Global Expansion of Family Medicine

Family Medicine is proliferating worldwide. These sessions profile the growth, development, and lessons learned in the expansion of family medicine and primary care globally.

Workshop Topics

Workshop sessions that focus on clinical issues are denoted with an asterisk (*).

Thursday, September 8, 2016, 9–10 a.m.

Room Location: Techwood

Building International Partnerships in Family Medicine Development: Pearls and Pitfalls

Jeff Markuns, EdM, MD, FAAFP; Laura Goldman, MD; Kristin Shaw, MPH; Steve Cummings, MD; and Brian Jack, MD

Successful partnerships between local stakeholders and international consultants can be an important catalyst in creating sustainable programs responsive to unique local contexts. Although, there can be challenges as well. In this discussion, we aim to discuss challenges and benefits in building collaborations between local and international partners. We will share examples of productive partnerships, and share successes and setbacks in navigating these collaborations and utilizing them to meet local partners’ specific goals in developing and expanding family medicine. Specific programs unique to different countries will be discussed to allow comparison with participants’ own programs. We’ll discuss collaborations, such as as direct engagement with national government leaders in Vietnam to support primary care policy development; support for development of a private college of family medicine in Myanmar; promoting an updated curriculum and supporting research in Cambodia; and establishment of the first fully accredited post-graduate medical training program in Lesotho.

Room Location: Kennesaw

Building Family Medicine in Malawi, Beyond the Rhetoric

Elizabeth Hutchinson, MD; Esther Johnston, MD, MPH; Anna McDonald, MD; and Kami Harless, MD            

We are witnessing a pivotal time for global family medicine expansion. Many countries are reorienting family medicine as the cornerstone of their health care system, and expanding family medicine training. Although the practice of family medicine will have distinct characteristics around the world, the core values remain and includes care that meets the fundamental health needs of the patient; integrated care, prioritized by need, and offers healing above cure, when appropriate. Countries birthing family medicine, such as Malawi, need more than rhetoric to build a new medical culture. To support training in Malawi, University of Washington-affiliated residents have partnered with the University of Malawi and a district hospital, which is the teaching site for the first class of Malawian family medicine residents. The visiting residents demonstrate how a family physician, as a leader of a health care team, can provide quality care in a resource poor setting, while mentoring and modeling the values of family medicine.

Thursday, September 8, 2016, 10:15–11:15 a.m.

Room Location: Spring

Connecting Family Medicine Programs Across Borders to Improve Health Worldwide

Ruben Hernandez, MD; Rachel Bramson, MD, FAAFP; Jennifer Hoock, MD, MPH; Sofia Blanco, MD; Alejandra Cascante, MD; and Teresa Upun, MPAS

For years, physicians, educators, residents, and medical students have visited Central America to work in diverse medical settings, from cultural and clinical competencies to providing faculty development. The recently signed “Carta de San Jose” (2016 Costa Rica Summit, WONCA Iberoamerica) brings into focus the need for Central American nations to unite and engage in promoting a family medicine workforce to improve health. The region shares unique history and tradition of cooperation among their governments. Each country is at a different stage in family medicine training, from introducing the concept of primary care into the workforce to well-established family medicine pre-doctoral and residency training. During this presentation, representatives from Central American and U.S. programs that work in the area will share experiences and stimulate discussion for future collaboration and action. Topics include how to distinguish milestones and levels of family medicine workforce development, and defining opportunities for academic relationships and interchange.

Room Location: International Ballroom

Ultrasound in Global Health*

John Gibson, MD, FAAFP

Ultrasound skills are becoming an essential competency for the global health provider. Imaging options internationally are quite limited and ultrasound provides the best and most cost effective alternative. We will present a one-hour introduction to basic cardiac ultrasound using protable ultrasound equipment.

Thursday, September 8, 2016, 11:20 a.m.–12 p.m.

Room Location: Roswell

Training Opportunities in Global Health: The Gorgas Course and Beyond

Lynn Oliver, MD; and Anna McDonald, MD

Recent surveys of family medicine residents and recent graduates show a trend towards a strong commitment and interest in working in global health. Despite this emerging interest, limited time in residency allows for little opportunity to train in tropical medicine in the field. Although many residents and qualified physicians will work overseas and/or take care of patients who travel to, or originate from other countries, there are few opportunities for formalized training in tropical medicine. For those who wish to pursue further training in tropical medicine, there are several courses that allow for in-depth exposure to diagnosis and treatment of these illnesses, which allow qualification for a diploma in tropical medicine & hygiene (DTM&H). This session will include brief presentations by individuals who have completed such courses. Focus will be on the application process, daily activities, curriculum, and practical application of knowledge gained during these courses for those who have participated.

