Abstracts
Abstract
Background: There is currently a maldistribution of physicians across Canada, with rural areas facing a greater physician shortage. The taskforce between the College of Family Physicians and the Society of Rural Physicians created a report, “The Rural Road Map for Action” (RRMA) to improve rural Canadians' health by training and retaining an increased number of rural family physicians. Using the RRMA as a framework, this paper aims to examine the extent to which medical schools in Canada are following the RRMA.
Methods: Researchers used cross-sectional survey and collected data from 12 of 17 medical school undergraduate Deans from across Canada using both closed and open ended survey questions. Results were analyzed using quantitative (frequencies) and qualitative methods (content analysis).
Results: Medical schools use different policies and procedures to recruit rural and Indigenous students. Although longitudinal integrated clerkships offer many benefits, few students have access to them. Leadership representation on decision-making education committees differed across medical schools pointing to a variation in the value of rural physicians’ perspectives.
Conclusion: This study illustrated that medical schools are making efforts that align with the RRMA. It is critical they continue to make strategic decisions embedded in educational policy and leadership to reinforce the importance of and influence of rural medical education to support workforce planning.
Résumé
Contexte : À l’heure actuelle, la répartition des médecins sur le territoire canadien est inégale, les régions rurales étant confrontées à une plus forte pénurie de médecins. Le groupe de travail constitué par le Collège des médecins de famille du Canada (CMFC) et la Société de la médecine rurale du Canada (SMRC) a produit un rapport intitulé « Plan d’action pour la médecine rurale » (PAMR) qui vise à améliorer la santé des Canadiens vivant en milieu rural par la formation et la rétention d’un nombre accru de médecins de famille en milieu rural. Partant du cadre du PAMR, cet article évalue dans quelle mesure les facultés de médecine du Canada suivent le Plan d’action.
Méthodes : Les chercheurs ont eu recours à une enquête transversale, comportant des questions fermées et ouvertes, pour recueillir des données auprès de 12 des 17 doyens aux études de premier cycle des facultés de médecine canadiennes. Les résultats ont été analysés à l’aide de méthodes quantitatives (calcul des fréquences) et qualitatives (analyse de contenu).
Résultats : Les facultés de médecine appliquent des politiques et des procédures différentes pour recruter des étudiants ruraux et autochtones. Les stages intégrés longitudinaux offrent de nombreux avantages, mais peu d’étudiants y ont accès. La représentation des dirigeants au sein des comités décisionnels sur l’éducation diffère selon les facultés de médecine, ce qui indique une variation de la valeur des perspectives des médecins ruraux.
Conclusion : Cette étude montre que les facultés de médecine déploient des initiatives qui sont conformes au PAMR. Il est essentiel que leurs décisions stratégiques demeurent ancrées dans un leadership et une politique éducative visant à renforcer et à mettre en valeur l’exposition des étudiants à la médecine rurale pour appuyer la planification des effectifs.
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Bibliography
- Shah TI, Clark AF, Seabrook JA, Sibbald S, Gilliland JA. Geographic accessibility to primary care providers: comparing rural and urban areas in Southwestern Ontario. Can Geogr 2020;64(1):65–78. http://dx.doi.org/10.1111/cag.12557
- Sibley LM, Weiner JP. An evaluation of access to health care services along the rural-urban continuum in Canada. BMC Health Serv Res. 2011;11. https://doi.org/10.1186/1472-6963-11-20
- Rourke JTB. Postgraduate medical education for family practice in Canada. J Rural Heal. 2000;16(3):280–7. https://doi.org/10.1111/j.1748-0361.2000.tb00474.x
- Canadian Institute for Health Information. Supply, distribution and migration of physicians in Canada 2015 – data tables. [Internet]. Ottawa, ON: Canadian Institute for Health Information; 2016. Available from https://secure.cihi.ca/estore/productSeries.htm?pc=PCC34 [Accessed on Sep 25, 2022].
- Bosco C, Oandasan I. Review of family medicine within rural and remote Canada: education, practice, and policy. College of Family Physicians of Canada. 2016.
