Labrador program prepares MDs for northern, remote practice
Sharon Gray
CMAJ 1997;157:1429-30
[ en bref ]
Sharon Gray is information officer at the Health Sciences Centre, Memorial University, St. John's.
© 1997 Canadian Medical Association (text and abstract/résumé)
In brief
Across Canada, residency programs are attempting to train more physicians to practise in rural and remote areas. The Northern Family Education Program developed in Newfoundland and Labrador is proving that physicians can learn to like life in remote areas.
En bref
Partout au Canada, les programmes de résidence s'efforcent de former plus de médecins qui se destineront à la pratique en régions rurales ou éloignées. Le Programme d'éducation familiale du Nord mis en place à Terre-Neuve et au Labrador montre que les médecins peuvent apprendre à apprécier la vie en région éloignée.
In 1992, Dr. Ian Feltham went to Goose Bay, Labrador, as part of the first group of family practice residents to enrol in the Northern Family Medicine Education Program (NorFaM). Five years later he's still there, operating his own practice with the help of his wife Sioban, an Irish-trained midwife.
"We didn't anticipate staying here, but NorFaM exposed me to a lot of different aspects of medicine and I liked the independence it encouraged," says Feltham. "Goose Bay really needed a community doctor, so I took on the job."
He is typical of many NorFaM graduates, 90% of whom eventually opt for rural practice -- which is exactly the goal organizers set. "There is a growing consensus that urban training in a highly specialized, tertiary care setting does not adequately prepare physicians for rural practice," explained Dr. Michael Jong, who launched the program at the Melville Hospital in Goose Bay. "We developed this program in response to the need for rural and northern family physicians in Canada."
Dr. Martin Eckhardt, another NorFaM graduate who stayed in Goose Bay, finished his residency in 1994 and now teaches other NorFaM participants. "I took the program because I thought it would be interesting, particularly because of the cross-cultural aspects and travelling along the coast of Labrador," he said. "It's a good testing ground when you're out on a coastal visit because it helps to develop confidence and clinical skills."
NorFaM offers a special 7-month rural-practice rotation for family medicine residents that includes a variety of experiences in a northern setting, as well as summer and winter camping retreats. Residents are also taught in the clinic and hospital setting, with the emphasis on unique aspects of rural and northern practice.
"The family physician is valued as a good clinician and family medicine is community based, offering a resource to a defined population," said Jong. "Above all, the doctorpatient relationship is central to the role of the family physician."
To prepare physicians for the unique demands they will face in the north, NorFaM offers extra training in specialized areas such as surgery, obstetrics, emergency medicine, intensive care and medical evacuation.
"Rural physicians have less access to specialist services than their urban counterparts and they must be competent to handle situations in which the urban doctor would normally refer a patient," said Dr. David Beach, the former director of NorFaM who now practises in Elliot Lake, Ont. "This program is designed to provide residents with the knowledge and skills to feel comfortable working with limited or no specialist support."
In addition to the extra training, residents learn about sociocultural and economic issues they may face in rural and northern communities. Labrador introduces doctors to diverse groups of patients, ranging from the isolated Inuit, Innu and Métis to residents of coastal communities with populations of fewer than 1000 people. Each resident is assigned to a coastal community in Labrador, which will be visited regularly during the 7-month stay.
The program includes traditional training. Days begin with seminars given by faculty members and residents, followed by rounds. Teleconferences, chart reviews, workshops and other academic activities seen in regular teaching centres are also part of the NorFaM program. However, it differs from similar programs by including wilderness training, and residents are taken camping in both summer and winter. "We want them to appreciate the wilderness, appreciate that there is life after work," said Jong. "Many people are not aware how nice it is to go camping."
Not only is the wilderness experience fun, said Beach, but it also gives residents a glimpse of what living on the land must have been like for the region's early residents. "This helps them gain an understanding of certain aspects of the aboriginal culture of the region," he said.
One reason for the program's success is strong community support. The backing from the Melville Hospital Board was crucial during its launch, and the current Health Labrador Corporation has continued to support the program.
"Once again," said Beach, "the people of Newfoundland and Labrador have shown that they're not only on the eastern edge of the country, but also on the leading edge of family medicine education in Canada."
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