Northern Ontario School Of Medicine Research Articles

The Virtual Community of Practice Facilitation Model

This study examines the instructional design, learning experiences, and outcomes of a virtual community of practice (VCoP). In 2019, the Northern Ontario School of Medicine launched a continuing professional development program consisting of an asynchronous online module followed by an optional series of facilitated case-based videoconference workshops, designed as a VCoP. This program evaluation study employed a convergent parallel mixed methods design and combined data sources from participant pre- and post-program surveys and reflections with a content analysis of semi-structured interviews. The paper reports key enablers that contributed to the following outcomes: the value of an online module as a baseline of knowledge; the impact of the shared case studies, experiences, and peer support on reflection and modifications to medical practice; and skill development and patient-centered care as a result of module and VCoP participation. A model for the effective design and delivery of VcoPs is proposed that results in acquisition of new knowledge and skills and promotes patient-centred practice.

Undergraduate Medical Students' Perceptions of Nutrition Education at the Northern Ontario School of Medicine.

The objective of this evaluation was to determine Northern Ontario School of Medicine (NOSM) undergraduate medical education (UME) students' perceptions of the curriculum related to their nutrition knowledge, attitudes, and counseling self-efficacy/confidence. A 16-item electronic survey (Qualtrics©) was developed, and it included nutrition competency statements, adult and pediatric nutrition assessment and counseling confidence, and nutrition curriculum satisfaction. Students in Years 2, 3, and 4 (n = 192, 66%-73% female) were invited to answer the survey. Of the 61 respondents, 50.8% were Year 2, 34.9% Year 3, and 10.6% Year 4. Overall, 72.1% of the respondents were dissatisfied. Respondents perceived they were least competent in strategies to prevent and treat disease (72.1%), in applying basic dietary strategies (65.6%), and in ethics and nutrition management (62.3%), whereas 52.5% felt competent in the team approach to nutrition care. Respondents reported lowest confidence (less than 10%-15%) in specialized nutrition support, cancer care, renal nutrition, and mental health/eating disorders for both populations. NOSM medical learners reported curriculum dissatisfaction, nutrition incompetence, and poor levels of perceived confidence in nutrition management. Results will be used to inform nutrition curriculum enhancements and future outcome evaluations. Current and future physicians with enhanced nutrition knowledge, awareness of the Registered Dietitian (RD) roles, and an understanding of when to refer patients to an RD can provide better patient-centred care.

Ten years of graduates: A cross-sectional study of the practice location of doctors trained at a socially accountable medical school.

The study predicted practice location of doctors trained at a socially accountable medical school with education programs in over 90 communities. 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 regression models were used to assess practice location in northern Ontario; northern Canada; or other region; and rural (population <10,000) or urban community. There were 435 doctors with 334 (77%) practising as family doctors (FPs), 62 (14%) as generalist specialists and 39 (9%) as other medical or surgical specialists. Approximately 92% (128/139) of FPs who completed both UG and PG at NOSM practised in northern Ontario in 2019, compared with 63% (43/68) who completed only their PG at NOSM, and 24% (30/127) who completed only their UG at NOSM. Overall, 37% (23/62) of generalist specialists and 23% (9/39) of other specialists practised in northern Ontario. Approximately 28% (93/334) of FPs practised in rural Canada compared with 4% (4/101) of all other specialists. FP northern Ontario practice was predicted by completing UG and PG at NOSM (adjusted odds ratio = 46, 95% confidence interval = 20-103) or completing only PG at NOSM (15, 6.0-38) relative to completing only UG at NOSM, and having a northern Ontario hometown (5.3, 2.3-12). Rural Canada practice was predicted by rural hometown (2.3, 1.3-3.8), completing only a NOSM PG (2.0, 1.0-3.9), and age (1.4, 1.1-1.8). This study uniquely demonstrated the interaction of two mechanisms by which medical schools can increase the proportion of doctors' practices located in economically deprived regions: first, admit medical students who grow up in the region; and second, provide immersive UG and PG medical education in the region. Both mechanisms have enabled the majority of NOSM-trained doctors to practise in the underserved region of northern Ontario.

