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Northern Routes

Building Relationships across Northern Ontario

Partnerships are key to ensuring that the Northern Ontario School of Medicine (NOSM) achieves its potential. Reaching beyond the usual buildings and classroom walls, NOSM spans across all of Northern Ontario where our distributed, community-engaged model thrives. Our school’s relationships stretch from Kenora to Moose Factory and from Red Lake to M’Chigeeng First Nation.

Our partnerships are relationships that are based on NOSM’s values.

Indigenous community experiences

Forty First Nations communities across Northern Ontario are crucial to our success. By completing a placement in a First Nations community during their first year, NOSM’s medical students are immersed cultural traditional activities. Students see firsthand how care is provided in health centres or nursing stations and learn about locally-relevant public health programs. Students often recall that non-clinical experiences have a tremendous impact on how they provide care after their placement. One such experience is traveling to the community.

Pre-pandemic, students travelled to their host community right around this time each spring. This is a particularly challenging time of year for travelling to some remote or fly-in communities. Fog and bad weather can determine whether or not a plane is able to land in some communities in the far north. From their travels, students learn how community members live. When they later see a First Nations person in a hospital or clinic setting, they better understand the reality of what they went through to get there.

Rural and remote training and Francophone partnerships

A substantial proportion of the population of Northern Ontario is made up of those who live in rural and remote communities, where health challenges are very different than in the larger centres in the North. During their second year, NOSM medical students complete two four-week placements in one of 50 small, rural, or remote communities. These are the communities and people most impacted by the shortage of health-care professionals. Also, with a focus on Francophone experiences NOSM has developed strong relationships in many key ways to build a Francophone health curriculum and retention program.

Clinical experiences in mid-sized communities 

In the third year of the MD program, students spend eight months living in one of Northern Ontario’s 15 mid-sized communities. Spending most of their time in family practice, NOSM students learn their core clinical medicine by helping to care for patients in communities like Sioux Lookout and Temiskaming Shores. Students may choose to do their placement in predominantly Francophone towns like Kapuskasing or Hearst.

Upon completion of their MD, medical students transition to the role of resident. Residents learn a specific type of medicine and their continued education takes place in hospitals and clinics, as well as many of these same rural, remote, Francophone, and Indigenous communities across Northern Ontario.

Far-reaching collaboration is key

Our partnerships are collaborative projects. With shared strategic developments and planned co-investments, we will enhance our work, provide access to improved health care for Northern Ontario, foster innovation and create new opportunities. Much of our research—particularly in primary care—is based on networks of physicians investigating population health, social determinants of health and big data. Like NOSM’s distributed, community-engaged learning model, more than half of the School’s research takes place outside the campus settings.

NOSM collaborates widely with major academic partners, both locally and regionally. We have more than 500 agreements in place with our partners. Our newly renewed affiliations with the two Academic Health Science Centers (AHSC), Heath Sciences North in Sudbury and Thunder Bay Regional Health Sciences Centre are prized. We’re exploring four priorities, with these AHSCs integrated leadership structures, collective health human resource planning, specialty and subspecialty residency expansion, and areas of collaborative research.

Health equity and advocacy

Regional clusters and local communities play an important role in shaping opportunities for health and well-being. That is why our school is committed to working with community members to reduce health disparities among populations in marginalized settings in Northern Ontario. To strengthen our administrative structures, we plan to formalize our networks in key regions that will align with our areas of strength in health equity research, education, and service.

We are building bridges with these important regional networks to promote alignment, partnership and collaboration and to address identified health priorities to return to our original mandate focused in northern Ontario for it’s health care needs.

Health inequities have arisen from the multigenerational effects of colonization and the legacy of residential schools. School-wide initiatives and community collaborations strive to address the barriers—whether social, economic or political—that prevent true health equity. Our goal? To improve the health and well-being of Indigenous communities across Northern Ontario and building respectful relationships between local communities and the NOSM faculty and students.

