Pine.nosm.ca/cemestr/ CEMESTR: what happens when medical schools and communities intersect? Rachel Ellaway, Roger Strasser, Lisa Graves, Cathy Cervin,

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pine.nosm.ca/cemestr/ CEMESTR: what happens when medical schools and communities intersect? Rachel Ellaway, Roger Strasser, Lisa Graves, Cathy Cervin, David Marsh, and Laurel O’Gorman Northern Ontario School of Medicine CLIC 2013

pine.nosm.ca/cemestr/ Disclosure statement We have no involvement with industry or any other entity that constitutes a conflict of interest to disclose with respect to this presentation.

pine.nosm.ca/cemestr/ Background Medical education is (yet again) in a time of change Policy and ideological change around social accountability, addressing health inequalities … A common and recurrent theme is society’s contract with medicine, and with medical education The concept of community is bound into these changes

pine.nosm.ca/cemestr/ Background Many models of how medical education programs should and do interact with communities: –Community Oriented: activities address topics in community health but still take place in traditional academic settings –Community Based: activities take place in the community –Community Engaged: program engages community in design, conduct and evaluation Evidence is unclear, fragmented, ideological

pine.nosm.ca/cemestr/ Systematic review We initiated a systematic review with the question: ‘how do different relationships between medical education programs and communities impact educational and health outcomes?’

pine.nosm.ca/cemestr/ Study A two-arm systematic review: 1.standard outcomes review - Kirkpatrick criteria and strict filtering based on empirical methods and analyses to explore ‘what works?’ 2.realist enquiry to explore ‘what works, for whom and in what context?’ – mechanisms, contexts, outcomes

pine.nosm.ca/cemestr/ Material Sources: Medline, ERIC, CINAHL, WOS Criteria titles/abstracts include health/medicine, education and community item is available online or through library or interlibrary loan, article is in English or French, published since 1970 article is evidence-based and/or incorporates an evaluative/outcomes component

pine.nosm.ca/cemestr/

Review 39 reviewers from around the world Allocated to outcome, realist or both Online system – purpose built for the study All materials accessible All reviews conducted through web forms and held centrally Tracking and analytics tools

pine.nosm.ca/cemestr/ State of the review Active items: 323 Items reviewed: 221 Outcomes reviews: 124 Realist reviews: 240 Number of reviewers: 46 Time to completion of reviews: ~November Then synthesis and reporting …

pine.nosm.ca/cemestr/ Challenges Formulating our question Developing and refining methods BEME registration Large body of material to review Getting reviewers to review A great many case studies and position papers, very little empirical work

pine.nosm.ca/cemestr/ Emerging themes Community is a fluid concept: –Not-the-hospital –A location where GPs or patients are –Where service learning happens –Something that is under-served –An intrinsic good –The focus of social responsibility –An ideological construct Who represents community? Leaders rather than community members or workers …

pine.nosm.ca/cemestr/ Emerging themes Ethical and moral dimensions, biases Orientation to community is culture/context specific: –In UK: community hardly ever discussed as a focus, only as a location –In US: community an individual rather than institutional responsibility – volunteerism –In Canada and Australia: community = rural and remote (interchangeably), hardly ever urban –In India and Sub-Saharan Africa: community as a fundamental health challenge

pine.nosm.ca/cemestr/ Emerging themes The benefits: –Alignment with broad policy and culture shifts –Learning grounded in complex real world experiences –Learners motivated, develop service mentality –Learners develop activist capabilities, interests Community benefit rarely considered, but: –Ownership and engagement important –Projects that effect positive change –Very occasionally broader improved health outcomes

pine.nosm.ca/cemestr/ Reprise Study is ongoing: ~50% of reviews Rolling synthesis Reporting in 2014 Developing models and meta-models that capture and describe a complex web of philosophies, practices and ideologies that shape how medical programs engage with the idea and the reality of community Developing new research questions and generating new scholarship

pine.nosm.ca/cemestr/ CEMESTR: what happens when medical schools and communities intersect? Rachel Ellaway, Roger Strasser, Lisa Graves, Cathy Cervin, David Marsh, and Laurel O’Gorman Northern Ontario School of Medicine CLIC 2013