Comparing and using prominent social accountability frameworks in medical education: moving from theory to implementation in Northern Ontario, Canada.

BackgroundSocial accountability in medical education is conceptualized as a responsibility to respond to the needs of local populations and demonstrate impact of these activities. The objective of this study was to rigorously examine and compare social accountability theories, models, and frameworks to identify a theory-informed structure to understand and evaluate the impacts of medical education in Northern Ontario.MethodsUsing a narrative review methodology, prominent social accountability theories, models, and frameworks were identified. The research team extracted important constructs and relationships from the selected frameworks. The Theory Comparison and Selection Tool was used to compare the frameworks for fit and relevance.ResultsEleven theories, models, and frameworks were identified for in-depth analysis and comparison. Two realist frameworks that considered community relationships in medical education and social accountability in health services received the highest scores. Frameworks focused on learning health systems, evaluating institutional social accountability, and implementing evidence-based practices also scored highly.ConclusionWe used a systematic theory selection process to describe and compare social accountability constructs and frameworks to inform the development of a social accountability impact framework for the Northern Ontario School of Medicine. The research team examined important constructs, relationships, and outcomes, to select a framework that fits the aims of a specific project. Additional engagement will help determine how to combine, adapt, and implement framework components to use in a Northern Ontario framework.

Distributed education enables distributed economic impact: the economic contribution of the Northern Ontario School of Medicine to communities in Canada

BackgroundMedical 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 community-specific impact is often unknown. Communities that contribute to the success of DME have an interest in knowing the local economic impact of this participation. To provide this information, we estimated the economic impact of the Northern Ontario School of Medicine (NOSM) on selected communities in the historically medically underserviced and economically disadvantaged Northern Ontario region.MethodsEconomic impact was estimated by a cash-flow local economic model. Detailed data on program and learner spending were obtained for Northern Ontario communities. We included spending on NOSM’s distributed education and research programs, medical residents’ salary program, the clinical teachers’ reimbursement program, and spending by learners. Economic impact was estimated from total spending in the community adjusted by an economic multiplier based on community population size, industry diversity, and propensity to spend locally. Community employment impact was also estimated.ResultsIn 2019, direct program and learner spending in Northern Ontario totalled $64.6 M (million) Canadian Dollars. Approximately 76% ($49.1 M) was spent in the two largest population centres of 122,000 and 165,000 people, with 1–5% ($0.7 M – $3.1 M) spent in communities of 5000–78,000 people. In 2019, total economic impact in Northern Ontario was estimated to be $107 M, with an impact of $38 M and $36 M in the two largest population centres. The remaining $34 M (32%) of the economic impact occurred in smaller communities or within the region. Expressed alternatively as employment impact, the 404 full time equivalent (FTE) positions supported an additional 298 FTE positions in Northern Ontario. NOSM-trained physicians practising in the region added an economic impact of $88 M.ConclusionsBy establishing programs and bringing people to Northern Ontario communities, NOSM added local spending and knowledge-based economic activity to a predominantly resource-based economy. In an economically deprived region, distributed medical education enabled distributed economic impact.

Creating a Lactation-Friendly Learning Environment for Medical Students and Residents: A Northern Canadian Perspective.

Background: Lactation is a normal postpartum physiological process that can continue in excess of 3 years and is often the sole nutritional source for infants in the first 6 months of life. Breastfeeding not only provides infant nutrition, but also facilitates maternal-infantile bonding. Lactating mothers separated from their children face multiple challenges in finding and accessing appropriate spaces and time for milk expression. Maternal employment is a great barrier to breastfeeding and accordingly has led to multiple advancements in the area of breastfeeding policy. One example of a policy is the Baby-Friendly Initiative. This initiative focused on breastfeeding promotion, support, and protection. However, the impact of such campaigns on lactating medical students and residents is thought to be low. Furthermore, breastfeeding rates differ vastly according to geographic locations in North America. Trends indicate decreased rates of breastfeeding in northern rural areas in comparison with southern urban counterparts. This highlights the need for increased protection, support, and creation of safe-lactation spaces for all working mothers including medical students and residents, and especially those in rural areas. Goals: To review challenges of breastfeeding as a medical trainee and delineate the creation of a lactation policy for medical learners and residents. Methodology: We conducted a literature review of breastfeeding policy and experiences of breastfeeding while in the learning environment. Results: Challenges of breastfeeding in medical school and residency include the complex, high-paced medical working environment where taking breaks or time off is often difficult. Few medical schools across North America have any breastfeeding policy. Conclusion: The Northern Ontario School of Medicine's lactation policy serves as a possible solution to the barriers medical students and residents face when breastfeeding in the academic environment. This policy creates lactation-friendly medical learning spaces through the entitlement of dedicated space and time for milk expression.

