Distributed Medical Education Research Articles

Enhancing Indigenous health research capacity in northern Ontario through distributed community engaged medical education at NOSM: A qualitative evaluation of the community engagement through research pilot program

The Community Engagement Through Research (CETR) program matches Indigenous communities interested in exploring their own health research questions with NOSM learners seeking experience in health services research, supervised by faculty experienced in community-based participatory research. Qualitative research was conducted using key informant interviews to examine outcomes of the matching of medical students with Indigenous distributed medical education (DME) communities in NOSM's distributed curriculum, in particular improvements for capacity for Indigenous health research in Northern Ontario. Interviews showed that community-centred research was appreciated by community, students and faculty and the social accountability aspect was acknowledged. Students and community members found meaning in the immediate applicability of the research to real community problems and felt inspired by it. The challenges that were identified were mainly related to time and resource constraints, including providing sufficient research training for learners, and the time period required for research ethics board approvals. The program successfully brought together communities interested in conducting their own health research, with medical students interested in learning about and conducting health research with Indigenous communities. It is therefore an example of successful community based participatory research supporting the social accountability mandate. Challenges are mainly administrative in nature. The program has the potential to be scalable and financially sustainable.

Experiential interprofessional education for medical students at a regional medical campus

Regional medical campuses are often challenged with providing effective interprofessional education (IPE) opportunities for medical students that are comparable to those at main campuses. At distributed teaching sites, there is often less IPE infrastructure and fewer learners of other health professions. On the other hand, distributed medical education (DME) settings often have community-based clinical environments and fewer medical students, which can provide unique opportunities for IPE curriculum innovation. At the Niagara Regional Campus (NRC) of McMaster University, the Horizontal Elective for Interprofessional Growth & Healthcare Team ENhancement (HEIGHTEN) was developed to provide first-year medical students the opportunity to learn from and work alongside nurses in a community hospital. This study assesses HEIGHTEN's impact on students' knowledge, confidence, and attitudes towards interprofessional care, as well as student satisfaction with the learning experience using a mixed methods evaluation. Findings suggest that HEIGHTEN provided an enjoyable learning experience, fostered positive interprofessional attitudes and an appreciation for the nursing role. Voluntary participation by medical students was high and increased both within the regional campus and with students from other campuses travelling to participate. This model for IPE can be feasibly replicated by distributed teaching sites to provide medical students with hands-on, experiential learning early in training, leading to positive attitudes and behaviours supporting interprofessional collaboration (IPC).

The invisible work of distributed medical education: exploring the contributions of audiovisual professionals, administrative professionals and faculty teachers.

Distributed medical education (DME) is becoming increasingly prevalent. Much of the published literature on DME has focused on the experiences of learners in distributed programs; however, our empirical work leads us to believe that DME changes the context significantly, not only for learners, but also for other important members of the educational community including audiovisual professionals, administrative professionals and faculty teachers. Based on a three-year ethnographic study, we provide a detailed account of how alliances between various workers involved in DME develop to produce and deliver an undergraduate medical curriculum across geographically separate campuses. We explore the question 'What is the work involved in the delivery of a DME program?' and cast a critical gaze on the essential but invisible, and therefore potentially unrecognized and underappreciated, contributions of AV professionals, administrative professionals, and faculty teachers. Our goal is to make visible the complexity of DME, including the essential contributions of these workers. The study was theoretically framed in sociomateriality and conceptually framed in Star and Strauss' notion of articulation work.

Outcomes of Using Peer‐Mentors and Bi‐Directional Development of CanMEDS Core Competencies at a Distributed Medical Education Site