Room Location: Spring

Virtual Journal Club: A Unique Way to Expand a Family Medicine Collaboration in Western Kenya

Daria Szkwarko, DO; Kamau Peter Boro; Fadya El Rayess, MD, MPH; Olga Valdman, MD; and Patrick Chege, MD, MMEd

Through the Academic Model Providing Access to Healthcare (AMPATH)—a nearly 20-year-old academic consortium of North American institutions and Moi University in western Kenya–family medicine faculty and learners from the University of Massachusetts and Brown University are collaborating with Moi University Department of Family Medicine to help support and expand clinical education and primary care research. Since it is often challenging to have a constant ‘on the ground’ presence, we have created a virtual monthly journal club to discuss topics in family medicine and review study design and methodology. This presentation will review the logistical aspects of setting up a successful virtual journal club, will reveal some of the challenges, and will incorporate video interviews of our family medicine resident and faculty colleagues in western Kenya regarding their experiences with this virtual model.

Thursday, September 8, 2016, 2:15–3 p.m.

Room Location: Kennesaw

The Use of Osteopathic Manipulative Medicine in Global Outreach Programs*

Camille Bentley, DO; Brianna Anthony; and Charlie Escheverria

The goal of osteopathic manipulative medicine (OMM) is to improve the structure and function of the body and its innate self-healing mechanisms. In settings of limited resources, OMM is particularly useful and effective as a treatment for common musculoskeletal complaints, as well as other disease processes because there is no cost and no supplies needed. By using one’s hands to evaluate and treat, a physician can improve a patient’s function by optimizing the body’s structure as well as provide insight for more long-term improvement without the use of medication or diagnostic tests. It is particularly helpful in a global health setting because there is always something one can do, whether it is improve lymphatic flow, maximize respiratory excursion, or simply reduce tension and provide comfort. A few cases commonly seen on short-term medical outreach campaigns will be introduced and discussed.

Thursday, September 8, 2016, 4–5 p.m.

Room Location: Spring

Global Faculty Development Tool Kit

Fadya El Rayess, MD, MPH; Ann Evensen, MD, FAAFP; Daria Szkwarko, DO; Bill Cayley, Jr, MD, Mdiv; David Klee, MD, FAAFP; Olga Valdman, MD; and Esther Johnston, MD, MPH

Family medicine residencies, departments, and medical school clerkships are being developed in a number of low- and middle-income countries. Faculty development opportunities for family medicine faculty in these programs are often limited. It is not known how best to introduce, support, and improve faculty development in these settings. At the 2016 Society of Teachers of Family Medicine (STFM) conference, members of the group on global health formed a faculty development working group with the goal of developing resources and processes to support international faculty development, such as a faculty development resource kit tailored for use in low-resource settings. During this session, we will review existing faculty development resources available through the World Organization of Family

Doctors, STFM, and Consortium of Universities for Global Health. This will be followed by a large group discussion of gaps in the resources. Feedback from participants, including our international colleagues, will guide the next steps for the working group.

Friday, September 9, 2016, 9–10 a.m.

Room Location: Roswell

Advanced Rural-Global Medical and Surgical Resident Training Track

Zhanna Winchell, MD; Shivum Agarwal, MD; Charles Cassidy, IV, MD; and Stephen Twyman, MD

Family medicine physicians that perform more procedures and surgeries in their practice are well poised to help fill the growing global burden of unmet surgical and medical needs. However, few family medicine residency training programs offer the full breadth of procedural training that would meet the needs of the rural and globally underserved. This program aims to prepare full spectrum family medicine physicians to provide essential medical and surgical services in low-resource settings around the world by developing a surgical track as part of a full-spectrum family medicine residency program. Surgical patients are referred and track residents will learn to take care of these patients by working with general and specialty surgeons both inside and outside of the operating room. After completion of the surgical track, residents will be experienced in various general surgery, orthopedic surgery, urology, obstetrics/gynecology, and ultrasound procedures necessary in resource-poor areas.

Friday, September 9, 2016, 10:15–11:15 a.m.

