Global Education Consulting What Do Consultees Want From Us?

Warren Heffron MD Professor Emeritus University of New Mexico Faculty In His Image Residency Tulsa, Oklahoma

Goal Provide a review of 35 consultations to provide an educational experience by which participants can learn some basic skills in international educational consulting and share their own experiences with other participants.

Objectives Determine your interest in consulting Identify your areas of expertise Formulate some consulting plans for the future Meet potential collaborators for future consulting work Experience multiple types of consultations

Scenario You have an interest in offering your services as an international consultant in family medicine education. You have student and resident teaching experience in this country. You wonder how you can prepare yourself to be a good consultant and how do you market your services?

Preparation Consultant school. AAFP consultant training: Residency Problem Solutions. (RPS) CIHI global health conference Talk to consultants Do a needs assessment Do it and learn

Market Yourself Invitation Advertise Personal contact Subcontract to consultant agencies Work for agency, USAID, WHO,

Last 35 Consultations USAID Subcontractor Ministries of Health Medical Schools Individual Residencies Missionary Programs Private Institute Several continuity consultations

Description Voluntary agency In His Image International AAFP CIHI ( two residencies, one national ) Personal / Volunteer No payment, (30 of 35) Skewed to meeting needs of economically developing countries Multiple countries

Countries Afghanistan Albania (multiple) Cameroon China, Chengdu, Wuhan, Shenyang 2, Haikou 2, Macau 3, Beijing, Xiamen Ecuador (multiple) Egypt 3 India 3 Malawi Mongolia Nicaragua Rwanda 2 Saudi Arabia 2 USA

Types of Consults Feasibility studies for new residency. Residency development Residency evaluation Faculty development, group of residencies and individual Departmental consultation Visiting professor External board examiner

Types Continued Program Director, Chair development Curriculum development Teaching / Role modeling Research development Administrative skills Continuing Medical Education, workshops, lectures

Types Ministry of Health, Multiple visits, consultants Plan national family medicine development Department in Medical School / residency Curriculum National Academy Train the trainers program for GPs Systems interactions

Types Informal Personal mentoring Teaching (right up there with faculty development in terms of needs) Mixed Follow up of a previous consultation (Continuity of consultations)

General Stories Recommendations do not fit a template. I’ve given quite varied advice based on local needs and resources. Even advice I might deem unethical elsewhere, ie less than ideal teaching. Gratifications, disappointments. Generally feel no problem with safety. Keep recommendations at manageable #.

Feasibility You are asked to visit a hospital in Cameroon. It has 200 beds and a surgery residency, and faculty are available in several specialty areas. They think a family practice residency to train FPs for their part of the country might be helpful. They ask you to come and see if a FM residency might be appropriate for their hospital. What do you do?

Feasibility Needs Family doctors Ministry of Health Medical School Medical organizations Board specialization Accreditation Certification Leadership Resources Motivation Support Governing hospital Finances Patients Faculty, FP, Specialty Applicants Facilities

Feasibility needs Strengths & weaknesses Availability of continuity experiences Non MD faculty resources Existing programs Part of a system Ancillary programs

New Residency Last year you visited a hospital in Malawi for a feasibility study. They have 150 beds in a new and very up to date facility, several specialist teachers, and a nursing school. Based on your advice last year they have decided to start a family medicine residency. They ask you to come and help plan to open the program. What do you do?

New Residency Firm institutional support MOH support Leadership, long term Family medicine and specialist teachers Faculty development if needed Secure financing Are adequate staff available

New Residency All criteria re feasibility need to be met Ambulatory site for practice/teaching Timetables for all criteria to be met Recruit staff, residents, patients Curriculum developed Specialty teaching rotations

New Residency Hospital rotations arranged Community, public health rotations arranged Accreditation process Responsible person for each area Affiliations developed if needed

Established Residency You have visited a residency in Macau, China and they ask you to come back for another visit to evaluate the program and make recommendations for future growth. How do you handle this request?

Established Residency Review overall progress and quality of program. Match goals and objectives? Assess function and quality of residents Assess function and quality of faculty Assess inpatient and outpatient care and teaching Assess facilities Help with future planning

Established Residency Review curriculum and make recommendations for change Assess administrative capabilities Review the community medicine activities and measure quality Identify deficiencies, especially in staff and faculty needs. SWOT analysis

Established Residency Recruiting practices, faculty, residents, staff Ongoing training of “ “ “ Ongoing feedback of “ “ “ Ongoing motivation of “ “ “ Ongoing goals of “ “ “ Suggestions for improvement Teach us how to replicate our residency

Established Residency Plan interactions with administration of the hospital Help with providing justifications for the existence of the residency Enhance teaching skills of faculty in other specialties Assist residents in career planning Continuity of care

Established Residency While Here: Help Us Provide lectures at multiple venues Mentor residents and faculty Evaluate hospital for rotations Consultation with program director and clinic director Plan future curriculum Inpatient vs. outpatient training Review our open ended curriculum Type of certificate

Help Us How should we interact with the government educational systems Prepare and recruit faculty Are residents “staff” Determine pay scales Should we use residency into a career track for our own future physician needs Liaison options with other programs

Help Us Plan our future directions Plan our space needs Medical library Other recommendations Personal development counseling, faculty Share samples of your curricular goals and objectives

Help Us Improve prestige of family doctors

Faculty Development Perhaps the greatest need, current teachers Direct observation and feedback Program wide skills needed, assessment Workshops / conferences for multiple residencies Individual medical schools and residents Include residents as future teachers

Faculty Development, Content Preceptor Ambulatory Inpatient Curriculum Lecture skills Research Writing skills Administrative skills Teaching clinical skills, PE, history taking, procedures, communication, teaching within culture, language, evidence based medicine, problem based learning Evaluation skills

Faculty Development, Content Information Technology Medical School affiliation (how to) Residency director development Interactions with professional organizations Focus on their needs and interests Focus on prioritization and future planning MOH projects Functioning in a rapidly evolving setting Mentoring, role modeling

Faculty Development Teach to the needs of learners Maintaining your own medical competence

Medical School Department Overlap with residency faculty development Chair development Interactions with undergraduate and postgraduate education Faculty promotion Faculty degree tracks, MD PhD, Certification Leadership Interdepartmental interaction / politics

Medical Schools Problem solving, trouble shooting Interactions with MOH Survival Multiple residency affiliations Curriculum development Faculty training and recruitment Providing CME

University Our FM residency is entirely hospital based training, when residents graduate in our country they do not admit to hospitals. Is there a disconnect? The residency program is largely observational learning. How do we incorporate more active learning into our curriculum? Few jobs for graduates.

Visiting Professor Weeks to months to a year General resident and student teaching Started a residency program Coordinated rural training sites Community medicine involvement

External Board Examiner Reviewed credentials against requirements Reviewed publications of candidates Individual two hour blocks of one on one oral examinations

Countrywide FM Development AAFP CIHI subcontract of large USAID grant In country NGO Three years, multiple visits 5 consultants Large needs assessments Medical School Ministry of Health

Countrywide National insurance program National pharmacy program Continuing professional development Academy of Family Doctors Train the trainers program for rural FP’s Accreditation and certification Changes impacting all of these areas

CME Programs Participation in almost every country Clinical Combine with faculty development activities Workshops, lectures, academy meetings Re-education of specialists to teach in FP/GP programs

Teaching Come and teach in my program from a month to forever Current acute (time wise) need in Malawi for November of 2012