Northern Ontario School of Medicine Integrated Investigation

Integrated Impact Investigations into the Northern Ontario School of Medicine

(en anglais)

The Centre for Rural and Northern Research (CRaNHR) at Laurentian University conducts interdisciplinary research on health equity issues, including health human resources. The Northern Ontario School of Medicine (NOSM) has a social accountability mandate to improve the health and well-being of the people of Northern Ontario, Canada. The collaborative research of CRaNHR and NOSM outlined below is consistent with key provincial government priorities as stated in, for example, Patients First and the First Nations Health Action Plan.

The CRaNHR-NOSM Integrated Impact Investigations is a research portfolio that comprises several interconnected research streams using a mixed method approach. These studies are gaining national and international attention. In addition, findings continue to inform decision-makers at the NOSM, provincial ministries of health and education as well as at the North East and North West Local Health Integration Networks.

Current Research Streams

Multi-Year Tracking Study of the Students and Graduates of the Northern Ontario School of Medicine
J.C. Hogenbirk, J.E. Sherman, M.G. French, P.E. Timony, W. Warry, and E.F. Wenghofer in collaboration with the NOSM Tracking Study Advisory Committee

This study comprises the core of the Integrated Impact Investigation research program and follows medical learners at the Northern Ontario School of Medicine (NOSM) during their undergraduate and postgraduate medical education and into medical practice. A mixed-methods approach uses surveys, interviews, focus groups, and administrative data to measure practice location, the scope of practice and patient groups served. Findings have implications for the funding and delivery of this novel way of training physicians for rural medical practice. The findings may be of interest to other provinces/territories and countries seeking to improve access to and quality of medical care in medically underserved areas.

(Funded by the Ministry of Health and Long-Term Care, 2005 – 2018)

Exploring the experiences of NOSM family medicine graduates practicing in rural and northern Ontario

W. Warry, J.E. Sherman, H. Cheu, M.G. French, and J. Russell, in collaboration with the NOSM Tracking Study Advisory Committee.

This study will explore the path that family medicine physicians have taken since graduating from NOSM. Graduates of the first four classes who completed a family medicine residency and who are currently practicing in Northern Ontario will be invited to participate in semi-structured interviews. Participants will be asked to reflect on the NOSM curriculum and its impact on their career and practice, including the choices they have made, their preparedness for and satisfaction with rural and northern practice, challenges they have faced, and future career aspirations. Findings will help NOSM assess its effectiveness and strengthen its educational and professional support programs.

(Funded as part of the Integrated Impact Investigations)

The economic contribution of the Northern Ontario School of Medicine (NOSM) to Northern Ontario: 2016 update

J.C. Hogenbirk, D.R. Robinson, W. Warry, and R.P. Strasser

The objective is to determine the economic impact of NOSM in 2016 when the undergraduate and postgraduate medical education programs have been well-established for several years. The study uses economic base model methods to determine the current economic contribution of NOSM activities, learners and personnel in the communities and the region of Northern Ontario.

(Funded as part of the Integrated Impact Investigations)

Assessing NOSM's Admissions Process in the context of NOSM's Social Accountability Mandate
J.C. Hogenbirk and O.M. Mian in collaboration with the NOSM Admission Team

Two new studies build on recently completed work that examined scoring and weighting of the characteristics of applicants to the Northern Ontario School of Medicine (NOSM). The first study will assess whether a Computer-Based Assessment for Sampling Personal Characteristics (CASPer™) aligns with NOSM's social accountability mandate. NOSM is piloting the use of the CASPer™ online evaluation tool for potential inclusion in the admission process. CRaNHR's study will analyze admissions data from 2015 to help NOSM decide if CASPer™ can be used to augment or replace existing components of NOSM’s admissions process, evaluated in the context of the NOSM's social accountability mandate.

The second study will determine if student characteristics at admission predict academic performance during undergraduate medical education. To do so, this retrospective study will use admission data from 2006 – 2016 to examine how the academic performance of NOSM medical students varies with rural or northern background, cultural/linguistic background, GPA or other NOSM admission scores. These results may help NOSM decide if specific student groups require customized training methods.

(Funded by the Northern Ontario School of Medicine, 2016)

Impact of the Northern Ontario School of Medicine on Physician Recruitment and Retention: Program Expenditures in Northern Ontario

J.C. Hogenbirk and W. Warry

This pilot study will examine the association between NOSM graduates practicing in Northern Ontario communities and spending on provincial recruitment and retention programs. We will extract provincial government data to assess changes in use and spending for recruitment, retention and locum programs in Northern Ontario communities, cross-tabulated against the number of NOSM graduates now practicing in selected Northern Ontario communities.

