1. Making a Real Difference in the Lives of Ontarians: Beyond Access to Impact and Healthier Lives Research Team Members: Lorraine Carter, Mary Hanna, Wayne Warry

2. […] distance education is much more familiar to me than actually attending a classroom….So that has been how I have navigated that education system - I’m married to a police officer and so we’ve had all northern placements. Distance education is the only way to go really.

3. Our Goals  To examine key aspects of continuing education for health professionals in rural, remote, and First Nations communities in northern Ontario  To explore perceptions of impact of the learning experience on professional practice

4. Stage Setting  distance education: situations in which there was physical distance between the learner and the instructor  online learning: integration of pedagogy, instructional technologies, and the internet for the purposes of teaching and learning

5. Research Methodology  A mixed methods design including several programmatically-focused cases  Six programs recruited for inclusion  Purposive sample: all participants involved in the program, i.e., health professionals in the role of student, educational providers including program managers, instructional designers, supporting staff

6. Partners and Participants  Partners: four online nursing courses; one interprofessional series for health leaders in northern Ontario; one series for allied health professionals working in remote First Nations  Five of six programs delivered out of Northern Ontario; one out of Southern Ontario  Students: 99 participants in total (55 completed pre- surveys; 68 completed post-survey;11 interviews); 86 nurses  Education providers/supporting staff: 14 participants

7. Student Group, n = 99 *Learner Sample is denoted by voluntary survey submissions and interviewees only; not all learners within a program GenderProfessionCultural IdentityWorkplace Geography Predominantly female Predominantly nurses ~14% other health/allied health professions <5% identified as Aboriginal 40% identified as Francophone Communities worked in on a regular basis ~57% northern urban ~37% northern rural ~10% northern remote ~10% male1- 30 years in their profession First language: ~% 50 English ~% 37 French ~13% other languages Re the above, in some instances, participants worked in more than one community.

8. Essentials for Success The Student The Instructor Access Actual Learning Experience Multiple Roles Impact on Practice Impact on Life and Work Making a Difference

9. Essentials for Success, The Learner  When is technology appropriate? Which technology is appropriate?  What about experiential learning?  Learning styles and mixing of technologies  Not a lesser experience  Community of practice made possible Essentials for Success, The Teacher  Need for pedagogical knowledge and technical skill  Need for just in time support  Know students and where they are from  Engagement and interaction

10. Access, The Actual Experience  Not a panacea: institutional and technological issues  Resilience and problem solving skills  Part of working and studying in Northern Ontario I do not have to travel to urban areas for education which can be costly over and above the cost of the course itself not to mention dangerous winter driving conditions for 6-8 months of the year. Access to updating knowledge and skills necessary to stay competent in my field. Access, Multiple Roles I had two children instead of going to post-secondary and so once I had raised them all up and started another family, I decided it was time to go back to school…This whole experience has been one of opportunity.

11. Impact, Practice  It absolutely [does]…it absolutely upped my game.  Professional practice yeah, definitely it has – the review of nursing information and that kind of stuff, really enforced a lot of things for me, in my practice, especially a lot to do with research. Impact, Life and Work  I think it’s [distance infrastructure] critical. I mean the travel costs being what they are, the geography that has to be spanned…  I am located 4-6 hours from a college/university campus so distance learning is the only way possible for me to obtain my BScN degree while working full time….

12. A Few Observations Related to Culture  Inadequate supports for educational programs serving First Nations communities  Comment by one participant “…never nursed an Asian person”  Not a great deal was said by learners with regards to cultural safety; had expected different  Our experience as researchers and educators working with the First Nations program

13. I do not have a sense that there is uniform availability or uptake of different technologies for learning [referring to First Nations/remote communities]. There [are] often budgetary limitations that make it challenging to translate all learning programs into other languages of interest…program planners offering online learning activities may assume the Internet grants 24.7 access to everyone and is inclusive of all cultures despite geography.

14. So What Does It All Mean?  Strong evidence of impact; need for evidence in the health sector  Chicken or egg question  Do we value experiences more when they are scarce? Does this valuing increase transfer of knowledge and skills to practice?  Are the skills of critical thinking and research more important in a northern nursing setting than a southern nursing setting?  What about the influence of gender and online learning?  Are autonomy and resilience more important in a northern nursing setting than a southern nursing setting?  How can be better support and enable teachers who teach online so that students experience engagement and authentic learning?  What is the relationship between a northern geography and a human culture? How might such a relationship affect the learning of working professionals?

15. Issues of Transferability  Other geographical settings  Other professional learners  Specific cultural groups

16. We would love to hear from you. Lorraine Carter: cartel1@mcmaster.ca Mary Hanna: MX_Hanna@laurentian.ca