Community engagement: a key to successful rural clinical education

Evaluation of rural clinical attachments has demonstrated that the rural setting provides a high-quality clinical learning environment that is of potential value to all medical students. Specifically, rural clinical education provides more 'hands on' experience for students in which they are exposed to a wide range of common health problems and develop a high level of clinical competence. Northern Ontario in Canada is a large rural region that has a chronic shortage of healthcare providers. The Northern Ontario School of Medicine (NOSM) was established with a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario, and is a joint initiative of Laurentian University, Sudbury, and Lakehead University, Thunder Bay, which are over 1000 km apart. The NOSM has developed a distinctive model of medical education known as distributed community engaged learning (DCEL), which weaves together various recent trends in medical education including case-based learning, community-based medical education, electronic distance education and rural-based medical education (including the preceptor model). The NOSM curriculum is grounded in Northern Ontario and relies heavily on electronic communications to support DCEL. In the classroom and in clinical settings, students explore cases from the perspective of doctors in Northern Ontario. In addition, DCEL involves community engagement through which communities actively participate in hosting students and contribute to their learning.This paper explores the conceptual and practical issues of community engagement, with specific focus on successful rural clinical education. Community engagement takes the notion of 'community' in health sciences education beyond being simply community based in that the community actively contributes to hosting the students and enhancing their learning experiences. This is consistent with the focus on social accountability in medical education. Implementing community engagement is quite challenging; however; its potential benefits are substantial and include the improved recruitment and retention of healthcare providers who are responsive to cultural diversity and community needs and are collaborating members of the whole health team.