International Consultations Breadth and Depth Warren Heffron M.D. University of New Mexico

Goal Develop consulting interest skills and experience by participating in a series of problems encountered in international consultations demonstrating ranges of narrow to broad and superficial to deep.

Consultant Great consultants are not great because of superior techniques or that they know everything…..but because of their passion.

Scenario 1 Broad You receive an e mail from a colleague in China who says she is a part of a group of seven residency directors who have started family medicine residencies in China, India, Kazakhstan and Afghanistan. You have worked with all of them in the past and they now are expanding their programs and have had a few graduates

1 Cont who would like to become faculty in their programs, or will be faculty in a new program. No one has had teaching experience and they ask if you would come and teach them all how to teach. What do you do?

Needs Varied, very different cultures and learning styles, some only outpatient, some very intense inpatient work involving lots of ICU care, surgery and complicated ob. All programs only have one or two faculty and there is a great need for more. There are no faculty development programs available to them.

Plans They ask if you can get them faculty development programs in the US that will allow them to return home as trained teachers. Is this feasible, wise? They ask if you might make “rounds” and visit each program sharing some faculty development skills with them. Is this possible?

Plans What would you do to meet their needs?

Scenario 2 (Deep) You have a good friend who went to India four years ago and started a family medicine residency. It is in a 100 bed hospital which also has OB and rural surgery residencies. The residents manage a large number of very sick patients with few resources. He is the only family medicine faculty in the hospital.

2. (Cont) The residents manage acute trauma in the casualty area, have three or four patients in the ICU, do surgery, complicated obstetrics, follow children, have a busy ambulatory experience and a series of community clinics in surrounding villages. They have graduated one class of two and the next class of three will graduate soon.

2 (Cont) He asks if you will come and do a complete evaluation of their program and give them advice as to their progress and where they should go from here. He sends you a well written and complete curriculum, the Indian requirements for certification, their evaluation materials. What do you do?

2 (Cont) You arrive and the first days go very well, you have a series of meetings with the PD and get a good understanding of the program. You meet with all the residents, the administrative leaders and the faculty in the other two residencies and some of their residents. You make rounds on the in patient service and observe the residents in clinic.

2 (Cont) By the third day you are quite impressed but there are so many demands on the PD that any time you have with him is constantly interrupted by a myriad of needs, from residents, patients, staff, and administrative duties. Do you jump in and help him with the tasks. Your background would let you be a valuable help to him?

2 (Cont) How do you handle the interruptions with this tremendously over burdened friend whom you want to help? You have taken along a copy of the RRC requirements from the US and the AAFP RAP guidelines. Would you use these in your consultation?

2 (Cont) Best time spent dealing with a few days of focused time answering questions. Plus side by side working. Follow up written consultation with offer of continued contact and repeat consultation and looking for help.

Scenario 3 (Narrow) You are contacted through the CIHI office to see if you would be willing to help a fairly well established residency in Timbuktu. Things are going well but they would like to start doing some research to add an academic credence to their program. They have requested CIHI to find someone to bring them some research skills. What do you do?

Scenario 4 (Superficial) You were at a CIHI conference In Denver last year and an OB/GYN friend approached you and asked if you could talk to a friend of his in Kosovo who is thinking that family medicine would help their health care system. What do you tell him?

Superficial Already have a department in the medical school and eight residencies in district hospitals with multi disciplinary teaching centers. 50 residents a year, and a key family doctor as vice minister of health. What might they need?

Broad and Deep You hear of a request from USAID to help develop a department of Family Medicine and a residency program in an East African country. You receive a small grant to make a survey / study trip, and you learn.

learn There are no family doctors in the country. The dean of the national medical school is willing to name an internist as chair of a new department. The teaching hospital is in a different city than the medical school

learn The ministry of health strongly supports the development of family medicine, and offer support for a clinical site. You feel it is feasible to develop a department and a residency. What do you do?

Plan Apply for a much larger grant. What do you include? You get it and go back and draw up a plan for the department and a residency. The dean likes it and wants you to present it to the Ministry of Health….

Work - Years Now some short term and long term goals