Room Location: Kennesaw

Family Medicine: At The Frontier of an Urban City in Nigeria (West Africa)

Mofolasade Adeyi, MD

Traditionally, global health resources for sub-Saharan Africa have been targeted towards alleviating the burden of communicable diseases. However, with an increase in the urbanization of African cities, the health needs of the urban populace are quickly becoming apparent. Of the 70 percent of global deaths from non-communicable diseases–such as heart disease, stroke, cancer, mental health disorders–eight out of ten occur in low- and middle-income countries. Thus, there is an increasing need for for resilient and resourceful family physicians to practice in these settings. This presentation will discuss the major causes of morbidity and mortality in urban cities in sub-Saharan Africa, with a focus on Lagos, Nigeria. There will be group discussions around the practice of family medicine in Lagos, and the differences between practicing rural versus urban family medicine in sub-Saharan Africa. Potential opportunities to attain volunteer or rotational experiences will also be highlighted.

Friday, September 9, 2016, 11:20 a.m.–12 p.m.

Room Location: Inman

Family Medicine in Palestine: Opportunities for Involvement

David McRay, MD, FAAFP

Family Medicine was recognized as a discipline by the Palestinian Medical Council in 2010. Under the supervision of Dr. Samar Musmar, the first family medicine training program was begun at An Najah University. The program continues to struggle to find its footing in the complex health care situation in Palestine. In April 2016, the Ministry of Health sponsored a workshop in Ramallah to focus on ways to enhance the training of family physicians. Representatives from various parts of the health care sector, as well as from several other countries, participated in the workshop. In this session, we will look at ways for US family physicians to participate in this exciting educational opportunity.

Room Location: International Ballroom

Family Medicine in China: An Insider's Perspective

James Tian, MD and Chi Ma, MD

The Chinese government recognizes the value and need for family medicine within its medical system. However, implementing the needed changes has been met with challenges on many levels, such as gaining acceptance within the medical system; designing an effective training model; earning the trust of patients; financial issues among which salaries for family physicians is a major impediment; difficulty recruiting medical students; and others. Dr. James Tian trained as a psychiatrist in China, but when he learned of the new specialty of general practice (as family medicine is called in China), he was immediately drawn to it and sought training in it. He is convinced of the value of general practice for his country and fully aware of the hurdles family physicians achieving a fully integrated position within the medical system. He will share why China accepted general practice; a short history of the development of general practice in China and the model currently used; why it is so important for the people of China and what some of the solutions are for overcoming the problems that hinder its full implementation. He will also briefly discuss how a U.S. family physician can help the development of general practice in China. There are lessons to be learned from the Chinese experience that can be applied elsewhere. Discussion is encouraged and time for questions will be included.

Friday, September 9, 2016, 2:30–3:15 p.m.

Room Location: Roswell

Family Medicine Cares International: Improving Health Care in Haiti

Mary Jo Welker, MD, FAAFP; and Evelyn Lewis&Clark, MD, MA, FAAFP

Significant work has been accomplished over the past three years to further the development of family medicine in Haiti and improve the health of its people. Of particular note, the ongoing faculty development program continues in 2016 with a webex and also a trip in October. Family Medicine Cares International (FMCI) conducted its third delegation trip to Haiti in February 2016. The delegation of 26 individuals, including three FMCI resident scholars, was divided into three teams: patient care, service, and medical education. The patient care team treated over 1,300 patients at multiple sites throughout Haiti (the most since the earthquake). They also dispensed deworming medication to all patients and their families, thus impacting thousands of Haitians. In collaboration with the service team, they completed over 150 well-child visits at one of the schools. The service team improved conditions for over 400 children at two schools and one orphange. The medical education team presented two symposia on emerging diseases and women’s health. The two faculty development workshops were enthusiastically received. As a result, an ongoing faculty development training program for the two family medicine residency programs in Haiti has been developed and is being implemented through webex, small team visits, delegation trips, as well as electronic communications.

Room Location: Spring

Training the Trainers Where They Are Needed: Applying Multiple Methods of International Faculty Development in Family Medicine

Jeff Markuns, EdM, MD, FAAFP

Developing family medicine as a specialty is key to building improved primary care in many developing countries. A core group of academic physicians with expertise in primary care is necessary to train new family doctors. However, many countries lack this human resource capacity. Faculty development programs can help to address this need. This presentation will review multiple methods of international faculty development in family medicine to train these trainers, including fellowships, workshops, videoconferencing, and degree-granting programs. We will outline a variety of our own efforts and describe curricular approaches including goals and objectives, teaching methods, and evaluations. We will review barriers and successes of each method, and engage in group discussion to share others’ experiences in faculty development in family medicine. We will address the challenges and successes others have faced and compare or contrast with our own programs.