INTRODUCTIONDue to the growing portfolio of skills needed to succeed as doctors, time and resources allocated by medical schools in Canada to teach anatomy have been greatly reduced and redirected towards other topics. Operating a distributed education campus requires even greater austerity and has the potential to hinder learner acquisition of key medical competencies. Studies in the past have looked at using peer approaches to deal with similar problems in medical education in the anatomy lab. Near peer‐mentoring (NPM), defined as the guidance of less experienced colleagues by colleagues with more experience, was implemented at the distributed education branch of the Schulich School of Medicine & Dentistry in Windsor, Ontario. This paper explores how NPM impacts peer learning and core medical competencies in both learners and teaching assistants (TAs). Some of the CanMED core competencies explored in this study are Medical Expert, Communicators, Collaborators, Leaders, Scholars and Professionals.METHODSSecond year medical students volunteered to be TAs for anatomy labs. TAs were responsible for providing feedback on lesson plans, guiding students through lab dissections and answering questions on content. Implementing near‐peer TAs improved teacher to learner ratio to a high degree. Four near‐peer TAs, provided reflections on acquisition of CanMEDs medical competencies through NPM. TA involvement varied depending on the demands of the 1st year curriculum, ranging from 2–8 hours per week during teaching sessions and 1–2 hours of preparation time per lab, per TA. An initial survey was administered to student learners to qualitatively evaluate their current experience in the anatomy lab. A follow‐up survey will be distributed at the end of the final anatomy session. Finally, the faculty anatomist provided a reflection on how the near‐peer mentors helped deliver the anatomy instruction at the distributed education site.RESULTSTwenty‐six learners of thirty‐eight first year learners completed the initial survey. On average, the learners indicated that Medical Expert was their most improved competency during anatomy labs. Learners felt they improved the least on the Leadership competency during anatomy labs. When evaluating TAs, learners ranked the Communicator and Professional competencies the highest.TAs found the near‐peer program to be a meaningful opportunity to integrate and apply multiple competencies at once. Upon reflection, TAs thought that the Medical Expert, Communicator and Leader competencies were most used. In order to improve delivery of anatomy labs in the future, TAs thought more time should be dedicated to understanding the details in delivering the lab session.The near‐peer TA program was felt to improve access to help in learner's critical thinking skills. Further, faculty noted TA development of professional skills including leadership, communication and being collaborators.CONCLUSIONSTeaching Assistants had a positive overall impact on learners experience in anatomy lab. TAs themselves felt near‐peer mentoring to be an emotionally impactful opportunity to practice integrating the CanMed core competencies such as medical expertise, communication and leadership.

Sociomateriality

Distributed medical education (DME) is a type of distance learning in which students participate in medical education from diverse geographic locations using Web conferencing, videoconferencing, e-learning, and similar tools. DME is becoming increasingly widespread in North America and around the world.Although relatively new to medical education, distance learning has a long history in the broader field of education and a related body of literature that speaks to the importance of engaging in rigorous and theoretically informed studies of distance learning. The existing DME literature is helpful, but it has been largely descriptive and lacks a critical "lens"-that is, a theoretical perspective from which to rigorously conceptualize and interrogate DME's social (relationships, people) and material (technologies, tools) aspects.The authors describe DME and theories about distance learning and show that such theories focus on social, pedagogical, and cognitive considerations without adequately taking into account material factors. They address this gap by proposing sociomateriality as a theoretical framework allowing researchers and educators to study DME and (1) understand and consider previously obscured actors, infrastructure, and other factors that, on the surface, seem unrelated and even unimportant; (2) see clearly how the social and material components of learning are intertwined in fluid, messy, and often uncertain ways; and (3) perhaps think differently, even in ways that disrupt traditional approaches, as they explore DME. The authors conclude that DME brings with it substantial investments of social and material resources, and therefore needs careful study, using approaches that embrace its complexity.

Adapting the forms of yesterday to the functions of today and the needs of tomorrow: a genealogical case study of clinical teaching units in Canada.

Emergent discourses of social responsibility and accountability have in part fuelled the expansion of distributed medical education (DME). In addition to its potential for redressing physician maldistribution, DME has conferred multiple unexpected educational benefits. In several countries, its recent rise has occurred around the boundaries of traditional medical education practices. Canada has been no exception, with DME proliferating against a backdrop of its longstanding central node, the clinical teaching unit (CTU). The CTU first appeared just over 50 years ago with its position in Canadian health care largely taken-for-granted. Given the increasing prominence of DME, however, it is timely to reconsider what the place of tertiary centre-based practices such as the CTU might be in shifting medical education systems. From a genealogical perspective, it becomes clear that the CTU did not just "happen". Rather, its creation was made possible by multiple interrelated cultural, social, and political changes in Canadian society that, while subtle, are powerfully influential. Making them visible offers a better opportunity to harmonize the benefits of longstanding entities such as the CTU with novel practices such as DME. In so doing, the medical education field may sidestep the pitfalls of investing significant resources that may only produce superficial changes while unwittingly obstructing deeper transformations and improvements. Although this work is refracted through a Canadian prism, reconceptualizing the overall design of medical education systems to take advantage of both tradition and innovation is a persistent challenge across the international spectrum, resistant to tests of time and constraints of context.

