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Larkins S, Iputo J, Sen Gupta T. Fit for purpose? Selection processes should consider aptitude in terms of skills, personal characteristics and context. MEDICAL EDUCATION 2016; 50:389-391. [PMID: 26995475 DOI: 10.1111/medu.12978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Kuper A. When I say… equity. MEDICAL EDUCATION 2016; 50:283-284. [PMID: 26896013 DOI: 10.1111/medu.12954] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/02/2015] [Accepted: 10/16/2015] [Indexed: 06/05/2023]
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Strasser R, Couper I, Wynn-Jones J, Rourke J, Chater AB, Reid S. Education for rural practice in rural practice. EDUCATION FOR PRIMARY CARE 2016; 27:10-4. [PMID: 26862793 DOI: 10.1080/14739879.2015.1128684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite the substantial differences between developing and developed countries, access is the major rural health issue. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: (1) a rural upbringing; (2) positive clinical and educational experiences in rural settings as part of undergraduate medical education; (3) targeted training for rural practice at the postgraduate level. This paper presents examples of successful rural primary care-based education in different parts of the world, then introduces the Wonca Rural Medical Education Guidebook which was launched at the 2014 Wonca Rural Health World Conference and concludes with a brief report of the 2015 conference held in Dubrovnik Croatia.
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Affiliation(s)
- Roger Strasser
- a Northern Ontario School of Medicine , Dean and CEO, Laurentian University in Sudbury and Lakehead University in Thunder Bay , Canada
| | - Ian Couper
- b Centre for Rural Health , University of the Witwatersrand (Wits) , Johannesburg , South Africa
| | - John Wynn-Jones
- c WONCA Working Party on Rural Practice, Chair , Montgomery , Wales
| | - James Rourke
- d Dean of Medicine , Memorial University of Newfoundland , St John's , Canada
| | - A Bruce Chater
- e Rural and Remote Medicine , University of Queensland , Theodore , Australia
| | - Steve Reid
- f Primary Health Care Directorate , University of Cape Town , Cape Town , South Africa
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Abstract
Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status. Nowhere is the worldwide shortage of health professionals more pronounced than in rural areas of developing countries. Sub-Saharan Africa (SSA) includes a disproportionately large number of developing countries; therefore, this article explores SSA in depth as an example. Using the conceptual framework of access to primary health care, sustainable rural health service models, rural health workforce supply, and policy implications, this article presents a review of the academic and gray literature as the basis for recommendations designed to achieve greater health equity. An alternative international standard for health professional education is recommended. Decision makers should draw upon the expertise of communities to identify community-specific health priorities and should build capacity to enable the recruitment and training of local students from underserviced areas to deliver quality health care in rural community settings.
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Affiliation(s)
- Roger Strasser
- Northern Ontario School of Medicine, Sudbury and Thunder Bay, Ontario, Canada;
| | - Sophia M Kam
- School of Rural and Northern Health, Laurentian University, Sudbury, ON P3E 2C6 Canada
| | - Sophie M Regalado
- Northern Ontario School of Medicine, Sudbury and Thunder Bay, Ontario, Canada;
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Sharafkhani M, Armat MR, Emami Zeydi A. Social Accountability in Nursing Education: A Necessary Yet Neglected Issue. Nurs Midwifery Stud 2015; 4:e29378. [PMID: 26835465 PMCID: PMC4733500 DOI: 10.17795/nmsjournal29378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/14/2015] [Accepted: 07/02/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mohammad Sharafkhani
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Reza Armat
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Amir Emami Zeydi
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Strasser R, Worley P, Cristobal F, Marsh DC, Berry S, Strasser S, Ellaway R. Putting communities in the driver's seat: the realities of community-engaged medical education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1466-70. [PMID: 26017354 DOI: 10.1097/acm.0000000000000765] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
"Community" has featured in the discourse about medical education for over half a century. This discourse has explored relationships between medical education programs and communities in community-oriented medical education and community-based medical education and, in recent years, has extended to community-engaged medical education (CEME). This Perspective explores the developing focus on "community" in medical education, describes CEME as a concept, and presents examples of CEME in action at Flinders University School of Medicine (Australia), the Northern Ontario School of Medicine (Canada), and Ateneo de Zamboanga University School of Medicine (Philippines).The authors describe the ways in which CEME, which features active community participation, can improve medical education while meeting community needs and advancing national and international health equity agendas. They suggest that CEME can redefine student learning as taking place at the center of the partnership between communities and medical schools. They also consider the challenges of CEME and caution that criteria for community engagement must be sensitive to cultural variations and to the nature of the social contract in different sociocultural settings.The authors argue that CEME is effective in producing physicians who choose to practice in rural and underserved areas. Further research is required to demonstrate that CEME contributes to improved health, and ultimately health equity, for the populations served by the medical school.
