Nothing Ordinary:

Book Title: Nothing Ordinary: The Story of the Northern Ontario School of Medicine

Author: Larry Krotz

Publication Information: Toronto, Ontario, Cormorant Books, 2021, 256 pp., $ 24.95, paperback

Mayors and hospital administrators around Northern Ontario were struggling. Despite their best efforts over the years, they were unable to recruit sufficient physicians to serve their region. Medical systems signed recruitment agreements with physicians from all over the world, who then left the region as soon as their contracts expired. Small communities relied heavily on locum tenens physicians, which led to expensive and fragmented care. Northern Ontario is the size of France and Germany combined, with a population of 800,000, and the lack of consistent health care for such a large region was hurting patients and hampering economic growth, placing a constant strain on these small communities.

It was in this context that local leaders developed a better strategy; they would create a new medical school, one rooted in service to its many Northern Ontario constituencies. This school would recruit local students who were committed to the region, and it would promote principles of social accountability and excellence in medicine. The push for this new school began in 2000, when a group of mayors traveled to Toronto to lobby for their idea. That trip provided the impetus for founding the Northern Ontario School of Medicine (NOSM).

Nothing Ordinary tells the story of that quest to create something extraordinary. Author Larry Krotz interviewed dozens of people, including graduates of the new school, physician mentors, mayors, hospital administrators, and NOSM faculty. He paints a comprehensive picture of how NOSM came to be, describing the obstacles that had to be overcome in order to fulfill its vision, and he illustrates how one medical school can transform the communities it serves.

Nothing Ordinary shines when it tells the stories of young doctors who graduated from the school, and when it explains in very personal ways how NOSM has changed the lives of its stakeholders. Brief segments entitled “Voices” appear between chapters; each segment provides a fascinating glimpse into the lives of these individuals.

Another topic of general interest is how NOSM has benefitted the communities it serves. By almost any measure, it has been a huge success in improving local health care access and in retaining physicians in northern communities. In one study, the number of unfilled physician positions in five surveyed communities dropped from 29 to 1 after NOSM became operational, and one of those communities decreased its spending on recruitment contracts from $200,000 to $50,000 (p. 159).

Sections of this book that would appeal to medical school and residency faculty describe how NOSM developed its curriculum and refined its philosophy. The school is founded on principles of “problem-based learning, case-based learning, rural-based medical education, community-based medical education, electronic distance education, and, not least, the social accountability of medical education” (p. 52). Krotz develops these themes in some depth, delving into the social and cultural context of the school and how it partners with the Indigenous and Francophone communities it serves. For example, the first-year curriculum includes a 4-week cultural immersion program in an Indigenous community; that experience increases students’ awareness of the unmet needs as well as the cultural strengths of those communities. Krotz enumerates ongoing challenges the school is trying to address, such as finding better ways to recruit First Nations providers.

As to the remaining portions of Nothing Ordinary, this is most definitely a niche book. It provides extensive details about the founding of the school, administrative and political hurdles that had to be overcome, contract disputes for adjunct faculty, how the first dean was hired and why he was chosen, and so on. That level of specificity would be interesting mostly to those who have close personal ties with NOSM.

Such detailed discussions of policy and pitfalls might be useful for administrators, educators, or policymakers seeking to found medical schools or satellite campuses based on the NOSM model. Unfortunately, for the average practicing physician, the ratio of details to story line in Nothing Ordinary is too high.

The story of NOSM is undoubtedly important. NOSM has become a model for improving rural health care; it has inspired medical educators in many countries, including Australia, Norway, Scotland, the United States, and the Congo. Those visionaries are taking note of NOSM’s success as they strive to improve their own rural health care access. The story itself is fantastic and inspirational, but unfortunately the writing sometimes obscures that. I found myself wishing that this book had been much more crisply edited, to allow the underlying strength of a great story to become more apparent.