Comparing Methods of International Faculty Development in Family Medicine: Building Family Medicine in Vietnam Jeff Markuns, MD, EdM Laura Goldman, MD STFM Annual Meeting 2010

Objectives of Presentation On completion of this program, you should be able to: 1.Describe the need for faculty development in Family Medicine in developing countries 2.Outline three different models for providing international faculty development in Family Medicine 3.Discuss the benefits and disadvantages of each model 4.Apply lessons from these programs to incorporate local adaptations to future international faculty development work

Background Family Medicine is a key component of building improved primary care in developing countries In these countries, a core group of academic physicians in specialties other than Family Medicine itself are necessary to develop curriculum and train an initial cohort of Family Medicine physicians There is an additional need to provide faculty development for this new cohort of Family Medicine physicians

The Case of Vietnam

Evolution of Outpatient Care Commune Health System developed 1960s 1960s – Health Care Workers 1970s – Nurses 1980s – Assistant Physicians 1990s – Generalist Physicians 2004– 50% staffed by GPs

Montegut AJ et al Fam Med 2007 Family Medicine in Vietnam

To improve health care delivery to the people of the Socialist Republic of Vietnam by reforming the training of primary health care physicians Develop, implement and evaluate a national family medicine training program National Goals

March 2000

Family Medicine in Vietnam

Three Models of Faculty Development In-country training-of-trainer workshops U.S.-based fellowship programs International videoconferencing

Comprehensiveness Continuity Coordination Community Prevention Family Source: Edward J. Shahady: priniciples of Family Medicine: An overview, in Essentials of Family Medicine, 2nd Ed. Williams and Wilkins, 1993, pp 3-8.

Training of Trainer Workshops Workshops for Departments of Family Medicine, post-graduate faculty, and specialty educators Focused on principles of primary care or clinical teaching skills

Workshop in Clinical Teaching Haiphong: September 2009 –23 physicians from all of the major medical colleges and universities in Vietnam –Multispecialty Gen med 14% Med subspecialties 19% OB/GYN 14% Pediatrics 14% Surgery 14% –More than half with >15 yrs teaching experience 3 BU faculty

Workshop in Clinical Teaching Goals –One Minute Preceptor –Learning climate –Learning contract –Using role plays and video in teaching –Applicable to home environment –Train the trainer model

Methods 5 day workshop Flexible approach Model learning climate –Learning contracts –Using role play and video –Mini-lectures with audience response system Produce 4 videos of teaching encounters in Vietnamese to take home

Assignments & Exercises Complete learning contract by writing personal goals for the workshop Use of learning contracts to negotiate 3 goals for workshop and present to group Role plays of the one-minute preceptor Videotape review of role plays

Assignments & Exercises Direct observation of teaching encounters Using checklists in group discussions

Assignments & Exercises Write clinical teaching scenarios for role plays Record video of teaching scenario Lead group in review of videotape teaching tool

Vietnamese Faculty Review Video

Workshop Evaluation

What Works Highly interactive –With each mini-lecture, participants were surveyed via electronic response system –Educational contract on the first day, participants wrote their own goals, interacted with material and became invested in workshop –Small group breakouts with facilitator –Demonstration videos of concepts with live oral translation and written scripts in Vietnamese and English

What Works Application to local setting –Cases written by Vietnamese participants Opportunities for participants to teach using tools and checklists Provide tools (i.e. videos) to take home and use at home institutions Flexible approach Modeling

What to Watch Out For Ambitious goal for 5 days workshop –Learning contract took more time than anticipated –Not enough time to teach skill of giving feedback Leave enough time!