Cardiovascular Harm From Egg Yolk and Meat: More Than Just Cholesterol and Saturated Fat.

Cardiovascular Harm From Egg Yolk and Meat: More Than Just Cholesterol and Saturated Fat.

Northern Ontario School of Medicine.

Northern Ontario School of Medicine.

Retaining graduates of non-metropolitan medical schools for practice in the local area: the importance of locally based postgraduate training pathways in Australia and Canada.

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. Data were obtained using a cross-sectional survey of graduates of the James Cook University (JCU) medical school, Queensland, Australia, who had completed advanced training to become a specialist (a 'Fellow') in that field (response rate = 60%, 197 of 326). Medical education, postgraduate training and practice data were obtained for 400 of 409 (98%) fully licensed doctors who completed undergraduate medical education or postgraduate training or both at the Northern Ontario School of Medicine (NOSM), Ontario, Canada. Binary logistic regression used postgraduate training location to predict practice in the school's service region (northern Australia or northern Ontario). Separate analyses were conducted for medical discipline groupings of general/family practitioner, general specialist and subspecialist (JCU only). For JCU graduates, significant associations were found between training in a northern Australian hospital at least once during postgraduate training and current (2018) northern Australian practice for all three discipline subgroups: family practitioner (p<0.001; prevalence odds ratio (POR)=30.0; 95% confidence interval (CI): 6.7-135.0), general specialist (p=0.002; POR=30.3; 95%CI: 3.3-273.4) and subspecialist (p=0.027; POR=6.5; 95%CI: 1.2-34.0). Overall, 38% (56/149) of JCU graduates who had completed a Fellowship were currently practising in northern Australia. For NOSM-trained doctors, a significant positive effect of training location on practice location was detected for family practice doctors but not for general specialist doctors. Family practitioners who completed their undergraduate medical education at NOSM and their postgraduate training in northern Ontario had a statistically significant (p<0.001) POR of 36.6 (95%CI: 16.9-79.2) of practising in northern Ontario (115/125) versus other regions, whereas those who completed only their postgraduate training in northern Ontario (46/85) had a statistically significant (p<0.001) POR of 3.7 (95%CI: 2.1-6.8) relative to doctors who only completed their undergraduate medical education at NOSM (28/117). Overall, 30% (22/73) of NOSM's general speciality graduates currently practise in northern Ontario. The findings support increasing medical graduate training numbers in rural underserved regions, specifically locating full specialty training programs in regional and rural centres in a 'flipped training' model, whereby specialty trainees are based in rural or regional clinical settings with some rotations to the cities. In these circumstances, the doctors would see their regional or rural centre as 'home base' with the city rotations as necessary to complete their training requirements while preparing to practise near where they train.