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Affiliation(s)
- Roger Strasser
- R. Strasser is dean, Northern Ontario School of Medicine, Sudbury and Thunder Bay, Ontario, Canada. P. Worley is dean, Flinders University School of Medicine, Adelaide, Australia. F. Cristobal is dean, Ateneo de Zamboanga University School of Medicine, Zamboanga, the Philippines. D.C. Marsh is deputy dean, Northern Ontario School of Medicine, Sudbury, Ontario, Canada. S. Berry is associate professor, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. S. Strasser is former associate dean, Flinders University, Northern Territory, Darwin, Australia. R. Ellaway is assistant dean, Curriculum and Planning, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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Hogenbirk JC, French MG, Timony PE, Strasser RP, Hunt D, Pong RW. Outcomes of the Northern Ontario School of Medicine's distributed medical education programmes: protocol for a longitudinal comparative multicohort study. BMJ Open 2015. [PMID: 26216154 PMCID: PMC4521518 DOI: 10.1136/bmjopen-2015-008246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The Northern Ontario School of Medicine (NOSM) has a social accountability mandate to serve the healthcare needs of the people of Northern Ontario, Canada. A multiyear, multimethod tracking study of medical students and postgraduate residents is being conducted by the Centre for Rural and Northern Health Research (CRaNHR) in conjunction with NOSM starting in 2005 when NOSM first enrolled students. The objective is to understand how NOSM's selection criteria and medical education programmes set in rural and northern communities affect early career decision-making by physicians with respect to their choice of medical discipline, practice location, medical services and procedures, inclusion of medically underserved patient populations and practice structure. METHODS AND ANALYSIS This prospective comparative longitudinal study follows multiple cohorts from entry into medical education programmes at the undergraduate (UG) level (56-64 students per year at NOSM) or postgraduate (PG) level (40-60 residents per year at NOSM, including UGs from other medical schools and 30-40 NOSM UGs who go to other schools for their residency training) and continues at least 5 years into independent practice. The study compares learners who experience NOSM UG and NOSM PG education with those who experience NOSM UG education alone or NOSM PG education alone. Within these groups, the study also compares learners in family medicine with those in other specialties. Data will be analysed using descriptive statistics, χ(2) tests, logistic regression, and hierarchical log-linear models. ETHICS AND DISSEMINATION Ethical approval was granted by the Research Ethics Boards of Laurentian University (REB #2010-08-03 and #2012-01-09) and Lakehead University (REB #031 11-12 Romeo File #1462056). Results will be published in peer-reviewed scientific journals, presented at one or more scientific conferences, and shared with policymakers and decision-makers and the public through 4-page research summaries and social media such as Twitter (@CRaNHR, @NOSM) or Facebook.
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Affiliation(s)
- John C Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Margaret G French
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Patrick E Timony
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Roger P Strasser
- Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ontario, Canada
| | - Dan Hunt
- Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ontario, Canada
- Association of American Medical Colleges, Washington DC, USA
| | - Raymond W Pong
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
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Strasser R. Social accountability and the supply of physicians for remote rural Canada. CMAJ 2015; 187:791-792. [PMID: 26054607 DOI: 10.1503/cmaj.150266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Roger Strasser
- Northern Ontario School of Medicine (Strasser), Lakehead University, Thunder Bay, Ont., and Laurentian University, Sudbury, Ont.
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Tackett S, Grant J, Mmari K. Designing an evaluation framework for WFME basic standards for medical education. MEDICAL TEACHER 2015; 38:291-6. [PMID: 25923235 DOI: 10.3109/0142159x.2015.1031737] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To create an evaluation plan for the World Federation for Medical Education (WFME) accreditation standards for basic medical education. METHODS We conceptualized the 100 basic standards from "Basic Medical Education: WFME Global Standards for Quality Improvement: The 2012 Revision" as medical education program objectives. Standards were simplified into evaluable items, which were then categorized as inputs, processes, outputs and/or outcomes to generate a logic model and corresponding plan for data collection. RESULTS WFME standards posed significant challenges to evaluation due to complex wording, inconsistent formatting and lack of existing assessment tools. Our resulting logic model contained 244 items. Standard B 5.1.1 separated into 24 items, the most for any single standard. A large proportion of items (40%) required evaluation of more than one input, process, output and/or outcome. Only one standard (B 3.2.2) was interpreted as requiring evaluation of a program outcome. CONCLUSIONS Current WFME standards are difficult to use for evaluation planning. Our analysis may guide adaptation and revision of standards to make them more evaluable. Our logic model and data collection plan may be useful to medical schools planning an institutional self-review and to accrediting authorities wanting to provide guidance to schools under their purview.
