Dr. Doug Myhre is the associate dean of the Distributed Learning and Rural Initiatives (DLRI) program at the Cumming School of Medicine (CSM). In this role, he oversees rural medical education rotations at the undergraduate and postgraduate levels as well as continuing medical education and faculty development.
Earlier this year, the College of Family Physicians of Canada (CFPC) honoured members of the DLRI program, including Dr. Myhre, for their commitment to education, research, and excellence in the practice of family medicine.
In a conversation with Dr. Myhre about the program, he gave some insight into how it all started, why the program is important and what makes it unique.
Q: How did your passion for rural medicine begin?
A: When I finished my family medicine residency at Dalhousie University, I wanted to practise in a smaller centre so that I could work within a generalist environment. I wanted to do it all, from surgical assists, to office practice, to childbirth care. I sought an environment where family physicians were valued for their breadth of knowledge and were supported to maintain their procedural skills. For family reasons, that was Lethbridge. While in practice there, I came to realize the importance of decentralized or distributed medical education as both a mechanism to stop the erosion of skills from resident trainees, and as a recruitment tool.
Q: What is the important thing people should know or understand about the DLRI?
A: When you look at the DLRI vision and mission, Engage Communities, Inspire Social Accountability, Create Opportunities, it encompasses why we do what we do, and how we are involved in over 4,100 weeks of education every year outside of Calgary. We are the face of the Cumming School of Medicine outside of the city, including the Yukon and the Northwest Territories. We also try to be the face of those communities with faculty members. We believe community engagement should be based on social accountability. As we have grown so much, we need more rural physicians to join us in medical work and we need the medical work to become more decentralized and truly be based physically in the smaller communities of Alberta.
The program contributes a lot to the work of the faculty. We have 4,100 learner weeks of teaching supported every year outside the city, from pediatrics to surgery to family medicine, from undergraduate to postgraduate to faculty development. In addition, we publish two to six peer-reviewed articles annually in medical education literature. Contributions such as these have helped increase funding for the medical school over the past several years.
Q: What factors do medical students consider when looking at a career in rural medicine and how do the strategies of the DLRI help to influence their decision?
A: This is a well researched area. The earlier and the longer our medical learners have exposure to a rural generalist practice, the greater their likelihood of choosing that career. Short blocks of four weeks do not create a positive impression or build a mentoring relationship. In fact, they may actually hinder it. These short blocks are as exhausting for our teaching doctors outside the city because they are with the student constantly for this short time.
Longer clerkships, such as the University of Calgary Longitudinal Integrated Clerkship (UCLIC) or earlier exposures such as family medicine job shadowing, help us to break the myths of rural lifestyle and practice. At the end of the day, learners consider the scope of practice, well-being (family support and call support), maintenance of skills (Continuing Professional Development) and the financial opportunities in their decisions.
Q: What makes the DLRI different/unique from other programs across Canada?
A: The main difference is in how we engage our medical school colleagues. We have funding that supports many staff across the CSM programs from undergraduate medical education, to postgraduate and continuing medical education, but we want to be the flavour that is present everywhere and not gathered into one space. DLRI also tries not to reproduce the patterns of urban education in communities outside of the cities.
We need the medical school to be explicitly present in all our teaching communities such as Yellowknife and Pincher Creek. Their teaching commitment, from family medicine to surgery, undergraduate and postgraduate, is huge and these type of commitments require that we respond to those teaching doctors.
Q: Tell us about Dr. Cathy Scrimshaw and the work she does within the program?
A: Dr. Scrimshaw, or “Scrimmy,” has been a powerful, consistent advocate for socially accountable rural medicine for decades. She is respected nationally and is the kind of physician that leads from within the group. She started her practice on Fogo Island, Newfoundland and moved to Pincher Creek to continue a broad scope generalist practice.
Dr. Scrimshaw has served in a number of different capacities including the National Board of the College of Family Physicians of Canada and as Past President of the Alberta College of Family Practice. Over a decade ago, Dr. Scrimshaw worked very closely with members of the Pincher Creek medical community to develop an integrated primary disciplinary team. Due to no small amount of effort, Dr. Scrimshaw and her colleagues in Pincher Creek brought forth an example, created and sustained here, that was the key to convincing provincial decision makers that that multidisciplinary health teams, in the form of the modern Primary Care Network, was a worthwhile and cost-effective model to follow in other communities.
Dr. Scrimshaw is committed to rural medical education and has been recently awarded the Rural Preceptor of the Year Award by the Rural Alberta South Family Medicine Residents through the CSM. Dr. Scrimshaw still maintains a varied and diverse practice including obstetrics, indigenous outreach medicine, hospital in-patients, long-term care, and of course daily clinic work in a multidisciplinary team environment. She was also named the 2016 recipient of the Jean-Pierre Despins Award by the College of Family Physicians of Canada.
Q: Is there anything else you would like to let us know about the program?
A: We have grown so much and I think have been effective in starting to bring a social accountability focus to medical education at the CSM. Our community area is massive and includes all of Alberta. There are more changes coming and before my term as associate dean is complete in June 2018, I want DLRI to be fully embedded in the communities we serve and ensure we receive direction and energy from these physicians.