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Socially Accountable Medical Education is a global educational movement transforming the development and delivery of medical schools in higher education. It is described as an upstream policy approach that seeks to align medical education and local community healthcare needs. To better understand social accountability as a policy initiative, we conducted a narrative review to identify key themes in the literature around frameworks of implementation. Our findings illustrate that social accountability has been mostly defined to date in terms of outcomes and related-actions and that there is a lack of focus on critical social constructs, such as power and place, that can reorient processes and inequities within health systems and educational institutions. We conclude that while socially accountable medical education is a promising paradigm shift in higher education, we call for a more complexified, contextualized, and nuanced approach.

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.

Only 13% of older Canadians achieve weekly physical activity (PA) recommendations suggesting that health promotion efforts are warranted. Tai Chi (TC) is a martial art identified as an accessible form of PA for older adults. While research has supported TC's ability to enhance health among those with chronic conditions, no studies have investigated healthy older adults who are experienced in TC practice. To uncover avenues to enhance PA rates and adherence, the study purpose was to explore qualitatively, the perspectives of experienced, healthy older adult TC practitioners. Older adults who identified as healthy and had been practicing TC for at least 1 year were recruited from a community-based program in Northwestern Ontario, Canada. Semi-structured interviews, observations, and field notes were collected and analyzed using deductive and inductive content analysis. Eleven participants (Mean age = 64.9 years; male, n = 8) with an average of 13.6 years TC experience were enrolled. Analysis revealed five themes with associated subthemes including: reasons for joining (e.g., becoming active); participant principles related to TC and aging (e.g., being kind to an aging body); barriers to practice (e.g., class size); facilitators for practice (e.g., energy from softness), and group dynamics (e.g., delivery format). Findings suggest that in this population, TC is gentle and holistic, and facilitators to practice outweigh the barriers. Researchers and health care providers should adopt similar program characteristics (e.g., group-based format, supportive instructors, facilitated social network) when seeking to promote PA in older adults. Keywords: Tai Chi; exercise adherence; group dynamics; qualitative research, Introduction Adults over the age of 50 comprise roughly 37% of the Canadian population (Statistics Canada, 2020), and this cohort is projected to grow at a rapid rate in the [...]

Background Methods Results Conclusion Clinical reasoning processes are complex and interwoven with culture and context. While these relationships have been explored to understand the outcomes of clinical reasoning, there has been little exploration of how to integrate these relationships when teaching and learning clinical reasoning.Using semi‐structured interviews, this research explored the role of context and culture in clinical reasoning medical education. Participants were clinical teachers recruited from across Northern Ontario. The data were analysed independently by two reviewers using both thematic analysis and critical discourse analysis, and peer reviewed by a third researcher.The role of context and culture is inherent to the personal, professional and pedagogical aspects of clinical reasoning, especially when teaching about the complexities of Northern Ontario. The major themes that came through were: 1) teaching and learning clinical reasoning needs reflexivity, 2) developing clinical reasoning skills needs time and 3) clinical reasoning pedagogy should acknowledge and encompass practice variation and patient diversity.Teaching clinical reasoning in Northern Ontario involves being aware of the complexities that are inherent in interacting with patients and communities. Through personal, professional and pedagogical models, the students and teachers can address the complexities of cultural and contextual clinical reasoning. [ABSTRACT FROM AUTHOR]

Given that postsecondary institutions are increasingly seen as sites to promote health, critical scholars are calling attention to how the contemporary Western weight-centred health paradigm reinforces a "size matters" message that is fueling harmful attitudes towards and judgments of bodies. As such, research that highlights strategies to promote safe teaching and learning environments for students and faculty, regardless of body shape and size, is of utmost importance. Through 26 participant interviews, this study examines the experiences of critical obesity scholars who teach courses that engage critical approaches to obesity, fatness, and body size. The findings of this study shed light on the developing field of critical obesity scholarship, the types of challenges faced by critical obesity scholars in higher education, and how these scholars are building community as a way of coping with challenges facing the emerging field.

Environmental education is one site of many that reinforces dominant obesity discourses and weight-based oppression through privileging fit, able bodies. Using personal narratives and insights from the nascent field of fat studies, we offer a critical analysis of obesity discourse in environmental writing in general and environmental education in particular. We argue that intersectional analyses of embodiment, abjection, and crisis rhetoric could be generative for both environmental education and fat studies.