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Affiliation(s)
- Sean Tackett
- a Johns Hopkins University School of Medicine , USA
| | - Janet Grant
- b The Centre for Medical Education in Context (CenMEDIC) , UK
| | - Kristin Mmari
- c Johns Hopkins Bloomberg School of Public Health , USA
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Larkins S, Michielsen K, Iputo J, Elsanousi S, Mammen M, Graves L, Willems S, Cristobal FL, Samson R, Ellaway R, Ross S, Johnston K, Derese A, Neusy AJ. Impact of selection strategies on representation of underserved populations and intention to practise: international findings. MEDICAL EDUCATION 2015; 49:60-72. [PMID: 25545574 DOI: 10.1111/medu.12518] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/07/2014] [Accepted: 04/28/2014] [Indexed: 05/03/2023]
Abstract
CONTEXT Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions. METHODS A cross-sectional questionnaire was administered to students starting medical education in five institutions with a social accountability mandate in five different countries. The questionnaire assessed students' background characteristics, rurality of background, and practice intentions (location, discipline of practice and population to be served). The results were compared with the characteristics of students entering medical education in schools with standard selection procedures, and with publicly available socio-economic data. RESULTS The selection processes of all five schools included strategies that extended beyond the assessment of academic achievement. Four distinct strategies were identified: the quota system; selection based on personal attributes; community involvement, and school marketing strategies. Questionnaire data from 944 students showed that students at the five schools were more likely to be of non-urban origin, of lower socio-economic status and to come from underserved groups. A total of 407 of 810 (50.2%) students indicated an intention to practise in a non-urban area after graduation and the likelihood of this increased with increasing rurality of primary schooling (p = 0.000). Those of rural origin were statistically less likely to express an intention to work abroad (p = 0.003). CONCLUSIONS Selection strategies to ensure that members of underserved communities can pursue medical careers can be effective in achieving a fair and equitable representation of underserved communities within the student body. Such strategies may contribute to a diverse medical student body with strong intentions to work with underserved populations.
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Affiliation(s)
- Sarah Larkins
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
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Mc Menamin R, Mc Grath M, Cantillon P, Mac Farlane A. Training socially responsive health care graduates: is service learning an effective educational approach? MEDICAL TEACHER 2014; 36:291-307. [PMID: 24650270 DOI: 10.3109/0142159x.2013.873118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Health care educators strive to train graduates who are socially responsive and can act as "change agents" for communities they serve. Service learning (SL) is increasingly being used to teach the social aspects of health care and develop students' social responsiveness. However, the effectiveness of SL as an educational intervention has not been established. AIM To assess the evidence for the effectiveness of SL. METHOD Seven electronic databases were searched up to 2012 and included all articles on SL for pre-professional health care students. Hand searching was also conducted. RESULTS A total of 1485 articles were identified, 53 fulfilled the search and quality appraisal criteria and were reviewed across six domains of potential SL effects: (i) personal and interpersonal development; (ii) understanding and applying knowledge; (iii) engagement, curiosity and reflective practice; (iv) critical thinking; (v) perspective transformation and (vi) citizenship. CONCLUSION While SL experiences appear highly valued by educators and students the effectiveness of SL remains unclear. SL is different from other forms of experiential learning because it explicitly aims to establish reciprocity between all partners and increase students' social responsiveness. Impact studies based on the interpretative paradigm, aligned with the principles of social accountability and including all stakeholder perspectives are necessary.
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Strasser R, Hogenbirk JC, Minore B, Marsh DC, Berry S, McCready WG, Graves L. Transforming health professional education through social accountability: Canada's Northern Ontario School of Medicine. MEDICAL TEACHER 2013; 35:490-6. [PMID: 23496120 DOI: 10.3109/0142159x.2013.774334] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND The Northern Ontario School of Medicine (NOSM) has a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario. NOSM recruits students from Northern Ontario or similar backgrounds and provides Distributed Community Engaged Learning in over 70 clinical and community settings located in the region, a vast underserved rural part of Canada. METHODS NOSM and the Centre for Rural and Northern Health Research (CRaNHR) used mixed methods studies to track NOSM medical learners and dietetic interns, and to assess the socioeconomic impact of NOSM. RESULTS Ninety-one percent of all MD students come from Northern Ontario with substantial inclusion of Aboriginal (7%) and Francophone (22%) students. Sixty-one percent of MD graduates have chosen family practice (predominantly rural) training. The socioeconomic impact of NOSM included new economic activity, more than double the School's budget; enhanced retention and recruitment for the universities and hospital/health services; and a sense of empowerment among community participants attributable in large part to NOSM. DISCUSSION There are signs that NOSM is successful in graduating health professionals who have the skills and desire to practice in rural/remote communities and that NOSM is having a largely positive socioeconomic impact on Northern Ontario.
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Affiliation(s)
- Roger Strasser
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, Ontario, Canada.
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