LO13: Development of a national, standardized simulation case template

Innovation Concept: A major barrier to the development of a national simulation case repository and multi-site simulation research is the lack of a standardized national case template. This issue was recently identified as a priority research topic for Canadian simulation based education (SBE) research in emergency medicine (EM). We partnered with the EM Simulation Education Researchers Collaborative (EM-SERC) to develop a national simulation template. Methods: The EM Sim Cases template was chosen as a starting point for the consensus process. We generated feedback on the template using a three-phase modified nominal group technique. Members of the EM-SERC mailing list were consulted, which included 20 EM simulation educators from every Canadian medical school except Northern Ontario School of Medicine and Memorial University. When comments conflicted, the sentiment with more comments in favour was incorporated. Curriculum, Tool or Material: In phase one we sought free-text feedback on the EM Sim Cases template via email. We received 65 comments from 11 respondents. An inductive thematic analysis identified four major themes (formatting, objectives, debriefing, and assessment tools). In phase two we sought free-text feedback on the revised template via email. A second thematic analysis on 40 comments from 12 respondents identified three broad themes (formatting, objectives, and debriefing). In phase three we sought feedback on the penultimate template via focus groups with simulation educators and technologists at multiple Canadian universities. This phase generated 98 specific comments which were grouped according to the section of the template being discussed and used to develop the final template (posted on emsimcases.com). Conclusion: We describe a national consensus-building process which resulted in a simulation case template endorsed by simulation educators from across Canada. This template has the potential to: 1. Reduce the replication of effort across sites by facilitating the sharing of simulation cases. 2. Enable national collaboration on the development of both simulation cases and curricula. 3. Facilitate multi centre simulation-based research by removing confounders related to the local adoption of an unfamiliar case template. This could improve the rigour and validity of these studies by reducing inter-site variability. 4. Increase the validity of any simulation scenarios developed for use in national high-stakes assessment.

English

The Northern Ontario School of Medicine delivers medical education aiming to improve the health outcomes for persons living in Northern Ontario, including those in underserviced rural and geographically remote communities. Second year students experience rural medicine and living during two four-week long placements set in remote and rural communities (RRCP) supervised by local physicians. This place-based approach to medical education aims to equip learners with the skills and dispositions needed to work there successfully. The goal of the study was to develop a better understanding of RRCPs from different perspectives:&nbsp; Institutional, community-preceptors and students. Data was collected by review of institutional documents, semi-structured interviews, and questionnaires to obtain information about the aims of each group. A place-based educational framework informed the analysis which developed themes and sub-themes using a constructivist approach. The aims of each group were in five themes, social accountability, community engagement, integrated learning, forming the rural clinician, and living in place as a rural clinician.&nbsp; Differences were, however, apparent in terms of emphasis and perceived relevance, with these being related to the perceptual, political, ideological and social dimensions.&nbsp; For example, the finding that students did not value extra-clinical learning about or within the wider community can be viewed as students having a different place-relationship with the community than their teachers in terms of the social dimension. The data suggests that curricula should include consideration of the various ways students and teachers interact with placement communities with the aim of gaining understanding of, and bridging the gap between, their different expectations. &nbsp; Key words: Place-based education, medical education, rural placements.

Northern Ontario School of Medicine

Northern Ontario School of Medicine

Co-creating Simulated Cultural Communication Scenarios with Indigenous Animators: An Evaluation of Innovative Clinical Cultural Safety Curriculum.

Background:Building on partnerships with Indigenous communities and with the support of the Northern Ontario School of Medicine, faculty created groundbreaking, authentic cultural immersion curriculum designed to foster culturally safe interpersonal skills and cultural understanding. However, structural barriers to the teaching of clinical communication skills for culturally safe care to Indigenous patients persisted. To address this challenge, faculty collaborated with Indigenous animators on the co-creation of a new teaching modality of Simulated Cultural Communication Scenarios. We evaluated student learning experience, the faculty teaching experience, the attainment of teaching goals, benefits, and areas for improvement for this approach.Methods:We piloted 9 Simulated Cultural Communication Scenarios with 64 medical students and 17 tutors. We collected quantitative and qualitative data regarding their experiences and perceptions of the new curriculum. The quantitative data was statistically summarized, and the qualitative data was coded and thematically analyzed.Results:The emergent themes indicate that co-created Simulated Cultural Communication Scenarios support the acquisition of culturally safe clinical skills because the modality fosters authentic, safe, context rich, and anti-oppressive patient dialogue with Indigenous animators. Recommendations for optimizing the sessions included ensuring tutors have a deep understanding of the significance of cultural safety in patient care. As the pedagogy is different from the familiar standardized clinical skills sessions, tutors and students benefit from education on the pedagogical approach.Conclusion:Simulated Cultural Communication Scenarios, co-created with cultural insiders and academic educators, represent an authentic education approach to teaching culturally safe clinical encounters. The findings contribute to our understanding of translating social accountability into the clinical setting.

