Professor Roger Strasser Northern Ontario School of Medicine

2. Recruitment & Retention of Health Care Providers in Remote Rural Areas: The View from Up Over and Down Under Professor Roger Strasser Northern Ontario School of Medicine

4. Recruitment & Retention Strategies • education and training • regulatory initiatives • financial incentives & rewards • personal & professional support • sustainable service models

5. Rural Health Around the World • access is the rural health issue • resources concentrated in cities • communication • and transport difficulties • rural health workforce shortages

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

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

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

9. Interprofessional Teamwork • Much talked about in the cities • Actually happens more • in rural communities - workforce shortages - community relationship - “do the necessary”

10. Sustainable Rural Health Services • health service authority/agency • health care providers • community participation

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

12. Retention Factors academic involvement recognition and reward support from “the system” active community engagement

13. Rural Based Medical Education response to workforce shortages specific knowledge and skills high quality learning environment

14. Rural Clinical Education more hands-on experience greater procedural competence more common conditions

15. Impact of Rural Based Medical Education more skilled rural doctors enhanced rural health care improved rural health outcomes broader academic developments economic developments

16. Australia Rural and Remote GP Program - Rural Workforce Agencies Retention Payments Rural Postgraduate Training - GP and Specialist Rural Based Medical Education

17. Australian Rural Academic Initiatives Rural Undergraduate Support and Coordination University Departments of Rural Health Rural Clinical Schools

18. Canada Differs Province to Province Recruitment incentives Alternative funding models Rural postgraduate training Rural medical school programs

19. Northern Ontario School of Medicine Faculty of Medicine of Lakehead Faculty of Medicine of Laurentian Social Accountability mandate Commitment to innovation

20. Northern Ontario Southern Ontario • Sioux Lookout In, by and for Northern Ontario

21. Doctor’s Life Cycle high schools program local premed programs undergraduate program postgraduate programs professional development graduate studies

22. Admissions 2005-2010 12,000 applications for 346 places • 20% of applicants interviewed • 15% of interviewees enrolled Class Profile • 91% Northern Ontario • 7% Aboriginal 22% Francophone • GPA 3.7 • Age 26 (except 28 charter class) • 68% Female 32% Male

23. Distributed CommunityEngaged 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

24. Organization / Deliveryof NOSM Curriculum Phase 1 Phase 2 Phase 3 Residency Year 1 101 102 103 104 105 106 Year 2 107 108 109 110 111 Year 3 Comprehensive Community Clerkship Year 4 Clerkship & Electives Licensure Examination Years 5, 6 and Beyond Individual Specialty Choice Elective Case Based Modules

26. Patient CentredCase Based Learning complex “real life” scenarios structured discussion, analysis and problem solving informed tutor / facilitator

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

28. Rural Distributed Medical Education high quality clinical and educational experiences electronic access to information and educational resources maximum human contact

30. Community Engagement • community active participant • - interdependent partnership • ensures student “at home” • contributes to student’s • learning experience • education and research activities • community capacity building

31. NOSM Outcomes CaRMS - 100% matched 63% rural family medicine 33% general specialties 11 medical schools (of 17) 35% residency with NOSM “deep roots” in Northern Ontario >65% of NOSM residents stay

32. NOSM Charter Class NOSM

33. NOSM Residents

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

35. Essentials for Success • Context counts • Community participation • Standards and quality • Definition of success • Challenge conventional wisdom • Vision, mission and values • Program blueprint

37. References • Strasser R. Rural Health Around the World: Challenges and Solutions. Family Practice 2003; 20: 457-463. • Strasser R., et al. Canada's new medical school: the Northern Ontario School of Medicine - social accountability through distributed community engaged learning. Academic Medicine. 2009; 84: 1459-1456 • Strasser, R. Community engagement: a key to successful rural clinical education. Rural and Remote Health 10: 1543. (Online), 2010. Available from: http://www.rrh.org.au • Strasser R, Neusy, A-J. Context Counts: Training Health Workers in and for Rural Areas. Bull World Health Organ 2010; 88: 777 – 782