Family Medicine Education and Health Systems Family Medicine

Family Medicine Education and Health Systems Family Medicine Residencies: Partnering with Health Systems

Warren Heffron M. D. Professor Emeritus University of New Mexico Family Medicine Albuquerque, NM In His Image Residency Visiting Faculty Tulsa, Oklahoma

Question � Can you think of a system in the world that family medicine could not fit into and perhaps improve?

Answer �A system that doesn’t want family medicine.

Question � What are several venues for augmenting the capacity and quality of health care delivery that cross national borders and political systems?

Goal � Provide a forum for mutual exchange of information among the presenter and the participants to foster the use of family medicine education programs to enhance the health of the people of the world.

Objectives At the end of the program the attendees will: � Have an enhanced understanding of how work in teaching residencies can increase the capacity for medical education and health care delivery across any system. � Have shared some opportunities for global teaching that could lead to international teaching.

History � Globally rooted in general practice � The GP / now FP was the doctor � 1947 AAGP � 1969 AAFP, ABFM � 1972 Wonca

AAFP � Large numbers of members working internationally � 1, 576 international members from 101 countries. 17. 1% Canada, 11. 1% Central America and Caribbean. � Informal support and help � VP for international activities Dr. Dan Ostergard � CIHI � International Consultations- Jamaica, Albania, Macau, India � Global Health Conference � Key member of Wonca

Wonca � World Organization of Family Doctors � Headquarters in Singapore � 120 Member organizations � 100 Countries � 43 Academic departments � 14 countries � 1, 800 direct members

Capacity Building: Health Care / Education � Standing on a street corner in Kabul. “What on earth am I doing here. “ � Some of the worst health statistics in the world. � Medical education drastically interrupted � Women get little health care. � New residency in family medicine

Global Capacity Building � Overwhelmed by the magnitude of needs and do nothing. (Pessimist) � So optimistic we jump in and try to accomplish so much we burn out. (Optimist) � Set a realistic goal and set out to accomplish something within the bounds of resources. (Realist)

Family Medicine Residency Education � Adds significantly to global health care by educating physicians and improving the kind of health care needed especially in the resource poor sectors of the world. � Training local physicians in their own national medical educational, socioeconomic, and cultural systems is more efficient than bringing them to the west where return is low.

Malawi � 14, 000 people � 450 physicians. (1/30, 000) � 45 with post graduate training, elsewhere � 10 family physicians, all trained elsewhere � No post graduate training in family medicine � Where do you get the biggest impact on health care?

China � Historically western specialty dominated � Traditional chinese medicine � New priority to train family doctors � Start currently retraining specialists to be faculty in new family medicine residencies � Within three years, 500 new residencies 30, 000 residents in training � Faculty development needed

Hope Partnerships International � NGO Network of seven residencies in 4 countries (“closed”). Facilitate development of high quality family medicine residencies, and collaboration among members. � Residency consulting � Faculty development � Medical educational conferences � Teaching

Hope Partnerships International Macau � More than 30 years as a mission clinic and center in Macau � Residency started in 2002. 8 years 15 grads � Largely outpatient, inpatient exp. � Seven FP faculty, expat and local � Coordinating a network of other China programs

HPI Network � Residents 1 -6, � Faculty 1 -7 � Graduates 0 -8 � Length 3 -4 years � Years of program 2002 -2010 � New programs developing

HPI Network Curriculae � Ambulatory care: all � Hospital care: 1 � Obstetrics: 1 � Basic specialties: all � Community Experiences: all � Resident supervision: all

HPI Network Graduate Activities � Stayed to teach in the residency. � Government clinic or hospital practice. � Private practice. � Starting other residencies

HPI Self Description � Missionary

HPI Network Needs � Human resources, additional faculty � Accreditation by government � Recognition as specialty � Long term funding � Volunteer academic help, short and long term

Emmanuel Hospital Association (EHA) � India, conversion of missionary hospitals � Christian India based organization � 23 hospitals � 43 community health centers � Three family medicine residencies � Consortium with CMC Vellore, government of Nagaland to develop a new residency there

Changing generation of Nagas

Nagaland

Albania and Albanians � AAFP extensive consulting in Albania � Ministry of Health, Medical School � Academy of Family Physicians � ABC medical center, Internship � Transformation conference

Albanians - Kosova � Medical School and residency program � Eight decentralized community based teaching centers � Didactics one day a week in the university � Volunteer teachers and annual conference � Ethnic Albanians in Monte Negro and Macedonia

Kabul Afghanistan � Soviet Invasion 1979, Taliban ousted 2001 � MOH Basic Package of Health Services 2003 � Dr. Tim Fader, first family medicine residency 2004 CURE hospital � Curriculum designed to function in District Hospitals � Needs: FM faculty, most specialties, women, Dari speaking is a plus

Kabul, Afghanistan � Serious disruption of medical education � Even more serious disruption of health care delivery to women � Hospital rebuilt by American military � 2 Residencies, 22 residents, 15 graduates 5 teaching in one residency 4 in the other � Intermittent specialist availability � Needs: faculty, women

Kabul

Aswan Egypt � Germania Hospital over 100 years old � Medicine, Surgery, Ob, Pediatric, services � Ambulatory clinics � Two community clinics in nearby villages � Residency started 4 residents in 2009 � Second year class added in 2010 � Third year class in 2011 � Biggest need is Egyptian visa carrying Arabic speaking FP’s.

Aswan

Rwanda � Department in National Medical School � Series of residency programs in the university teaching hospital and disctrict hospitals throughout the country � Co-operation with NGO and GO, ( medical school and the ministry of health

Ecuador � Hospital Vozandes: Residency started in 1980’s. � Successful graduates impacted the ministry of health and the medical education system and let to governmental support and programs. � Residency has now grown and sends its own graduates internationally.

Cameroon � Mbingo Baptist hospital. Mission hospital with an internal medicine primary care residency � Banso Baptist Hospital currently recruiting a family medicine program director to start a new program. � Both hospitals have a surgery residency and the other requisite specialties represented.

Mbingo Deaf School

Opportunities � Formal affiliations with US residencies and programs globally � Student, resident, faculty exchanges � Faculty development programs � Sabbaticals � Long term and short term exchanges � Volunteerism � Grants

Other Models � University of Cincinnati, Jeff Heck � One or two communities but involve students, residents, faculty and consultants on a longitudinal basis for a period of years. � Includes community education, public health as well as curative and preventive practices, and research projects.

Residents and Residencies do the Capacity Building � Increased family medicine training programs and medical education � Increased health care delivery capacity � Provide future leaders � Become change agents

Multidisciplinary Education � Family medicine residents � Family nurse practitioners � Clinical officers � Midwives � Medical assistants ( practitioners ) � Community educators � Village health workers

Other Impacts � Ministries of Health, job creation � Specialty recognition � Physician certification (boards) � Residency accreditation � Specialty associations / academies � Education organizations (STFM like)

Opportunities � Government � Military � Academic agencies, USAID, Peace Corps Institutions � Companies � THINK BIG: Think GLOBALLY