recruitment & retention of health care providers in remote rural areas: the view from up over...
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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
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Recruitment & Retention Strategies
• education and training
• regulatory initiatives
• financial incentives & rewards
• personal & professional support
• sustainable service models
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access is the rural health issue
• resources concentrated in cities
• communication
and transport difficulties
• rural health workforce shortages
Rural Health Around the World
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Rural Health Services
• access is the major issue• “safety net”• local services preferred• limited resources• workforce shortages• different from cities
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Rural Health Care
•specialists’ support role
•partnership not putdown
•consultant support local service
•not assume patients will travel
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Rural Practitioners
• wide range of services• high level of clinical
responsibility• relative professional
isolation• specific community health
role
“Extended Generalists”
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Interprofessional Teamwork
- workforce shortages- community relationship- “do the necessary”
• Much talked about in the cities• Actually happens more in rural communities
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Sustainable Rural Health Services
• health service authority/agency
• health care providers
• community participation
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Recruitment Facilitators
for Rural Practice • rural upbringing• positive undergraduate rural clinical experiences• targeted postgraduate training for rural practice
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Retention Factors
• academic involvement
• recognition and reward
• support from “the system”
• active community engagement
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Rural Based Medical Education
• response to workforce shortages• specific knowledge and skills• high quality learning environment
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Rural Clinical Education
• more hands-on experience• greater procedural competence• more common conditions
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Impact of Rural Based Medical Education
• more skilled rural doctors
• enhanced rural health care
• improved rural health outcomes
• broader academic developments
• economic developments
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Australia
• Rural and Remote GP Program
- Rural Workforce Agencies
• Retention Payments
• Rural Postgraduate Training
- GP and Specialist
• Rural Based Medical Education
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Australian Rural Academic Initiatives
• Rural Undergraduate Support and Coordination• University Departments of Rural Health• Rural Clinical Schools
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Canada
• Differs Province to Province
• Recruitment incentives
• Alternative funding models
• Rural postgraduate training
• Rural medical school programs
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Northern Ontario School of Medicine
• Faculty of Medicine of Lakehead
• Faculty of Medicine of Laurentian
• Social Accountability mandate
• Commitment to innovation
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In, by and for Northern Ontario
Northern Ontario
Southern Ontario
• Sioux Lookout
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Doctor’s Life Cycle
• high schools program
• local premed programs
• undergraduate program
• postgraduate programs
• professional development
• graduate studies
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Admissions 2005-201012,000 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
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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
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Organization / Delivery
of NOSM CurriculumPhase 1 Phase 3
Year 1
101102103104105106
Residency
Year 2
107108109110111
Year 3
Comprehensive Community
Clerkship
Year 4
Clerkship&
Electives
Licensure Examination
Years 5, 6and Beyond
IndividualSpecialtyChoice
Case Based Modules
Phase 2
Elective
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Patient CentredCase Based Learning
• complex “real life” scenarios
• structured discussion, analysis
and problem solving
• informed tutor / facilitator
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Principles for Longitudinal Integrated Curricula
• comprehensive patient care over time• continuing learning relationships with clinicians• achieve core clinical competencies across multiple disciplines simultaneously
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Rural Distributed Medical Education
• high quality clinical and educational experiences• electronic access to information and educational resources• maximum human contact
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Integrated Clinical Learning
InterprofessionalLearners and
Providers
MedicalStudents
Clinical Teachers
PostgraduateResidents
Patient & Family
Context: •Clinical setting•Area of care•Physical environment•Practice culture•Community
Learning occurs at points of overlap –multiple overlap can lead to richer learning
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Community Engagement
• community active participant - interdependent partnership• ensures student “at home”• contributes to student’s learning experience• education and research activities• community capacity building
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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
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NOSM Charter Class
NOSM
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NOSM Residents
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Benefits of NOSM
• More generalist doctors• Enhanced healthcare access• Responsiveness to Aboriginal, Francophone, rural, remote• Interprofessional cooperation• Health research• Broader academic developments• Economic development
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Essentials for Success
• Context counts• Community participation• Standards and quality• Definition of success • Challenge conventional wisdom• Vision, mission and values• Program blueprint
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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
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