Abstract
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 develop a high level of clinical competence. Northern Ontario in Canada is a large rural region that has a chronic shortage of healthcare providers. The Northern Ontario School of Medicine (NOSM) was established with a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario, and is a joint initiative of Laurentian University, Sudbury, and Lakehead University, Thunder Bay, which are over 1000 km apart. The NOSM has developed a distinctive model of medical education known as distributed community engaged learning (DCEL), which weaves together various recent trends in medical education including case-based learning, community-based medical education, electronic distance education and rural-based medical education (including the preceptor model). The NOSM curriculum is grounded in Northern Ontario and relies heavily on electronic communications to support DCEL. In the classroom and in clinical settings, students explore cases from the perspective of doctors in Northern Ontario. In addition, DCEL involves community engagement through which communities actively participate in hosting students and contribute to their learning.This paper explores the conceptual and practical issues of community engagement, with specific focus on successful rural clinical education. Community engagement takes the notion of 'community' in health sciences education beyond being simply community based in that the community actively contributes to hosting the students and enhancing their learning experiences. This is consistent with the focus on social accountability in medical education. Implementing community engagement is quite challenging; however; its potential benefits are substantial and include the improved recruitment and retention of healthcare providers who are responsive to cultural diversity and community needs and are collaborating members of the whole health team.
Highlights
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
Australia was at the forefront of developments in rural clinical education with the introduction of Rural Health Training Units in rural regional hospitals, and governmentfunded initiatives through the Rural Undergraduate Support and Coordination Program, University Departments of Rural Health and Rural Clinical Schools[1,2,3]
This paper presents community engagement as an important contributor to successful rural clinical education
Summary
The development of rural clinical placements by medical schools was initially driven by the workforce imperative. Since the mid-1980s, research evidence has been accumulating that there is a specific range of knowledge and skills required by rural practitioners. When compared to their metropolitan counterparts, rural practitioners provide a wider range of services and carry a higher level of clinical responsibility in relative professional isolation[13]. This has led to the inclusion of specific curriculum content on rural health and rural practice in undergraduate medical programs and in rural-based family medicine residency programs[14,15,16]. Rural clinical education provides more hands-on experience for students, with the result that they are exposed to a wide range of common health problems and develop greater procedural competence[18]
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