Disclosure: This presentation has been funded by: Northern Ontario School of Medicine (NOSM) which is funded by the Government of Ontario I sit on the board of directors for the following organizations: NOSM (CEO of NOSM Corporation) Sudbury Regional Hospital Thunder Bay Regional Health Sciences Centre

Distributed Community Engaged Learning: How Crazy is That? Dr Roger Strasser Dean and Professor Northern Ontario School of Medicine

Faculty of Medicine of Lakehead Faculty of Medicine of Laurentian Social Accountability mandate Commitment to innovation

In, by and for Northern Ontario Northern Ontario Southern Ontario Sioux Lookout

Recruitment Facilitators for Rural Practice rural upbringing positive undergraduate rural clinical experiences targeted postgraduate training for rural practice

Key Academic Principles Interprofessional Integration Community Oriented Distributed community engaged learning Generalism Diversity

Distributed Community Engaged Learning An instructional model that allows widely distributed human and instructional resources to be utilized independent of time and place in community partner locations across the North

Organization / Delivery of NOSM Curriculum Phase 1Phase 3 Year Residency Year Year 3 Comprehensive Community Clerkship Year 4 Clerkship & Electives Licensure Examination Years 5, 6 and Beyond Individual Specialty Choice Case Based Modules Phase 2 Elective

All Placement Sites Thunder Bay Sudbury Toronto Aboriginal Community Sites Integrated Community Experience Sites Comprehensive Community Clerkship Sites

Residency Programs Family Medicine Residents of the Canadian Shield (RoCS) 3 rd year enhanced skills – emergency medicine, anesthesia, maternity care, etc

RC Specialty Programs General Internal Medicine General Surgery Pediatrics Obstetrics & Gynecology Psychiatry Anesthesiology Orthopedic Surgery Community Medicine

Continuing Education Professional Development hundreds of events many online sessions CME/CPD interprofessional faculty development leadership development

Health Professional Education rehabilitation sciences interprofessional education - integrated clinical learning communities of practice dietetic internship program physician assistants digital library service

Research Programs building on existing strengths broad canvas of research approaches laboratory, clinical, community Northern Ontario research questions Northern Health Research Conferences

NOSM Charter Class CaRMS - 100% matched 1 st round 70% rural family medicine 30% general specialties 11 medical schools (of 17) 40% residency with NOSM “deep roots” in Northern Ontario >60% of NOSM residents stay

FM RoCS Graduates

NOSM Charter Class NOSM

Benefits of NOSM More generalist doctors Enhanced healthcare access Responsiveness to Aboriginal, Francophone, rural, remote Interprofessional cooperation Health research Broader academic developments Economic development

Socioeconomic Impact $67-82M new economic activity 245 new jobs economic development host universities’ status raised improved HHR recruitment communities feel empowered

Innovative Education and Research for a Healthier North Enhanced Education Strengthened Research Quality Learning Environment Excellent Faculty Relations Community Collaboration

“Community” in Health Sciences Education community oriented - learning about the community community based - learning in community context community engaged - active community contribution

Community Engagement community active participant - interdependent partnership ensures student “at home” contributes to student’s educative experience education and research activities community development

Community Engagement individuals and organizations partnerships and collaborations Aboriginal and Francophone Local NOSM Groups education and training (DCEL) research community development

Partnerships & Relationships Communities of the North Universities and Colleges Hospitals and Health Services OTN, KOTM and Contact North Other Medical Schools

Membership of LNGs Faculty Members from community Community leaders Non-academic NOSM personnel Local academic and health service providers (i.e. Hospitals) Local Group Leader

Comprehensive Community Clerkship 30 weeks in large rural and small urban communities Based in Family Practice Learn clinical disciplines in parallel Students learn and live in community

Principles for Longitudinal Integrated Curricula comprehensive patient care over time continuing learning relationships with clinicians achieve core clinical competencies across multiple disciplines simultaneously

Importance of Relationships student-teacher/student-student/ student-community four levels: clinical, institutional, social and personal (Worley) paying attention as part of curriculum improves learning

Clinicians Patients Personal Principles Professional Expectations University Research Health Service Government Community Medical Students Worley, 2006 Integrity Model

Rural Health Services access is the major issue “safety net” local services preferred limited resources workforce shortages different from cities

Rural Practitioners wide range of services high level of clinical responsibility relative professional isolation specific community health role “Extended Generalists”

Rural Health Care specialists’ support role partnership not putdown consultant support to local service not assume patients will travel

Information Technology greatly reduced isolation education and information clinical support - Telehealth

Key Considerations Context counts Community participation Standards and quality Definition of success Prevailing mindset Vision and Mission

NOSM and OPOP Collaboration to enhance care Community engagement Distributed learning Telehealth Research partnerships