The document discusses service learning at the Northern Ontario School of Medicine (NOSM) at both the local and global level. NOSM aims to link service learning to its social accountability mandate through community engagement. At the local level, NOSM involves Francophone, Aboriginal, remote and rural communities, including a required 4-week placement for first year students in an Aboriginal community. This helps students learn about issues facing Indigenous populations. Globally, NOSM is developing a global health curriculum thread to highlight linkages between northern and global health issues and promote service learning and cultural competency. Challenges include integrating citizenship training and linking local experiences to broader global issues and contexts.

1. Service-learning: Linking the Local
and Global Learning Environment
Siobhan Farrell
Dr. Basia Siedlecki

2. Faculty/Presenter Disclosure
• Faculty: Siobhan Farrell and Dr. Basia
Siedlecki
• No Relationships with commercial interests:
– Siobhan Farrell-Employee of the
Northern Ontario School of Medicine
– Basia Siedlecki-faculty member of the
Nortern Ontario Schoolof Medicine and
staff physician at Georgian Bay General
Hospital

3. Objectives
• To describe service learning at the
Northern Ontario School of Medicine
(NOSM) at the local and global level
• To review the links between service
learning and community engagement
and social accountability mandate
• To explore how service learning can be
an effective tool in developing healthy
campus-community partnerships

4. Challenges in Medical Education
• Are we providing learners with the
tools that they will require to function
effectively in order to serve society?
• Are we adequately addressing health
disparities and promoting social
justice?

5. Other Challenges for Medical
Schools
• Knowledge, information explosion
• Multiple stakeholders
• Educated consumers/public
• Demand for equity and social justice
• Need for cultural competency
• Societal needs and expectations

6. NOSM1
• Outcome of many partnerships
with individuals, communities,
hospitals, clinics, etc.
• Francophone, Aboriginal, remote
and rural communities involved
• 4 week placement in Aboriginal
community 1st year2

7. Map of NOSM Territory

8. Social Accountability and
Curriculum
• Students learn about Aboriginal health, culture and
issues facing those communities
• Students work with and learn from community
members and health care providers, as well as
deepening their understanding as to how culture and
geography impact the experience of accessing and
receiving health care
• Service learning projects promote a deeper
understanding of both local and global issues
• Curriculum shows not just community needs, but
empowers learners to meet needs in both their
clinical work and by being advocates for change

9. Learning about Aboriginal Culture
and Communities
Supported by many of the First Nation and Métis
communities to introduce first year students to the
issues facing Indigenous populations including:
• Culture
• Social support networks and social environment
• Biology and genetic endowment
• Income, social status
• Education and literacy
• Employment and working conditions
• Physical environment
• Healthy child development
• Access to health services
• Gender
• Personal health practices and coping skills

14. Student Experiences
• While some students initially have
trepidations about spending a
month in a First Nations
community, time is spent educating
them to reflect on their
preconceived notions and biases
• While in community, students are
encouraged to be mindful of their
biases and to document for
themselves, privately, what
changes they may be experiencing

15. Outcome of Aboriginal Placements
• Placement during their first year is an
invaluable experience.
• Among Canadians, few people have
any actual insight into the world of
these communities or of the people that
inhabit them
• Issues in most communities include
suicide, alcoholism, drug abuse,
education, leadership, housing,
governance, economy, health,
environment, religion, culture, language
…

18. Why is Service Learning
Valued at NOSM?
• Helps to demonstrate NOSM’s commitment to
social accountability
• Provides opportunities for learners and provides
resources for individuals and communities
• Helps learners examine their values and beliefs
• Develops leadership skills in students
• Promotes intercultural and international
understanding
• Demonstrates role that community organizations
provide in supporting population health outside
the traditionally defined health care system

19. Links to Global Health
• Service-learning planning is now taking
place in concert with the development of a
global health curricular thread
• Global Health thread can highlight the
strong linkages between content from the
northern context to the global community,
focusing on issues like access, equity, the
environment and sociopolitical issues