(Funded by the Training for Health Equity Network and the Northern Ontario School of Medicine, 2016)

Training for Health Equity Network – Graduate Outcomes Study (THEnet GOS) (International Study)

J.C. Hogenbirk, M.G. French, and W. Warry, in collaboration with the NOSM Tracking Study Advisory Committee and THEnet schools

The objective of this international study is to determine the link between medical admissions policies, training locations or educational curriculum and physician practice location or scope of practice. The study is conducted as part of an international collaboration of eleven medical schools known as the Training for Health Equity Network (THEnet)). This longitudinal prospective study will be augmented by a CRaNHR-NOSM led initiative to conduct a retrospective analysis of the association among learner characteristics, intent towards practice in underserved areas and actual practice location and practice profile.

(Funded by the Northern Ontario School of Medicine, 2016)

Finnmark Tracking and Socio-Economic Studies (Canadian-Norwegian study)

J.C. Hogenbirk, W. Warry, and M.G. French, in collaboration with the NOSM Tracking Study Advisory Committee and colleagues at UiT-The Arctic University of Norway

This international collaboration will adopt the methodologies of the CRaNHR-NOSM Integrated Impact Investigations to a distributed medical education program that is emerging to serve the needs of the underserved population of Finnmark County in Norway. These studies share similar research objectives and the adaptation of methods and ensuing results will inform the Finnmark program as well as the CRaNHR-NOSM Integrated Impact Investigations in Northern Ontario.

(funded by UiT-The Arctic University of Norway (Tromsø), 2016)

Exploring

Completed Research

(2005 – 2010: Phase I) (2010 – 2015: Phase II) Multi-Year Tracking Study of the Students and Graduates of the Northern Ontario School of Medicine
J.C. Hogenbirk, J.E. Sherman, M.G. French, P.E. Timony, W. Warry, and E.F. Wenghofer in collaboration with the NOSM Tracking Study Advisory Committee

This multi-faceted mixed methods study followed medical learners at the Northern Ontario School of Medicine (NOSM) during their undergraduate and postgraduate medical education and into medical practice. Phases I and II have been completed, with Phase III, expanded in scope and currently underway.

(funded by the Ministry of Health and Long-Term Care, 2005 – 2015)

(2016) Exploring NOSM's Admissions Process in the context of NOSM's Social Accountability Mandate

J.C. Hogenbirk, O.M. Mian, M. Hanna, O. Prowse, B. Schoales, D. Marsh, and R. Barnett

The Northern Ontario School of Medicine (NOSM) was created with a social accountability mandate to help improve the health of the people of Northern Ontario. In becoming socially accountable, NOSM seeks to admit students who are representative of the cultural and linguistic diversity of Northern Ontario. This research examined admissions data from 2006 – 2015 to determine if NOSM's applicant screening process was selecting students who are more representative of the Northern Ontario population, including Indigenous and Francophone peoples as well as people from rural or underserved areas.

(funded by the Ministry of Health and Long-Term Care under the Health Systems Research Fund, 2013 – 2016)

(2015) Assessing the Impact of the Northern Ontario School of Medicine (NOSM) on Underserved Communities of Northern Ontario: Impact on Physician Recruitment and Retention Activities
J.C. Hogenbirk, O.M. Mian, M.G. French, J. Osika, and R.P. Strasser

Several Northern Ontario School of Medicine (NOSM) graduates have established their practices in rural underserviced communities in Northern Ontario. This study assessed the impact that the arrival of these NOSM graduates and NOSM's educational programs have had on recruitment and retention of physicians in these communities.

(funded by the Northern Ontario School of Medicine, 2015)

(2009) Exploring the Socioeconomic Impact of the Northern Ontario School of Medicine

R.W. Pong, B. Minore, D.R. Robinson, J.C. Hogenbirk, M.E. Hill, R. Strasser, G. Bandoh, O.M. Mian, R. Page, M.G. Delmege, and P.E. Timony

This study examined the social and economic impact of NOSM on selected communities in Northern Ontario. CRaNHR used administrative data and narratives obtained from key informant interviews and focus groups to ascertain the short-term and longer-term impact of NOSM, particularly with respect to the local economy, the physician workforce in northern Ontario, Lakehead, and Laurentian Universities selected health care institutions (such as hospitals and public health units), and on selected northern Ontario communities.

(Funded by the Ontario Ministry of Health and Long-Term Care, 2008-2009)

(2006) An Examination of the NOSM Student Selection Process

K.C. Tilleczek, J. Konkin, R.W. Pong, and D.M. Cudney

CRaNHR researchers used a qualitative, ethnographic approach to examine several issues, such as applicants' views of the student selection process, the selection criteria and changes in the student selection process over several years. Research findings were used to inform NOSM's student selection process.

