1. Majority World Family Medicine Capacity Building Through Fellowship Trained Educators AAFP Global Health Initiative San Diego 13 October 2011 Bruce Dahlman, MD MSHPE Institute of Family Medicine - Nairobi

2. Objectives 1. Understand the ongoing need and significant potential for globally aware and culturally sensitive family medicine educators to assist start-ups of family medicine training programs in majority world contexts 2. Utilizing a workshop format, discuss the current form of global health fellowship training in US family medicine programs.

3. Objectives 3. Explore the potential intersection of global health fellowship program objectives and these majority world educator needs. 4. Create a set of core principles around which global health fellowships could collaborate to prepare global family medicine educators.

4. Group Introductions – 5 minutes Your name and academic or practice setting Your title and current connection to global family medicine One expectation or question for the workshop Later: Your majority world family medicine education/ teaching experience Later: Your institution’s global fam med track

5. A Case Example - Kenya 2000 - Moi U. program initiated; 2005 - first intake of registrars; 2008 – first 3 graduates Four rural teaching sites; all ten initial faculty were expatriate coming from church hospitals Now over a dozen graduates; most in MoH Three new universities are in various phases of starting new residencies; the MoH plan is to add1-2 new teaching sites every year How will young, local graduates be prepared as the educators to match this scaling-up goal?

6. A Case Example - Rwanda 2007 National University of Rwanda becomes interested in family medicine 2008 Partnership formed with U Colorado (Dr. Cal Wilson) and USAID funding secured; curriculum written and approved by NUR 2008 Sept. First class of 7 residents at two 350 district hospitals, each 2 hrs fm Kigali One qualified family doctor available to begin teaching (Dr. Inis Bardella) but based in Kigali to organize the program with the University

7. Case Example - Rwanda 2009 Dr. Michael Miller replaces Dr. Bardella 2010 Dr. Cal Wilson arrives as second family medicine educator 2011 3rd site added with Dutch GPs assisting Bottom line: The MoH and NUR desire to start family medicine required most clinical training to initially occur without on-site family doctors as part of the teaching team. Your reactions?

8. Case Example - Uganda 1988 Dr. John Ross from Newfoundland Canada begins a Community Practice residency in a rural district hospital at Tororo DH Academic program of Makerere U. – Kampala Twelve initial registrars (residents) – all posted to clinical care in district hospitals but none groomed to become faculty Became dormant after 4-5 years when the one expatriate mentor left Could additional initial faculty allowed it to thrive?

9. Case Example - Ethiopia 2009 – Addis Ababa University partners with U. of Toronto to explore family medicine development – other partners follow Ref: preceding Prof. Millard Derbew plenary and concurrent session now by U Toronto Desire to open several teaching sites in district sized hospitals in the Addis Ababa area But few, if any, Ethiopian post-graduate family medicine qualifications practice in Ethiopia How can plans for this aggressive start happen?

10. East Africa Post-graduate Education All University based “Accreditation” by Univ. senate and Nat’l. CHE No national or regional professional accrediting body University emphasis is on the resident’s original thesis level research dissertation Require qualified faculty from the specialty But local family medicine doctors who could be faculty do not yet exist!

11. Majority world examples My Story My area of family medicine work is East Africa 1992 – Family doctor and medical director at AIC Kijabe Hospital – rural Kenya 1995 – Institute of Family Medicine formed to start family medicine training in rural hospitals 2000 – Partnering with Moi University; 5 years 2002 – 2010 INFA-MED Director Support to KAFP, PBSG CME and ALSO Support to NRCK and emergency skills training Support to start EAHPEA

12. Your majority world case story? 3 – 4 examples in 10 minutes Your majority world country/program of service? Your involvement in family medicine education? When/ where did family medicine start? How were the initial clinical faculty needs met? One lesson learned?

13. Discussion in groups of 4 – 6 Assumptions Family medicine has some relevance to majority world contexts Definition of family medicine might be different in majority world contexts Ministry of Health has given some interest in family medicine University context and a “working group”

14. Discussion in groups of 4 – 6 Group questions – 10 minutes 1. Do expatriates have a role in family medicine education start-ups in majority world countries? 2. What are the potential strengths these educators could bring? 3. What risks/ liabilities/ misconceptions could such educators carry? 4. How can these liabilities be minimized?

15. Groups report – 5 minutes 1. Do expatriates have a role in family medicine education start-ups in majority world countries? 2. What are the potential strengths these educators could bring? 3. What risks/ liabilities/ misconceptions could such educators carry? 4. How can these liabilities be minimized?

16. Who is available to teach? Short term – Def. = less than a year Tenured faculty on a sabbatical year Clinical preceptor/ educators on leave of absence Coverage? Call? Malpractice? Benefits? Medical tourism – “Can you use me for a week?” Long term – “Education as relationship” Retirees – away from the grandkids? Early retirees – secure retirement funding? New residency graduates – but two issues... Debt $$ $$ $$ $$ and... Preparation

17. Preparation to be majority world family medicine educators Large group inventory – 5 minutes What ATTITUDE development, SKILL set or Knowledge area would you recommend be included in a one-year fellowship to develop a culturally-sensitive global family medicine educator? Why is your suggestion important?

18. Core Principles of a Global Family Medicine Educator Large group synthesis - Five minutes Descriptors of who you would want to join you at a rural majority world district hospital to assist a recent national family medicine graduate to begin a new teaching centre of excellence... Common curriculum competencies?

19. Global Health Fellowships Inventory 2 minutes each Your name and institution Your family medicine global health track at: Residency Any educator prep. components? Majority world partners? Fellowship? Started when? No. participants? Any distinctives?

20. Core Principles of a Global Family Medicine Educator Education Is preparing global educators your interest? Is there interest to collaborate together? Common interest with faculty development colleagues? Common “branding” – “certification”?

21. Majority world partnerships – Clarifying our role Common interest with majority world education interests? East African Family Medicine Initiative Dr. Christine Gibson, U Calgary The East African Health Professions Educators Association

22. Global Family Medicine Education Fellowship Ways forward – Your suggestions

23. Comments and questions Thank you E: bdahlman@aimint.netbdahlman@aimint.net 612.877.2181