Scitech  Inequities in med school

Canadian aboriginals and rural people under-represented: report

Aboriginal people and people born into rural communities are under-represented in Canadian medical schools, finds a report published by the Canadian Council on Learning. The paper cites the results of a 2001 survey which found that only 10.8 per cent of first-year medical students were from rural areas despite the fact that 22.4 per cent of the country’s population lives in rural areas. Among aboriginal people, the under-representation appears to be even more pronounced. While aboriginal people make up 4.5 percent of the population, only 0.7 per cent of the survey’s respondents identified themselves as such. For rural aboriginals, who account for half of all Canadian aboriginals, enrollment numbers are even lower, with only one-third of all aboriginal medical students being from rural areas.

The report draws a connection between under-representation in Canadian medical schools, and the severe healthcare crises faced by Canada’s rural and aboriginal communities. According to the report, under-representation of these communities is particularly detrimental, as patients treated by a physician from a similar background are more likely to heed prevention advice, comply with treatment recommendations, and seek medical care.

Though the report does not delve into reasons for aboriginal under-representation in Canadian medical schools, Ronald Niezen, a professor of Anthropology at McGill who has worked on public health issues among the Cree of Northern Quebec and Manitoba, suggests that it may be a product of marginalization and lack of professional role models

“I know from talking to young people, if you say, ‘How do you imagine yourself in the future?’ you won’t very often get people saying, ‘I see myself doing this professional degree,’” Niezen said. “It simply doesn’t occur to people because there are so many obstacles, and it’s also that it isn’t something that is encouraged as a life ambition.”

What might be done to help correct for these social inequalities? Research out of Australia has shown that building medical schools with a focus on medicine in rural communities is a promising possibility. A Canadian example of such a school is the Northern Ontario School of Medicine (NOSM), founded in 2005. The school has campuses in Thunder Bay and Sudbury, as well as a number of research and teaching centers in more remote locations. Dr. Roger Strasser, the school’s founding Dean, discussed how NOSM is helping to correct inequalities through its curricula.

“The academic programs that we put in place, particularly the education training programs, are based on research evidence that shows that the three factors most strongly associated with going into rural practice after training are, first of all, a rural background. Second, positive clinical and educational experiences in the rural setting as part of the undergraduate education program. Third, is training at the postgraduate level, in the residency program, that prepares the residents to practice in rural areas,” Strasser said.

NOSM also has a selection and admissions process that favours applicants who come from Northern Ontario or from northern, rural, remote, aboriginal, or francophone communities elsewhere, and maintains academic standards similar to those required for admission to other Canadian medical schools.

Initiatives at other Canadian universities to encourage rural and aboriginal student enrollment include programs that help students cope with the culture shock of moving from a small, close-knit community to an urban centre. Other solutions proposed in the paper include modifying certain admissions criteria for rural and aboriginal students, and supporting programs aimed at encouraging elementary school students to pursue careers in healthcare.

Neizen mentioned, however, that though there may not be large numbers of aboriginal students in medical schools, many people do practice traditional medicine.

“We shouldn’t look at education narrowly either, or professional qualifications, or healing, because there are very effective healers that I have met in aboriginal communities who are not professionals,” he said. “Where they excel is in counselling and spiritual practices and working with people through addiction problems. And, that [traditional practice] is something that some people do see themselves doing quite clearly, and do it effectively in practice.”