Policy Report

From pipelines to pathways: the Memorial experience in educating doctors for rural generalist practice


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James Rourke1
MD, Former Dean of Medicine, 2004-2016 - Director, Centre for Rural Health Studies - Professor of Family Medicine *

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Shabnam Asghari2
PhD, Research Director, Centre for Rural Health Studies - Associate Professor, Faculty of Medicine

Oliver Hurley3 MEnvSc, Research Coordinator, Centre for Rural Health Studies

Mohamed Ravalia4 MBChB, Assistant Dean, Rural Medical Education Network - Associate Professor of Family Medicine

Michael Jong5 MBBS, Professor of Family Medicine, Labrador Health Centre

Wanda Parsons6 MD, Assistant Dean, Admissions - Associate Professor of Family Medicine

Norah Duggan7 MD, Family Medicine Undergraduate Director - Associate Professor of Family Medicine

Katherine Stringer8 MBChB, Chair and Associate Professor of Family Medicine

Danielle O'Keefe9 MD, Postgraduate Family Medicine Program Director - Assistant Professor of Family Medicine

Scott Moffatt10 MD, Assistant Dean, Student Affairs - Associate Professor of Family Medicine

Wendy Graham11 MD, Associate Professor, Discipline of Family Medicine

Carolyn Sturge Sparkes12 PhD, Clinical Assistant Professor – Coordinator, Aboriginal Health Initiative

Janelle Hippe13 MA, Research Assistant, Learners & Locations project

Kristin Harris Walsh14 PhD, Research Assistant, Learners & Locations project

Donald McKay15 PhD, Associate Dean, Undergraduate Medical Education Professor of Physiology

Asoka Samarasena16 MBBS, Assistant Dean Post Graduate Medical Education


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16 Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, Prince Philip Drive, St. John's, NL A1B 3V6, Canada

ACCEPTED: 7 August 2017

Memorial University of Newfoundland experience in educating doctors for rural generalist practice

early abstract:

Context: This report describes the community context, concept and mission of Memorial University of Newfoundland (Memorial) and its "pathways to rural practice" approach which includes influences at the pre-medical school, medical school experience, postgraduate residency training, and physician practice levels. Memorial's pathways to practice helped Memorial to fulfill its social accountability mandate to populate the province with highly skilled rural generalist practitioners.
Programs/Interventions/Initiatives: The "pathways to
rural practice" includes initiatives in four stages: (1) before admission to medical school (2) during undergraduate medical training (MD program) (3) during post-graduate vocational residency training (4) after post-graduate vocational residency
training. Memorial's Learners & Locations (L&L) database tracks students through these stages. The Aboriginal initiative, the MedQuest program and the admissions process that considers geographic or minority representation in terms of those selecting candidates and the candidates themselves - occurs before the student is admitted. Once a student starts Memorial's MD program, the student has ample opportunities to have rural based experiences through pre-clerkship and clerkship where some take place exclusively outside of St. John's tertiary hospitals. Memorial's postgraduate (PG) Family Medicine (FM) residency (vocational) training program allows for deeper community integration and longer periods of training within the same community which increases the likelihood of a physician choosing rural family medicine. After post-graduate training, rural physicians were given many opportunities for professional development as well as faculty development opportunities. Each of the programs and initiatives were assessed through geospatial rurality analysis of administrative data collected upon entry into and during the MD program and PG training (L&L). Among Memorial MD-graduating classes of 2011-2020, 56% spent the majority of their lives before their 18th birthday in a rural
location and 44% in an urban location. As of September 2016, 23 Memorial MD-students self-identified as Aboriginal where 2 (9%) were from an urban location, 20 (91%) were from rural locations.
For Year 3 Family Medicine, graduating classes 2011 to 2019, 89% of placement weeks took place in rural communities and 8% took place in rural towns. For Memorial MD graduating classes 2011-2013 who completed Memorial Family Medicine vocational training residencies, (N=49), 100% completed some rural training. For these 49 residents (vocational trainees), the average amount of time spent in rural areas was 52 weeks out of a total average FM
training time of 95 weeks. For Family Medicine residencies from July 2011 - October 2016, 29% of all placement weeks took place in rural communities and 21% of all placement weeks took place in rural towns. For 2016-2017 first year residents, 53% of
the first year training is completed in rural locations reflecting an even greater rural experiential learning focus.
Lessons Learned: Memorial's pathways approach has allowed for the comprehensive training of rural generalists for NL and the rest of Canada and may be applicable to other settings. More challenges remain, requiring ongoing collaboration with
governments, medical associations, health authorities, communities and their physicians to help achieve reliable and feasible healthcare delivery for those living in rural and remote areas.