1. 1 PREPARATION OF FAMILY MEDICINE RESIDENTS AND MEDICAL STUDENTS INTERESTED IN INTERNATIONAL EXPERIENCES Subcommittee on International Family Medicine Commission on Education American Academy of Family Physicians Barbara Doty, M.D., FAAFP Eric Clarkson, MS4 Inis Jane Bardella, M.D., FAAFP

2. Seminar Objectives After completion of this seminar participants will be able to: Develop goals and objectives for resident/student international experiences; Develop and implement a process to ensure appropriate preparation for and debriefing after resident/student international experiences; Effectively evaluate resident/student international experiences.

3. Seminar Format Overview of Special Considerations in the Preparation … International Experiences Educational Goals and Objectives Evaluation Supervision Resident/Student Preparation Liability and Malpractice Debriefing Wrap-up

4. Why International? Valued and supported by the AAFP Component of many Medical School and Residency programs –308 or 67% of FM residencies have educational opportunities outside the US Increasing interest by students and residents –International Health Opportunities in Family Medicine www.aafp.org/cgi-bin/ihcop.pl –AAMC Data –Bazemore AW. Nenein M. Goldenhar L. Szaflarski M. Lindsell CJ. Diller P. The effect of offering international health training opportunities on family medicine residency recruiting. Fam Med 2007;39(4):255-60.

5. Benefits of International Experiences Cultural Sensitivity/Competence Service-based learning Advanced disease management Management of unique diseases Personal and professional growth Limited resource practice Humanitarianism

6. Reprint Process Maintained by the Division for International and Interprofessional Activities Developed and revised by the Subcommittee on International Family Medicine of the Commission on Education 2006 revision by a Working Group of the SIFM

7. Discussion: International Plans Current International Experiences Plans for International Experiences Challenges to International Experiences Challenges to International Experiences

8. Learning Goals Develop a broader world view Develop an awareness of diverse psychosocial and cultural beliefs Understand differences in community structure and resources, and how this affects health care delivery Experience alternative approaches to health care delivery systems in a setting of limited resources

9. Learning Goals Experience the impact of patient and/or community education on health care Enhance patient-physician communication skills, including use of interpreters Participate in prevention activities Participate in the care of conditions unique to a geographic region Provide education to a community group in the host community

10. Educational Objectives Describe the health care system Describe the influence of politics on access to health care Discuss how life styles and health beliefs affect health and care seeking Contrast care provided in the local system with a resource rich setting Reflect on the observed aspects of community and public health, and how these contrast with the US system

11. Discussion: Goals and Objectives Examples of Goals and Objectives Plans for Implementation

12. Evaluation Define measurable outcomes Establish academic expectations for performance Include deadlines for completion Clarify methods of evaluation such as: –written papers –group presentations –poster presentations –testing on specific content –level of participation

13. Evaluation Examples 1.Describe the health care system in your learning community and the influence of politics on access to health care. 2.Discuss how the life styles and health beliefs of the population affect their health and care seeking in positive and negative ways.

14. Evaluation Examples 3.Contrast the preventive, disease management, and public health initiatives provided to a patient in the local system with that provided in a resource-rich setting. 4.Compare and contrast the public health system observed during your experience with the health care system in the US.

15. Discussion: Evaluation Methods Examples of Evaluation Methods Challenges in Evaluation

16. Supervision WHO – Identify responsible individual(s) WHAT – Define responsibilities and expectations WHERE – Delineate location and timeline HOW – Specify method of communication and availability of supervisor WHY – Clarify role of supervisor and responsibilities to the academic institution

17. Discussion: Ensure Supervision Methods and Processes for Supervision Challenges in Supervision

18. Personal Preparation 1.Financial arrangements 2.Transportation, food, housing 3.Health and travel insurance 4.Passport, visa 5.Personal health needs: special accommodations chemoprophylaxis immunizations http://www.cdc.gov/travel/destinat.htm

19. Personal Preparation 6.Sight seeing and touring agendas 7.Local transportation and safety 8.Personal and professional items to bring 9.Communication resources (telephone or e-mail) 10.Duration of the rotation

20. Educational Preparation Courses/Self-Study preparation –Demographic/geographic readings –In country language and communication skills –Medical ethics in scarcity –Cultural sensitivity –Interdisciplinary team health care –Regional health care delivery system

21. Educational Preparation Courses/Self-Study preparation –Family planning/ Maternal and child health principles –Tropical medicine/infectious/chronic disease epidemiology common to the region –Nutrition resources & dietary practices –Access to medical technology and sanitation –Community-oriented primary care

22. Discussion: Preparation Examples of Methods for Personal Preparation Examples of Methods for Educational Preparation

23. Liability and Malpractice Liability Considerations –Mandatory orientation –Require physical exam and travel medicine consultation –Require proof of insurance/evacuation insurance –Require host-country letter of understanding –Provide State Department advisories

24. Liability and Malpractice Liability Considerations –Provide resources for health advice: http://www.cdc.gov/travel/yb/ –Provide information on high-risk activities –Require narcotic avoidance –Require signatures of understanding –Attorney review of informed consent and indemnification letter

25. Liability: Learner Responsibilities Familiarize yourself with the cultural and medical environment Familiarize yourself with the expectations of the foreign facility: research cultural, social, and medical aspects of the work environment. Communicate clearly with directors, supervisors, and teachers at the host facility regarding environment and expectations.

26. Discussion: Liability Methods and Processes to Address Liability and Malpractice Challenges in Liability and Malpractice

27. Debriefing Life changing experience Feelings, reactions Facilitated session –Discussion –Formal presentation –Publication Develop perspective Personal and professional growth

28. Debriefing Examples 1.Prepare and present an educational tool useful for the host community for health promotion/disease prevention. 2.Develop a powerpoint presentation on the health care system in your host community and present formally at your institution. 3.Submit for publication a commentary on your observations while in country.

29. Discussion: Debriefing Methods and Processes for Debriefing Challenges in Debriefing

30. Wrap-Up Preparation and Planning –Most of the work –Ensures a successful experience Evaluation –Part of planning –Ensures accountability –Necessary for sustainability Debriefing –Equal importance to planning –Closure –Personal and professional development

31. 31 Thank you! New Resource: http://www.faimer.org/resources/opportunities/index.html