1. Development of a Residency-Based, Research-Based, Collaborative Partnership in Chogoria, Kenya Roger K. Gerstle, MD, FAAFP Munson Family Practice Residency Program October 11, 2013

2. 2 Activity Disclaimer No financial interests to disclose

3. Objectives Understand how and why to set up a continuity residency-based international elective Understand principles of collaboration with the host site Understand how to incorporate clinical research into a residency-based international program Understand how to extend such a program into the larger communities in both sites 3

4. Residency Background Munson Family Practice Residency Traverse City, MI MD/DO since 1997 6-6-6 Mission: …train high quality family practice physicians who are well prepared to serve the rural communities of northern Michigan. 4

5. Interest in Global Health Residents: sporadic efforts Faculty: dormant urges Medical community: mission trips Hospital: supportive of mission trips Community: strong interest –Rotary –Schools –Community College –Churches 5

6. First Steps Attaining consensus Obtaining hospital support Shared vision –Continuity experience –Teams of faculty/residents –Collaboration with a teaching site –Shared responsibility Between faculty With residents With site 6

7. Factors to Consider New vs. Existing Safety of residents and faculty Travel distance Travel cost Housing costs Cost of living at venue Medical case diversity exposure Needs of the community we would be joining Access to additional cultural activities Excitement of venue 7

8. Finding the Right Site Latin America vs. Africa Site visits Jan 2012 Chogoria, Kenya –Existing Michigan State University College of Osteopathic Medicine elective –Medical interns, clinical officer students, nursing students –Developing FM residency 8

9. First Visits 2012 –Heather: Resident Handbook –Rob: Pediatric Needs Analysis 2013 –Two teams 9

10. Emergence of a Shared Vision Help where most needed Standardized order sets New residency –Yearly visit to TC Material help 10

11. Standardized Order Sets Little is standardized! Kenyan Ministry of Health guidelines Hospital largely run by interns Inadequate charts 11

12. Research Component Study: impact of implementation of pneumonia order sets –Length of stay, mortality Shared vision IRB approval Funding avenue Legitimacy 12

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14. Resident Involvement Just show up? No! Research Didactics Find peer group 14

15. Funding The grant hunt In kind contributions 15

16. Donations Hospital School district Local businesses Equipment manufacturers 16

17. Local Extensions Other physicians Study group Other medical professionals Schools Community College ?Sister city 17

18. Publicity Local paper Hospital bulletins Facebook Rotary 18

19. Challenges The schedule back home –Faculty –Residents Changing landscape Cultural differences –Residents new to travel –Cultural hegemony Finances 19

20. Practical Matters Assistance to residents Money transfer Phones, internet Residency as hub Handbook 20

21. Future Directions Residency development ?Outlying clinics ?Other specialties, other medical professionals More order sets What Chogoria wants! 21

22. Questions? 22