T eaching & Learning Family Medicine Abroad: The Hangzhou Experience Guozhen Liu, MD Thomas Anderson, MD

The background information

 Teaching and learning family medicine abroad: the Hangzhou experience refers to a collaborative program for teaching and learning family medicine abroad, sponsored by Genesys Regional Medical Center (GRMC) and Sir Run Run Shaw Hospital (SRRSH) of Zhejiang University Medical School

Where is Genesys Regional Medical Center? ▶ Grand Blanc ▶ Michigan ▶ USA Genesys Regional Medical Center

Where is Sir Run Run Shaw Hospital? Hangzhou City Hangzhou City Zhejiang Province Zhejiang Province P.R. China P.R. China

The Goal of the program ☞ Help transform Chinese medical system from specialty based care to primary care based care

Objectives of the program 1. Establish an ACGME standard Family Medicine Residency Program in SRRSH to train FM residents 2. Train the trainers in the Department of Family Medicine in SRRSH 3. Train the community practicing physicians to become family physicians 4. Cross training medical students and residents

The History

The Initial Visit to SRRSH in 2006

SRRS hospital tour in 2006

2007 Dr. Fang visited GRMC

Dr. Steibel and Dr. Liu visited SRRSH in 2009

How does International Service Clinic Work? Patients are all seen by the Patients are all seen by thespecialists: –Ear pain: ENT –Chest pain: Cardiologist –Knee: orthopedics –Vaginal discharge: Gynecologist

The idea for a collaborative training program  We saw patients in ISC for two weeks  They witnessed what a FM doctor can do  New idea formed: staffing ISC with our faculty and helping training FM doctors in SRRS hospital  In return, SRRSH will pay GRMC  Creating the collaborative training program

Good idea????

The environment for the new specialty-- Family Medicine to be born Chinese population: 1.3 billion Chinese population: 1.3 billion Medical care: all specialty based. No primary care. Medical care: all specialty based. No primary care.

The environment for the new specialty-- Family Medicine to be born It is difficult to see a physician It is difficult to see a physician It is expensive to see a physician It is expensive to see a physician

The environment for the new specialty-- Family Medicine to be born  1998 ： Ministry of Health pondered about family medicine education  1999 ： Family Medicine became a medical specialty in China  2000 ： FM residency training started  2001 ： Train the practicing physician to become FP started

The environment for the new specialty-- Family Medicine to be born In March 2010, a joint statement by six ministries of Chinese central government calls for “training 300,000 FPs in the next 10 years”. In March 2010, a joint statement by six ministries of Chinese central government calls for “training 300,000 FPs in the next 10 years”. The timing couldn’t be more perfect!!

Good idea! Let’s start the program! Officially started on March 22, 2010

The Signing Ceremony May 28 th, 2010

Signing ceremony group picture President of SRRSH Provincial Health Bureau Provincial DRC National DRC Chancellor of ZU Genesys CEO Party secretory of ZU Med School Provincial education bureau Famous Professor

The program The program

The trainers –Family Medicine Residency Program Faculty at GRMC –Department of Family Medicine Network Faculty from MSU CHM –Selected faculty from other part of the United States –Each faculty will work for one to two months at a time at SRRSH

The trainees The trainees: The trainees: –FM Faculty from SRRSH –FM residents from SRRSH –Community practicing physicians –Medical students from Zhejiang University Medical School –Medical students from MSU CHM

Train the SRRSH FM faculty by apprenticeship

Train the SRRSH FM faculty by apprenticeship Train the SRRSH FM faculty by apprenticeship SRRSH faculty with me at Four Season Green Community Health Center

Residents’ training Train the residents by slightly modified ACGME standard curriculum Train the residents by slightly modified ACGME standard curriculum Dr. Pearson teaching FM resident in SRRSH Precepting residents at outpatient clinic