CFDR Research Showcase, Early Bird Abstracts: June 6, 2019

Through the support of Dietitians of Canada (DC) and the Canadian Foundation for Dietetic Research (CFDR), the 2019 Research Showcase at the DC conference represented a wide variety of practice-based nutrition research projects in Canada. The 2019 Research Showcase consisted of several new elements this year. Early Bird abstracts were considered for either oral or oral ePoster sessions. New this year was the presentation of 11 Early Bird abstracts as oral presentations within the regular conference sessions: we called these “Lightning Rounds”. The remaining 27 Early Bird abstracts were presented as oral ePosters on June 6, 2019; authors presented their research in 2–3 minutes plus 2 minutes for questions, using their ePosters. For 2019, there were 3 concurrent oral ePoster sessions. All accepted, and presented, abstracts from the Early Bird submission are published in the Journal. This research event would not be possible without the commitment and dedication of many people. On behalf of DC and CFDR, we extend a special thank you to members of our abstract review committee: Susan Campisi (University of Toronto); Elaine Cawadias (Retired); Andrea Glenn (St. Francis Xavier University); Brenda Hartman (Brescia College, Western University) Mahsa Jessri (University of Ottawa); and Jessica Lieffers (University of Alberta). Thanks also to our moderators for the Oral ePosters: Barb Anderson (Acadian University); Jane Bellman (Dietitians of Canada); Brenda Hartman (Brescia College, Western University); Jessica Lieffers (University of Alberta); Dawna Royall (Dietitians of Canada); and Lee Rysdale (Northern Ontario School of Medicine). We enjoyed interacting with many of you at the oral research presentations as we highlighted the findings from our dietetic colleagues across our country! Finally, a special thank you to Gareth Willows Tribe and Michelle Naraine at CFDR for their assistance and support throughout the review process. Christina Lengyel, PhD, RD Chair, 2019 Early Bird Committee Associate Professor Director of the Dietetics Program Human Nutritional Sciences University of Manitoba Janis Randall Simpson, PhD, RD, FDC Chair, 2019 Late Breaking Committee Professor Emerita University of Guelph Executive Director, CFDR

Tracking Indigenous Applicants Through the Admissions Process of a Socially Accountable Medical School.

To describe the admissions process and outcomes for Indigenous applicants to the Northern Ontario School of Medicine (NOSM), a Canadian medical school with the mandate to recruit students whose demographics reflect the service region's population. The authors examined 10-year trends (2006-2015) for self-identified Indigenous applicants through major admission stages. Demographics (age, sex, northern and rural backgrounds) and admission scores (grade point average [GPA], preinterview, multiple mini-interview [MMI], final), along with score-based ranks, of Indigenous and non-Indigenous applicants were compared using Pearson chi-square and Mann-Whitney tests. Binary logistic regression was used to assess the relationship between Indigenous status and likelihood of admission outcomes (interviewed, received offer, admitted). Indigenous qualified applicants (338/17,060; 2.0%) were more likely to be female, mature (25 or older), or of northern or rural background than non-Indigenous applicants. They had lower GPA-based ranks than non-Indigenous applicants (P < .001) but had comparable preinterview-, MMI-, and final-score-based ranks across all admission stages. Indigenous applicants were 2.4 times more likely to be interviewed and 2.5 times more likely to receive an admission offer, but 3 times less likely to accept an offer than non-Indigenous applicants. Overall, 41/338 (12.1%) Indigenous qualified applicants were admitted compared with 569/16,722 (3.4%) non-Indigenous qualified applicants. Increased representation of Indigenous peoples among applicants admitted to medical school can be achieved through the use of socially accountable admissions. Further tracking of Indigenous students through medical education and practice may help assess the effectiveness of NOSM's social accountability admissions process.