Friday, September 9, 2016, 4:15–5:15 p.m.

Room Location: Techwood


Developing Family Medicine in Ethiopia

Naheed Lakhani, MD, MPH

Background: The first family medicine training program in Ethiopia was launched on February 4, 2013, at Addis Ababa University to prepare full-spectrum doctors for Ethiopia. The program has faced challenges. A needs assessment was conducted in Ethiopia to enhance program success. Methods: Study components included interviews with program residents and faculty; observation of these clinical rotations (internal medicine, obstetrics and gynecology, surgery, pediatrics, and clinic); and review of prior assessments. Results were compiled into key program areas of curriculum, training, and evaluation. Results: Areas of improvement are summarized here. Curriculum-related areas of improvement included having an attendance policy and documenting work hours. Training-related areas of improvement included working with faculty to better integrate family medicine at rotation sites, improving training on physical examination skills, hiring and training more Ethiopian faculty. Evaluation-related areas of improvement included providing and obtaining scheduled resident feedback. A complete table of results will be in the final presentation.

Expansion of Family Medicine Residency Training in Ethiopia: Process and Progress

Ann Evensen, MD, FAAFP

Family medicine residency training in Ethiopia began at Addis Ababa University in 2012. The first seven graduates received diplomas in February 2016. Several graduates have been retained as faculty members in Addis. The Federal Ministry of Health is now in support of expansion of family medicine residency training to universities outside of the capitol. This presentation will summarize progress in the development of family medicine in Ethiopia and describe processes and relationships that have supported further expansion. Successful expansion of training sites will require partnerships between medical personnel, administrators, and communities to determine the best role for family physicians outside of Addis Ababa. Expansion will also require adaptation of systems and individuals to accommodate needs unique to family medicine residencies, including community-based, longitudinal, outpatient experiences, and team-based public health care.

Saturday, September 10, 2016, 9–10 a.m.

Room Location: Roswell

Developing Post-Graduate Family Medicine Curriculum Through Use of a Competency-Based Tool: Experience of a U.S., Cambodian, and Myanmar Collaboration

Laura Goldman, MD and Jeff Markuns, EdM, MD, FAAFP

In many low-resource settings, the focus in medical education has been on lectures and observation. Competency-based education attempts to shift the emphasis to doing, rather than observing, and employs more learner-engaged methods and emphasis on skills acquisition. We created a tool to write curriculum that was competency-based and then adapted it to each setting. In Cambodia, we used official government documents. In Myanmar, we based our curriculum on previous work done by the faculty. We held multiple faculty development workshops and engaged faculty in listing competencies, writing learning objectives, and choosing teaching and evaluation methods. The tool served to train faculty in competency-based education and resulted in a curriculum that was responsive to the local context. We will present the tool and evaluations of the workshops. We will discuss barriers to implementation. Copies will be available to participants who may want to apply it to their own work.

Room Location: Techwood

Global Health Opportunities after Residency: Perspectives from Recent Graduates

Daria Szkwarko, DO; Katherine Jarrell, MD; Chelsea Glass, MD; Mena Ramos, MD; Naushad Amin, MD; Annie Khan, DO; and Anna McDonald, MD

New global health opportunities for family medicine trainees after residency continue to emerge. Options range from global health fellowships to on-the-ground experiences like the Peace Corps Global Health Service Partnership (GHSP). This session will include brief presentations by several individuals who are currently involved or recently completed various post-residency programs. Opportunities to be discussed will include, but are not limited to: family medicine global health fellowships, GHSP, and the HEAL Initiative. Breakout sessions with presenters will enable attendees to ask specific questions and learn more about life after residency.

Saturday, September 10, 2016, 10:15–11:15 a.m.

Room Location: Spring

Saturday, September 10, 2016, 11:20 a.m.–12 p.m.

Room Location: Kennesaw

Consultation Follow Up for Family Medicine Training Development in Honduras

Ruben Hernandez, MD; Javier Sevilla-Mártir, MD; and Alexander Paz

For over a decade, Indiana University and other academic institutions have been in collaboration with Honduran institutions to provide global health opportunities for students, residents, and faculty, as well as at the national level in the consultation process to develop a structured family medicine program. There can be limitations in the continuity of a program design, despite the continuous interest by the organizations involved to create advanced changes. During this presentation, Honduran delegates will present the current state of the family medicine postgraduate project. Indiana University faculty will share the background, steps during the consultation process, current status, and opportunities to collaborate.