The role, the risk, and the reciprocity: creating positive early rural placements in medical education.

INTRODUCTION: The Northern Ontario School of Medicine University seeks to address rural physician shortages in Northern Ontario. One key strategy the school employs is the use of experiential learning placements embedded throughout its undergraduate curriculum. In second year, students embark on two 4-week placements in rural and remote communities. This study sought to explore the factors that contribute to a positive learning experience from the preceptor's perspective. METHODS: Semi-structured interviews were conducted with five community preceptors who have participated in these placements. Using the information from these interviews a survey was created and sent to another 15 preceptors. Data were analyzed using qualitative methods and frequencies. RESULTS: Three key themes were identified from both the interviews and survey data: the role of early rural and remote placements; the risks of these placements; and the need for a reciprocal relationship between institutions, preceptors, and students to create a positive learning environment. CONCLUSION: Preceptors value the opportunity to teach students, but the aims of these placements are not clear and preceptors and local hospitals need more workforce resources to make these experiences positive.

Power/knowledge: A sociomaterial perspective on a new accreditation process during COVID-19.

INTRODUCTION: The COVID-19 pandemic had significant impacts on many aspects of health care and education, including the accreditation of medical education programmes. As a community of international educators, it is important that we study changes that resulted from the pandemic to help us understand educational processes more broadly. As COVID-19 unfolded in Canada, a revised format of undergraduate medical accreditation was implemented, including a shift to virtual site visits, a two-stage visit schedule, a focused approach to reviewing standards and the addition of a field secretary to the visit team. Our case study research aimed to evaluate the sociomaterial implications of these changes in format on the process of accreditation at two schools. METHODS: We interviewed key informants to understand the impacts, strengths and limitations of changes made to the accreditation format. We used an abductive approach to analyse transcripts and applied a sociomaterial lens in looking for interconnections between the material and social changes that were experienced within the accreditation system. RESULTS: Stakeholders within the accreditation system did not anticipate that changes to the accreditation format would have significant impacts on how accreditation functioned or on its overall outcomes. However, key informants described how the revised format of accreditation reconstructed how power was distributed and how knowledge was produced. The revised format contributed to changes in who held power within each of the programmes, within each of the visiting teams and between site members and visiting team members. As power shifted across stakeholders in response to material changes to the accreditation format, key informants described changes in how knowledge was produced. CONCLUSIONS: Our findings suggest that the most powerful knowledge about any given programme might best be obtained through individualised tools, technologies and voices that are most meaningful to the unique context of each programme. Deliberate attention to how knowledge and power are influenced by the interactions between material and social processes within accreditation may help educators and leaders see the effects of change.

Teaching compassion for social accountability: A parallaxic investigation.

BACKGROUND: In an arts integrated interdisciplinary study set to investigate ways to improve social accountability (SA) in medical education, our research team has established a renewed understanding of compassion in the current SA movement. AIM: This paper explores the co-evolution of compassion and SA. METHODS: The study used an arts integrated approach to investigate people's perceptions of SA in four medical schools across Australia, Canada, and the USA. Each school engaged approximately 25 participants who partook in workshops and in-depth interviews. RESULTS: We began with a study of SA and the topic of compassion emerged out of our qualitative data and biweekly meetings within the research team. Content analysis of the data and pedagogical discussion brought us to realize the importance of compassion in the practice of SA. CONCLUSIONS: The cultivation of compassion needs to play a significant role in a socially accountable medical educational system. Medical schools as educational institutions may operate themselves with compassion as a driving force in engaging partnership with students and communities. Social accountability without compassion is not SA; compassion humanizes institutional policy by engaging sympathy and care.

Operation Remote Immunity: exploring the impact of a service-learning elective in remote Indigenous communities.

