Scaling Up Training- Is there a role for Standards? Scott Barnhart, MD, MPH

Case Study- Gondar University Ethiopia 80 million Physicians: 2-2,400 or 0.03 / 1,000 Nurses and Mid-wives: 16,800 or .21 / 1,000

Ethiopia

80 million

Physicians: 2-2,400 or 0.03 / 1,000

Nurses and Mid-wives: 16,800 or .21 / 1,000

Case Study- Gondar University Government mandate to increase physician training Rapid Rise Medical Students from 50 to 350 Year Entering Med Students 2003 56 2004 83 2005 122 2006 111 2007 202 2008 222 Maximum 350

Government mandate to increase physician training

Rapid Rise Medical Students from 50 to 350

What is Needed to Train 350 Medical Students? 350 medical students per class = 700 medical students and 1st year residents. Approximately 5000 Health Science Students How many beds? How many patients? Spectrum of diseases? How many faculty?

350 medical students per class = 700 medical students and 1st year residents.

Approximately 5000 Health Science Students

How many beds?

How many patients?

Spectrum of diseases?

How many faculty?

Gondar University Full spectrum health sciences Hospital 350 beds Busy outpatient clinic Mortality – 70% Infectious diseases 4 faculty in Department of Medicine Ratio of 1 med student, 1 resident / hospital bed.

Full spectrum health sciences

Hospital 350 beds

Busy outpatient clinic

Mortality – 70% Infectious diseases

4 faculty in Department of Medicine

Ratio of 1 med student, 1 resident / hospital bed.

Uganda Hospital Standards Project Seeks to establish a minimum standard for: Governance / Leadership Quality Improvement Physical Infrastructure Human Resources Clinical Services Medical Records Infection Control Training

Seeks to establish a minimum standard for:

Governance / Leadership

Quality Improvement

Physical Infrastructure

Human Resources

Clinical Services

Medical Records

Infection Control

Training

Training Standards All trainees have supervisor Trainees oriented Scope of privileges defined and displayed Educational objectives defined Clinical care is accompanied by education Trainees are evaluated; Supervisors are supported to both train and oversee care provided by trainees.

All trainees have supervisor

Trainees oriented

Scope of privileges defined and displayed

Educational objectives defined

Clinical care is accompanied by education

Trainees are evaluated;

Supervisors are supported to both train and oversee care provided by trainees.

Questions Are standards needed for clinical training? If yes- what are the important elements? Supervision? Time on task? Objectives / competencies? Number and spectrum of patients?

Are standards needed for clinical training?

If yes- what are the important elements?

Supervision?

Time on task?

Objectives / competencies?

Number and spectrum of patients?

Innovations- How to train 400+ students per year? Proposed - Center of Excellence for HIV, Tb and Infectious Disease Focuses on 70% of all mortality Trains all medical and nursing students in an intensive 4 month rotation Seeks to serve high volume – 60,000 patients Combined ½ day clinical and ½ day didactic Relies on experienced fellows to leverage very limited faculty

Proposed - Center of Excellence for HIV, Tb and Infectious Disease

Focuses on 70% of all mortality

Trains all medical and nursing students in an intensive 4 month rotation

Seeks to serve high volume – 60,000 patients

Combined ½ day clinical and ½ day didactic

Relies on experienced fellows to leverage very limited faculty