competitive advantage that we can muster.
Not only that, but modern technology now means that not all of the players need to be located within a single metropolitan area. It’s becoming quite feasible for a widely scattered group of collaborators to become major players in health research on the world stage.
And I’m delighted to see that we at NOSM are not the only ones thinking in this vein. The introduction of the Local Health Integration Networks, or LHINs, by the provincial government are another sign of the need to think regionally, and to integrate health services across regions and systems.
My only personal disappointment with the LHINs is that there are two, rather than one, in Northern Ontario. A single unit would have better mirrored the growing movement to integrate health research and education across the North for the good of all. Pan-Northernism, I am convinced, is and will continue to be the way of the future.
To learn more about NOSM and our efforts to improve the health of people across Northern Ontario, visit our website at www. normed.ca