BACKGROUND: The novel coronavirus, COVID-19, emerged in December 2019. Shortly after, vaccines against the virus were distributed in Canada for public use, but the remoteness of many northern Indigenous communities in Ontario posed a challenge for vaccine distribution and dissemination. The Ministry of Health partnered with the Northern Ontario School of Medicine University (NOSMU) and the air ambulance service, Ornge, to assist in delivering the vaccination doses to 31 fly-in communities in the Nishnawbe Aski Nation and Moosonee, all within Ontario. These deployments were considered "service-learning electives" for Undergraduate and Postgraduate medical learners from NOSMU who joined the operation in two-week deployments. NOSMU is renowned for its social accountability mandate and gives its medical learners opportunities to participate in service-learning to enhance their medical skills and cultural sensitivity. The purpose of this study is to examine the relationship between social accountability and medical learners' experiences during a service-learning elective in northern Indigenous communities in Ontario during the COVID-19 pandemic. METHODS: Data were collected through a planned post-placement activity completed by eighteen Undergraduate and Postgraduate medical learners, who participated in the vaccine deployment. The activity consisted of a 500-word reflective response passage. Thematic analysis was used to identify, analyze, and report the themes within the collected data. RESULTS: Two themes were identified by the authors, which formed a concise overview of the collected data: (1) confronting the realities of working in Indigenous communities; and (2) service-learning as a path to social accountability. CONCLUSIONS: These vaccine deployments were an opportunity for medical learners to engage in service-learning and engage with Indigenous communities in Northern Ontario. Service-learning is an exceptional method which provides an opportunity to expand knowledge on the social determinants of health, social justice, and social accountability. The medical learners in this study reiterated the idea that learning medicine through a service-learning model leads to a greater depth of knowledge on Indigenous health and culture, and enhances medical knowledge compared to classroom learning.

The SAFE (Social Accountability as the Framework for Engagement) for Health Institutions project: Rapid evidence narratives.

PROBLEM ADDRESSED: Family physicians stand to benefit from assistance with the implementation of social accountability strategies. OBJECTIVE OF PROGRAM: To develop rapid evidence narratives for key social accountability topics that summarize and mobilize evidence for practical use in social accountability strategies linking front-line, "bottom-up" actions with complementary "top-down" standards from the SAFE (Social Accountability as the Framework for Engagement) for Health Institutions evaluation tool. PROGRAM DESCRIPTION: The SAFE for Health Institutions project aims to accelerate transformation toward greater social accountability in family medicine practices and in other settings where family physicians work. A social accountability evaluation tool was developed to help with this transformation and includes a framework of 253 comprehensive top-down standards. Key social accountability topics linked to these standards were identified for rapid reviews of the literature, conducted between June and November 2021, with evidence reported as narratives. These rapid evidence narratives provide practical, evidence-based context including suggestions on how to address each topic across the micro, meso, and macro levels of care, connecting bottom-up actions with corresponding considerations for top-down policies, processes, and structures. Summaries of the rapid evidence narratives are being developed as a series of articles for Canadian Family Physician, focusing on what family physicians can do in clinical practices, with interdisciplinary teams, and in other work settings to accelerate change toward adopting or advancing socially accountable strategies. CONCLUSION: Rapid evidence narratives that summarize and mobilize evidence on key social accountability topics further the understanding of social accountability in family medicine and in other settings where family physicians work. Mapping actions across the micro, meso, and macro levels of care is a practical way to link front-line, bottom-up actions with a top-down social accountability strategy.

Global patterns in endemicity and vulnerability of soil fungi.

Fungi are highly diverse organisms, which provide multiple ecosystem services. However, compared with charismatic animals and plants, the distribution patterns and conservation needs of fungi have been little explored. Here, we examined endemicity patterns, global change vulnerability and conservation priority areas for functional groups of soil fungi based on six global surveys using a high-resolution, long-read metabarcoding approach. We found that the endemicity of all fungi and most functional groups peaks in tropical habitats, including Amazonia, Yucatan, West-Central Africa, Sri Lanka, and New Caledonia, with a negligible island effect compared with plants and animals. We also found that fungi are predominantly vulnerable to drought, heat and land-cover change, particularly in dry tropical regions with high human population density. Fungal conservation areas of highest priority include herbaceous wetlands, tropical forests, and woodlands. We stress that more attention should be focused on the conservation of fungi, especially root symbiotic arbuscular mycorrhizal and ectomycorrhizal fungi in tropical regions as well as unicellular early-diverging groups and macrofungi in general. Given the low overlap between the endemicity of fungi and macroorganisms, but high conservation needs in both groups, detailed analyses on distribution and conservation requirements are warranted for other microorganisms and soil organisms.

A conceptual framework to describe and evaluate a socially accountable learning health system: Development and application in a northern, rural, and remote setting.

