Roger Strasser

• NOSM University

Family physicians in Ontario provide most of the primary care to the healthcare system. However, given their broad scope of practice, they often provide additional services including emergency medicine, hospital medicine, and palliative care. Understanding the spectrum of services provided by family physicians across different regions is important...

OBJECTIVES In recent years, Indigenous health curricula have been integrated into medical education in response to international calls to improve Indigenous health care. Instruments to evaluate Indigenous health education are urgently needed. We set out to validate a tool to measure self-reported medical student preparedness to provide culturally s...

Background: This project aimed to build an understanding of the lived realities of social accountability. The COVID-19 era offered acontextual lens and time marker. Social accountability is gaining importance as an educational concept. To maximize the value, it is essential to know how the concept is interpreted from multiple stakeholder perspectiv...

Our research aims to map the breadth and depth of the existing literature regarding educational approaches in health professions education underpinned by the concept of social accountability.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘XII: Family medicine and the future of the healthcare system’, a...

This scoping review will address a critical knowledge-practice gap by synthesizing the existing literature reporting on the implementation of educational approaches in and by building on current strengths to advance curriculum development and implementation.

While social accountability (SA) is regarded as an obligation or mandate for medical school administration, it runs the danger of becoming a bureaucratic checkbox. Compassion which leads to social responsiveness (SR), in contrast, is often recognized as an individual characteristic, detached from the public domain. The two, however, complement each...

Access to health workers who are fit for purpose, motivated and protected is a fundamental force of health service delivery and the achievement of universal health coverage and the health and health-related Sustainable Development Goals. Data and knowledge of the distribution, skill mix and future development needs of the health workforce can mean...

The 19th World Rural Health Conference, hosted in rural Ireland and the University of Limerick, with over 650 participants coming from 40 countries and an additional 1600 engaging online, has carefully considered how best rural communities can be empowered to improve their own health and the health of those around them. The conference also consider...

Introduction: The emergency department (ED) in rural communities is essential for providing care to patients with urgent medical issues and those unable to access primary care. Recent physician staffing shortages have put many EDs at risk of temporary closure. Our goal was to describe the demographics and practices of the rural physicians providin...

Background In an arts integrated interdisciplinary study set to investigate ways to improve social accountability (SA) in medical education, our research team has established a renewed understanding of compassion in the current SA movement. Aim This paper explores the co-evolution of compassion and SA. Methods The study used an arts integrated ap...

Introduction The study predicted practice location of doctors trained at a socially accountable medical school with education programs in over 90 communities. Methods A cross-sectional study examined practice location 10 years after the first class graduated from the Northern Ontario School of Medicine (NOSM), Canada. Exact tests and logistic regr...

Leslie et al.'s (2022) article caused me to reflect on the complexities and contradictions that are Canada. Healthcare in Canada is a hodgepodge of different health systems all assembled under the umbrella of the Canada Health Act (1985). Canadians expect medicare to deliver high-quality healthcare close to home wherever they live. For this aspirat...

Objectives: To investigate the acceptability and the effectiveness of a virtual adaptation of a well-established, mandatory, community-based pre-clinical remote area health placement in which medical students learn about the social and environmental determinants of health in remote Australia; and make recommendations to guide the delivery of futur...

Background There are few examples of the practical application of the concepts of social accountability, as defined by the World Bank and WHO, to health system change. This paper describes a robust approach led by First Nations Health Authority and the Rural Coordination Centre of British Columbia. This was achieved using partnerships in British Co...

Background Medical schools with distributed or regional programs encourage people to live, work, and learn in communities that may be economically challenged. Local spending by the program, staff, teachers, and students has a local economic impact. Although the economic impact of DME has been estimated for nations and sub-national regions, the comm...

Developed in Northern Ontario, Canada, Integrated Clinical Learning (ICL) involves a team of clinical teachers from a range of health professions teaching a team of students and trainees together in common community and clinical settings. It is the balanced integration of educational strategies to develop healthcare providers and team-based compete...

Background: COVID-19 has the potential to disproportionately affect the rural, remote, and Indigenous populations who typically have a worse health status and live in substandard housing, often with overcrowding. Our aim is to investigate the potential effect of COVID-19 on intensive care unit (ICU) resources and mortality in northwestern Ontario....