A great example of this is the relationship accord we signed with Nishnawbe Aski Nation (NAN) on March 23. The accord will guide NAN and NOSM as we move forward in supporting the NAN Health Transformation process with the goal of developing mutually supported initiatives that will build capacity and strengthen the health system within NAN territory.

I have been proud to work with a sophisticated matrix of multiple stakeholders that gave birth to this school – municipalities, colleges, politicians, community leaders, Indigenous and Francophone champions, donors and hospitals and Universities all are playing a role helping NOSM reach its full potential- to fulfill its mission, namely, to improve the health of Northern Ontarians by being socially accountable in our education and research programs and advocating for health equity.

Strengthening Indigenous Cultural Safety

The National Indigenous Cultural Safety (ICS) Learning Series is an ongoing series of webinars for people who wish to know more about Indigenous Cultural Safety and who may be working with Indigenous people in varying capacities across settings. The series explores anti-Indigenous racism, discrimination and cultural safety and identifies how each informs our systems, why they persist, and how we can address them. View the recorded webinars. At NOSM, we have come together to create a culture of diversity, inclusion, respect, social accountability and wellness. Let’s work in a culture of kindness and #RespectTheDifference.

NOSM Grad helps to end Atikokan’s doctor shortage 

A few years ago, Atikokan was a town in crisis having only one full-time and one half time family physician for a population of approximately 2,800 people. The community relied heavily on a rotation of locums to meet its health-care needs.

Today, the town has a stable physician workforce that is able to provide patient-centered care, continuity of care, and importantly, a supportive network for physicians. Dr. Shawn Minor is a graduate of the Northern Ontario School of Medicine (NOSM) MD Class of 2016 and completed his residency at University of British Columbia in 2018. Originally from Thunder Bay, he and his wife, with their young children, decided to return to Atikokan to be closer to their extended family. Read more.

Addressing the Gaps, Alumni Stories, Community Stories, Gallery, In the Spotlight

NOSM alumnus helps to end Atikokan’s doctor shortage

Gallery

A few years ago, Atikokan was a town in crisis having only one full-time and one half time family physician for a population of approximately 2,800. The community relied heavily on a rotation of locums to meet its health-care needs.

Today, the town has a stable physician workforce that is able to provide patient-centered care, continuity of care and, importantly, a supportive network for physicians. Dr. Shawn Minor is a graduate of the Northern Ontario School of Medicine (NOSM) MD Class of 2016 and completed his residency at University of British Columbia in 2018. Originally from Thunder Bay, Dr. Minor and his wife, with their young children, decided to return to Atikokan to be closer to their extended family.

“I was the fourth doctor to join the community,” says Dr. Minor. “There was a kind of snowball effect at that point. Some of the locums who had been part of the Atikokan rotating pool of locums started to see physicians signing up to start permanent practices in the community. I think that prompted a realization that they wouldn’t be able to rotate in and out indefinitely, and we had a number of physicians sign on within eight months.”

The town of Atikokan, located 200 km west of Thunder Bay, is well known to outdoor enthusiasts as one of the main access points into beautiful Quetico Provincial Park, the “Canoeing Capital of Canada.” The name Atikokan, is Ojibwa-Chippewa translated as ‘caribou bones’ or ‘caribou crossing.’

Dr. Minor says it’s an ideal place to practice, in part, because of the unique and innovative ways he is personally able to deliver care. “The thing I love most is being able to do home visits with my vulnerable older patients. I’ve done home visits by bicycle, by motorcycle, I’ve also walked to home visits during my lunch,” he says. “I’ve done portable ultrasound injections during home visits because the technology is so compact and the geography of the town is easy to navigate, allowing me to go in person. I can go to the hospital in the morning then bike to the clinic after, and I really enjoy this lifestyle and continuity of care. It’s amazing.”

He says patients also gain several advantages. The Atikokan physician community is close-knit and mutually supportive, leading to better care in ways that are not accessible in urban centres.

