Published: 2019-05-06

Dear UTMJ Reader,

It is with great pleasure that we present Volume 96, Issue 2 of the University of Toronto Medical Journal, which focuses on the important and timely topic of Rural Health. Canada is the second largest country by area with a total land mass of almost ten million square kilometres.1 The majority of Canadians reside in large urban centres close to the Canada – United States border, leaving much of the country sparsely inhabited. Rural communities are dispersed across Canada’s vast terrain and account for almost 20% of the Canadian population.2 The large geographical area inhabited by Canadians and regional variations in population density pose significant challenges to the provision and delivery of healthcare.

Rural communities experience several barriers to accessing timely and effective healthcare services. Shortages of healthcare providers working in rural settings have limited patient access to basic services, including primary care, acute care, diagnostic imaging, mental health services and care provided by allied health professionals. Many individuals living in rural communities are forced to travel long distances to access healthcare services which can be costly and time consuming, particularly when routine follow up, treatment or testing is required. Patients may also become isolated from their families and communities while they receive ongoing care in distant hospitals. Even when healthcare services are locally available, access to these services can be hindered by unacceptably long wait times and physician burnout.3 This is particularly concerning given that individuals living in rural communities have poorer overall health, higher rates of disability and shorter life expectancies compared to those in urban or suburban centres.4 The delivery of effective and efficient healthcare services to the large population of individuals living in rural settings is therefore of crucial importance to the health of Canadians and the success of the Canadian healthcare system.

This issue on Rural Health highlights important health disparities between rural and urban communities, describes current barriers to accessing healthcare services in rural settings and discusses innovative strategies that are being developed and implemented to improve the quality of care delivered to rural communities in Canada. In this issue, you will also find articles on the strength and resilience of rural communities, the personal experiences of medical students and physicians practicing in rural settings, and Project ECHO which is an initiative aimed at linking expert specialist interprofessional teams at large academic centres with rural physicians. The importance of Indigenous Knowledge and Ways of Knowing is explored in our interview with Dr. Dawn Martin-Hill, one of the original founders of the Indigenous Studies Program at McMaster University and the inaugural Paul R. McPherson Indigenous Studies Chair. In our interview with Dr. Merrilee Brown, a Rural Family Physician in Port Perry, ON, Lecturer at the University of Toronto Department of Family and Community Medicine, and member of the Rural Ontario Medical Programme Board of Directors, we further discuss the challenges and rewards of practicing medicine in rural communities and identify opportunities for medical students to get involved in Rural Health initiatives.

We would like to thank the UTMJ editorial team for their hard work in preparing this issue, the authors that allowed us to showcase their important work, the patrons that continue to support the UTMJ and, most importantly, you the reader. We hope that you enjoy reading this issue as much as we enjoyed preparing it.

Mark Lukewich and Mazen El-Baba





  1. Statistics Canada. 2012. Canada Year Book 2011: Geography. Retrieved April 19, 2019 from geo/geo-eng.htm.

  2. Statistics Canada. 2012. The Canadian population in 2011: Population counts and growth. Retrieved April 19, 2019 from recensement/2011/as-sa/98-310-x/98-310-x2011001-eng.cfm#a4.

  3. Canadian Medical Association. 2013. Ensuring equitable access to care: Strategies for Governments, Health System Planners, and the Medical Profession. Retrieved April 19, 2019 from

  4. CanadianInstituteforHealthInformation.2006.HowhealthyareruralCa- nadians? An assessment of their health status and health determinants. Re- trieved April 19, 2019 from ans_2006_report_e.pdf.



Mazen El-Baba; Mark Lukewich

Page 1

Primary Research

Diagnostic and prognostic implications of peak leukocyte count in the intensive care unit

Nafeesa Alibhai, Sameer Hirji, Naheed Jivraj, Bijan Teja

Page 6 – 10


Impact of Hawthorne effect on healthcare professionals: a systematic review

Woo Jin Choi, James J Jung, Teodor P Grantcharov

Page 21 – 32



Bridging the divide: rural exposure for urban medical students

Jasmine Waslowski, Tristan Brownrigg

Page 53 – 54

Letters to the Editor


Interview with Dr. Merrilee Brown

Happy Inibhunu, Annie Yu

Page 63 – 64

Interview with Dr. Dawn Martin-Hill

Meghan Kerr, Anna Kurdina

Page 65 – 68