- Ketcheson M. Desperate for help’ as nursing vacancies soar in northern Manitoba, union says in urgent plea. CBC News. 2021 Nov 30; https://www.cbc.ca/news/canada/manitoba/gillam-manitoba-nursing-shortage-1.6268039
- World Health Organization. The world health report 2008: primary health care – now more than ever. 2008. https://apps.who.int/iris/handle/10665/43949
- Starfield B, Shi L, Mackinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x
- Verma P, Ford JA, Stuart A, Howe A, Everington S, Steel N. A systematic review of strategies to recruit and retain primary care doctors. BMC Health Serv Res. 2016;16(1). http://dx.doi.org/10.1186/s12913-016-1370-1
- Advancing rural family medicine: the Canadian collaborative taskforce. The rural road map for action - directions [Internet]. 2017. www.cfpc.ca/arfm.%0Ahttp://www.cfpc.ca/uploadedFiles/Directories/Committees_List/Rural Road Map Directions ENG.pdf
- Soles T, Wilson R, Oandasan IF. Family medicine education in rural communities as a health service intervention supporting recruitment and retention of physicians. Can Fam Physician. 2017;63:32–8.
- Wilson CR, Rourke J, Oandasan IF, Bosco C. Progress made on access to rural health care in Canada. Can Fam Physician. 2020;66(1):31–6. https://doi.org/10.4103/CJRM.CJRM_84_19
- Curran V, Rourke J. The role of medical education in the recruitment and retention of rural physicians. Med Teach. 2004;26(3):265–72. https://doi.org/10.1080/0142159042000192055
- Pong R, Heng D. The link between rural medical education and rural medical practice location: literature review and synthesis. Sudbury, ON: Laurentian University. 2005. http://cranhr.com/pdf/Physician_Planning_Unit_report_Final.pdf
- Rourke J, Wilson R, Oandasan IF, Bosco C, Rural road map implementation committee. A case study of Canada’s rural practice training 21st-Century journey. Soc Innov J. 2020; https://socialinnovationsjournal.com/index.php/sij/article/view/423/366
- Parker K, Oandasan I. The Interprofessional collaborative organization map and preparedness assessment tool (IP-COMPASS). MedEdPORTAL. 2012. https://doi.org/10.15766/mep_2374-8265.9257
- Canadian Institutes of Health Research, Canada NS and ERC of, Social Sciences and Humanities Research Council of Canada. Ethical conduct for research involving humans. 2018.
- Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. https://doi.org/10.1177/1049732305276687
- Hart LG, Larson EH, Lishner DM. Rural definitions for health policy and research. Am J Public Health. 2005;95(7):1149–55. https://doi.org/10.2105/AJPH.2004.042432
- Oler Q. Access to Aboriginal doctors a struggle for Indigenous population. Global News. 2018; https://globalnews.ca/news/4769750/access-aboriginal-doctors-struggle-indigenous-population/
- Truth and Reconciliation Commission of Canada. Honouring the truth, reconciling for the future: summary of the final report of the Truth and Reconciliation Commission of Canada. 2015.
- Mian O, Hogenbirk JC, Marsh DC, Prowse O, Cain M, Warry W. Tracking Indigenous applicants through the admissions process of a socially accountable medical school. Acad Med. 2019;94(8):1211–9. https://doi.org/10.1097/ACM.0000000000002636
- Royston PJ, Mathieson K, Leafman J, Ojan-Sheehan O. Medical student characteristics predictive of intent for rural practice. Rural Remote Health. 2012;12(3). https://doi.org/10.22605/RRH2107
- Birden H, Barker J, Wilson I. Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship. Med Teach. 2016;38(9):946–56. https://doi.org/10.3109/0142159X.2015.1114594
- Walters L, Greenhill J, Richards J, et al. Outcomes of longitudinal integrated clinical placements for students, clinicians and society. Med Educ. 2012;46(11):1028–41. https://doi.org/10.1111/j.1365-2923.2012.04331.x
- Hirsh D, Walters L, Poncelet AN. Better learning, better doctors, better delivery system: possibilities from a case study of longitudinal integrated clerkships. Med Teach. 2012;34(7):548–54. https://doi.org/10.3109/0142159X.2012.696745
- Couper I, Worley PS, Strasser R. Rural longitudinal integrated clerkships: lessons from two programs on different continents. Rural Remote Health. 2011;11(1):1–11. https://doi.org/10.22605/RRH1665
- Snow SC, Gong J, Adams JE. Faculty experience and engagement in a longitudinal integrated clerkship. Med Teach. 2017;39(5):527–34. https://doi.org/10.1080/0142159X.2017.1297528
- Curran V, Rourke L, Snow P. A framework for enhancing continuing medical education for rural physicians: A summary of the literature. Med Teach. 2010;32(11). https://doi.org/10.3109/0142159X.2010.519065
- LaDonna KA, Taylor T, Lingard L. Why open-ended survey questions are unlikely to support rigorous qualitative insights. Acad Med. 2018;93(3):347–9. https://doi.org/10.1097/ACM.0000000000002088