Thank you very much, Madam Chair and members of the committee.
I'm Roger Strasser, dean and CEO of the Northern Ontario School of Medicine. It is my pleasure to share with you NOSM's experience in improving the recruitment and retention of health care professionals in rural, remote and indigenous communities.
With me today are Dr. Catherine Cervin, vice-dean, academic, and Dr. Sarita Verma, who will take over from me as the dean and CEO on July 1, so she's dean and CEO designate for the school.
I'm going to read the prepared remarks, but I also have some slides to show. The prepared remarks are not completely in sync with the slides, so I'm going to refer to the slides quickly as we go through.
Let me say that since its inception, NOSM has proudly defied traditional health professional education. The school was born of a grassroots movement. First of all, I have a slide to show you of Ontario's population distribution. As you can see, northern Ontario is geographically vast and very sparsely populated, with many indigenous communities, first nations and Métis communities.
Northern Ontario School of Medicine opened officially in 2005. It serves as the faculty of medicine at Lakehead University in Thunder Bay and Laurentian University in Sudbury, 1,000 kilometres apart. We have a social accountability mandate, which is a commitment to be responsive to the health needs of the people and the communities of northern Ontario, with a focus on improving the health of the people of northern Ontario.
In sum, I would say that the Northern Ontario School of Medicine is an Ontario government strategy to address the health needs of northern Ontarians, improve access to quality care and contribute to the economic development of northern Ontario.
Essentially, the school was founded on this research evidence, that is, the three factors most strongly associated with going into rural practice after education and training. First is a rural upbringing: having grown up in a rural area. The second factor is positive clinical and educational experiences at the undergraduate level—that's the basic training—in the rural setting: learning in rural clinical settings and community settings. Then, after graduation, the third is the training that prepares the graduates to practise in the rural setting. That's really the evidence base for all activities of the school.
I'll go through the slides quickly.
First, distributed community-engaged learning is our distinctive model of medical education and health research, and this slide shows what it looks like, with over 90 sites in northern Ontario where our students, residents and other learners may undertake part of their clinical learning. Next is community engagement, the centrepiece—that is, the interdependent partnerships that we have with communities right across northern Ontario.
In relation to indigenous communities, we regularly hold what we call indigenous community partnership gatherings. We've had five of them. In the top left-hand corner of this slide you can see that “Follow Your Dreams” was held at Wauzhushk Onigum First Nation in June 2003, and in September 2018, so just recently, we were back at the same first nation for the number five, “Gathering Together for Life and Well-being”.
Also, the bottom left-hand side of that slide shows a series of gatherings that were held specifically with a focus on research, the first one in 2008 in Thunder Bay on partnership opportunities in research gathering, and then, in 2016, an indigenous health research gathering that led into the 2017 “Pathways to Well-being” workshop, which was really about involving indigenous youth and looking to a future that doesn't include suicide.
At NOSM, several measures are in place to support physician recruitment and retention. High school students are encouraged to see a future for themselves that might include a health career and studying medicine. The next slide shows that every year at Lakehead University and at Laurentian University we have a week-long health careers camp, which we now call “Camp Med”. Then, three times in first nations, we had the “Walking in Two Worlds” health science camps, specifically for first nations young people, with our own indigenous physician graduates as the keynote speakers in each of the three first nations.
We have also been working in Nunavut, and I'll say more about this shortly. We held a health careers camp in February of last year with federal government support, and we're planning another one in May of this year, which brings together high school students from the communities across Nunavut, similar to the camps in northern Ontario. It's really about making the connection between what they're learning in high school and health careers.
These are some pictures from the health careers camp in Nunavut in February of last year.
We also have a partnership with Matawa First Nations Management and Eabametoong First Nation, so we have a remote first nation residency stream in our family medicine residency program. We are also active in a partnership with other agencies in northern Ontario and have developed a physician resource action plan for northern Ontario.
We have this international dimension, which I'm going to dwell on momentarily. Before I do, this slide shows some of the outcomes from the school. These are quotes from our students. I think the one that's highlighted, “you don't know it until you live it”, really sums up the value of our program.
With regard to this slide on career directions that are chosen by our graduates from our MD program, it's 62% family medicine—mostly rural. That's almost double the national average for Canada for those going into family medicine. You can see that 12% of our graduates are indigenous physicians. When you look at the graduates from the MD program who did their residency in northern Ontario, 94% are practising in northern Ontario, including about a third in the small or remote rural communities.
On this slide, you see that recruiting and retaining health care professionals for rural, remote and indigenous communities is an ongoing challenge in many parts of the world. The school has garnered an international reputation for its success in improving northern Ontario's ability to recruit and retain health professionals.
Since 2011, we've been partnering with countries in the north of Europe for European Union-funded projects. The most recent one started in 2015. It's the Recruit and Retain 2: Making it Work project, which is putting into practice in different jurisdictions in the northern periphery and Arctic region what we learned from the first project. NOSM is part of this because of our success, expertise and experience in transforming the northern Ontario health care landscape. As I said, most recently we've been working in Nunavut, as well, with the Government of Nunavut Department of Health and others in Nunavut.
In January of this year, we had a big forum—multi-site, multi-country video forum—where we presented the framework for remote rural stability. That's what's on the screen. I'm going to speak quite a bit more about that now. It's the result of that seven-year partnership, and the lead partners are now Sweden, Scotland, Norway, Iceland and us, for Canada. It's about stakeholders getting together and drawing on the evidence and lived experience of what works, what's successful in recruiting and retaining health and other public sectors in remote rural communities.
Let me quickly take you through this framework. You'll see that there are three components, and each of them has three elements.
There's planning. It's really important to start by looking at the health needs of the population, and then design a service model that meets the needs of that population and is attractive to physicians and other health care providers. Then it's targeting where you're going to find those particular providers to recruit them. That's the planning.
Recruiting, then, is about sharing the information and active community participation, community engagement, supporting and recognizing that when you recruit a physician or other health workforce into a community, it's a whole family. The family has to feel at home and wanting to be in the community.
Retaining is equally important. It's a workplace that's supportive, with continuous professional development and training the next generation. That's the retaining part.
This is the very last slide. In the centre of that circle are the essentials for success, recognizing that remote, rural, indigenous communities are each unique. They have their own perspective. The service models that work best in those communities are designed in those communities, for those communities.
That means active community participation. That means real investment, real money and resources to actually make this happen, to make this work, as well as having an annual cycle of activities, not just doing it once but on a regular basis, and ensuring that you're continuing to monitor that.
In summary, you have to set your goals and your vision, keep your eyes on the prize and stick to it, because there are plenty of naysayers, plenty of doubters. What I've learned is to smile and nod to them, and then just get on and do what I was planning to do in the first place, challenge conventional wisdom.
In a very short way, I've told you about the Northern Ontario School of Medicine, about our success in the recruitment and retention of our health workforce in northern Ontario and supporting work in Nunavut, in partnership with international partners—