1. Global Maternal and Child Health in Rural Malawi : A Resident-Centerd Evaluation Of A New ACGME-Approved Rotation Christina Miller, MD; Sumedh Mankar, DO; Jacqueline Uy, MD; Marc Debay, MD, PhD, MPH; Crischelle Shank, MD, DTM&H; Karen Studer MD, MPH; Jamie Crounse, MD, MPH

2. 2 Activity Disclaimer ACTIVITY DISCLAIMER It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. [No Authors] have indicated they have no relevant financial relationships to disclose.

3. Overview Background Rotation Site Participating Residents Goals and Objectives Preparation Objective Outcomes Subjective Evaluations Future Directions 3

4. Background Why offer an international rotation? Residents –Educational Benefits Medical Students –Recruitment 4

5. Overview Background Rotation Site Participating Residents Goals and Objectives Preparation Objective Outcomes Subjective Evaluations Future Directions 5

6. Rotation Site: Malawi The Warm Heart of Africa

7. Rotation Site: Malamulo Rural Malawi (surrounded by tea estates) Established 1915 275 Beds 45-80% Occupancy Wards

8. Overview Background Rotation Site Participating Residents Goals and Objectives Preparation Objective Outcomes Subjective Evaluations Future Directions 8

9. Family and Preventive Medicine Residents Sumedh Mankar, D.O. (Feb. – Mar.) Edward Perry, M.D. (Mar. – Apr.) Jacqueline Uy, M.D. (Apr. – May) Christina Miller, M.D. (May – June)

10. Overview Background Rotation Site Participating Residents Goals and Objectives Preparation Objective Outcomes Subjective Evaluations Future Directions 10

11. Rotation Objectives ACGME accredited rotation –Addressed training requirements for both Family and Preventive Medicine Preventive Medicine –Quality Improvement –Community outreach Family Medicine –Obstetrics –Newborn Care –Gynecology

12. Overview Background Rotation Site Participating Residents Goals and Objectives Preparation Objective Outcomes Subjective Evaluations Future Directions 12

13. Rotation preparation GLBH 607: Global Maternal and Child Health –Malawian culture –Global health assessment tools –Proposed a community health resident project –Logistics

14. Overview Background Rotation Site Participating Residents Goals and Objectives Preparation Objective Outcomes Subjective Evaluations Future Directions 14

15. Rotation Evaluation: An Overview Residency-Centered Preventive Medicine –Projects –Director Evaluations of Resident –Subjective resident attainment of population medicine Residency-Centered Family Medicine –Procedures –Director Evaluations of Resident –Subjective resident evaluation Site-Centered Evaluations –Key Informant Interviews –Focus Group Interviews

16. Preventive Medicine Projects: Hospital QI Maternity Ward Patient Profile –Demographics, HIV, complications C-section –Decision to incision time Maternal Mortality –Analysis of maternal death over 3 years

17. Hospital needs assessment –Stakeholders –Key Informants –Focus Groups Women’s Center Cervical Cancer Analysis –Summary of 18 months of data from 2500 pap smears –Included intervention to increase pap smear follow-up Preventive Medicine Projects: Community Health

18. Preventive Medicine: Resident Evaluations Number of Residents reporting achievement of Population Medicine Competencies (N=4) Culture4 Communication4 Policy3 Community3 Systems/leadership3 Public Health2 Financial Planning2

19. Family Medicine: Procedures Name of Procedure Average Performed in Malawi (Per Resident) Average Performed in 2 weeks of OB or GYN rotation in US Pap Smear92 Vaginal Delivery710 C-Section35 LEEP/Colposcopy31 BTL11 Other (tear repair, lmplanon) 13

20. Overview Background Rotation Site Participating Residents Goals and Objectives Preparation Objective Outcomes Subjective Evaluations Future Directions 20

21. Family Medicine: Resident Feedback Scale of 0 to 10, averaged among 4 residents Was most meaningful/valuable rotation 8.75 Appropriate for Family Medicine 8.25 Increased interest in aiding the underserved8.5 Increased interest in global health8.25 Educational7.75 Met FM training Requirements 7.5 Felt Prepared for Rotation 7.5 0105 Not at all NeutralWithout a doubt

22. Site-Centered Evaluations: Key Informant Interviews –Hospital Director Must ensure rotation is beneficial for people of Malawi –Logistic Coordinator Need hospital input for QI projects –OB Charge Nurse Coordinate with Nursing School for rotation times

23. Site-Centered Evaluations: Focus Groups –OB Nurses More time on each unit –Administrators Residents should have learner attitude –Clinical Officers Identification badges and white coats

24. Overview Background Rotation Site Participating Residents Goals and Objectives Preparation Objective Outcomes Subjective Evaluations Future Directions 24

25. Future directions Malamulo Hospital-selected improvement projects Ongoing research and publications Partnerships between Malamulo and Loma Linda Future rotations duration: 6 weeks

26. Conclusion ACGME Approved Rotation meeting requirements for both Family Medicine and Preventive Medicine A careful analysis of objective and subjective attainment from a site-based and a resident-based perspective Strong interest in this rotation, as evidenced by improved matching of residents to the combined program and interest in the rotation from traditional family medicine and preventive medicine residents

27. Thank you