Comprehensiveness of distributed medical education systems: a regional population-based perspective

Andrea M Burrows,Kevin B Laupland

doi:10.1186/s12909-020-02466-x

Abstract

BackgroundThe core business of medical schools includes clinical (education and service) and academic (research) activities. Our objective was to assess the degree to which these activities exist in a distributed medical education system in Canada.MethodsA population-based design was utilized. Programs were contacted and public records were searched for medical trainees and faculty positions within a province in Canada during the 2017/2018 academic year. Data were expressed as positions per 100,000 residents within the Lower Mainland, Island, and Northern and Southern interior geographical regions.ResultsSubstantial differences in the distribution of medical students by region was observed with the highest observed in the Northern region at 45.5 per 100,000 as compared to Lower Mainland, Island, and Southern regions of 25.4, 16.8, 16.0 per 100,000, respectively. The distribution of family medicine residents was less variable with 14.9, 10.7, 8.9, and 5.8 per 100,000 in the Northern, Island, Southern, and Lower Mainland regions, respectively. In contrast, there was a marked disparity in distribution of specialty residents with 40.8 per 100,000 in the Lower Mainland as compared to 7.5, 3.2, and 1.3 per 100,000 in the Island, Northern, and Southern regions, respectively. Clinical faculty were distributed with the highest observed in the Northern region at 180.4 per 100,000 as compared to Southern, Island, and Lower Mainland regions of 166.9, 138.5, and 128.4, respectively. In contrast, academic faculty were disproportionately represented in the Lower Mainland and Island regions (92.8 and 50.7 per 100,000) as compared to the Northern and Southern (1.4 and 1.2 per 100,000) regions, respectively.ConclusionsWhile there has been successful redistribution of medical students, family medicine residents, and clinical faculty, this has not been the case for specialty residents and academic faculty.

Highlights

The core business of medical schools includes clinical and academic activities
There were marked differences in the distribution of medical students by region adjusted by population with the highest observed in the Northern region at 45.5 per 100,000 as compared to Lower Mainland, Island, and Southern regions of 25.4, 16.8, 16.00 per 100,000, respectively
The decentralization of medical education has distributed some aspects of the medical school structure; specialty resident trainees and academic faculty are disproportionately concentrated in the Lower Mainland and Island regions

Summary

Introduction

The core business of medical schools includes clinical (education and service) and academic (research) activities. It has been increasingly recognized that such urban-centric medical training models have failed to adequately address the needs of the population with underservicing of smaller cities and communities [2,3,4,5]. In a distributed education system, medical schools are organized within a hub and spoke structure with a parent program and “satellite” sites; these satellite sites are located in cities and where trainees perform most of their training external to the main parent program [1, 8, 12]. There is limited research comparing the distribution of faculty and trainees across the medical school structure and the implications in education, clinical service and research this may have for learners, faculty and communities

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