Enhanced recovery after surgery reduces length of stay after colorectal surgery in a small rural hospital in Ontario.

Introduction: Enhanced recovery after surgery (ERAS) programmes include pre-operative, intraoperative and post-operative clinical pathways to improve quality of patient care while reducing length of stay (LOS) and readmission. This study assessed the feasibility and outcomes of an ERAS protocol for colorectal surgery implemented over 2 years in a small, resource-challenged rural hospital.

Methods: A prospective cohort study used retrospectively matched controls to assess the effect of ERAS on LOS in patients undergoing colorectal surgery in a small rural hospital in northern Ontario, Canada.

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

Introduction: The study predicted practice location of doctors trained at a socially accountable medical school with education programs in over 90 communities.

Methods: 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.

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

Background: Medical 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.

Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries?

Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce.

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.

Introduction: 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.

Methods: 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.

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

Purpose: 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.

Method: 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.

Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study.

Background: Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions.

How underserviced rural communities approach physician recruitment: changes following the opening of a socially accountable medical school in northern Ontario.

Introduction: The Northern Ontario School of Medicine (NOSM) opened in 2005 with a social accountability mandate to address a long history of physician shortages in northern Ontario. The objective of this qualitative study was to understand the school's effect on recruitment of family physicians into medically underserviced rural communities of northern Ontario.

Methods: We conducted a multiple case study of 8 small rural communities in northern Ontario that were considered medically underserviced by the provincial ministry of health and had successfully recruited NOSM-trained physicians.

The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting.

Objective: Opioid use disorder has been declared a public health crisis across North America and opioid agonist therapy (OAT) is the standard of care for these patients. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not yet been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT.

Impact of the rural pipeline in medical education: practice locations of recently graduated family physicians in Ontario.

Background: The "rural pipeline" suggests that students educated in rural, or other underserviced areas, are more likely to establish practices in such locations. It is upon this concept that the Northern Ontario School of Medicine (NOSM) was founded. Our analysis answers the following question: Are physicians who were educated at NOSM more likely to practice in rural and northern Ontario compared with physicians who were educated at other Canadian medical schools?

Methods: We used data from the College of Physicians and Surgeons of Ontario.

Milestones on the social accountability journey: Family medicine practice locations of Northern Ontario School of Medicine graduates.

Objective: To assess the effect of different levels of exposure to the Northern Ontario School of Medicine's (NOSM's) distributed medical education programs in northern Ontario on FPs' practice locations.

Design: Cross-sectional design using longitudinal survey and administrative data.

Setting: Canada.

Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network.

Introduction: Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km(2). The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province.

Driving Distance to Telemedicine Units in Northern Ontario as a Measure of Potential Access to Healthcare.

Introduction: The Ontario Telemedicine Network (OTN) uses technology to help make medical services more accessible to people in medically underserved rural and remote parts of Ontario, Canada. We examined access to OTN-enabled health and medical services in Northern Ontario, which has 775,000 people in communities scattered across an area of 803,000 km(2).

Materials And Methods: We used ArcGIS Network Analyst (Esri, Redlands, CA) to conduct a service area analysis with travel time as a measure of potential access to care.

Outcomes of the Northern Ontario School of Medicine's distributed medical education programmes: protocol for a longitudinal comparative multicohort study.

Introduction: The Northern Ontario School of Medicine (NOSM) has a social accountability mandate to serve the healthcare needs of the people of Northern Ontario, Canada. A multiyear, multimethod tracking study of medical students and postgraduate residents is being conducted by the Centre for Rural and Northern Health Research (CRaNHR) in conjunction with NOSM starting in 2005 when NOSM first enrolled students. The objective is to understand how NOSM's selection criteria and medical education programmes set in rural and northern communities affect early career decision-making by physicians with respect to their choice of medical discipline, practice location, medical services and procedures, inclusion of medically underserved patient populations and practice structure.

Urban washout: how strong is the rural-background effect?

Objective: To test predictors of practice location of fully qualified Monash University Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates.

Design: Cohort survey, 2011.

Setting: Australia.

The economic contribution of the Northern Ontario School of Medicine to communities participating in distributed medical education.

Introduction: The economic contribution of medical schools to major urban centres can be substantial, but there is little information on the contribution to the economy of participating communities made by schools that provide education and training away from major cities and academic health science centres. We sought to assess the economic contribution of the Northern Ontario School of Medicine (NOSM) to northern Ontario communities participating in NOSM's distributed medical education programs.

Methods: We developed a local economic model and used actual expenditures from 2007/08 to assess the economic contribution of NOSM to communities in northern Ontario.

Promising quantities, disappointing distribution. Investigating the presence of French-speaking physicians in Ontario's rural Francophone communities.

Introduction: Previous studies have suggested that there may be a lack of French language healthcare services in the province of Ontario. The purpose of this study was to determine if physicians in Ontario who expressed a proficiency in providing services in the French language are located in 'Francophone communities'.

Method: Responses from 10,968 Ontario-based family physicians (FPs) certified by the College of Family Physicians of Canada and uncertified general practitioners (GPs) who responded to the 2007 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey were analysed and compared to the 2006 census of the population of Ontario.

Transforming health professional education through social accountability: Canada's Northern Ontario School of Medicine.

Background: The Northern Ontario School of Medicine (NOSM) has 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 70 clinical and community settings located in the region, a vast underserved rural part of Canada.

Methods: NOSM and the Centre for Rural and Northern Health Research (CRaNHR) used mixed methods studies to track NOSM medical learners and dietetic interns, and to assess the socioeconomic impact of NOSM.

Postgraduate specialty training in northeastern Ontario and subsequent practice location.

Introduction: Physician specialists are under-represented in communities in northern Ontario, even in larger communities of approximately 100 000 population. The positive association between postgraduate training in northern or rural areas and eventual practice in these locations has been well documented in the literature, but only for family medicine/general practice. Few, if any, studies have explored the association for other specialties.

Starting rural, staying rural: how can we strengthen the pathway from rural upbringing to rural practice?

Objective:   To determine if selecting rural background students into the Monash Bachelor of Medicine and Bachelor of Surgery (MBBS) program affects vocational training location and intended practice location after training.

Design:   Retrospective cohort mail survey.

Setting:   Australia.

Framework for Canadian telehealth guidelines: summary of the environmental scan.

A Canadian project (the National Initiative for Telehealth Guidelines) was established to develop telehealth guidelines that would be used by health professionals, by telehealth providers as benchmarks for standards of service and by accrediting agencies for accreditation criteria. An environmental scan was conducted, which focused on organizational, human resource, clinical and technological issues. A literature review, a stakeholder survey (245 mail-outs, 84 complete responses) and 48 key informant interviews were conducted.

An audit of the appropriateness of teletriage nursing advice.

This study assessed the appropriateness of advice given by teletriage nurses to patients in northern Ontario. Assessments used audiotapes and printed records of 73 calls, selected from approximately 350 calls based on sound quality, completeness, and consent of caller and teletriage nurse. Audits were conducted independently by one family physician, one nurse practitioner, and one registered nurse with teletriage experience.