MP43: Evaluation of undergraduate point of care ultrasound instruction in a rural Canadian medical school

Introduction: Point of care ultrasound is a burgeoning tool in clinical medicine and its utility has been demonstrated in a variety of contexts. It may be especially useful in rural areas where access to other imaging equipment (such as CT) is limited. However, there exists debate about the utility of teaching ultrasound theory and technique to medical undergraduates, particularly those in their first two years of study. This study evaluated the efficacy of teaching undergraduate-tailored ultrasound training sessions to first and second-year medical students at the Northern Ontario School of Medicine (NOSM), a rural-focused medical institution. Methods: Sixty students participated in tailored ultrasound teaching sessions that involved both lecture and hands-on components. Participating students were assessed following each session, as well as at study completion, in terms of ultrasound knowledge, anatomy, pathology, orientation, and interpretation of computerized tomography (CT) scans (transferability). Participants’ performance was measured against a control group of their peers. Program evaluation was completed using Likert-type scales to determine participant comfort with ultrasound before and after the training, and areas of strength and improvement. Results: Participating students showed statistically significant improvement in ultrasound interpretation and anatomical orientation with trends toward improved anatomy and pathology knowledge, and ability to interpret computerized tomography (CT) scans compared to controls. Students participating in the course expressed improved comfort with ultrasound techniques and desire for future integration of ultrasound into their training, but noted that increasing frequency of training sessions might have improved retention and confidence. Conclusion: Results suggest that using an undergraduate-focused and system-specific ultrasound training course yields retention in ultrasound interpretation ability and objective improvement in relational anatomy knowledge. Trends toward improvement in general anatomy, pathology and CT interpretation suggest areas of future study.

Dietetic Research Event: June 7 and 8, 2018.

Vancouver, British Columbia was the host city of the 2018 Dietitians of Canada Annual Conference. Through the support of Dietitians of Canada (DC) and Canadian Foundation for Dietetic Research (CFDR), the 2018 Research Showcase was an informative exchange of research and experience-sharing efforts. The submissions for this year's CFDR event represented the diversity of dietetic research conducted within Canada. The 2018 Research Showcase highlighted the Early Bird abstracts in 2 formats; some as 10 minutes oral sessions and others as ePosters with a short oral component. The Late Breaking abstracts were displayed as ePosters. This research event would not be possible without the commitment and dedication of many people. On behalf of DC and CFDR, we would like to extend a special thank you to members of our Early Bird abstract review committee: Susan Campisi (University of Toronto); Elaine Cawadias (Retired); Andrea Glenn (St. Francis Xavier University); Mahsa Jessri (University of Ottawa); Jessica Lieffers (University of Saskatchewan). Members of the Late Breaking abstract review committee included: Laurie Drozdowski (University of Alberta); Laura Forbes (Co-chair)(University of Guelph); Joann Herridge (Hospital for Sick Children); Grace Lee (Toronto General Hospital); Lee Rysdale (Northern Ontario School of Medicine); Jessica Wegener (Ryerson University); Sarah Woodruff Atkinson (University of Windsor). We would also like to thank all of our moderators, Pierrette Buklis (CFDR Board), Marcia Cooper (Health Canada), Jenny Gusba (CFDR Board), Brenda Hartman (Brescia College), Paula Brauer (University of Guelph), Dawna Royall (DC), and MaryAnne Smith (DC), who kept our research presentation sessions on time during the conference. Finally, a special thank you to France Bertrand and Michelle Naraine at CFDR for their assistance and support throughout the review process. We enjoyed interacting with many of you at the oral research presentations as we highlighted the research findings from our dietetic colleagues across our country! Christina Lengyel, PhD, RD Chair, 2018 Early Bird Abstracts Review Committee Associate Professor Director of the Dietetics Program Food and Human Nutritional Sciences University of Manitoba Janis Randall Simpson, PhD, RD, FDC Chair, 2018 Late Breaking Abstracts Review Committee Professor Emerita University of Guelph Executive Director, CFDR.

