Thank you for the question.
The first question was about designated places set aside for aboriginal people to be medical students. Essentially, as we were starting to develop the plan for our medical school, there was heated debate amongst the aboriginal people themselves about whether we should have designated seats put aside for aboriginal people. There were those who said, “Well, unless there are designated seats, our people won't get into medical school.” Others said, “No, we shouldn't do that, because it gives the impression that these aboriginal students are getting in through the back door and the standards are lower, and that creates a stigma for them.”
The approach we have at Northern Ontario School of Medicine is a sort of middle ground. We have a class size of 56 students each year, and two seats are set aside for aboriginal students. But we see that as a floor, not a ceiling, and we've never had as few as two students in a class. We have a target approach and aim to reflect the population distribution of northern Ontario in each class. So we've been successful in having somewhere between three and six aboriginal people in the class, which then translates to between 5% and 11% of the class.
Other medical schools, as you've heard, have designated seats and they're not necessarily filled. That's partly because there needs to be an active process to encourage aboriginal people to want to apply to become medical students in that school. So we have an aboriginal admissions stream. We actually start in the elementary schools to encourage students to think about becoming doctors and health professions in the future.
When our medical students are in those first nations communities, they go into the schools and talk about themselves, university, medical school, and so on. We have a high school program where aboriginal students come in and spend a week. It's a summer science camp. They spend a week on the university campus making the connection between the science they study at high school and health. Thanks to television, in recent years we've had a CSI theme, and this has been very popular with the students.
So you have to work hard to encourage aboriginal students to see themselves as potentially future physicians, to study and get the grades, and to fund their way into medical school. You have to look at the whole picture and develop a pipeline, a pathway of aboriginal people into medical school.
Your second question, as I understood it, is that you'd like to know more about the World Health Organization report. I'm an expert panel member giving advice on that. This report has a focus on the retention and recruitment of health workers in rural and remote areas worldwide. As I said, there are four categories of recommendations. The first one is education, and there are five recommendations. The first is to recruit students from rural backgrounds.
The second is to establish medical and health science schools outside of major cities, similar to the Northern Ontario School of Medicine and the success we've had. There are other examples around the world of medical schools and health science schools that have been established in rural areas, or at least in locations that are not in metropolitan and major urban areas.
The third recommendation is that all students should have clinical experience in rural settings--do clinical rotations in the rural clinical setting.
The fourth is that the curriculum should include a focus on rural health and rural practice. There is a defined set of knowledge and skills that rural practitioners require. Dr. Wootton mentioned before that rural practitioners are extended generalists, so it's important that all medical students develop the knowledge and understanding that a special skill set goes with being a rural practitioner, and help them to understand that, with a potential future career in mind.
The fifth recommendation in education is continued education and professional development to help rural practitioners keep up to date and maintain and update their skills while they're in practice. As you can imagine, in a small community it's hard to get away from the community to access education. You have to get a locum, travel, and so on. So providing education that's tailored to the needs of the practitioners, and accessible, usually using alternate communications, is a great benefit.
So that covers that recommendation.
More quickly, the other recommendations include, under regulations, an enhanced guide for practice, recognizing that rural practitioners, whether they're nurses, doctors, pharmacists, or physiotherapists, are actually extended generalists, and the regulations recognizing and supporting that, in terms of the legislation.
Another recommendation is supporting different types of health workers. These include nurse practitioners—“physician assistants” is the language used in Canada. There is demonstrated value in having a spectrum of different types of health workers providing care in rural areas.
Compulsory service is another. In some countries, new graduates are required to do one or two years of service in a rural area. This has been shown to enhance both retention and recruitment.
Also recommended are financial supports in the way of subsidy during education, with a return of service requirements. There are programs like this in Canada as well. Financial incentives are mostly around bonuses for staying in rural practice and supports for setting up as rural practitioners. There is a series of those.
The last group is personal and professional support, ensuring, in terms of living conditions, that the rural practitioners have good places to live, that they have a safe and supported work environment, that they're supported by the system and by specialists in the urban areas—outreach support.