International Faculty Development in FM through Videoconferencing 2009 AAFP Family Medicine Global Health Workshop – September 11, 2009 Jeffrey F. Markuns, MD, EdM Elizabeth G. Henry, MHS Alain J. Montegut, MD

Learning Objectives 1.Describe the need for faculty development in Family Medicine in certain international settings such as Vietnam 2.Outline an educational program for an introductory faculty development course in Family Medicine 3.Identify barriers and facilitators to use of videoconferencing in international education programs

Background Developing Family Medicine as a specialty is a key component of building improved primary care in many developing countries. In these countries, a core group of academic physicians in Family Medicine are necessary to develop curriculum and train Family Medicine physicians

The Case of Vietnam

Background - Vietnam Family Medicine is a new specialty in Vietnam Family Medicine is the centerpiece of a nationwide plan for building infrastructure in primary care A core group of academic faculty is needed

Family Medicine in Vietnam

Montegut AJ et al Fam Med 2007 Family Medicine in Vietnam

Some basic health indicators in Vietnam Source : Ministry of Health of Vietnam Indicators Total population (million) Population growth rate (percent) Infant mortality rate (per 1,000 live births) Under five mortality rate (per 1,000 live births) Maternal mortality ratio (per 100,000 live- births) Birth weight < 2500g (percent) Life expectancy (years)

Current situation of the community health services Most General Physicians work there just after Medical School It’s difficult to update their professional capabilities They can practice all their life without any retraining, exams… The working conditions in community health centers are very poor. Budget for CHC is very restricted

We recommend the creation of educational programs that will lead to a specialty that will be the cornerstone for the delivery of primary health care to the people of Vietnam: FAMILY MEDICINE

March 2000

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

Establish and maintain departments of Family Medicine Complete a post-graduate and medical school curriculum in Family Medicine Upgrade community training sites Conduct faculty development in Family Medicine GHPCI Recommendations:

Past Faculty Development Programs Workshops in Vietnam –Topic focused Fellowship programs in the U.S. –Mix of didactics, observations, project work Masters degree program in the Philippines

Overall Program Goals To create an introductory faculty development program in Family Medicine To use videoconferencing to provide a method for facilitating international faculty development

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

Educational Goals Participants should be able to: Understand the principles and practice of Family Medicine as expressed by and applied to educational and clinical settings 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 teaching associates –Facilitated either face-to-face or through videoconferencing Curriculum development project –Preparing curriculum using goal analysis, objectives, teaching and evaluation methods

Educational Content Included: Introduction to FM and Global Health Curriculum development Basic skills in research and evidence based medicine Cultural competence Chronic disease model

Educational Objectives Didactic objectives included: Describe the role of primary health care in global health Explain the theory of competency-based training Effectively read and evaluate a research article Outline the chronic care disease model using diabetes as an example List key principles in the provision of culturally competent care Prepare and present a curriculum for a specific content area in Family Medicine

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

Curriculum Project In this curriculum, you should:  consider the specific needs of learners  the learners’ abilities and environment  clinical importance  public health needs

Curriculum Project The curriculum and complete syllabus should include:  Educational goal(s)  Goal analysis  Learner and context analysis  Competency-based objectives  Proposed teaching methods, including one prepared module  Proposed student evaluation methods, including a specific prepared tool  Proposed program evaluation method(s)

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

Methods 11 modules  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

Initial Learner Characteristics

Demographics

Student Experience

Faculty Experience

Pre-Post Tests p<0.05

Successes Delivered all 11 modules to both sites Excellent participation at site 1 throughout entire course Despite challenges, videoconferencing still rated positively by students Cost-effective alternative to on-site delivery of teaching material for future projects Project presentations contained substantial elements from course

Challenges Used IP (rather than ISDN) to cut costs 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 Site 2 with higher quality technology than Site 1 High dropout rate from Site 2 Time difference (12 hours) for scheduling

Lessons Number your slides Speak very slowly and clearly, pausing for questions Have the two groups mute their microphones during the presentation and un-mute when they have a question Video and audio quality drops with multiple sites Face-to-face components remain important

Conclusions Learners have positive feelings towards videoconferencing Teaching faculty are less positive, but see potential for the technology Videoconferencing may be a successful method for international faculty development Advanced technology is required to support multi-site videoconferencing

Recommendations Consider curriculum redesign for future international faculty development through videoconferencing Experiment with ISDN versus IP for similar courses in the future Consider institutional IT upgrades

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