“My colleagues and I are in constant communication with one another. They can call me from the Emergency Department and I can do the same. I am able to access my clinic’s Electronic Medical Records (EMR) from the hospital and find information about a patient’s individual medical history really quickly—which was a source of frustration in an urban Emergency, where I frequently had no context or patient history to reference,” says Dr. Minor. “Likewise, I’ve had urgent calls from colleagues in Emergency asking if they should do resuscitation and I’m able to offer appropriate advice based on the patient’s wishes that were documented in the clinic. It truly allows for the most appropriate, patient-centred emergency care.”

Dr. Minor says it takes supportive physician leaders to build a community of practice that will sustain a physician and health-care workforce in a small Northern community. “Locums enjoyed rotating here because one of the long-term doctors was supportive. Anytime they came, they knew they’d have back-up and there was always help available in emergencies. That level of support is a huge factor in deciding to work full-time in a community,” Dr. Minor says.

“I think if physicians arrive in a place where they feel supported by the community and by the people who work there, they tend not to feel overwhelmed, they have better experiences, and they are able to find a good balance,” says Dr. Minor.

Some physicians continue to come and go, but four are in Atikokan to stay. “We have one doctor who commutes from Vancouver and another commutes from Toronto,” Dr. Minor explains. He describes the flexibility of scheduling as a strength. “It’s an interesting mix of people with different scheduling styles which works because we are supportive of each other and we are able to give one another enough flexibility to work in different ways. We are also fortunate to have a competent clinic manager to put it all together.”

Since NOSM’s inception in 2002, the School’s goal has been to graduate physicians and health-care professionals to meet the health needs across the region. With a total of 714 NOSM MD graduates to date, there is still a need for more than 300 family physicians and specialists in rural and remote Northern communities. Of this group, 126 family physicians are needed, with 86 of these needed in rural communities.

NOSM recently received a $210,000 donation from Derek Day from his late mother’s estate—the Estate of Ruth Day—to assist in transforming physician workforce planning in Northern Ontario. This generous donation will support the creation of a new Rural Generalist Pathway at NOSM.

The School recently launched its new strategic plan, The NOSM Challenge 2025.

Please consider joining The Challenge and donors like Derek Day who are making a difference in transforming health care in Northern Ontario. To make a difference, make your gift at nosm.ca/give.

 

In the Spotlight, Uncategorized

Daring Leadership in an ever-changing and unpredictable world

NOSM’s best-attended Northern Lights Forum features a key address from Dr. Jane Philpott and Dr. Gigi Osler.

Dr. James Goertzen, NOSM’s Associate Dean, Continuing Education and Professional Development (CEPD), spearheaded the 2021 Northern Lights Forum. He and the CEPD organizing team arranged for Dr. Jane Philpott and Dr. Gigi Osler to each provide a key address on the theme of Daring Leadership in Difficult Times. This virtual forum enabled NOSM faculty to join small breakout sessions where they had opportunities to ask questions and interact directly with Drs. Philpott and Osler.

Dr. Jane Philpott is a family physician and former Member of Parliament. Currently the Dean of the Faculty of Health Sciences and Director of the School of Medicine at Queen’s University, she offered the following words to participants, “I hope you’ll take on the really hard jobs and learn how to deliver on your dreams and on the mandate you’ve been given in those roles. I hope you’ll continue to dare to be an ally for those who need allies, and to admit the privilege that many of us operate under, and to learn from the people around you. I hope you’ll dare to make mistakes and learn through them and you’ll dare to take a stand.”

Dr. Jane Philpott’s talk acknowledged the added complexity of leading through an unpredictable future. “Coming out of the pandemic, our institutions collectively and separately need to have daring leadership. More than ever before, daring leadership must actually deliver.”

