1. Teaching as Outreach: A case study of the Northern Medical Program Laura Ryser 1, Greg Halseth 1, Neil Hanlon 1, Dave Snadden 1, and Joanna Bates 2 1 University of Northern BC 2 University of BC

2. Overview Rural health care restructuring Emergence of the NMP NMP teaching impacts on physicians Issues for teaching as outreach Conclusion

3. Rural Health Care Restructuring I Began in 1980s Regionalized services to reduce government expenditures Professionalized / specialization of health care professionals Fewer human and financial resources

4. Rural Health Care Restructuring II Increased demands with aging population Support located in distant locations Physician fatigue and burnout

5. The Emergence of the Northern Medical Program “We were getting nowhere talking to the BCMA or the (provincial) government for that matter, so we formed our own medical society which is called the Northern Medical Society, and that has, I think, changed the face of medicine in the North.” NMP Interview 2007

6. Background of NMP June 2000: 7,000 northern BC residents and physicians protest physician shortage 6 months later: agreement for distributed medical education between UBC, UNBC, and UVIC “Train physicians in the north, for the north”

7. Methodology Research Design –Collaboration between NMP / Geography (UNBC) and Faculty of Medicine (UBC) –What do we really need to know? How did the NMP impact physician workload / participation in teaching? What needs to be done to improve operations of the NMP? –25 interviews with key leaders / physicians involved with the NMP in 2007.

8. Challenges with Teaching I New roles New staff Less flexibility around holidays / time off Difficulty finding substitutes to take time off Commitments to teaching schedule

9. Challenges with Teaching II Expanding workloads Teaching duties Finding volunteer patients More liaison with university staff Affects patient waitlists Lack of office space Lack of O.R. time

10. “Five years ago, I had 2 days of surgery a week and one family practice resident to teach. Now, I have 5 trainees (both undergrad medical students and residents) working with surgeons and I get only a half a day a week in the O.R.” NMP Interview 2007

11. Building Social Capital NMP became focal point for cooperation NMP broadened networks Cooperation improved levels of trust “It’s popular to be part of the NMP. Non- doctors ask whether you’re involved. I think the community wants it to succeed, and they’re interested in people’s roles”. NMP Interview 2007

12. Building Social Cohesion I More opportunities for interaction –Faculty development information sessions –Teaching rounds –Sponsored lectures –Surgery club Enhances participation in existing events –Northern Doctor’s Day –Jasper retreat –Bob Ewert dinner

13. Building Social Cohesion II Physician participation increased sense of ownership over NMP Physician morale improved “Everybody feels good that we’re not only a first class hospital, but also teaching the next generation of physicians”. NMP Interview 2007

14. Building Social Cohesion III NMP is fostering interaction amongst GPs, students, different departments, and academics “With students around, you tend to interact with many disciplines, so the students act as a second-hand bridge between the disciplines that might not be there”. NMP Interview 2007

15. Social Learning I Social interaction led to mutual transfer of knowledge and skills –Exposed medical staff to other organizations with different expectations –Exposed to international practice leaders –Students ask questions from different perspectives

16. “If you’re doing things a certain way, and then you see it through the eyes of a young student, you may be more flexible and open to improvement”. NMP Interview 2007

17. Social Learning II Creates a learning environment –Creates an openness of new ideas / ways of doing things –Problem-based learning groups –Encourages doctors to be up-to-date

18. “It’s important for the medical community to be involved in teaching because it keeps them up-to-date. When you’re teaching you can’t get sloppy. That’s the biggest benefit of the NMP”. NMP Interview 2007

19. Institutional Capacity More resources are available –Hospital obtained more infrastructure and upgrades to support students –Access to cadavers / video conferencing NMP became a financial lever Expanded human resource supports –Residents expand the support network –Students save time by interviewing the next patient NMP has become a recruitment tool

20. Addressing Issues for Teaching I Human Resources –Need more specialists to complete rotational rounds –Facilitate breaks from NMP duties Institutional Structures –Improve understanding about how restructured departments are working –Promote who to contact for various departments –Sufficient infrastructure / office space

21. Addressing Issues for Teaching II Social Interaction –Ensure social and professional interaction continue to maintain relationships and networks Research –Explore impacts of teaching / mentoring on patient waiting lists

22. Conclusion Teaching can be a tool for creating social learning environments that can produce change Must be accompanied with resources commensurate to the task NMP as effective teaching outreach mechanism

23. 3333 University Way, Prince George, BC, Canada V2N 4Z9 http://www.unbc.ca/cdi Dr. Greg Halseth, Acting Director Phone: (250) 960-5826 Fax: (250) 960-6533 Email: halseth@unbc.ca Community Development Institute (CDI)