Building Capacity Through Medical Education Inis Jane Bardella, M.D., FAAFP Medical Education Consultant

Beginnings

Goals Challenge to think differently Motivate to medical education action Reinvigorate the old

Objectives Discuss the partial successes and ongoing challenges related to improving health in the developing world Discuss building medical education capacity as the most effective and sustainable means to improve health globally Discuss the opportunities and challenges for students, residents, faculty and physicians in practice in medical education capacity building

What Has Been Accomplished Money and Stuff – $100,000,000,000s  World Health Organization  Word Bank  United States Agency for International Development  US State Department  Centers for Disease Control and Prevention  European Union  Commonwealth Fund  Canada  Australia  Medical Missions  Foundations

What Has Been Accomplished Morbidity and Mortality Improvements  Tropical diseases  Communicable diseases  Chronic diseases  Maternal outcomes  Infant health  Childhood immunization  Trauma outcomes

What Has Been Accomplished Development Beginning  Professional education and development Community health workers CME/CPD Visiting faculty Residency programs Long term expat faculty

What Has Been Accomplished Development (Cont’)  Leadership development Informal vs Strategic  “Technical assistance” Advice and consultation  Family medicine Present in most regions Variable progress

Remaining Challenges Indigenous “Capacity” – Quantity, Competence PPROFESSIONALS – not technicians EEducators LLeaders RRetention MMentoring Progressive morbidity and mortality improvement FFAMILY MEDICINE PPublic Health EElimination of industrialized-majority world disparity

“Sustainability”  Human Pipeline (Recruitment) Retention Ongoing  Financial Indigenous Expatriate  Political – Major Stability Perspective Corruption

Remaining Challenges Donor Focus  “He who pays the piper picks the tune.”  Stealing the best and brightest Non-medical  Electricity  Internet access  Internet bandwidth

What is the solution? Family medicine Medical education of nationals

Family Medicine: Ecuador Acknowledgement: Dr. Calvin Wilson 1986 to Present, Formal start 1988 GOAL: Higher quality, more strongly trained primary care physicians Leadership  HCJB Mission hospital Hoy Cristo Jesus Bendice  Surgery and IM  Expatriate faculty  Wife-husband national faculty

Family Medicine: Ecuador Accomplishments FM established  Contextualized to Ecuador  Residency competitive  Respected  Faculty National Pipeline Visiting expatriate  Service and referral  HCJB FM clinic training sites 70-80% teacher retention

Family Medicine: Ecuador Accomplishments Academic university affiliation, support FM recognized as a specialty Self sustaining national FM program

Family Medicine: Pakistan Acknowledgement: Dr. Cindy Haq 1990 to Present Goals  Educate about FM  Develop residency  Establish DFM Leadership  Multispecialty  Expatriates  Nationals

Family Medicine: Pakistan Accomplishments Family medicine established  Residency  Department at Aga Khan National FP chair Well regarded Best teaching faculty A leading program National and expatriate involvement  National leadership  Visiting expatriate faculty All goals accomplished

Family Medicine: Kenya Acknowledgement: Dr. Bruce Dahlman 1995 to Present, Residency 2005 Goals  Expertly manage most all conditions  Knowledge, skills to provide personalised, up-to-date, accessible, quality, cost-effective care  District, Sub-district, Private  Address MOH goals Leadership  Long term expatriate Mission hospital FPs  National Moi University Dean  Multispecialty

Family Medicine: Kenya Accomplishments FM Established – 2005  Residency at 3 hospitals  Presence at 3 universities Moi – FM Division Aga Khan 2011 – FM Department Nairobi 2011 – FM Curriculum Committee MOH, Family Medicine Coordinating Committee

Family Medicine: Kenya Accomplishments Kenyan Association of Family Physicians  Practice-based CME Institute of Family Medicine  Mission NGO  Promoting FM in East Africa  Faculty development  ALSO, ACLS, ETAT Emergency Triage Assessment &Treatment + Admission Care Transitioning to national leadership

Family Medicine: Kyrgyzstan Acknowledgement: Drs. Barton Smith and Paul Fonken 1996 to Present GOAL: Comprehensive health system reform  Primary healthcare core Opportunity seized – Initial leadership  MOH  Science Technology Language Institute  USAID  UK Dept For Intl Development Nat’l Health Professionals  Trainers (faculty)  Family physicians  Primary care doctors  Primary care nurses