Dr. Philpott highlighted her three essential traits of daring leadership: Vision, Determination, and Humility.  She wove in themes of equity and inclusion, explaining that having a vision is common among all of humanity, however what’s not evenly, nor fairly distributed throughout humanity is having access to the systemic supports that are necessary to realize that vision. She encouraged NOSM leaders to recognize the opportunity they have in their roles, “It’s a privilege to have the opportunity to advance in the direction of your dream and it’s a privilege to be able to do so. With that, comes enormous responsibility.”

She also emphasized the importance of daring leaders being willing to be “doers” and exercising both “tenacity” and “dogged determination”. Equally important is that they are compassionate listeners who exercise humility. “A daring leader needs to be both a dreamer and a doer… you must be willing to say ‘I’m ready to roll up my sleeves. I want to be part of this solution.’”

Dr. Gigi Osler is the Chair of the Canadian Medical Forum, President-Elect of the Federation of Medical Women in Canada, Co-Chair Virtual Care Task Force, Otolaryngology Head and Neck Surgeon, and Former President Canadian Medical Association (CMA). In her address, Dr. Osler shared her personal challenges with imposter syndrome as the first woman of colour to become the President of the CMA. “The idea of the presidency terrified me. But the prospect of contributing to positive change excited me.”  In 2018, Dr. Osler became President of the CMA. She was the 8th woman to hold that position, and the first woman of colour since the CMA was formed in 1867.

She spoke about cognitive diversity and highlighted research that suggests better diversity in the physician workforce leads to better health outcomes for patients. “In the for-profit corporate world, they understand this. Companies with more diverse boards have better return on investment than similar companies with less diverse boards.”

“The research suggests that better diversity beyond just gender alone, could lead to better outcomes for patients … there’s less data looking at factors such as Indigeneity, gender identity, disability, ethnicity, socioeconomic status. But it’s important … for example, a recent large population study provides evidence that when black newborn babies are cared for by black physicians their mortality is reduced by 50 per cent. That is the benefit of diversity.”

She highlighted that the academic medical community’s recent focus on equity, diversity and inclusion “requires fundamental shifts in power. It’s easier to fix people (to tell people to develop their leadership skills) and it’s harder to fix systems and structures. Telling people to lean in and speak up shifts the responsibility of change from organizations, systems, and structures, to the people with less power. In this time of reckoning and social justice, we have to start having conversations about fundamentally changing systems and structures that were built in a different era,” says Dr. Osler.

Her final take away was the importance of being a role model as a black, Indigenous and people of color (BIPOC) leader in medicine. “When I became president, I hadn’t truly recognized the importance of representation in leadership until men and women came up to me (and still do) to say they’d never seen someone that looked like them in a position of power; and because of that they could see themselves in those positions of power. And I realized that it’s hard to be, until you see.”

The Northern Lights forum blended leadership development activities with engaging learning opportunities at NOSM, a strategic priority in the School’s plan to innovate health professions education. Those who attended the event said it was one of NOSM’s best and most memorable to-date.

“It was exciting to have 53 NOSM faculty members learning with, and opening up on the topic of daring and vulnerable leadership and the concept of learning from failure,” says Dr. Goertzen. “Imposter syndrome was mentioned many times and we were all able to recognize that even leaders with a wealth of experience can feel the same sense of emotions as a new or inexperienced physician leader.”

Blended learning activities included the creation of two online leadership development modules at NOSM: 1. Introduction to psychological safety 2. Physician workforce diversity and patient outcomes. Post Forum learning will be reinforced with the development of additional educational modules.

A special thank you to Drs. Jane Philpott, Gigi Osler and Dennis Kendel for contributing important perspectives. We also wish to acknowledge the contributions of Drs Zaki Ahmed, Naana Jumah, Joseph LeBlanc, Sarah Newbery, as well as Yolanda Wanakamik as NOSM presenters who grounded discussions in the context of NOSM and Northern Ontario. Successful events are only possible with invisible support behind the scenes and hats off to the CEPD staff who took great care to deliver an excellent virtual forum.

NOSM University