Health care and academic institutions are increasingly committing to social accountability, a strategic shift that requires priorities, activities, and evaluations to be co-determined with all relevant partners. Consequently, governments, accreditors, funders, and communities are calling for these institutions to communicate their progress towards social accountability. The purpose of this study was to develop a conceptual framework around a socially accountable learning health system. This article presents an integrated analysis of two studies: (i) a narrative review of 11 prominent social accountability and health services conceptual frameworks and (ii) a reflexive thematic analysis of 18 key informant interviews. Using a systematic conceptual framework development and integrated theory of change/realist evaluation methodologies, we describe a synthesis of these findings to develop a conceptual framework for describing and evaluating socially accountable health professional education. The resulting framework describes assessment phases of social accountability, transitions between phases, learning cycles, and the actors and systems that collectively mobilise social accountability at multiple levels in health and education systems. The framework can be used to evaluate interventions or characterise progress towards social accountability in different settings, as illustrated in the example at the end of the paper. The framework emphasises the significance of designing, mobilising, and evaluating social accountability as part of a contextualised learning health system.

Exploring rural medical education: a study of Canadian key informants.

INTRODUCTION: Recruiting and retaining primary healthcare professionals is a global healthcare problem. Some countries have been using medical education as a strategy to aid in the recruitment and retention of these healthcare professionals. The purpose of this study is to engage with key informants and explore the learning processes that support medical students to prepare for a rural career. METHODS: Seven key informants with extensive experience in rural medical education participated in semi-structured interviews. The interviews were audio-recorded and professionally transcribed. Transcripts were analyzed using thematic analysis. RESULTS: Four key themes were identified. Respondents discussed the different ways they conceptualized 'rural'. Informants suggested that relationships could either be barriers or facilitators to rural practice and that certain educational strategies were necessary to help train students for rural careers. Finally, informants discussed different characteristics that rural physicians need. CONCLUSION: The finding of this study suggests that preparing students for rural practice requires a multifaceted approach. Specifically, using certain educational strategies, pre-selecting or developing certain characteristics in students, and helping students develop relationships that attach them to a community or support working in a rural community are warranted.

Aging as a Productive Process: A Critical Analysis of Aging Policy in Newfoundland and Labrador, Canada.

There has been a growing focus on healthy aging in the political agenda. Discourses contained within policy documents have the potential to shape our notions of healthy aging and well-being. This comprehensive critical document analysis of provincial aging policies in Newfoundland and Labrador (2006-2015) contributes to a larger research study exploring aging women's notions of health and the body in relation to the aging process. The findings highlight how healthy aging discourses focus on the concept of productivity and how a certain type of health is required for ongoing contribution. The paper concludes by arguing that if healthy aging is framed around one's ability to remain productive, notions of health will remain limited to an externalized measure of output versus subjective experience of well-being.

Improving obesity management training in family medicine: multi-methods evaluation of the 5AsT-MD pilot course.

BACKGROUND: Quality, evidence-based obesity management training for family medicine residents is needed to better support patients. To address this gap, we developed a comprehensive course based on the 5As of Obesity Management™ (ASK, ASSESS, ADVISE, AGREE, ASSIST), a framework and suite of resources to improve residents' knowledge and confidence in obesity counselling. This study assessed the course's impact on residents' attitudes, beliefs, and confidence with obesity counselling. METHODS: The course combines lectures with a bariatric empathy suit experience, standardized and in-clinic patient practice, and narrative reflections. Using a multi-methods design we measured changes in 42 residents' attitudes, beliefs, and self-confidence and thematically analyzed the narrative reflections to understand residents' experience with the course content and pedagogy. RESULTS: Following the course, residents reported improved attitudes towards people living with obesity and improved confidence for obesity counselling. Pre/post improvement in BAOP scores (n = 32) were significant (p < .001)., ATOP scores did not change significantly. Residents showed improvement in assessing root causes of weight gain (p < .01), advising patients on treatment options (p < .05), agreeing with patients on health outcomes (p < .05), assisting patients in addressing their barriers (p < .05), counseling patients on weight gain during pregnancy, (p < .05), counseling patients on depression and anxiety (p < .01), counseling patients on iatrogenic causes of weight gain (p < .01), counseling patients who have children with obesity (p < .05), and referring patients to interdisciplinary providers for care (p < .05). Qualitative analysis of narrative reflections illustrates that experiential learning was crucial in increasing residents' ability to empathically engage with patients and to critically reflect on implications for their practice. CONCLUSION: The 5AsT-MD course has the potential to increase residents' confidence and competency in obesity prevention and management. Findings reflect the utility of the 5As to improve residents' confidence and competency in obesity management counselling.