Background: Recruiting and retaining a skilled health workforce is a common challenge for remote and rural communities worldwide, negatively impacting access to services, and in turn peoples' health. The research literature highlights different factors facilitating or hindering recruitment and retention of healthcare workers to remote and rural ar...

Introduction: The objective of this study was to identify commonalities between one regionally based medical school in Australia and one in Canada regarding the association between postgraduate training location and a doctor's practice location once fully qualified in a medical specialty. Methods: Data were obtained using a cross-sectional surve...

Background: Social support may be beneficial for medical students who must develop adaptive strategies to respond to the demands and challenges during third-year clerkship. We provide a detailed description of the supportive behaviours experienced by third-year students during a longitudinal integrated clerkship (LIC) in the context of rural famil...

BACKGROUND Community engagement is believed to be an important component of quality primary health care. We aimed to capture specific examples of community engagement by general practices, and to understand the barriers that prevent engagement. METHODS We conducted 20 distinct interviews with 31 key informants from general practice and the wider co...

Many new medical programs have been established during the last 20 years, and this trend seems set to continue as the health care needs of the world’s populations become more complex and demand increases for more physicians to provide the necessary health care. In this paper, we address how best to establish a new medical school, based on our exper...

Objective: To describe and compare the scope of practice (SoP) of GPs and FPs between the rural northern, rural southern, urban northern, and urban southern regions of Ontario. Design: Cross-sectional retrospective analysis of the 2013 College of Physicians and Surgeons of Ontario official register and annual membership renewal survey data. Set...

Objective: To explore the Northern Ontario School of Medicine (NOSM) student and graduate experience of generalism in rural practice, in the context of a growing discourse on generalism. Design: Qualitative analysis. Setting: Northern Ontario School of Medicine in multiple sites across northern Ontario, which is the NOSM campus. Participants:...

Background: Northern Ontario School of Medicine (NOSM) serves as the Faculty of Medicine of Lakehead and Laurentian Universities, and views the entire geography of Northern Ontario as its campus. This paper explores how community engagement contributes to achieving social accountability in over 90 sites through NOSM's distinctive model, Distribute...

To achieve sustainability, remote and rural communities require health service models that are designed in and for these settings and are responsive to local population health needs. This paper draws on a panel discussion at the Rural and Indigenous Health Symposium held in Toronto, ON, on September 21, 2017. Active community participation is an im...

Introduction: The Northern Ontario School of Medicine (NOSM) opened in 2005 with a social accountability mandate to address a long history of physician shortages in northern Ontario. The objective of this qualitative study was to understand the school's effect on recruitment of family physicians into medically underserviced rural communities of no...

This study evaluates whether three definitions of rural and urban residence predict prostate cancer progression. People were classified as urban or rural using three definitions: rural and small town (RST), Beale's rural-urban continuum codes, and the Rurality Index of Ontario (RIO) 2008 score. This was a chart-based cohort study of males with pros...

New Zealand has a maldistributed workforce that is heavily dependent on recruiting international medical graduates. Shortages are particularly apparent in high needs communities and in general scope specialties in provincial regions. The University of Waikato in partnership with the Waikato District Health Board has proposed a third medical school...

The transition from hospital to home is a vulnerable period for the elderly patient with complex conditions, who are often frail, at risk for adverse events and unable to navigate a system of poorly coordinated care in the postdischarge period. This article presents the results of a randomized control trial evaluating the effectiveness of an interv...

This chapter examines the extent to which place based and research oriented university-community engagement (UCE) models can sustain UCE in “non-campus” rural settings. It examines how effective partnerships function in non-campus rural settings, and their contributions to achieving the reciprocal aims of communities and universities. It highlights...

Purpose: This study evaluates the potential impact of three definitions of rural and urban residence on the prediction of prostate cancer progression. Methods: This was a chart-based cohort study of males with prostate cancer who underwent external beam radiation therapy (EBRT) at the Regional Cancer Program at Health Sciences North in Sudbury Onta...

Context: Longitudinal integrated clerkships (LICs) represent a model of the structural redesign of clinical education that is growing in the USA, Canada, Australia and South Africa. By contrast with time-limited traditional block rotations, medical students in LICs provide comprehensive care of patients and populations in continuing learning relat...