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. The pandemic reshaped medical education accreditation. A case‐study in Canada unveils how format changes impacted power dynamics and knowledge production. The lesson: Personalized tools and voices matter for unique contexts. [ABSTRACT FROM AUTHOR]

Research on body image has repeatedly shown that elite athletes are at higher risk for body dissatisfaction and eating disorders. Competitive athletes in leanness- focused sports, such as rock climbing, have proven to be at an even greater risk. This study explored the experiences often rock climbers, between the age of 19 and 46, through semi-structured interviews to better understand how body image is experienced within the sport o f rock climbing. In discussing body image, rock climbers identified four main themes: (1) climbing experiences, (2) health and fitness, (3) climbing body culture, and (4) body image and self-esteem. Results from this study provide a more complete picture of the body standards within rock climbing and its impact on participants within the sport. The implications of these findings will be discussed., Competitive athletes are believed to be an 'at risk' population for body image disturbance and disordered eating due to the emphasis and pressure on performance, weight standards, and body shape [...]

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. This paper explores the co-evolution of compassion and SA. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Abstract: Since the 1990s, concerns about a global obesity epidemic have flourished. These concerns regarding obesity are expressed in popular culture and scientific literature and emphasize both weight and weight [...]

Given the substantial impacts of non-native species on invaded systems, an understanding of the rates and spatial patterns of invasive spread is critical. Spread may vary across spatial scales, with dispersal of invasive species occurring both via diffusive spread at local sites and long-distance jump dispersal at larger scales. Research on earthworm invasions in North American forests has focused on patterns of spread across landscapes, with less examination of spread at local sites. We sampled the exotic earthworm Dendrobaena octaedra (Savigny, 1826) on 500 m x 500 m grids at three sites in the boreal forest of northeastern Alberta in 2006 and again in 2012-2013 to examine distributional changes over time. Earthworms spread farther from roads (the presumed site of initial introduction) over time, and spatial patterns at our sites suggest transport by vehicles and waterways are key vectors of dispersal at the local level. Spread was estimated to be occurring at a rate of at least 17.9 m/year. Our study indicates that both diffusive spread and jump dispersal of earthworms can be important at local scales and that local diffusive spread may be substantially higher than previously estimated. Key words: boreal forest, Dendrobaena octaedra, earthworms, invasive species, local spread, spatial pattern, spread rate. Etant donne les impacts considerables des especes non indigenes sur les systemes envahis, la comprehension des taux et de la distribution spatiale de la dissemination envahissante est d'une importance critique. La dissemination peut varier selon l'echelle spatiale, la dispersion d'especes envahissantes s'effectuant tant par dissemination par diffusion a l'echelle locale que par dispersion par grands sauts a des echelles plus grandes. La recherche sur les invasions de lombrics dans les forets nordamericaines s'est axee sur les motifs de dissemination a l'echelle des paysages, s'interessant moins a la dissemination locale. Nous avons echantillonne du lombric exotique Dendrobaena octaedra (Savigny, 1826) sur des grilles de 500 m x 500 m en trois sites dans la foret boreale du nord-est de l'Alberta en 2006, puis en 2012-2013, afin d'examiner les variations de leur repartition dans le temps. La dissemination des lombrics s'eloignait des routes (sites presumes de l'introduction initiale) avec le temps, les motifs de repartition spatiale dans les sites etudies donnant a penser que les vehicules et les cours d'eau constituent des vecteurs cles de la dispersion a l'echelle locale. Il a ete estime que la dissemination s'effectuait a un taux d'au moins 17,9 m/an. Notre etude indique que tant la dissemination par diffusion que la dispersion par sauts des lombrics peuvent etre importantes a des echelles locales et que la dissemination locale par diffusion peut etre sensiblement plus importante que ce que laissaient croire les estimations passees. [Traduit par la Redaction] Mots-cles: foret boreale, Dendrobaena octaedra, lombrics, espece envahissante, dissemination locale, motif spatial, taux de dissemination., Introduction Information on the spread of non-native species is essential for predicting and managing invasions. However, determining rates of spread is challenging because data from multiple time points and across [...]

Objective Indigenous women experience structural barriers to wellness rooted in colonialism and related socio-political processes, making participation in physical activity and access to balanced nutrition challenging. In response, a holistic wellness program was developed in Lloydminster, Alberta, Canada. Multiple program iterations have since been completed in urban and rural including reserve) settings across Alberta: in Onion Lake Cree Nation, in, Lloydminster, and in Calgary. The program includes physical activity, nutrition education, access to local healthcare support, and sharing circles to facilitate reflection. This article collates three years of qualitative data between programs to answer the question: "What does the program do?" Methods Between 2017 and 2019, 24 participants, four facilitators, and three community champions completed post-program interviews. mixed-methods, qualitative, two-part analysis was completed involving thematic analysis of transcripts followed by a structured consensus-building approach called nominal group technique (NGT). Results Collaborative analyses revealed that the program enables: 1) self-actualization through collective effort, including development of knowledge, skills, beliefs, and behaviours needed to manage one's own health, 2) improved personal wellness, and 3) access to social and cultural supports. Cultural relevancy and safety were identified as key elements in the context that supported these changes. Conclusion The wellness program for Indigenous women demonstrates positive impacts on the health and wellbeing of participants. Benefits naturally extend to participants' families, as well as to communities involved through capacity-building. Alongside the education and resources offered, the program environment also contributes to this positive impact. [ABSTRACT FROM AUTHOR]