Global mismatches in aboveground and belowground biodiversity.

Human activities are accelerating global biodiversity change and have resulted in severely threatened ecosystem services. A large proportion of terrestrial biodiversity is harbored by soil, but soil biodiversity has been omitted from many global biodiversity assessments and conservation actions, and understanding of global patterns of soil biodiversity remains limited. In particular, the extent to which hotspots and coldspots of aboveground and soil biodiversity overlap is not clear. We examined global patterns of these overlaps by mapping indices of aboveground (mammals, birds, amphibians, vascular plants) and soil (bacteria, fungi, macrofauna) biodiversity that we created using previously published data on species richness. Areas of mismatch between aboveground and soil biodiversity covered 27% of Earth's terrestrial surface. The temperate broadleaf and mixed forests biome had the highest proportion of grid cells with high aboveground biodiversity but low soil biodiversity, whereas the boreal and tundra biomes had intermediate soil biodiversity but low aboveground biodiversity. While more data on soil biodiversity are needed, both to cover geographic gaps and to include additional taxa, our results suggest that protecting aboveground biodiversity may not sufficiently reduce threats to soil biodiversity. Given the functional importance of soil biodiversity and the role of soils in human well-being, soil biodiversity should be considered further in policy agendas and conservation actions by adapting management practices to sustain soil biodiversity and considering soil biodiversity when designing protected areas.

Disparidades Mundiales entre la Biodiversidad Sobre y Bajo el Suelo Resumen Las actividades humanas están acelerando el cambio en la biodiversidad mundial y han tenido como resultado unos servicios ambientales severamente amenazados. Una gran proporción de la biodiversidad terrestre está albergada en el suelo, pero la biodiversidad de este ha sido omitida de varias evaluaciones mundiales de biodiversidad y de las acciones de conservación, además de que el entendimiento de los patrones mundiales de la biodiversidad del suelo permanece limitado; particularmente, la extensión del traslape entre los puntos fríos y calientes de biodiversidad sobre y bajo suelo no está clara. Examinamos los patrones mundiales de estos traslapes mapeando los índices de biodiversidad sobre el suelo (mamíferos, aves, anfibios y plantas vasculares) y bajo el suelo (bacterias, hongos y macrofauna) que creamos con datos previamente publicados de la riqueza de especies. Las áreas de disparidad entre la biodiversidad sobre y bajo el suelo cubrieron el 27% de la superficie terrestre del planeta. El bioma de los bosques templados de plantas frondosas y mixtas tuvo la proporción más alta de celdas de cuadrícula con una biodiversidad alta sobre el suelo, pero baja para en el subsuelo, mientras que los biomas boreales y de la tundra tuvieron una biodiversidad intermedia bajo el suelo, pero baja para el sobre suelo. Aunque se requieren más datos sobre la biodiversidad del suelo, tanto para cubrir los vacíos geográficos como para incluir a taxones adiciones, nuestros resultados sugieren que la protección a la biodiversidad sobre el suelo puede no reducir suficientemente las amenazas para la biodiversidad del suelo. Dada la importancia funcional de la biodiversidad del suelo y el papel de los suelos en el bienestar humano, se debería considerar a la biodiversidad del suelo mucho más en las agendas políticas y en las acciones de conservación, adaptando a las prácticas de manejo para que mantengan a la biodiversidad del suelo y la consideren cuando designen áreas protegidas.

Side-swiped: Ecological cascades emanating from earthworm invasion.

Non-native, invasive earthworms are altering soils throughout the world. Ecological cascades emanating from these changes stem from earthworm-caused changes in detritus processing occurring at a mid-point in the trophic pyramid, rather than the more familiar bottom-up or top-down cascades. They include fundamental changes (microcascades) in soil morphology, bulk density, nutrient leaching, and a shift to warmer, drier soil surfaces with loss of organic horizons. In North American temperate and boreal forests, microcascades cause effects of concern to society (macrocascades), including changes in CO2 sequestration, disturbance regimes, soil quality, water quality, forest productivity, plant communities, and wildlife habitat, and facilitation of other invasive species. Interactions among these changes create cascade complexes that interact with climate change and other environmental changes. The diversity of cascade effects, combined with the vast area invaded by earthworms, lead to regionally important changes in ecological functioning.