Community physicians’ training Community physicians’ training Train the practicing physicians by shortened version of the ACGME FM curriculum Train the practicing physicians by shortened version of the ACGME FM curriculum –These physicians only have one year to be retrained to become FM physicians

First class of community physicians trained at SRRSH

Medical students’ training Medical students exchange: Medical students exchange: –ZU medical school students coming to GRMC for 8 weeks FM clerkship –MSU CHM students going to SRRSH for one month elective rotation

Welcome first six Chinese medical students from Zhejiang University Medical School

Activities for all trainees Activities for all trainees Teaching rounds Teaching rounds Lectures Lectures Workshops Workshops Office procedures Office procedures

Teaching rounds Teaching rounds

Lectures Lectures Lecture on depression

Workshops Family Medicine Clerkship for Chinese medical students from Zhejiang University Medical School

Office procedures Dr. Chen coaches an unsure Dr. Huang Dr. Huang: “I did it!”

The accomplishments

Students trained First Six Chinese Students Six MSU CHM students Second Six Chinese Students

Residents being trained

First class community practicing physicians graduated

Second class of community practicing physicians graduated

Three SRRSH FM Faculty Trained.

Eight Faculty from Genesys and MSU CHM experienced FM teaching at SRRSH Dr. Ruth Hart

Four Season Community Health Center became the outpatient training clinic for FM residents International Service Clinic became a model FM clinic

卫生部专家评估检查团反馈意见 浙江省有邵院为代表的最优秀的培训基地, 在这项工作中, 我们看到了 高校 ( 特别是浙大医学院 ) 所做的贡献, 毕业后规范化培训起步早, 经验 多, 很规范. 邵院的师资力量强, 门诊教学社区教学尤为出色, 有很完善的 在社区教学的教学大纲, 教学计划, 比现在卫生部的那套要详细很多, 操 作性更强, 希望浙江省以邵院这个全科培训基地为榜样, 将成绩发扬光 大. 邵院能直接提供的纵向全科医学服务, 在医院的轮训, 全科医学科自 己可以安排很多教学任务, 克服了专科化培训的 ( 门诊教学不足的弱项 ), 每周半天的社区门诊, 另有半天的社区教学, 这种纵向安排的特色, 是 全国第一家, 符合国家经验, 可以很好地贯彻全科学科的观念, 服务理念, 这种医院与社区紧密联系的教学模式, 在国内是最好最完美的全科教学 ( 横向比较了复旦, 华西, 他们都没有做到这样 ). 浙江省有邵院为代表的最优秀的培训基地, 在这项工作中, 我们看到了 高校 ( 特别是浙大医学院 ) 所做的贡献, 毕业后规范化培训起步早, 经验 多, 很规范. 邵院的师资力量强, 门诊教学社区教学尤为出色, 有很完善的 在社区教学的教学大纲, 教学计划, 比现在卫生部的那套要详细很多, 操 作性更强, 希望浙江省以邵院这个全科培训基地为榜样, 将成绩发扬光 大. 邵院能直接提供的纵向全科医学服务, 在医院的轮训, 全科医学科自 己可以安排很多教学任务, 克服了专科化培训的 ( 门诊教学不足的弱项 ), 每周半天的社区门诊, 另有半天的社区教学, 这种纵向安排的特色, 是 全国第一家, 符合国家经验, 可以很好地贯彻全科学科的观念, 服务理念, 这种医院与社区紧密联系的教学模式, 在国内是最好最完美的全科教学 ( 横向比较了复旦, 华西, 他们都没有做到这样 ). English Translation: The best family medicine program in China

Conclusion Conclusion FM is still in its infancy in China FM is still in its infancy in China Perfect timing for our collaborative program Perfect timing for our collaborative program This program is just a single spark This program is just a single spark But the single spark can start a prairie fire But the single spark can start a prairie fire The success of FM in China lies in the quality training programs such as our program in SRRSH The success of FM in China lies in the quality training programs such as our program in SRRSH