Across the globe, a “fit for purpose” health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief ov...

The transition from hospital to home is a vulnerable period for patients with complex conditions, who are often frail, at risk for adverse events and unable to navigate a system of poorly coordinated care in the post-discharge period. Care transition interventions are seen as effective care coordinating mechanisms for reducing avoidable adverse eve...

What good does it do to treat people's illness and then send them back to the conditions that made them sick? 1

Background: The Northern Ontario School of Medicine (NOSM) opened in 2005 with a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario. NOSM recruits students from Northern Ontario or similar backgrounds and provides Distributed Community Engaged Learning in over 90 clinical and commun...

Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status. Nowhere is the worldwide shortage of health professionals more pronounced than in rural areas of developing countries. Sub-Saharan Africa (SSA) includes a disproportionately large number of developing countries; therefore, t...

Ensuring access to high quality health care in remote and rural settings is particularly challenging. Remote and rural communities require health service models that are designed in and for these settings, and care provided by health practitioners with the requisite knowledge and skills responsive to people's health needs. Studies in many countries...

Objective: To assess the effect of different levels of exposure to the Northern Ontario School of Medicine's (NOSM's) distributed medical education programs in northern Ontario on FPs' practice locations. Design: Cross-sectional design using longitudinal survey and administrative data. Setting: Canada. Participants: All 131 Canadian medical...

WHO organized side session during the recent PMAC Conference held in January 2016. This session was directly linked to the directives of the WHA resolution WHA 66.23 which requested the WHO secretariat to develop a tool to evaluate health workforce education. A tool which was developed with the support of a multidisciplinary technical working group...

Despite the substantial differences between developing and developed countries, access is the major rural health issue. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: (1) a rural upbringing; (2) positive clinical and educational experiences in rural settings as part of undergra...

INTRODUCTION: This paper describes the transition processes that third-year medical students experience during their longitudinal integrated clerkship (LIC). The authors conceptualize at a granular level the stages that entwine the transition through a LIC. The purpose of this study was to understand the perspectives of 12 Northern Ontario School o...

Background: Over the past 20 years, there has been increasing focus on general practice and the role of general practitioners (GPs) in undergraduate medical education. Objective: This article explores the experiences in Australia and Canada of students learning medicine in the general practice setting, drawing on general practice and medical edu...

WHO Technical Officers and Technical Work Group members listed in Author section. The key objective of this report is to highlight the progress on the strategies and activities of WHO and its partners to transform health workforce education. It documents the activities undertaken in support of World Health Assembly resolution WHA66.23 on transform...

The roots for the Guidebook go back to 1992 when a very important meeting was held on the sidelines of the WONCA Global Family Doctor conference in Vancouver, Canada. At this meeting an interested group of rural practitioners saw the need for WONCA to develop a specific focus on rural doctors. As a result, the WONCA Working Party on Rural Practice...

Background: The relationships between medical schools and communities have long inspired and troubled medical education programmes. Successive models of community-oriented, community-based and community-engaged medical education have promised much and delivered to varying degrees. A two-armed realist systematic review was undertaken to explore and...

The Recruit and Retain Business Model is the principle product of the European Union Northern Periphery Programme (NPP) project Recruit and Retain. It is the work of eight partners working in eight countries and describes how seven steps can be used to implement 29 different products and services developed to address issues of how to recruit and re...

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 s...

The Wonca Working Party on Rural Practice (WWPRP) was formed in 1992 in response to the realization that rural healthcare faced many serious and similar challenges around the world. Over the years the members of the committee have come from many different countries but found inspiration and strength in developing and sharing educational and health...

A study published in CMAJ Open reports on the practice locations in 2014 of Memorial University of Newfoundland (MUN) medical graduates from 1973 to 2008.1 Its findings are notable in the context of recent endeavours to improve the supply of physicians to rural communities. In 2001, the medical schools of Canada committed to social accountability,...

"Community" has featured in the discourse about medical education for over half a century. This discourse has explored relationships between medical education programs and communities in community-oriented medical education and community-based medical education and, in recent years, has extended to community-engaged medical education (CEME). This P...