20. What is Global Health?
• Global health is the health of
individuals and populations in a
global setting
• Global and local are inextricably
linked
• Global populations are not
necessarily politically
demarcated

21. What does Global Health mean at
NOSM?
• Aboriginal populations (North Ontario,
Cascadian, circumpolar)
• Immigrant populations (unique health concerns
and issues with access to health care)
• Refugee populations
• Travel medicine
• Underserviced/under-resourced areas (Canada
and global)
• Altruism/volunteerism/international medical work
– building good global citizenship
• Shared educational and social goals and roles
(social mandate)

23. Global Health and NOSM students
• Working/training in under-resourced
areas
• Cultural safety:
– Awareness
– Attitude
– Knowledge
– Skills
• Complex cultural environment for
training & practice (multicultural,
inclusive)
• Equity, social justice, autonomy:
CanMEDS

24. Key Issues in the field of Global
Health today
• Globalization: movement of goods,
people, organisms, microbes,
parasites, etc.
• Conflict: trauma, physical and
mental suffering, loss of
infrastructure for prevention of
disease and maintenance of health
(social determinants of health)
• Poverty: directly correlated with
health status
• Millennium Development Goals5

25. Global Health at NOSM
• Global health curricular thread
includes:
– Clinical international electives
– Clinical work with global populations in
Canada
– Research and service learning projects
– Epidemiology and biostatistics
– Travel Medicine
– Cultural Safety/Intelligence
– Ethics and bioethics of global medicine

26. Integrating Global Health Content into
UME Curriculum
• Building global citizenship by promoting service
learning
• NOSM Global Health has a three-pronged
approach – working both in Canada and
internationally
– Developing and fostering relationships with
international partners to facilitate a positive,
challenging and educational experience for our
students in international settings
- preparing learners for their experiences, helping to
ensure their safety while away, and helping them
debrief after they return.
– Formal rotation in an Aboriginal community –
focusing on cultural rather than clinical work.
– Focusing on global issues in our local contexts

27. Challenges in linking Local and Global
Content with Service Learning
• Exploring best ways of teaching
citizenship, advocacy and social
accountability to wide range of students
with varying interests and backgrounds
• Building global citizenship by mitigating
the privileges of medical education with
the integration of service at all levels
• By linking local to global needs and
issues, students learn to see links in
relation to larger economic, social and
political realities
• Preparation and reflection are critical
elements

28. Future of Service Learning &
Global Health at NOSM
• Future: faculty/student collaborations on
local & international service/learning
projects.
• Institutional modeling of global citizenship
• Longitudinal relationships with
communities/health care providers/clinics
to foster continuity of service projects and
consistency in educational experiences
• Health systems projects
• Needs analyses: global issues
• Transitions to Canadian health care

30. References
• 1http://www.nosm.ca/
• 2http://www.nosm.ca/uploadedFiles/About_Us/Media_Room/Publicatio
ns_and_Reports/2006_11_05_Aboriginal_Pilot_Placement.pdf
• 3http://www.royalcollege.ca/portal/page/portal/rc/canmeds/canmeds201
5
• 4http://www.cfpc.ca/ProjectAssets/Templates/Resource.aspx?id=3031
• 5http://www.un.org/millenniumgoals/pdf/report-2013/mdg-report-2013-
english.pdf
• 6http://thenetcommunity.org/
• 7http://www.who.int/nutrition/challenges/en/
• 8http://www.cdp-hrc.uottawa.ca/projects/refugee-forum/
projects/documents/REFUGEESTATSCOMPREHENSIVE1999-
2011.pdf
• 9Ramsey AH, Haq C, Gjerde CL, Rothenberg D. Career influence of an
international health experience during medical school. Fam Med.
2004;36(6):412-6.
• 10Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ.
Educational effects of international health electives on U.S. and
Canadian medical students and residents: a literature review. Acad
Med. 2003;78(3):342-7.

31. Final Remarks and
Questions?