Remote and rural placements occurring during early medical training as a multidimensional place-based medical education experience

The Northern Ontario School of Medicine delivers medical education aiming to improve the health outcomes for persons living in Northern Ontario, including those in underserviced rural and geographically remote communities. Second year students experience rural medicine and living during two four-week long placements set in remote and rural communities (RRCP) supervised by local physicians. This place-based approach to medical education aims to equip learners with the skills and dispositions needed to work there successfully. The goal of the study was to develop a better understanding of RRCPs from different perspectives:  Institutional, community-preceptors and students. Data was collected by review of institutional documents, semi-structured interviews, and questionnaires to obtain information about the aims of each group. A place-based educational framework informed the analysis which developed themes and sub-themes using a constructivist approach. The aims of each group were in five themes, social accountability, community engagement, integrated learning, forming the rural clinician, and living in place as a rural clinician.  Differences were, however, apparent in terms of emphasis and perceived relevance, with these being related to the perceptual, political, ideological and social dimensions.  For example, the finding that students did not value extra-clinical learning about or within the wider community can be viewed as students having a different place-relationship with the community than their teachers in terms of the social dimension. The data suggests that curricula should include consideration of the various ways students and teachers interact with placement communities with the aim of gaining understanding of, and bridging the gap between, their different expectations.   Key words: Place-based education, medical education, rural placements.