Essential Elements in Global Health Education Nicholas Comninellis, MD, MPH President, Institute for International Medicine www.inmed.us - INMED Experience to date -

Presentation Objective At the completion of this presentation, participants will be able to d esign a more effective global health program

At the completion of this presentation, participants will be able to d esign a more effective global health program

Ours Is A Very Needy World Sudan 1993

Tom Dooley in Vietnam, 1955

Clinica Evangelica Morava Eastern Honduras Dr. Sam Marx hosted over 150 medical students during his 40 year career in Honduras.

Comninellis at Shanghai Charity Hospital,1981-83 Challenges: Water and air borne illnesses, TB, rheumatic fever, schistosomiasis

Comninellis at Shanghai Charity Hospital,1981-83 Challenges: Language, world-view, concepts of health and diseases

Comninellis in Angola, Africa, 1989-91 Measles, malaria, malnutrition, land mines

Comninellis at the University of Missouri-Kansas City To revive the International Medicine program at UMKC

“ We want to get personally involved!” Record Interest Among Health Care Profession Students

Record Interest Among

Health Care Profession Students

“ But… … We Don’t Know Where To Begin”

… We Don’t Know Where To Begin”

“ We Don’t Know Where To Begin” Where could I train? What organization to go with? How can I become familiar with those diseases? How can I get ready to get along in a different culture? How to work the finances?

Where could I train?

What organization to go with?

How can I become familiar with those diseases?

How can I get ready to get along in a different culture?

How to work the finances?

Institute for International Medicine Equipping healthcare professional students to serve in medical missions

International Medicine Certificate: Essential Considerations • What is global health/international medicine? • What are the desired learning outcomes/competencies? • What are the desired career outcomes? • What are the educational elements to achieve these outcomes?

• What is global health/international medicine?

• What are the desired learning outcomes/competencies?

• What are the desired career outcomes?

• What are the educational elements to achieve these outcomes?

What is global health/ international medicine? • It is useful to study health, especially health policy, in other developed nations • But most people interested in global health focus on developing nations or low-resource communities Working Definition: Promoting health in low-resource communities Albert Schweitzer

• It is useful to study health, especially health policy, in other developed nations

• But most people interested in global health focus on developing nations or low-resource communities

What are the desired learning outcomes/competencies? At completion of the International Medicine Diploma students in the context of a low-resource community will be able to: • Assess community health status based on the leading determinants of health • Prevent, diagnose and treat the leading diseases of poverty • Assure that health interventions are culturally appropriate • Design effective health interventions as part of a health leadership team • Successfully adapt one's lifestyle to a new cultural context

At completion of the International Medicine Diploma students in the context of a low-resource community will be able to:

• Assess community health status based on the leading determinants of health

• Prevent, diagnose and treat the leading diseases of poverty

• Assure that health interventions are culturally appropriate

• Design effective health interventions as part of a health leadership team

• Successfully adapt one's lifestyle to a new cultural context

What are the desired career outcomes? That graduates would incorporate into their careers: • Primarily: Service in developing nations • Secondarily: Service to culturally diverse and low-income people in their home nation Lani Ackerman Antoinette Brown

That graduates would incorporate into their careers:

• Primarily: Service in developing nations

• Secondarily: Service to culturally diverse and low-income people in their home nation

What are the educational elements achieve these outcomes? Didactic Curriculum that addresses: • Determinants of health • Diseases of poverty • Cross-cultural skills • Health leadership • Personal skills for international living Taught via online courses and …

Didactic

Curriculum that addresses:

• Determinants of health

• Diseases of poverty

• Cross-cultural skills

• Health leadership

• Personal skills for international living

Taught via online courses and …

25 renowned faculty Joe LeMaster MPH Nancy Crigger PhD, RN Daniel Hinthorn MD

What are the educational elements achieve these outcomes? Experiential 4-8 weeks working in ongoing community health, primary care or hospital medicine in a developing nation Belize Guatemala Uganda Kenya Ecuador Cameroon India Papua New Guinea Honduras Ghana Angola Zambia Jordan China Macau South Africa

Experiential

4-8 weeks working in ongoing community health, primary care or hospital medicine in a developing nation

Preceptorships – Not Group Trips With faculty who live on-site and have US-recognized credentials

What are the educational elements achieve these outcomes? Reflective • Each student gives a presentation at the training site to enhance skills of the staff • Each student writes a structured essay concerning application of his or her experience • Each student attends a debriefing after return from overseas

Reflective

• Each student gives a presentation at the training site to enhance skills of the staff

• Each student writes a structured essay concerning application of his or her experience

• Each student attends a debriefing after return from overseas

Who has completed the INMED International Medicine Certificate to date? • Between 2004-09 128 health profession students completed the 2-week course in international medicine and 4-8 weeks service experience in a developing nation • 38 resident physicians • 69 medical students • 4 public health students • 8 physician assistant students • 5 pharmacy students • 4 nurse practitioner students • Representing 64 universities and residencies

• Between 2004-09 128 health profession students completed the 2-week course in international medicine and 4-8 weeks service experience in a developing nation

• 38 resident physicians

• 69 medical students

• 4 public health students

• 8 physician assistant students

• 5 pharmacy students

• 4 nurse practitioner students

• Representing 64 universities and residencies

Population-Based, Public Health Emphasis Women DO Live Longer Than Men!

Women DO Live Longer Than Men!

What are the realized career outcomes to date? Service In Developing Nations: • As of March, 2009, 32% (41) had completed formal training (mean of 1-3 years) • Of those with completed training, 28% (12) had since returned to serve in a low-income nation for at least one month (mean of 7 weeks) • Of those with completed training, 100% reported interest in serving in a developing nation in the future

Service In Developing Nations:

• As of March, 2009, 32% (41) had completed formal training (mean of 1-3 years)

• Of those with completed training, 28% (12) had since returned to serve in a low-income nation for at least one month (mean of 7 weeks)

• Of those with completed training, 100% reported interest in serving in a developing nation in the future

What are the realized career outcomes to date? Comparative experience: • Drew University medical students given 2 weeks classroom on major tropical diseases and int’l health issues, and 4 weeks clinical experience in a developing nation • Published results in 2001: 52 participants from 1987-1998 returned a survey • 66% “had joined national or int’l relief organizations” • 80% “had travelled several times to the area of their original elective”

Comparative experience:

• Drew University medical students given 2 weeks classroom on major tropical diseases and int’l health issues, and 4 weeks clinical experience in a developing nation

• Published results in 2001: 52 participants from 1987-1998 returned a survey

• 66% “had joined national or int’l relief organizations”

• 80% “had travelled several times to the area of their original elective”

What are the major program challenges? Looking to the future: • Identification of new training sites and faculty • Assuring continued superb logistic support • Providing fellowship level opportunities for those who desire more training

Looking to the future:

• Identification of new training sites and faculty

• Assuring continued superb logistic support

• Providing fellowship level opportunities for those who desire more training

Conclusion Global health/international medicine education can significantly influence career choices towards service in developing nations

Global health/international medicine education can significantly influence career choices towards service in developing nations

Institute for International Medicine 6700 Troost, Suite 224 Kansas City MO 64131-4410 816-520-6900 [email_address] www.inmed.us Nicholas Comninellis, MD, MPH

6700 Troost, Suite 224 Kansas City MO 64131-4410 816-520-6900 [email_address]