International Medical Education: Do we have a responsibility to help?

1. International Medical Education: Do we have a responsibility to help? James D. Smith, MD Professor Emeritus

2. Outline for Workshop • Why Teaching? • The Need • Opportunities • Preparation • Rewards

3. Who Was the Ultimate Teacher?

4. Jesus the Teacher! • What example did he leave for us? • Servant attitude • Who did he teach? • Pharisees and Lawyers – Faculty? • Disciples – Residents? • Crowds – Medical students? • One on one – John 20:16 Mary Magdalene exclaimed “Teacher”

5. Jesus the Teacher! • Other than teaching what was one of Jesus most frequent activities? • Church planting? • Feeding the hungry? • Healing? • Other miracles? • Fishing?

6. Jesus the Teacher! • What effect did healing have on the recipient? • Thankfulness and praise – Luke 17:15-16 One healed leper out of ten returns • Joy – Act 3:8 the crippled man healed by Peter • Mark 2:1-12 Knowing Jesus could heal brought people to him for healing, but their sins were also forgiven

7. What Makes a Good Teacher? “Someone who loves his subject and loves his students”* *John Patrick

8. Why Might We be Reluctant to Consider Teaching? • Don’t like public speaking • Not sure how to prepare a lecture • Lack of self confidence • Takes to much time • Students don’t appreciate your efforts

9. Why be a Teacher? • Build into others lives • Share experiences with others • Leave something behind when we are gone

10. We are all Teachers! • We teach by: • Example and modeling • Attitude • Influence • Demonstration

11. Do We Want to be a Positive or Negative Influence? • We will be influencing a generation of young people!

12. What are Some of the Needs in the World? • The most affluent one third • Excellent health care • Excellent education • The middle one third • Want to improve medical education and training • The lower one third • Aspire to reach a higher level • Needs are overwhelming

13. What are Some of the Needs in the Least Affluent One Third?

14. What is the Need for Medical Personnel in the World? • Africa • 11% of the world’s population • 24% of the global burden of disease • Has 2-3% of the world’s health care workers • Uses 1% of the world’s health care dollars • 40% of the hospitals in Africa are mission hospitals • 60% of the health care is given in mission hospitals

15. Why Aren’t There More National Doctors? • THE BRAIN DRAIN! • Zambia has retained <10% of the 600 doctors trained between 1978-1999 • Ghana lost 630 doctors between 1993 – 2002 and over 11,000 other healthcare professionals • A recent survey of Nigerian medical students showed that >60% plan to emigrate • In 2007, 17,620 African doctors and nurses joined the National Health Service in the UK

16. OPPORTUNITY!

17. What would you do if: • You only made $1000/month or less? • You had to worry about your personal safety and that of your family on a daily basis? • The only job available when you finish training would be a small hospital in Churchill, Manitoba? • When you go to work, basic medicines and surgical supplies are not available? • A recruiter from the US offers you a job that solves all these problems? • Would you or I stay?

18. How can Training Health Care Workers be Translated to Missions? • You can multiply your hands • Demonstrate the Love of Christ • Attitude in patient care • How you treat others – patients, nurses, cleaners • We can teach medicine, but nationals may be better able to reach their own people for Christ because they know the culture and the language

19. How can Training Health Care Workers be Translated to Missions? • Why not just do direct patient care? • Rewards are more tangible • Instant gratification • But what happens when you leave? • In teaching you can do both!

20. How can Training Health Care Workers be Translated to Missions? • Medical missions can be an iffy business • If you are the only physician at a mission hospital what happens when you go on furlough, leave the field or retire? • What if your visa is not renewed? • What if there is civil unrest and you have to leave?

21. Where Am I Coming From? • Peace Corps doctor in Kenya • Academic staff at OHSU • Visiting Professor at the National University of Singapore • CMDE conference • MEI

22. Opportunities • Most countries will welcome teachers who are willing to share knowledge • Closed or creative access nations • Short term – 1-4 weeks

23. Opportunities • Most countries will welcome teachers who are willing to share knowledge • Medium term – 2-12 months • Long term – 1 year or longer • Invited Speaker

24. Opportunities • Medical Schools/Training Programs • Basic Science • Research • Clinical • Students • Residents/trainees • Specialties • Family Practice

25. Opportunities • New Medical Schools – few or inexperienced teaching staff • Special needs • Curriculum development • Problem Based Learning

26. Opportunities • Medical Schools/Training Programs • CME • ACLS and ATLS • Lectures to National Physicians

27. Leaving a legacy…

28. PAACS Graduates • Nineteen thus far & more in 2011 • All are practicing in Africa • Two are being trained as pediatric surgeons • We have 34 training in 6 hospitals at present • Goal – To train 100 surgeons by 2020

29. Individuals involved • Jim Jewell – Thoracic surgeon • Jana Bacote – Head of Surgery, Aga Khan Hospital in Nairobi, Kenya • Bill Bevins – Head of Family Medicine Department, Kabul, Afghanistan

30. Opportunities • Paramedical Fields • Nursing – Education specialists • Village Health Workers • Emergency Medical Technicians • First Responders

31. Opportunities • Paramedical Fields • Audiology

32. Opportunities • Paramedical Fields • Speech Therapy • Physical Therapy • Occupational Therapy

33. Preparation • When should I do this? • Student?

34. Preparation • When should I do this? • Resident?

35. Preparation • When should I do this? • Early Career?

36. Preparation • When should I do this? • Mid Career?

37. Preparation • When should I do this? • End of Career?

38. Preparation • Specialty Training? • Credentials • Board certified • Academic position • Education courses • Practice! Practice! Practice!

39. Preparation • Missions • May require theological or biblical training • Short term trips • Read biographies of missionaries • Get involved with your church mission board • Attend mission conferences

40. Cultural Considerations • Short term vs long term • You may be viewed as a threat • “You are eating out of my rice bowl” • Cachet of being a foreigner • Losing face • Visas and medical licenses • Teaching may be acceptable

41. Cultural Considerations • How can I overcome potential negative impressions? • Remember God has given us so much • Be thankful • Share • Don’t have a superiority complex

42. Cultural Considerations • Be sensitive to your hosts • Culturally • Respect their taboos • Respect government prohibitions

43. Cultural Considerations • Be sensitive to your hosts • Medical knowledge – may be inferior to ours, but? • Lack of or outdated texts available • Poor teaching techniques • Lack of experience • Paucity of equipment

44. Cultural Considerations • What can I do? • Start small • Ask a lot of questions • Learn from and observe what your hosts do

45. Cultural Considerations • What can I do? • Don’t be critical of their techniques • Develop trust and be truthful • Acceptance and respect will come

46. What Do We Have to Offer in Medical Education • Attitude – servant model, approachable • Interact with students in class room and patient care

47. What Do We Have to Offer in Medical Education • Encourage questions • Allow hands on not just observation • Demonstrate a methodical and evidence based approach

48. What Do We Have to Offer in Medical Education • Model patient care • Demonstrate and help residents with patient care

49. What Do We Have to Offer in Medical Education • Encourage residents to ask for help • Make friends of students, residents and faculty outside the hospital

50. REWARDS!