1. Collaborative residency training in Kenya and Ethiopia
Mark Johnson MD and
Elizabeth Hutchinson MD
Swedish Family Medicine First Hill

2. Objectives
Explore a model of collaboration with a training institution in the developing world involving a reliable presence of US residents and faculty at a sister program.
Demonstrate value added to both programs
Describe challenges faced in creating and sustaining a collaborative training effort
Learn the potential pitfalls of resident experiences in the developing world

3. Background 2005-2007 Swedish Family Medicine
identifies Kijabe Kenya as
an appropriate
International Elective site

4. 1. Curriculum development 2. Facilitate elective site
Elective goals and objectives aligned with AAPF global health curriculum
1. Curriculum development
2. Facilitate elective site
3. Assess competencies
“The acquisition of global, geographic, and culturally specific knowledge and skills will allow the family physician-in-training to formulate an individualized assessment and treatment plan appropriate to a wide range of specific circumstances. Such training is an integral part of residency training. The world is now our community and globalization trends challenge medical education to incorporate knowledge and skills appropriate to our emerging global community.”

5. 2007 Kijabe Hospital starts a family medicine residency
Increased academic focus
2. Early development of a residency training system

6. Swedish Global Health curricular re-focus
2008 shift in philosophical focus from:
Resident acquisition of knowledge, skills & experience TO
Collaboration with Kijabe to facilitate & improve
Family Medicine Residency training
Increased attention to specific AAFP goals:
“ ..to address distribution of health services in resource-poor settings and to tailor clinical interventions by taking into consideration socio-economic disparities”

7. Improving primary care training to address distribution of health services in resource poor settings
Mutual goals:
Improve quality training for Kenyan and US residents in Kenya
Increase exposure of Kijabe as a training site with “international collaboration.”
Help develop residency training systems

8. Specific areas of focus
Teaching exam skills
Critical thinking
Multidisciplinary collaboration
Giving feedback
Developing curricula

9. Perceived values of collaboration – for Kijabe
Kijabe is sought after by Kenyan medical students
Academic focus: evidenced-based, high quality
Improved ratio of supervising doctors to trainees
Cross-cultural relationships
Kenyan residents more likely to stay and practice
Progressively less need for expatriate leadership
A functional collaborative training model can be replicated in other sites

10. Perceived values of collaboration –at Swedish
90-100% of senior residents choose to participate in a global health elective
Residents perceive that there is a dual benefit: they are gaining knowledge and experience as well as helping to improve health disparity
Commitment to one site has improved continuity of resident experience

11. Challenges
Establishing relationships first with the site improves collaborative process
Consistency of teaching and supervision requires consistent presence
Though US are expected to “teach” they must also be aware that they are guests (i.e. religious rules, medical protocols)
US residents may be under trained and under prepared to teach in some areas

12. Summary
An intentional partnership between two residency training programs meets AAFP global health curriculum goals on two levels.
Resident acquisition of knowledge and skills
Improved distribution of health services
This model can be replicated
There is potential impact on the quality of primary care in the developing world
Improved quality of teaching
Higher standards of patient care
Increased attractiveness of FM in Kenya
Improved in-country retention of trainees
Less reliance on expatriate involvement

14. Our criteria for a second international site
Language
Outpatient and Inpatient Experience
Appropriate Medical Supervision
Safety
A host site need that we can fill
A global to local connection
Minimal social, political, religious conflicts
An opportunity to partner with a training site
An ethiopian doctor spoke at the university church about the need for physicians to volunteer in Gondor as there is a lack of providers available 14

15. Ethiopia

17. Benefits to Gondar Department of Medicine
Assistance in presenting grand rounds/ lectures
Assistance in bedside teaching with health officer students and medical students
Opportunity to show-off areas of success
Build relationships with international partners for future collaboration

18. Entrance to the hospital

19. Building the new hospital

20. New outpatient clinic

21. World Development Indicator Data Base: Accessed 9/5/2011

22. Department of Internal Medicine
6 faculty
9 general practitioners (GP’s)
20 interns
30 Fifth year medical students
30 Fourth year medical students
30 Health Officers

23. Bedside Rounds
In US-based
hospital

24. Bedside Rounds
In Ethiopia

25. Why have set international rotations for residents?
The RRC requires residents have physician supervisor
Standardization of expectations/ roles
Ensures you do work you are trained to do
Learn from others’ experiences
Minimal time needed to orient you
Streamlines housing, travel, contracts, etc.,
Build long term relationships between institutions

26. Teaching bedside or didactic

27. Café for Breakfast

28. 5 minute bus or 20 minute walk

29. Morning Report

30. Work Rounds on the sickest patients

31. Afternoon Clinics (2-4pm) – Partner with an Intern
ART clinic
Type 2 Diabetes Clinic
Type 1 Diabetes Clinic
Cardiology clinic
HTN clinic
Chronic disease clinic

32. Common Procedures the Interns need help performing
Lumbar Punctures
Paracentesis
Thoracentesis
IV placement
Splenic aspiration

33. Summary
1. An intentional partnership between two family medicine residency training programs meets AAFP global health curriculum goals on two levels.
Resident acquisition of knowledge and skills
Improved distribution of health services

34. Summary 2. This model can be replicated
3. There is potential impact on the quality of primary care in Kenya, Ethiopia and other sites
Improved quality of teaching
Higher standards of patient care
Increased attractiveness of primary care
Improved in-country retention of trainees
Less reliance on expatriate involvement

35. Questions?