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International Association for Medical Science Educators

International Association for Medical Science Educators If I had a clean slate….New medical school curricula Joel Lanphear, PhD Senior Associate Dean, Northern Ontario School of Medicine Associate Dean, Undergraduate Medical Education Marie Matte, PhD

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International Association for Medical Science Educators

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  1. International Association for Medical Science Educators If I had a clean slate….New medical school curricula Joel Lanphear, PhD Senior Associate Dean, Northern Ontario School of Medicine Associate Dean, Undergraduate Medical Education Marie Matte, PhD Director, Undergraduate Medical Education Northern Ontario School of Medicine

  2. If I had a clean slate….. we did….. almost….and here is our story….

  3. “ social accountability is medical education’s boldest challenge” Boelen (2008)

  4. Social Accountability Mandate Providing undergraduate and postgraduate medical education programs that are innovative and responsive to the individual needs of students and to the health care needs of the people of Northern Ontario.

  5. Paris Bordeaux Lyon Sudbury ThunderBay Toronto 500 km France / Ontario

  6. Aboriginal Populations of Northern Ontario • 1.3 million identified Aboriginal persons in Canada • 188,000 Aboriginal persons live in the province of Ontario • Incidence of TB 10x the national average • Life expectance of male and female Aboriginal persons 5-7 years less than the national average • Suicide rates among Aboriginal youth 11x the national average • Incidence of Type 2 Diabetes 3-5x the national average

  7. Francophone Populations of Northern Ontario • Francophone Populations of Northern Ontario • Higher incidence of heart disease among Francophone persons living in Northern Ontario • Higher incidence of tobacco use among Francophone persons living in Northern Ontario compared to the national average • Higher incidence of alcohol abuse among Francophone persons living in Northern Ontario compared to the national average • Reduced life expectancy of Francophone persons living in Northern Ontario

  8. 37 Northern Ontario communities identified as “under-serviced” in family physicians Total shortage of 132 family physicians in Northern Ontario 14 Northern Ontario communities designated as under-serviced in specialists with a total shortage of 129 Ministry of Health and Long Term Care of Ontario June, 2007

  9. Realities of Rural/remote Northern Ontario • geography and demography • attitudes and values • morbidity and mortality • limited resources • workforce shortages • Quality of life – many say they wouldn’t live anyplace else • Making a difference in a rural community

  10. closeknit supportive communities • strong behavioural norms • self reliance and stoicism • health low priority Rural Culture

  11. Graduates Entering Rural Practice… • Rural background • Positive clinical and educational experiences in rural setting during undergraduate training • Targeted training for rural practice at the postgraduate level

  12. The Context • Northeast – Northwest Political Division • Northeast – Northwest Population Differences • Two Larger Cities • Geographic Factors • Extraction” Mentality • Diversity

  13. Educational Resources • Two Universities 1000 km Apart • Pre-Existing Residency Programs • Pre-Existing Undergraduate Electives Programs • Excellent Funding for Start-up and Facilities

  14. Academic Governance Laurentian Faculty Senate Lakehead Faculty Senate Joint Faculty Senate Academic Council Standing Committees

  15. Development and Design of the NOSM Curriculum • Northern Ontario Community Consultation – SSM Workshop • Aboriginal community consultation – Follow Your Dreams Workshop • Francophone community consultation

  16. What is the educational philosophy/approach of the NOSM four year undergraduate medical education program?

  17. NOSM Educational Philosophy/Approach is based on six key academic principles…. • Interprofessional • Integration • Community oriented • Distributed Community Engaged Learning • Generalism • Diversity

  18. Interprofessional • The term interprofessional includes the key features of partnership, participation, collaboration, coordination and shared decision making. (2) The term is applicable to all NOSM endeavors Integration • Integration in short, is the combination and interaction of individuals around common purposes and goals to create meaningful experiences for students, residents, faculty and staff.

  19. Community Oriented • Community orientation is the conceptual and pragmatic understanding of the dynamics of communities in the North and the creation of meaningful, enduring partnerships between all Northern Communities and NOSM. Distributed Community Engaged Learning • Distributed Community Engaged Learning is 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.

  20. Generalism • Generalism is defined as a broad and holistic view and approach to activities, values and knowledge in educational, organizational and patient care activities. Diversity • Diversity encompasses a set of values that recognizes the richness of all cultures of Northern Ontario and the important ways they contribute to our lives.