To test predictors of practice location of fully qualified Monash University Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates. Cohort survey, 2011. Australia. Rural (n = 67/129) and urban (n = 86/191) background doctors starting at Monash University 1992-1999. Approximately 60% female, 77% married/partnered, 79% Australian-born, mean age...

Technical Working Group and WHO Technical Officers listed in Author section. The rationale for the evaluation toolkit: the World Health Assembly resolution and technical working group. The urgent need to ensure that the health workforce has a broad training which accurately reflects their existing and developing working practices prompted the 2013...

The economic contribution of medical schools to major urban centres can be substantial, but there is little information on the contribution to the economy of participating communities made by schools that provide education and training away from major cities and academic health science centres. We sought to assess the economic contribution of the N...

ContextThe purpose of this paper is to provide a critical analysis of a mobile research method, the guided walk, and its potential suitability in medical education research.Methods The Northern Ontario School of Medicine's (NOSM) longitudinal integrated clerkship served as the research context in which the guided walk method was used to explore the...

More undergraduate medical education programs are including curricula concerning the health, culture and history of Aboriginal people. This is in response to growing international recognition of the large divide in health status between Aboriginal and non-Aboriginal people, and the role medical education may play in achieving health equity. In th...

WHO Technical Officers and members present of the Technical Working Group are listed in the Author section. The purpose of this two day meeting was to review the work done by the sub-groups to date and suggest further modifications or refinements where necessary. The outcomes of the discussions during this meeting will be used as the basis for fu...

Background: The Northern Ontario School of Medicine (NOSM) has a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario. NOSM recruits students from Northern Ontario or similar backgrounds and provides Distributed Community Engaged Learning in over 70 clinical and community settings lo...

Aboriginal people are under-represented in epidemiological research, largely due to past failures to engage and recruit Aboriginal communities, research fatigue and the use of culturally inappropriate methods. A qualitative study was undertaken in rural and urban Aboriginal communities in north-eastern and south-western Ontario to identify cultural...

In the fall of 2008, MEDICC Review published a roundtable discussion with six of eight deans representing schools of health sciences with a strong social accountability mandate, who had just founded a new collaborative: the Training for Health Equity Network (THEnet). The topic was the changing paradigm of medical education. MEDICC Review returns t...

The World Health Organization has drawn up a set of strategies to encourage health workers to live and work in remote and rural areas. A comprehensive instrument designed to evaluate the effectiveness of such programs has not yet been tested. Factors such as Stated rural intention, Optional rural training, Medical sub-specialization, Ease (or self-...

Flinders University in Australia has had a rural longitudinal integrated clerkship for selected medical students, the Parallel Rural Community Curriculum, since 1997. The Northern Ontario School of Medicine (NOSM) in Canada introduced a similar clerkship for all NOSM students in 2007. An external evaluation of both programs was conducted in 2006 an...

With the burgeoning role of distributed medical education and the increasing use of community hospitals for training purposes, challenges arise for undergraduate and postgraduate programs expanding beyond traditional tertiary care models. It is of vital importance to encourage community hospitals and clinical faculty to embrace their roles in medic...

  To determine if selecting rural background students into the Monash Bachelor of Medicine and Bachelor of Surgery (MBBS) program affects vocational training location and intended practice location after training.   Retrospective cohort mail survey.   Australia.   Rural-background students at Monash 1992-1994 (n=24/40) and 1995-1999 (n=59/120) and...

Access to well trained and motivated health workers is the major rural health issue. Without local access, it is unlikely that people in rural and remote communities will be able to achieve the Millennium Development Goals. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: (i) a r...

Access to well trained and motivated health workers is the major rural health issue. Without local access, it is unlikely that people in rural and remote communities will be able to achieve the Millennium Development Goals. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: (i) a r...

Evaluation of rural clinical attachments has demonstrated that the rural setting provides a high-quality clinical learning environment that is of potential value to all medical students. Specifically, rural clinical education provides more 'hands on' experience for students in which they are exposed to a wide range of common health problems and dev...

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 t...

Rural and remote communities have long been challenging health care settings that rely on distant metropolises to supply their health workforce. The Northern Ontario School of Medicine, a pioneering faculty of medicine founded in 2005, was established to realize the potential of the rich learning environments found in such communities. This is the...