Faculty analysis of distributed medical education in Northern Canadian Aboriginal communities

CONTEXT: In 2005 the Northern Ontario School of Medicine (NOSM) in Canada implemented the world's first and (still) only mandatory Aboriginal community placement for all its medical students. ISSUES: The Aboriginal placement was created in part to address social accountability, defined as the obligation of medical schools to direct education, research and service activities towards addressing the priority health concerns of the community they serve. Concurrently, Aboriginal health policies have increasingly emphasized the need to involve Aboriginal people in healthcare planning and design health care that involves Aboriginal concepts of health and culturally safe care. Aboriginal delegates provided recommendations for the development of an Aboriginal health curriculum, which included the need for the medical school to acknowledge and respect Aboriginal history, health priorities and develop an Aboriginal community placement for all medical students. LESSONS LEARNED: To anticipate the challenges (e.g., distance, communication, technologies, student and cultural safety, pedagogical effectiveness/appropriateness) presented by a mandatory placement for first-year students in Aboriginal communities a pilot placement project was designed. The locations of the communities were carefully selected in order to assess a variety of challenges that might be encountered with rural and remote Aboriginal community placements. Pilot lessons included managing student expectations, which leaned towards a clinical rather than a community-based cultural placement focus. Areas for increased coordination and administrative support were identified, as well as the need for more extensive community level support. The students had an overall positive experience and learned about the realities of health care in the communities. Aboriginal community staff commented that the experience with the students was fulfilling and beneficial. It was also recognized that curriculum delivery methods required major adjustments and that the students required significant Aboriginal health curriculum in preparation to move forward from the pilot placement to a sustainable Aboriginal community curriculum. Two medical anthropologists, assisted and supported by an historian of medicine, identified and developed the core areas of academic knowledge required for students to begin their journey towards becoming culturally safe medical practitioners. Another important aspect of preparing students was a series of mandatory sessions led by the Aboriginal Affairs Office designed to complement academic sessions with practical information such as how to conduct oneself in the community, and current politics and treaties. A self-study project was developed to guide students through a process of increasing self-awareness of their own attitudes and perceptions about Aboriginal people and communities, and develop their competence to provide culturally safe medical care. New learning from several iterations of the placement was employed to fine-tune the curriculum, information technologies and supporting policies as the placement evolved into a cornerstone of the curriculum. CONCLUSIONS: Cultural immersion in Aboriginal communities is a way for medical students to gain an understanding of the needs and strengths of Aboriginal communities and learn what physicians might do to contribute effectively to Aboriginal health and wellbeing. Research is required to improve understanding about the aspects of this education experience that are most effective.

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