The role, the risk, and the reciprocity: creating positive early rural placements in medical education.

INTRODUCTION: The Northern Ontario School of Medicine University seeks to address rural physician shortages in Northern Ontario. One key strategy the school employs is the use of experiential learning placements embedded throughout its undergraduate curriculum. In second year, students embark on two 4-week placements in rural and remote communities. This study sought to explore the factors that contribute to a positive learning experience from the preceptor's perspective. METHODS: Semi-structured interviews were conducted with five community preceptors who have participated in these placements. Using the information from these interviews a survey was created and sent to another 15 preceptors. Data were analyzed using qualitative methods and frequencies. RESULTS: Three key themes were identified from both the interviews and survey data: the role of early rural and remote placements; the risks of these placements; and the need for a reciprocal relationship between institutions, preceptors, and students to create a positive learning environment. CONCLUSION: Preceptors value the opportunity to teach students, but the aims of these placements are not clear and preceptors and local hospitals need more workforce resources to make these experiences positive.

NorthBEAT: exploring the service needs of youth experiencing early psychosis in Northern Ontario.

Introduction: Early Psychosis Intervention (EPI) is critical for best outcomes. Among 369 diseases, psychosis is among those causing the greatest disability. Evidence-based interventions for youth in early stages of psychosis (EPI programs) have prevented chronic disability. Yet, EPI is frequently inaccessible for youth living in rural communities. Moreover, Indigenous youth often face more precipitous situations given inadequate staffing, and culturally unsafe care. The NorthBEAT (Barriers to Early Assessment and Treatment) project sought to understand the service needs of youth with psychosis in Northern Ontario. The goals were: (1) to describe the mental health of a subset of adolescents receiving EPI care; (2) examine Indigenous youth as a significant and vulnerable population; (3) to understand the barriers and facilitators for Indigenous and non-Indigenous youth receiving EPI. Methods: Mixed methods (structured and narrative interviews) included: psychometric scales interviews with youth, and narrative interviews with youth, their family, and service providers Data validation workshops were held with participants. Results: Structured interviews with 26 youth (M = 17 years) found the participants functioning moderately well with duration of untreated psychosis ranging from 1 to 96 months (M = 26 months). No significant differences were found in functioning or duration of psychosis between Indigenous and non-Indigenous youth. Narrative interviews were conducted with 18 youth, 11 family members, and 14 service providers. Identified barriers were a lack of knowledge about psychosis among service providers, a disconnected system leading to delays in treatment, help not wanted by youth, expansive geographical context. Service needs were: finding the right point of access, support for families, pre-crisis intervention, reduced stigma for youth and their families, and an EPI approach to care. Discussion: Rural and northern youth face similar barriers to accessing EPI as urban youth. However, northern youth face additional unique challenges due to expansive geographical context, limited resources and lack of knowledge about services.

Comparing and using prominent social accountability frameworks in medical education: moving from theory to implementation in Northern Ontario, Canada.

Background: Social accountability in medical education is conceptualized as a responsibility to respond to the needs of local populations and demonstrate impact of these activities. The objective of this study was to rigorously examine and compare social accountability theories, models, and frameworks to identify a theory-informed structure to understand and evaluate the impacts of medical education in Northern Ontario. Methods: Using a narrative review methodology, prominent social accountability theories, models, and frameworks were identified. The research team extracted important constructs and relationships from the selected frameworks. The Theory Comparison and Selection Tool was used to compare the frameworks for fit and relevance. Results: Eleven theories, models, and frameworks were identified for in-depth analysis and comparison. Two realist frameworks that considered community relationships in medical education and social accountability in health services received the highest scores. Frameworks focused on learning health systems, evaluating institutional social accountability, and implementing evidence-based practices also scored highly. Conclusion: We used a systematic theory selection process to describe and compare social accountability constructs and frameworks to inform the development of a social accountability impact framework for the Northern Ontario School of Medicine. The research team examined important constructs, relationships, and outcomes, to select a framework that fits the aims of a specific project. Additional engagement will help determine how to combine, adapt, and implement framework components to use in a Northern Ontario framework.

Contexte: La responsabilité sociale dans l'éducation médicale est conceptualisée comme étant la responsabilité de répondre aux besoins des populations locales et de démontrer l'impact de ces activités. L'objectif de cette étude était d'examiner rigoureusement et de comparer les théories, les modèles et les cadres de la responsabilité sociale afin d'élaborer un dispositif ayant des fondements théoriques qui servirait à cerner et à évaluer les retombées de l'éducation médicale dans le Nord de l'Ontario. Méthodes: Suivant une méthodologie de revue narrative, les théories, modèles et cadres principaux de la responsabilité sociale ont été recensés. L'équipe de recherche a extrait les concepts et les relations importants des cadres sélectionnés. Les cadres ont ensuite été comparés sur le plan de l'adéquation et de la pertinence à l'aide d'un outil de comparaison et de sélection des théories (le Theory Comparison and Selection Tool). Résultats: Onze théories, modèles et cadres ont été retenus pour une analyse et une comparaison approfondies. Deux cadres réalistes prenant en considération les relations communautaires dans l'éducation médicale et la responsabilité sociale dans les services de soins de santé ont reçu les scores les plus élevés. Les cadres axés sur l'apprentissage des systèmes de santé e, sur l'évaluation de la responsabilité sociale des institutions et sur la mise en œuvre de pratiques fondées sur les données probantes ont également obtenu des scores élevés. Conclusion: Nous avons utilisé un processus systématique de sélection des théories pour décrire et comparer les construits et les cadres de responsabilité sociale afin d'éclairer le développement d'un cadre de référence sur les retombées de la responsabilité sociale pour l'École de médecine du Nord de l'Ontario. L'équipe de recherche a examiné les construits importants, les liens entre ces derniers et les retombées afin de choisir un cadre pouvant répondre aux objectifs d'un projet spécifique. Des travaux ultérieurs permettront de déterminer de quelle manière il sera possible de combiner, d'adapter et de mettre en œuvre les composantes de ce cadre qui sera utilisé dans le Nord de l'Ontario.