Family Medicine: Kyrgyzstan Accomplishments Family medicine  Residency  Regional FM centers  FP association National and expatriate involvement  National leadership, faculty  Long term expatriate faculty  Visiting faculty Continuing medical education – required  Computer based  Web based

Family Medicine: Kyrgyzstan Accomplishments Quality improvement  EB national guidelines  Improved outcomes Asthma, HTN and ulcer Regional impact  Tajikistan  Kazakhstan  Uzbekistan Many partners  Kyrgyz Assoc of Family Group Practices and Family Nurses Kyrgyz State Medical Institute for Retraining and CME  International

Family Medicine: Albania Acknowledgement: Drs. Eralda Turkeshi and Guy Eshelman University residency 1997 to Present ABC Health Foundation 1995 Goals  Introduce FM  Train professionals  Provide quality PC Leadership  National  Expatriate Focus  Prepare Albanians to practice  Encourage FM residency  Develop national FPs/GPs

Family Medicine: Albania Accomplishments Final year medical student clinical training  Only hands-on experience 2 year internship  8 graduates  4 FM residency  5 active teachers Interest in FM Annual CME  Premier CME  2010 Semi-annual Development of FM teachers

Family Medicine: Albania Accomplishments Model of FM practice Partnerships  US  UK  Germany First FP faculty in DFM Current Dean supportive of FM  Need for UME FM curriculum  Need for expanded FM residency Bridging community and university

Family Medicine: Macau Acknowledgement: Dr. Chris Place 1999 to Present FM in China  1980 Hope Medical Group  2000 Hope FM residency Goals  High quality FM ed  Train Chinese nationals Leadership  Expatriate Long term  National goal

Family Medicine: Macau Accomplishments Western model adapted for China  Outpatient emphasis  8 Residency graduates  2 have become faculty FM degree program China University of Hong Kong Research projects Outreach to mainland China Mentoring emphasis CME conferences Faculty development

Family Medicine: Rwanda Acknowledgement: Dr. Calvin Wilson 2007 to Present Goal  Establish Africa centric family medicine Leadership  National primarily  Expatriate

Family Medicine: Rwanda Accomplishments FAMCO residency  7 third years  9 first years  3 District hospitals  Residents respected  Rwanda centric High level support  Political leaders  Dean  Rwanda Medical Council WONCA Africa and Europe 2009

Just The Beginning! Faculty development Shoulder to Shoulders Vietnam Afghanistan Uganda Iraq Kosovo Brazil Mainland China India Mongolia

What Does It Take? National connection – ownership  Health system, MOH  Medical school  Physicians  Context National pioneers  Leaders Policy Education  Faculty  Clinicians  Students

What Does It Take? Expatriate involvement  Modeling  Mentoring  Collaborations Multilevel commitment  National health policy  MOH  University  Other specialties  District, Community

What Does It Take? Reform  Primary care health system  Recruitment  Retention  Faculty pipeline  Development Money Action  Recognizing need  Seizing opportunity  Long term commitment

Where Do You Fit In? Caveats Give yourself Gain understanding and insight  Connect to the local environment  Find the true needs  Remember: You may not have the best solution Make a long term commitment  Collaborate  Be a resource  Mentor Advocate for your international colleagues Anticipate the challenges and barriers

Where Do You Fit In? Skills  Clinical  Technical  Communication Listening  Management  Leadership  Research Context  Application  Adaptation  Vision

Where Do You Fit In? Ethics  Learner vs cheap labor  Service vs obligation  Human value Advocate  Model Family Medicine  Consultant  “Expert”  Support the long termers

Where Do You Fit In? Collaborate  Projects  Research  Resources Mentor  Development  Research  Leadership  Networking

Where Do You Fit In? Visiting faculty  CME  Residency  Medical school  Faculty development Long distance  Consultant  Reviewer  Faculty development  Mentoring  Vision

Call to Action Do not just “drop in.” Find a way to actually change the world. Teach national physicians family medicine!

THANK YOU AND QUESTIONS

Family Medicine: Uganda 2004 to Present  Prior Community Medicine 1990s Goals  Review and refine FM curriculum  Develop faculty  Begin FM research  FM training center Leadership  National  Expatriate Multinational

Family Medicine: Uganda Accomplishments Family medicine established  Residency Research requirement  Department at Makerere

Family Medicine: Uganda Acknowledgement: Dr. Cindy Haq Remaining challenges  Insufficient quantity of faculty  Few residents trained  Funding  Policy support  Status of FM