  21. Curricular Concepts… • Large group learning • Experiential • Self-directed • Objective based • Integration • Competency based • Small group learning

  22. NOSM Curriculum Themes… • Theme 1: Northern and Rural Health • Theme 2: Personal and Professional Aspects of Medical Practice • Theme 3: Social and Population Health • Theme 4: Foundations of Medicine • Theme 5: Clinical Skills in Health Care

  23. All five themes (courses) continue throughout the four year undergraduate program… -in Phase 1, curriculum heavily weighted on Theme 4 (Foundations of Medicine ) content -in Phase 2 and Phase 3, curriculum is heavily weighted on Theme 5 (Clinical Skills) content

  24. Theme 1Northern and Rural Health Theme 1 introduces the student to certain unique and sometimes common realities of social and health care aspects of Northern Ontario such as…

  25. Theme 1 • Economic factors that can affect Northern and rural health • Impact of weather, geography and distance on the delivery of medical services • Social and cultural realities of aboriginal and francophone populations living in Northern Ontario • The scenery and the quality of life that exists in many parts of Northern Ontario

  26. Theme 2Personal and Professional Aspects of Medical Practice Theme 2 contributes to the social science and medical humanities portion of the UME curriculum…..

  27. Theme 2 • Demonstrate the physician’s role as an advocate on behalf of their patients • Recognize that the practice of medicine is a moral enterprise • Students must respect and adhere to professional boundaries at all times

  28. Theme 3Social and Population Health Theme 3 introduces the student to the cultural perspectives of individual and population health, community and public health, occupational health and social determinants of health…

  29. Theme 3 • Interpretation of community relations • Understanding public and occupational health policies • Health promotion and illness prevention strategies

  30. Theme 4Foundations of Medicine Theme 4 introduces the student to all aspects of medical science as they pertain to medical education.

  31. Theme 5Clinical Skills in Health Care Theme 5 provides an avenue for the student to acquire the necessary clinical skills for patient-centered interviewing and physical examinations.

  32. Threads • Medical Expert • Collaborator • Manager • Health Advocate • Scholar • Professional • Communicator • Aboriginal Health • Interprofessional Education & Work • Health Effects of Social Problems • WSIB Concepts/Curriculum • Dementia Project • Gender Issues • CMDA Patient Safety • Curriculum Competencies

  33. How are the medical sciences taught in Phase 1 of the NOSM undergraduate program? • Whole group sessions • Small group learning – Topic Oriented Sessions • Laboratory sessions

  34. Phase 1 Typical Week Schedule CBL = Case Based Learning TOS = Topic Oriented Session WGS = Whole Group Session SCS = Structured Clinical Session CLS = Community Learning Session LAB = Laboratory SAS = Student Assessment Session ICE = Integrated Community Experience MCS = Module Coordination Session DTS = Distributed Tutorial Session

  35. How are medical sciences taught in Phase 2 of the NOSM undergraduate program? • Virtual academic rounds • Distributed tutorial sessions

  36. Phase 2 Typical Week Schedule HCS = Hospital Care Sessions SES = Specialty Enhancement Sessions DFS = Discipline Focused Sessions AR = Academic Rounds PCS = Primary Care Sessions

  37. How are medical sciences taught in Phase 3 of the NOSM undergraduate program? • Academic rounds in all core clinical disciplines

  38. School Governance A medical school with no departments! • Faculty assigned to one of three Divisions: • Human Sciences • Medical Sciences • Clinical Sciences

  39. Distributed Community Engaged Learning at NOSM Developing Meaningful and Lasting Partnerships

  40. Community Engagement… • CBM 106 – 28 Aboriginal communities • CBM 108 – 28 rural/remote communities • CBM 110 – 28 rural/remote communities • Year 3 – Comprehensive Community Clerkship – 10 small urban/large rural communities • Year 4 – Sudbury and Thunder Bay

  41. In total, NOSM will engage over 70 communities in the delivery of the undergraduate curriculum…. • Post graduate and residency programs will require additional community involvement

  42. Challenges… • Identifying community readiness and partnering • Orientation of community members to the curriculum, preceptoring, assessment and evaluation • Curriculum continues • Maintaining curricular integrity • Logistics

  43. CBM 106 Task Force Chair: Director, UME Curriculum Readiness Working Group Chair: Phase 1 Coordinator Site Readiness Working Group Chair: Director, Aboriginal Affairs Student Readiness Working Group Chair: Director, Admissions and Student Affairs

  44. Site Readiness Working Group • Identify appropriate number of sites • Ensure community visits (X2) • Ensure adequate housing • Ensure adequate orientation to the curriculum (didactic and clinical) • Ensure Community Coordinators identified

  45. Student Readiness Working Group • Ensure students receive orientation to communities (on-site, in class) • Ensure travel arrangements • Ensure students were briefed on water advisory, safety, emergency contacts, and culture • Ensure student site selection process completed

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