U.S.-Based Faculty Development Structured course for training of trainers 12 Vietnamese physicians of various specialties were brought to participate in our one month course

Faculty Development Goals Understand the principles and practice of Family Medicine Develop basic academic skills in the areas of education, research, and leadership Become effective faculty members and leaders in Family Medicine in home institutions

Program Components 3 key components of curriculum: 1)Didactic small group lectures & discussion 2)Observations 3)Academic project work

Sample Critical Incident – Week 3 At the Health Center, the contact with the out-patient was shorter but the common principles were as respected as with the in-patient. The preceptive teaching applied to train the residents was the completely different method I’ve never seen. Common themes: Comprehensiveness of care Time available to see patients Equal respect between learner and teacher Method of precepting completely new concept

SAMPLE PROJECT MODULE

Evaluation

In-country Evaluation Rewrote Vietnamese curriculum for FM Textbook in progress

What Works Exposing trainers to –‘new’ concepts of primary care –novel methods of training –adapting current curriculum Useful components for training of trainers includes: –didactic lectures –teaching observations –critical incident sessions –project work

What to Watch Out For Adapt to local context Be aware of degree of difference in systems Don’t get over-scheduled! (Stay on task!) Maintain opportunities for reflection

International Videoconferencing Program An introductory faculty development program in Family Medicine Funded by the Vietnam Education Foundation Faculty Scholar Program Combinations of videoconferencing and face-to-face

Why videoconferencing? Less expensive than U.S. fellowships Reach multiple learners in multiple locations

Methods Learners at two sites (Hue, HCM City) in Vietnam Taught by U.S. faculty in collaboration with local Vietnamese teaching associates

Educational Goals Understand the principles and practice of Family Medicine Develop basic academic skills in the areas of education, research, and leadership Prepare curricular content essential to the development of Family Medicine educational programs in Vietnam

Program Components Didactic lectures –Face-to-face and videoconferencing Small group discussions –Led by on-site FM department heads –Facilitated either face-to-face or through videoconferencing Curriculum development project –Preparing curriculum using goal analysis, objectives, teaching and evaluation methods

Methods 11 modules  Didactic followed by group discussion  4 modules face-to-face at one site, videoconferenced to other  All others videoconferenced from U.S. to both sites in Vietnam  Final presentations face-to-face at single site

Didactics Primary health care in global health Competency-based training Utilizing the evidence base Chronic care disease model Culturally competent care Curriculum development in Family Medicine

Group Discussions Led by on-site FM department heads U.S. faculty remained available to answer questions and facilitate Mix of reflective exercises, review of didactic topic, and facilitation of project work

Initial Learner Characteristics

Demographics

Student Experience

Faculty Experience

Pre-Post Tests p<0.05

What Works Videoconferencing by itself is rated positively by students Cost-effective alternative to on-site delivery of teaching material for future projects Face-to-face components essential to bridge the technological, language and cultural gaps Local teaching associates essential Project work allow application of skills over time

What to Watch Out For IP less expensive, but diminished quality compared with ISDN IP video quality deteriorates significantly when connected to two sites (versus one) Audio lag or lack of connection at times Competing with other internet needs of institutions One site may have higher quality technology than another Time difference (12 hours) for scheduling

Summary In-country workshops work well for specific skill building U.S.-based fellowships provide intensive immersion and transformative learning experiences Videoconferencing works well to support local leaders and provide longitudinal training experiences

Summary Faculty development in Family Medicine is essential to building primary care infrastructure in developing countries Multi-modal approach used successfully in Vietnam Flexibility in adapting faculty development to local circumstances and needs is essential

Current Status of FM in Vietnam Post-graduate FM training programs at seven sites National conference held to integrate FM into undergraduate curriculum Two universities developing Master’s level degree training Plans and funding for new $800,000 academic FM center

Acknowledgements Pham Le An –Director, Family Medicine Center, Ho Chi Minh City University of Medicine and Pharmacy Nguyen Minh Tam –Head, Department of Family Medicine, Hue College of Medicine and Pharmacy Gerardine Sayers –Health Service Executive, Ireland Michael Allen –Dalhousie University, Canada Anna Gagliardi –University of Toronto, Canada