(Funded by the Northern Ontario School of Medicine)

Laying the Groundwork: Projects Informing the NOSM Integrated Impact Investigations

(2010) Tracking Study of Residents and Graduates of the Northern Ontario Stream Residency Program (NESR, NOSR)

R.W. Pong, H. Leung, M. Topps, J.C. Hogenbirk, K. Tilleczek, D. Heng & O. Mian

This study tracked the Family Medicine Residents when the residency program was administered by the Northeastern Ontario Medical Education Corporation.

(Funded by the Ontario Ministry of Health and Long-Term Care, 2005 – 2010)

(2009) Tracking Study of Participants of a Postgraduate Specialty Program in Northern Ontario

R.W. Pong, H. Leung, M. Topps, J.C. Hogenbirk, N.A. Cloutier, S.M. MacPherson, D. Heng, O. Mian, and H.E. Yungblut

Policy initiatives were introduced with a view to increase the supply of rural specialist physicians, including training specialists in rural settings for various lengths of time with the goal of fostering a greater understanding of rural health issues and increasing the skills needed for rural practice. This study tracked the participants of the Northeastern Ontario Postgraduate Specialty (NOPS) Program. It examined whether this Royal College of Physicians and Surgeons of Canada specialty residency training in northeastern Ontario had any effect on the practice location of specialists after completion of residency training.

(Funded by the Northeastern Ontario Medical Education Corporation, 2005-2007)

(2009) Multi-year Tracking Study of Residents and Graduates of a Rural Family Medicine Residency Program

R.W. Pong, J.C. Hogenbirk, O.M. Mian, D. Heng

This study tracked Family Medicine Residents when the residency program was administered by the Northeastern Ontario Medical Education Corporation up until program administration was assumed by the Northern Ontario School of Medicine (NOSM). This study was then incorporated into the Multi-year tracking study of the students and graduates of the Northern Ontario School of Medicine.

(Funded originally by the Northeastern Ontario Family Medicine program, then by the Northern Ontario School of Medicine, 1998 – 2009)

(2005) The link between Rural Medical Education and Rural Medical Practice Location: Literature Review and Synthesis

R.W. Pong and D. Heng

This study reviewed the evidence surrounding rural medical education and how it contributes to future rural practice location decisions in order to inform policy decisions and program planning.

(Funded by the Ministry of Health and Long-Term Care)

(2004) Evaluation of Rural Medical Education Programs
B. Chan, R.W. Pong, J. Rourke, T. Crichton, J. Goertzen, W. McCready, and K.C. Tilleczek*

This study examined the impact of family medicine residency programs on the practice locations of their graduates. In particular, it examined the effects of the nature of family medicine residency training on the likelihood that a physician will be in rural practice. The study was also interested in finding out the reasons for abandoning rural practice among those family physicians who had completed a rural training program but ultimately ended up working in an urban area. In addition to working with other members of the research team in analyzing a massive amount of secondary data, CRaNHR researchers were responsible for using qualitative research methods to study changes in practice location decisions.

(Funded by the Canadian Institutes of Health Research, 2002 – 2004)

(2004) Strengthening the Medical Workforce in Rural Canada: The Role of Rural/Northern Medical Education

R.W. Pong, R. Strasser, G. Tesson, S. Bornstein, V. Curran, M. Jong, J.C. Hogenbirk and F. Wang

These studies were conducted in collaboration with the Centre for Applied Health Research, Memorial University of Newfoundland. Study objectives were to document and assess the current state of knowledge regarding the role of rural/northern medical education in effecting a more equitable geographic distribution of medical human resources, including what we know, the strength of existing evidence, and knowledge gaps that need to be filled; examine the relevance of such knowledge and how it could be used to support rural/northern health policies and rural/northern medical education initiatives; and use the knowledge generated as a basis for preparing a multi-year, multi-site, interdisciplinary, and, possibly, international program of research on rural/northern medical education.

(Funded by the Canadian Institutes of Health Research, 2003 – 2004)

(2003) Evaluation of the Free Tuition Physician Recruitment Incentives
B. Minore, R.W. Pong, and M.E. Hill

At the request of the Ministry of Health and Long-Term Care, CRaNHR undertook an evaluation of the "Free Tuition" incentive program designed to encourage recruitment of physicians to underserviced communities in Ontario. The evaluation used a mailed survey to assess the opinions of current and past participants in the program. Their views were augmented by telephone interviews with individuals responsible for administering the program, as well as representatives of physician groups, communities, and health care facilities.

(Funded by the Ontario Ministry of Health and Long-Term Care, 2003)