University-based physical literacy programming for children: Canadian community stakeholders' recommendations.

'Physical literacy' (PL) education-that is, teaching foundational skills, attitudes, behaviors and knowledge about lifelong involvements in physical activities, is an important aspect for health promotion among children. Universities have been playing a critical role by teaching future PL professionals. Additionally, various universities have offered university-based PL programming for neighborhood children as a way of public health promotion service and community engagement. However, this additional role of universities and the ways of promoting the quality of this type of health promotion service programming have not been investigated in the current research literature. Therefore, the purpose of this study was to identify the practicable strategies to enhance the quality of university-based PL programming for children from the perspectives of community stakeholders. Overall, 24 community stakeholders who held professional positions that are related to PL education participated in a 90-min focus group interview. This grounded theory study identified that university-based PL programming for children should be (i) inclusive, (ii) collaborative, (iii) welcoming and (iv) responsive. Practical suggestions and recommendations were also provided. This study has provided empirical knowledge to prioritize aspects for the future actions in planning and implementing university-based PL programming for children and informed for further cross-cultural comparisons amongst the perspectives of participants, university service providers and community stakeholders. The knowledge acquired from this research will also be translated to university service providers who operate similar type of health promotion service programming to the public.

The female aging body: A systematic review of female perspectives on aging, health, and body image.

While most body image research has focused on young female populations, evidence has shown that as few as 12% of older women are satisfied with their body size. Recent studies have also highlighted how anti-aging discourses are promoting unrealistic body norms, which have shown to contribute to poor body image and altered health behaviors. A systematic review of empirical studies focused on older women's perspectives of health, body image, and the aging body is presented. Findings support that body image is a persistent, lifelong issue for women and should be considered when implementing healthy aging policies and practices.

The unseen invaders: introduced earthworms as drivers of change in plant communities in North American forests (a meta-analysis).

Globally, biological invasions can have strong impacts on biodiversity as well as ecosystem functioning. While less conspicuous than introduced aboveground organisms, introduced belowground organisms may have similarly strong effects. Here, we synthesize for the first time the impacts of introduced earthworms on plant diversity and community composition in North American forests. We conducted a meta-analysis using a total of 645 observations to quantify mean effect sizes of associations between introduced earthworm communities and plant diversity, cover of plant functional groups, and cover of native and non-native plants. We found that plant diversity significantly declined with increasing richness of introduced earthworm ecological groups. While plant species richness or evenness did not change with earthworm invasion, our results indicate clear changes in plant community composition: cover of graminoids and non-native plant species significantly increased, and cover of native plant species (of all functional groups) tended to decrease, with increasing earthworm biomass. Overall, these findings support the hypothesis that introduced earthworms facilitate particular plant species adapted to the abiotic conditions of earthworm-invaded forests. Further, our study provides evidence that introduced earthworms are associated with declines in plant diversity in North American forests. Changing plant functional composition in these forests may have long-lasting effects on ecosystem functioning.

Changes in the genetic structure of an invasive earthworm species (Lumbricus terrestris, Lumbricidae) along an urban - rural gradient in North America.

European earthworms were introduced to North America by European settlers about 400 years ago. Human-mediated introductions significantly contributed to the spread of European species, which commonly are used as fishing bait and are often disposed deliberately in the wild. We investigated the genetic structure of Lumbricus terrestris in a 100 km range south of Calgary, Canada, an area that likely was devoid of this species two decades ago. Genetic relationships among populations, gene flow, and migration events among populations were investigated using seven microsatellite markers and the mitochondrial 16S rDNA gene. Earthworms were collected at different distances from the city and included fishing baits from three different bait distributors. The results suggest that field populations in Alberta established rather recently and that bait and field individuals in the study area have a common origin. Genetic variance within populations decreased outside of the urban area, and the most distant populations likely originated from a single introduction event. The results emphasise the utility of molecular tools to understand the spatial extent and connectivity of populations of exotic species, in particular soil-delling species, that invade native ecosystems and to obtain information on the origin of populations. Such information is crucial for developing management and prevention strategies to limit and control establishment of non-native earthworms in North America.