Role of Retinoic Acid Signaling in Epicardial‐Related Events During Late Heart Development

BackgroundDuring the final stages of heart development, the myocardium grows and becomes vascularized with the aid of paracrine factors and cell progenitors derived from the epicardium. Here, we study the involvement of retinoic acid (RA), a metabolite of vitamin A, in epicardial‐related developmental processes involving the formation of the coronary vasculature and the growth of the ventricular compact zone.MethodsTo explore the developmental consequences of altered RA signaling in late cardiogenic events, we employed a previously characterized model of embryonic RA excess based on mouse embryos deficient in the retinaldehyde reductase DHRS3. We also employed a complementary model based on embryonic RA deficiency generated by administering WIN 18,446, a bis(dichloroacetyl)diamine inhibitor of RA synthesis to pregnant dams. Using these two models we studied the formation of the coronary plexus and the formation and recruitment of epicardial‐derived mural cells by coronary vessels. We further explored the effect of altered RA in vitro by studying the epicardial epithelial‐to‐mesenchymal transition (EMT), and the formation, migration and differentiation of epicardial‐derived precursor cells (EPDCs).ResultsOur results demonstrated that both excess and deficiency of embryonic RA‐signaling led to a thin ventricular myocardium and aberrant coronary vessel formation and remodeling. In the case of both excess, or deficient RA‐signaling, the endothelial tubes did not become invested with epicardial‐derived vascular smooth muscle cells (VSMCs). In vitro assays of epicardial EMT combined with transcriptomic and proteomic analyses revealed that RA signaling not only affects the differentiation of EPDCs, but also controls the cytoskeletal reorganization and secretion of angiogenic and cardiotrophic factors by the epicardium.ConclusionWe report that RA signaling affects epicardial signaling and plays critical roles in the development of the myocardium and the coronary vasculature.Support or Funding InformationThis work was supported in part by the grant R01HD077260 (ARM, MAK) from the National Institutes of Health and by a Fulbright U.S. Scholar Award to ARM funded by the U.S. Department of State's Bureau of Educational and Cultural Affairs, the Commission for Educational Exchange between the United States of America and Brazil and CAPES, the Brazilian Federal Agency for Support and Evaluation of Graduate Education. Additional support to MAK was provided by the University of Maryland School of Pharmacy Mass Spectrometry Center (SOP1841‐IQB2014) and by startup funds to ARM from the Northern Ontario School of Medicine. Conflicts of interest: none.

Community engagement: A central feature of NOSM’s socially accountable distributed medical education

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, Distributed Community Engaged Learning (DCEL). Studies involving qualitative and quantitative methods contribute to this paper, which draws on administrative data from NOSM and external sources, as well as surveys and interviews of students, graduates and other informants including the joint NOSM-CRaNHR (Centre for Rural and Northern Health Research) tracking and impact studies. Community engagement contributes throughout the lifecycle stages of preadmission, admission, and undergraduate medical education. High school students from 70 Northern Ontario communities participate in NOSM's week-long Health Sciences Summer Camps. The MD admissions process involves approximately 128 volunteers assessing written applications and over 100 volunteer interviewers. Thirty-six Indigenous communities host first year students and third-year students learn their core clinical medicine in 15 communities, throughout Northern Ontario. In general, learners and communities report net benefits from participation in NOSM programs. Community engagement makes a key contribution to the success of NOSM's socially accountable distributed medical education.

Queering the Medical Curriculum: How to Design, Develop, Deliver and Assess Learning Outcomes Relevant to LGBT Health for Health Care Professionals

This article was migrated. The article was marked as recommended. Lesbian, gay, bisexual and transgender (LGBT) persons have specific healthcare needs, and experience unique barriers in accessing health services. Research has suggested that medical practitioners are inadequately prepared to address the needs of the LGBT population. While some strategies for training such practitioners within medical schools have been proposed, few have been evaluated, and the best approach to training physicians in LGBT-focused care has yet to be determined. The purpose of this paper is to assess the effectiveness of the LGBT-focused curriculum currently delivered at the Northern Ontario School of Medicine, specifically in terms of its perceived contribution to students' understanding of LGBT health issues. Results showed that the curriculum introduced at NOSM was effective in increasing knowledge medical students had on LGBT health issues regardless of their pre-existing level of awareness of LGBT health issues. Further, the study found that the level of experience and expertise of the facilitator helping deliver the curriculum was key in achieving this educational goal. We also evaluated three assessment modalities (Multiple Choice Questions (MCQ), Objective Structured Clinical Examination (OSCE), and Clinical Decision-Making Cases (CDM)) for validity and reliability in testing the course objectives. Results indicate that outcomes can be reliably assessed by these three types of assessments.