Dan Hunt

Canada's New Medical School: The Northern Ontario School of Medicine: Social Accountability Through Distributed Community Engaged Learning

Like many rural regions around the world, Northern Ontario has a chronic shortage of doctors. Recognizing that medical graduates who have grown up in a rural area are more likely to practice in the rural setting, the Government of Ontario, Canada, decided in 2001 to establish a new medical school in the region with a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario. The Northern Ontario School of Medicine (NOSM) is a joint initiative of Laurentian University and Lakehead University, which are located 700 miles apart. This paper outlines the development and implementation of NOSM, Canada’s first new medical school in more than 30 years. NOSM is a rural distributed community-based medical school which actively seeks to recruit students into its MD program who come from Northern Ontario or from similar northern, rural, remote, Aboriginal, Francophone backgrounds. The holistic, cohesive curriculum for the MD program relies heavily on electronic communications to support distributed community engaged learning. In the classroom and in clinical settings, students explore cases from the perspective of physicians in Northern Ontario. Clinical education takes place in a wide range of community and health service settings, so that the students experience the diversity of communities and cultures in Northern Ontario. NOSM graduates will be skilled physicians ready and able to undertake postgraduate training anywhere, but with a special affinity for and comfort with pursuing postgraduate training and clinical practice in Northern Ontario.

Developing a medical school: Expansion of medical student capacity in new locations: AMEE Guide No. 55

Background: A concern about an impending shortage of physicians and a worry about the continued maldistribution of physicians to medically underserved areas have encouraged the expansion of medical school training places in many countries, either by the creation of new medical schools or by the creation of regional campuses. Aims: In this Guide, the authors, who have helped create new regional campuses and medical schools in Australia, Canada, UK, USA, and Thailand share their experiences, triumphs, and tribulations, both from the views of the regional campus and from the views of the main Medical School campus. While this Guide is written from the perspective of building new regional campuses of existing medical schools, many of the lessons are applicable to new medical schools in any country of the world. Many countries in all regions of the world are facing rapid expansion of medical training facilities and we hope this Guide provides ideas to all who are contemplating or engaged in expanding medical school training places, no matter where they are. Description: This Guide comprises four sections: planning; getting going; pitfalls to avoid; and maturing and sustaining beyond the first years. While the context of expanding medical schools may vary in terms of infrastructure, resources, and access to technology, many themes, such as developing local support, recruiting local and academic faculty, building relationships, and managing change and conflict in rapidly changing environments are universal themes facing every medical academic development no matter where it is geographically situated. Further information: The full AMEE Guide, printed separately, in addition contains case examples from the authors’ experiences of successes and challenges they have faced.

The Unintended Consequences of Clarity: Reviewing the Actions of the Liaison Committee on Medical Education Before and After the Reformatting of Accreditation Standards

Purpose To determine the frequency of severe action decisions made by the Liaison Committee on Medical Education (LCME) in two time periods and to speculate about contributing factors for any change. Method Two study periods were reviewed. Study Period 1 (1996–2000) was before a 2002 reformatting of the standards; Study Period 2 (2004–2009) was after that reformatting. The frequency of severe action decisions and patterns of noncompliance leading to those decisions in both periods were analyzed. Results There were more severe action decisions during Study Period 2 than Study Period 1, with a notable increase in the number of recommendations for probation. Study Period 1 had substantially more noncompliance with standards within the Institutional Setting and Educational Resource categories, whereas Study Period 2 had substantially more noncompliance within the Educational Program and Medical Student categories. Conclusions The 2002 reformatting of the standards enhanced the clarity of each standard and connected previously existing annotations to their standards. As a result of the reformatting, all documents and communications to schools were directly tied to specific standards. This has allowed the LCME to more easily identify areas of chronic noncompliance and to improve survey team training. The shift in patterns of standards out of compliance in the more recent time period is consistent with the effect of the reformatting. There may be other contributing factors for the increase in severe action decisions, but it is clear that the reformatting of standards has improved the LCME’s ability to monitor medical education programs.

