Background: Northern Ontario School of Medicine (NOSM) serves as the Faculty of Medicine of Lakehead and Laurentian Universities, and views the entire geography of Northern Ontario as its campus. This paper explores how community engagement contributes to achieving social accountability in over 90 sites through NOSM's distinctive model, Distributed Community Engaged Learning (DCEL). Methods:Studies involving qualitative and quantitative methods contribute to this paper, which draws on administrative data from NOSM and external sources, as well as surveys and interviews of students, graduates and other informants including the joint NOSM-CRaNHR (Centre for Rural and Northern Health Research) tracking and impact studies.

In 2005 the Northern Ontario School of Medicine (NOSM) in Canada implemented the world's first and (still) only mandatory Aboriginal community placement for all its medical students. Issues: The Aboriginal placement was created in part to address social accountability, defined as the obligation of medical schools to direct education, research and service activities towards addressing the priority health concerns of the community they serve. Concurrently, Aboriginal health policies have increasingly emphasized the need to involve Aboriginal people in healthcare planning and design health care that involves Aboriginal concepts of health and culturally safe care. Aboriginal delegates provided recommendations for the development of an Aboriginal health curriculum, which included the need for the medical school to acknowledge and respect Aboriginal history, health priorities and develop an Aboriginal community placement for all medical students. Lessons learned: To anticipate the challenges (eg distance, communication, technologies, student and cultural safety, pedagogical effectiveness/appropriateness) presented by a mandatory placement for first-year students in Aboriginal communities a pilot placement project was designed. The locations of the communities were carefully selected in order to assess a variety of challenges that might be encountered with rural and remote Aboriginal community placements. Pilot lessons included managing student expectations, which leaned towards a clinical rather than a community-based cultural placement focus. Areas for increased coordination and administrative support were identified, as well as the need for more extensive community level support. The students had an overall positive experience and learned about the realities of health care in the communities. Aboriginal community staff commented that the experience with the students was fulfilling and beneficial. It was also recognized that curriculum delivery methods required major adjustments and that the students required significant Aboriginal health curriculum in preparation to move forward from the pilot placement to a sustainable Aboriginal community curriculum. Two medical anthropologists, assisted and supported by an historian of medicine, identified and developed the core areas of academic knowledge required for students to begin

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