1. Family Physician’s Skills and Competencies in Global Settings Alex Ivanov, MBA Perry Pugno, MD Inis Bardella, MD Joel Shields

2. Medical Students 30.5% of students participated in the global health activities while in medical school Up from 6.8% in 1984 AAMC’s 2011 Medical School Graduation Questionnaire https://www.aamc.org/download/256776/data/gq-2011-rm.pdf 2

3. Student and Residents Attendance at the AAFP Global Health Workshop has grown like wildfire! –Students by 400%; –Residents by 200% 3

4. Residency Programs 2/3 of family medicine programs offer international health electives 4

5. “Global Health Initiatives are One of the Big Tools for Successful Recruitment of Medical Students into Your Program” Stan Kozakowski, MD Former Residency Program Director 5

6. Andrew Bazemore, MD et al., The Effect of offering international health training opportunities on Family Medicine Residency recruiting. Family Medicine, October 2007, Vol. 39, No. 4 Cynthia Haq, MD et al., New World Views: Preparing Physicians in Training for Global Health Work. Family Medicine, September 2000, Vol. 32, No. 8

7. How Do Residency Programs Address Global Health Interest? Establish GH Track or longitudinal international rotation Allow GH-active faculty and residents to design and implement international experiences

8. Consortium of Universities for Global Health (CUGH) 71 members (leading US and Canadian Universities) More than 150 academic programs of global health Proliferation of global health centers has been likened to “tsunami”

9. CUGH Survey September 14, 2009 Between 2006 -2009: Undergrads participating in GH initiative increased 1,286 to 2,687 Graduate students enrolled has more than doubled from 949 to 2,010 37 university programs listed 105 active student organizations focused on GH, avg. ~3/campus.

10. CUGH Survey Challenges Identified Absence of standardized curricula and core competencies and skills

11. Impact of the Lack of Standardized Curriculum AAFP members contact the academy requesting the academy to develop standardized curricula and core competencies and skills in GH

12. What the Survey Respondents Believe is Needed

13. “It Depends,...”

14. “ I think this all depends on where someone works. What is important is that physicians are adaptable and know the fundamentals of community health, public health, and they can pick up the clinical skills that are needed depending on the patient population”

15. “THOSE THAT ARE PREVELANT AND POORLY TREATED IN THE CONTEXT!!! In some areas, HIV may be the most critical thing to know, and in others, reproductive health may be more important. There will obviously be overlaps (e.g. knowledge of HIV important for Disaster medicine as well), but the important skills and competencies will totally depend on the context (city, village, country, region)”

16. “It depends on greatly variable situations with a myriad of different region-specific needs. Central and East Africa, where the needed skills lean very heavily toward hospital practice, complex obstetrics and gynecology, expanded surgical skills, and public health/community medicine; which are significantly different from the ambulatory and preventive medicine skills which are the focus of most North American and European FPs and many middle income countries”

17. Other Variables Sending program-specific needs Faculty experience Student/Resident level of preparation Duration of the rotation Same location over the time vs. new location every time First time vs. multiple times

18. AAFP Global Health Competencies and Skills Survey

20. Survey categories Public Health Cultural competency Clinical skills Community Health Family Medicine consultant/educator Personal survivor and safety Personal behavioral skills

21. AAFP Global Health Competencies and Skills Survey

28. Almost all of competencies and skills in every category were rated “Very Important” and “Somewhat Important”. “Not Very Important” highest scores: Bioinformatics – 34.4% Occupational health – 31.8% Pediatric Advanced Life Support – 32.6% Advanced Cardiac Life Support – 42.7%

29. AAFP Global Health Competencies and Skills Survey Open-end questions revealed additional skills and competencies: -Public Health: basic epidemiology and family planning competencies/maternal and child health -Cultural competencies: ethics, humility, adaptability -Clinical skills and competencies: basic exam skills -Community Health: building relationships with local communities, understanding our impact/burden on our hosts, truly participatory approaches to project development, accountability to community, team, self, partners, donors

30. Conclusions and observations One size does not fit all Competence needed in public health, community health, cultural competence, FM consultations and patient and community education Importance of development as a leader, an advocate, and an educator

31. Potential Use of the Survey Data Guidance and a tool to build a formal global health curriculum By students, residents and practicing physicians who plan their own international experience By faculty in planning and developing orientation talks, pre- and post GH experience briefings, on-site conferences, special GH courses, recommendations for self-study and GH book clubs

32. Ethical Challenges Short-term missions vs. long-term engagement Clinical care only vs. sustainability of local community Humility vs. arrogance and paternalism Dependence vs. positive change

33. “Unless a person is working full time in an area, that person should not be practicing clinical medicine there. A skillset is not as important as knowing how to teach a skillset or having competency to help with systems development, i.e. advancing capacity and human resources for health”

34. “Building relationships with local, community-based health care providers, educators, public health practitioners and members of the target community – these are the people who should identify community health problems, for which collaborative, evidence- based interventions can be developed and implemented (i.e. our role as international aid workers should NOT be to TELL people what THEIR problems are, but to work with them in developing solutions to their own identified needs”)

35. A GH program designed to develop public health, community health and educational skills and competencies in addition to clinical skills may lead to a positive change and sustainability of local community, the ultimate goal of each international experience The Bottom Line

36. Being the Change: Ending “Duffle- Bag” Medicine Natasha Demehri, FSU College of Medicine – Class of 2012 “…methods involved educating local healthcare workers, using local resources, expanding the local infrastructure, and working with the community to help it “heal itself.” Using this idea we can better address important global health challenges such as the “brain drain” that continues to plague much of Africa and Southeast Asia…” “… our most sustainable impact was teaching the clinical officers through classes in infectious disease and medical care, permitting them to care for the local community after we left”. AAFP International Update Newsletter, Winter 2011 – www.aafp.org/international/newsletter www.aafp.org/international/newsletter

37. For More Information and to Obtain detailed Survey Results Alex Ivanov, AAFP International Activities Manager aivanov@aafp.org 800-274-2237 x 4510

38. Questions?