Continuous quality improvement in an accreditation system for undergraduate medical education: Benefits and challenges*

Abstract Background: Accreditation reviews of medical schools typically occur at fixed intervals and result in a summative judgment about compliance with predefined process and outcome standards. However, reviews that only occur periodically may not be optimal for ensuring prompt identification of and remediation of problem areas. Aims: To identify the factors that affect the ability to implement a continuous quality improvement (CQI) process for the interval review of accreditation standards. Methods: Case examples from the United States, Canada, the Republic of Korea and Taiwan, were collected and analyzed to determine the strengths and challenges of the CQI processes implemented by a national association of medical schools and several medical school accrediting bodies. The CQI process at a single medical school also was reviewed. Results: A functional CQI process should be focused directly on accreditation standards so as to result in the improvement of educational quality and outcomes, be feasible to implement, avoid duplication of effort and have both commitment and resource support from the sponsoring entity and the individual medical schools. Conclusions: CQI can enhance educational program quality and outcomes, if the process is designed to collect relevant information and the results are used for program improvement.

Outcomes of the Northern Ontario School of Medicine's distributed medical education programmes: protocol for a longitudinal comparative multicohort study

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 NOSMs 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, χ2 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.

The Variables That Lead to Severe Action Decisions by the Liaison Committee on Medical Education.

Purpose To identify the variables associated with severe action decisions (SADs) (unspecified accreditation term, warning status, probation status) by the Liaison Committee on Medical Education (LCME) regarding the accreditation status of established MD-granting medical education programs in the United States and Canada. Method The authors reviewed all LCME decisions made on full survey reports between October 2004 and June 2012 to test whether SADs were associated with an insufficient response in the data collection instrument/self-study, chronic noncompliance with one or more accreditation standards, noncompliance with specific standards, and noncompliance with a large number of standards. Results The LCME issued 103 nonsevere action decisions and 40 SADs. SADs were significantly associated with an insufficient response in the data collection instrument/self-study (odds ratio [OR] = 7.30; 95% confidence interval [CI] = 2.38–22.46); chronic noncompliance with one or more standards (OR = 12.18; 95% CI = 1.91–77.55); noncompliance with standards related to the educational program for the MD degree (ED): ED-8 (OR = 6.73; 95% CI = 2.32–19.47) and ED-33 (OR = 5.40; 95% CI = 1.98–14.76); and noncompliance with a large number of standards (r pb = 0.62; P < .001). Conclusions These findings provide insight into the LCME’s pattern of decision making. Noncompliance with two standards was strongly associated with SADs: lack of evidence of comparability across instructional sites (ED-8) and the absence of strong central management of the curriculum (ED-33). These results can help medical school staff as they prepare for an LCME full survey visit.

When bad things happen in the learning environment.

Managing mistreatment of medical students and others in the learning environment. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Accreditation standards of DO- and MD-granting medical schools: an incomplete comparison.

Furthermore, the authors’ comparison of the accreditation standards overlooks a number of significant issues. For example, among its accreditation standards for MD educational programs, the Liaison Committee on Medical Education (LCME) requires the presence of research activities at the institutional level; opportunities for medical students’ engagement in those activities; curricular content related to the basic principles of clinical and translational research, including how such research is conducted, evaluated, explained to patients, and applied to patient care; systems of career advising for students; and attention to the “hidden curriculum” in the learning environment. None of these areas is addressed in the Commission on Osteopathic College Accreditation (COCA) standards. Moreover, COCA’s approach to diversity issues in medical education differs significantly from that of the LCME. COCA’s diversity standards are framed in the terminology of antidiscrimination statements, in contrast to LCME standards that require the development of proactive activities at schools (e.g., pipeline programs) to enhance diversity among faculty, staff, and students and contain an expectation that schools will recognize their collective responsibility for contributing to the diversity of the profession as a whole.