Ethnographies across virtual and physical spaces: a reflexive commentary on a live Canadian/UK ethnography of distributed medical education

This article draws on an ongoing ethnography of distributed medical education (DME) provision in Canada in order to explore the methodological choices of the researchers as well as the wider pluralisation of ethnographic frameworks that is reflected within current research literature. The article begins with a consideration of the technologically mediated ways in which the researchers do their work, a way of work that is paralleled within the DME curriculum that forms the focus of the ethnography. The article goes on to problematise relationships amongst the researchers and between the researchers and the field of research, and to consider the ways in which methodological choices are mediated. In so doing, the article proposes an acceptance of methodological pluralism that is tempered by the need to acknowledge the sometimes-slight differences that distinguish ethnographic paradigms.

160: Peer Group Mentoring of Faculty in a Distributed Medical Education Setting

Medical education is now being delivered in distributed medical education settings in many medical schools in Canada. There are scant financial and manpower resources. Foundational components necessary for faculty development have not been formally established. There was a need to implement a mentorship program to enhance faculty development. The pediatrics department in one such setting undertook a peer group mentoring pilot program to address these needs. The objective of this project was to explore the development of mentoring using a peer group model, and evaluate the benefits of such a model on faculty satisfaction, work-life balance, program and process development, personal and faculty development, as well as research gains. Adjunct faculty in the Department of Pediatrics were asked to be part of a pilot mentor-ship project for faculty in a distributed medical education setting. Research ethics approval was obtained. A collaborative and mixed methods approach was taken. The participants were interviewed at the end of the series of mentorship seminars. Evaluation forms were also collected at the end of each seminar. The group decided on a number of faculty development topics that were relevant to them. The framework for selection of topics was the CanMEDS non-expert roles. The seminars were presented at a regularly scheduled journal club. Participants: 6 to 11; Years in pediatric practice: 17 to 26 years; Number of faculty: 15; M:F – 2:1 The participants felt that the sessions were very helpful and increased collegiality. They remarked that they felt valued and that they were part of selecting the topics for peer group mentoring. Evaluation forms revealed moderate to high scores. This peer mentoring model may provide the stepping stone or the scaffolding on which to build a more conventional mentoring relationship. Benchmarks for the number of faculty achieving assistant professor status in the next five years should be made for those departments who adopt a peer mentoring program. More engagement and willingness to teach medical students and residents; increase research activities; engagement in hospital or medical school leadership; and higher medical student achievement in pediatrics could also be evaluated in the future. There is a lack of funding for this type of research. This pilot project adds to the scant body of work that supports peer or collaborative mentoring as an important pathway to achieving personal, institutional and societal goals.

Impact of a Regional Distributed Medical Education Program on an Underserved Community

To describe community leaders' perceptions regarding the impact of a fully distributed undergraduate medical education program on a small, medically underserved host community. The authors conducted semistructured interviews in 2007 with 23 community leaders representing, collectively, the education, health, economic, media, and political sectors. They reinterviewed six participants from a pilot study (2005) and recruited new participants using purposeful and snowball sampling. The authors employed analytic induction to organize content thematically, using the sectors as a framework, and they used open coding to identify new themes. The authors reanalyzed transcripts to identify program outcomes (e.g., increased research capacity) and construct a list of quantifiable indicators (e.g., number of grants and publications). Participants reported their perspectives on the current and anticipated impact of the program on education, health services, the economy, media, and politics. Perceptions of impact were overwhelmingly positive (e.g., increased physician recruitment), though some were negative (e.g., strains on health resources). The authors identified new outcomes and confirmed outcomes described in 2005. They identified 16 quantifiable indicators of impact, which they judged to be plausible and measureable. Participants perceive that the regional undergraduate medical education program in their community has broad, local impacts. Findings suggest that early observed outcomes have been maintained and may be expanding. Results may be applicable to medical education programs with distributed or regional sites in similar rural, remote, and/or underserved regions. The areas of impact, outcomes, and quantifiable indicators identified will be of interest to future researchers and evaluators.

Is Distributed Medical Education the Solution?

Is Distributed Medical Education the Solution?