1. OR Some of Warren’s Mistakes

2. Professor Emeritus University of New Mexico

3.  Incomplete pre trip communication  Logistical support  Contractual needs, written  On site contact information  How do you prevent problems?  Have you had any pre trip boo-boo’s?

4.  Contractual understanding of who pays, how, and when. Travel costs, international, local Lodging, meals, car rental, misc expenses Honorarium, Insurance, Dress expectations  Pre site visit questionaire

5.  Insufficient Time.  How do you correct?

6. Adequate travel time Appropriate jet lag correction time Assessment of data collection Logistics of scheduling all the people you will meet Time for summary conference Time for immediate report writing Avoid late night, early morning syndrome

7.  Incomplete communication re the desired outcomes of the consultation. “ do a consultation to make our residency / department better”  Can you guarantee total mutual understanding of what they want?

8.  At the end of the consultation you get four more requests  1. Can you develop our curriculum?  2. We have differing opinions about what we want to do.  3. Faculty members come to you unhappy with the program director.  4. Where can we get out of country funding?

9.  Prior written determination of What they want What you can deliver Pre site visit questionairre

10.  Let’s compare your residency to the RAP guidelines. “ We are not a North American residency, and we do not want to be one”

11.  Involve the consultee in determining criteria.  Mutually developed criteria included the relevant RAP suggestions and she was happy because she now had ownership in what we were goung to do together.

12.  Perceived superiority attitude. ( might as well be real)  Comments: How much better things things are in US How little they have “Developing countries” Any term they might consider derogatory

13.  Communication  Service attitude ( Humility )  Honest and open sharing  Learning attitude, listen attentively  Avoid expert trap  Realize our model may not be for all  Recognize your own biases

14.  Cultural inattentiveness  Shook hqands with covered Saudi resident  Any of you stories?

15.  Constant awareness of cultural differences  Read about cultural issues, history, geography  Ask advice  Importance of personal talk  Respect all, especially elderly and leaders

16.  Incomplete awareness of “political” ramifications of the consultation.  Aware only of those who support the program and meeting only with this group  Unaware of those who do not support or who actively oppose the program.

17.  Meet with all key persons in the program  Meet with key administrative staff who will provide resources and continued support  Meet with persons who do not support or oppose the program  Explore internal political interactions, factions, and power struggles

18.  Lack of local understanding of family medicine and what it is and what we do  Not recognizing the significant variability in training and function of family doctors / general practitioners  Assuming RRC standards and RAP criteria have universal relevance

19.  Educate yourself—Pre trip study  Early in consultation meet with MOH, Dean, Chairs, Program Directors, faculty, staff, students, other specialists  Warn people, your recommendations may take years to accomplish, CME programs,mentoring,post MD training

20.  Unorganized consultation  Delegate the process to some one else

21.  Mutual understanding of goals  Pre arranged mutualld developed schedule, yet with flexibility for reflection and additions  Systematic data gathering and synthesis  Presentation of preliminary recommendations  Formal written recommendations

22.  Non maximized consultation  May need more than one consultant, varied expertise  Insufficient time

23.  Consider a consultant team, ( even training )  Capitalize on different types of expertise  Divide responsibilities, and meetings, or one active and one observing at different times  Identify local resources for collaborating for ongoing plans

24.  Leaving them with uncertainties or unknown expectations regarding your opinions at the end of the consultation

25.  Have an oral exit interview ( group ) outlining your key recommendations  Seek input from consultees re key recommendations  Tie your recommendations into their ?s  Ask advice before includibg comments that are “far afield”

26.  Written report

27.  Formal, timely, complete written report  Include recommendations they feel are important  Tie to their requests for the consultation  Review before releasing by the person requesting ( paying for ) the consultation  Care with who gets the report and in non changeable format

28.  “Snapshot”, or one time consultation without developing an ongoing relationship

29.  Offer e mail, written or phone continuity  Continuity of consultations  Address sustainability of program  Confirm agreements and support  Include long term planning  Plan for broadly based support  Develop jobs for graduates

30.  Evaluation process