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More than 1180 non-native species, mostly of Palaearctic origin, have been recorded from the boreal zone of Canada, with the highest diversity on the island of Newfoundland and in the southern boreal zone of Ontario and Quebec. The non-native biota of the boreal zone (and of Canada in general) is poorly known in terms of species composition and distribution. A large proportion of species are associated with disturbed anthropogenic habitats such as urban areas, agricultural landscapes, transportation and communication corridors, and industrial developments. Natural habitats in the boreal zone have a high degree of resistance to invasion compared with those of other Canadian zones, likely owing to harsh climates, low light levels, poor soil nutrient availability, low soil pH, low productivity, and dense covering of the ground by plants, especially bryophytes. Of the relatively few non-native species that have successfully colonized the boreal zone, many decline greatly in abundance after a few years, suggesting biotic resilience. To date the boreal zone has shown the least resistance and resilience to large vertebrates (moose and white-tailed deer) translocated to islands, diseases of vertebrates, and earthworms. In general, the ecological impacts of non-native species on the boreal zone have been poorly studied, and there are few examples where such impacts are evident. Likewise, there has been little attempt to quantify the economic impacts of non-native species in either the boreal zone or in Canada as a whole. In the few cases where management measures have been implemented for highly destructive non-native species, results have been somewhat successful, especially where classical biological control measures have been implemented against insects on trees. Chemical and mechanical management measures have had only limited success in localized situations. Management resources are most effectively applied to reducing the risk of introduction. The risk to the boreal zone posed by future new non-native species is increasing with the warming climate and the fast and direct transport of goods into the boreal zone from points of origin. Five recommendations are provided to address recognized gaps concerning non-native species. Key words: boreal, non-native species, ecological impacts, risk, biological invasion. On a enregistre plus de 1180 especes non indigenes, surtout d'origine palearctique, dans la zone de la foret boreale du Canada, dont la plus grande diversite se retrouve sur l'ile de Terre-Neuve et dans la zone boreale meridionale de l'Ontario et du Quebec. Le biote non indigene de la zone boreale (et du Canada en general) est mal connu en ce qui concerne sa composition et sa distribution. Une forte proportion des especes est associee a des habitats perturbes par l'homme comme les milieux urbains, les paysages agricoles, les corridors de communication et de transport ainsi que les developpements industriels. Les habitats naturels de la zone boreale montrent un fort degre de resistance a l'invasion, comparativement a ceux d'autres zones du Canada, vraisemblablement a cause des climats rigoureux, des faibles degres d'illumination, de la faible disponibilite des nutriments du sol, du faible pH des sols, de la faible productivite, et de la dense couverture du sol par les plantes, surtout les bryophytes. Parmi les peu nombreuses especes ayant colonise avec succes la zone boreale, plusieurs connaissent un fort declin en abondance apres quelques annees suggerant une resilience biotique. A date, la zone boreale a montre les moindres resistances et resiliences chez les grands vertebres (orignaux et cerf de Virginie) transferes sur ces iles, les maladies des vertebres et les vers de terre. En general, on a peu etudie les impacts ecologiques des especes non indigenes de la zone boreale et il y a peu d'exemples oU ces impacts sont evidents. De meme, il y a eu peu de tentatives pour quantifier les impacts economiques des especes non indigenes, que ce soit en zone boreale ou au Canada en general. Dans les rares cas oU des mesures d'amenagement ont ete mises en place pour les especes non indigenes fortement destructives, les resultats ont eu assez de succes, surtout la oU les mesures de maitrise biologique classique ont ete utilisees contre les insectes et les arbres. Les mesures chimiques et mecaniques n'ont qu'un succes limite dans des situations localisees. Les ressources de l'amenagement sont plus efficaces lorsqu'elles sont appliquees pour reduire le risque d'introduction. Le risque pour la foret boreale pose par de futures especes non indigenes augmente avec le rechauffement climatique et le transport rapide et direct de marchandises dans la zone boreale, a partir de leurs points d'origine. Les auteurs font cinq recommandations pour prendre en compte les lacunes reconnues au sujet des especes non indigenes. [Traduit par la Redaction] Mots-cles: boreal, especes non indigenes, impacts ecologiques, risque, invasion biologique., 1. Introduction Since the Wisconsinan glacial maximum ~21400 years ago, the rate of change of species composition in Canada has been determined by natural processes such as the rate and [...]