Commentary

Original Articles

Delivering on Social Accountability: Canada’s Northern Ontario School of Medicine

Roger Strasser

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 community settings located in the region, a vast underserved rural part of Canada. This paper presents outcomes for graduates of NOSM’s undergraduate and postgraduate medical education programs with emphasis on NOSM’s social accountability mandate.

Methods: NOSM and the Centre for Rural and Northern Health Research (CRaNHR) used mixed methods that include administrative data from NOSM and external sources, as well as surveys and interviews of students, graduates and other informants.

Results: 92% of all NOSM students come from Northern Ontario with substantial inclusion of Indigenous (7%) and Francophone (22%) students. 62% of NOSM graduates have chosen family practice (predominantly rural) training. 94% of the doctors who completed undergraduate and postgraduate education with NOSM are practising in Northern Ontario. The socio-economic impact of NOSM included: new economic activity, more than double the School’s budget; enhanced retention and recruitment for the universities and hospitals/health services; and a sense of empowerment among community participants attributable in large part to NOSM.

Discussion: There are signs that NOSM is successful in graduating doctors who have the skills and the commitment to practice in rural/remote communities and that NOSM is having a largely positive socio-economic impact on Northern Ontario.

Keywords:     Social Accountability; Community Engagement; Distributed Medical Education

Assessing shared leadership in interprofessional team meetings: A validation study

Yu Han Ong, Issac Lim, Keng Teng Tan, Mark Chan, Wee Shiong Lim

Background: Shared leadership, a team property whereby leadership is distributed among team members, is increasingly salient in interprofessional team-based care. There is currently no validated scale to measure shared leadership in healthcare teams. We aim to describe the developmental and validation of the Clinical Shared Leadership Scale (CSLS) in the context of interprofessional geriatrics care.

Methods: We adapted the CSLS from the Woods (2005) and Carson (2007) scales that were originally used to study management teams. We collected survey data from 115 healthcare professionals who attended interprofessional team meetings (IPTM) in two subacute geriatrics ward. We analyzed internal consistency using Cronbach’s α, as well as construct, convergent, divergent, concurrent and predictive validity using exploratory factor analysis (EFA), inferential statistics and logistic regression.

Results: The 14-item CSLS scale has mean score of 52.32±4.86 (range: 14-70). The scale exhibited high internal reliability (Cronbach’s α=0.76). EFA identified three factors, namely social cohesion, joint involvement, and hierarchical structure (α: 0.76, 0.80 and 0.46 respectively). The good correlation of CSLS total score with internal team environment (ITE) (r=0.78, p<.01) and transactive memory system (TMS) (r=0.65, p<.01) supports convergent validity, whereas poor correlation with task complexity (r=0.17, p=.08) corroborates divergent validity. CSLS total scores increase significantly with increasing number of IPTM attended, higher ITE and higher TMS scores (p<.05), indicating concurrent validity. CSLS total and factor scores, with the exception of factor 3, predicted satisfaction outcomes.

Conclusion: The CSLS is a reliable and valid measure to assess shared leadership in interprofessional team meetings. The third factor, hierarchical structure, merits further study.

Keywords: Clinical Shared Leadership Scale, Interprofessional team, Shared leadership, Validation, Geriatrics

Short Communications

Near Peer Teaching of Surgical Physical Examination Skills in a Large Academic Medical Centre in Asia

Jie Ming Nigel Fong, Ming Jin Eugene Gan, Yan Zheng Daniel Lim, Jing Hao Nicholas Ngiam, Lok Kin Wesley Yeung, Sook Muay Tay

The surgical physical examination is a fundamental part of medical training. We describe our experience with a near-peer teaching program for surgical physical examination skills, which involved senior medical students tutoring junior students starting their clinical rotations. We assessed scores on an Objective Structured Clinical Examination of the abdominal, vascular, and lumps examination before and after teaching. There was improvement in scores for all examinations and overall positive feedback from all students. This suggests that near-peer teaching may be a useful adjunct to faculty-led teaching of clinical skills.

Keywords: Near Peer Teaching; Physical Examination; Surgery

How to review a medical curriculum

Richard Hays

A curriculum is an important component of a medical program because it is the source of information that learners, teachers and external stakeholders use to understand what learners will experience on their journey to recognition as a medical graduate. While many focus on and debate the content of a medical curriculum, with some suggestions that there should be national curricula for each jurisdiction or even a global curriculum for all medical programs, the curriculum content is only one factor to consider when designing, revising or accrediting a curriculum. Just as important are the alignment with the program’s mission and health workforce needs, the presence of agreed graduate outcomes, the theoretical bases of the curriculum, the prior learning of commencing students, the curriculum implementation models, the assessment of student progress and program evaluation processes. This paper presents a framework for this more holistic approach to reviewing a curriculum, proposing triangulation of information from several sources – documents, websites, learners, teachers and employers – and considering several accreditation standards that impact on curriculum design and delivery.

Keywords: Curriculum design; curriculum review; accreditation; social accountability; program evaluation