International Medical Education: Do we have a responsibility to help?

James D. Smith, MDProfessor Emeritus

Outline for Workshop

Why Teaching? The Need Opportunities Preparation Rewards

Who Was the Ultimate Teacher?

Jesus the Teacher!

What example did he leave for us?– Servant attitude– Who did he teach?

Pharisees and Lawyers – Faculty? Disciples – Residents? Crowds – Medical students? One on one – John 20:16 Mary

Magdalene exclaimed “Teacher”

Jesus the Teacher!

Other than teaching what was one of Jesus most frequent activities?– Church planting?– Feeding the

hungry?– Healing?– Other miracles?– Fishing?

Jesus the Teacher!

What effect did healing have on the recipient?– Thankfulness and praise – Luke

17:15-16 One healed leper out of ten returns

– Joy – Act 3:8 the crippled man healed by Peter

– Mark 2:1-12 Knowing Jesus could heal brought people to him for healing, but their sins were also forgiven

What Makes a Good Teacher?

“Someone who loves his subject and loves his students”*

*John Patrick

Why Might We be Reluctant to Consider Teaching? Don’t like public

speaking Not sure how to

prepare a lecture Lack of self

confidence Takes to much

time Students don’t

appreciate your efforts

Why be a Teacher?

Build into others lives

Share experiences with others

Leave something behind when we are gone

We are all Teachers!

We teach by:– Example and

modeling– Attitude– Influence– Demonstration

Do We Want to be a Positive or Negative Influence?

We will be influencing a generation of young people!

What are Some of the Needs in the World?

Upper Third

Income

Middle Third Income

Lower Third

Income

The most affluent one third – Excellent health care– Excellent education

The middle one third – Want to improve

medical education and training

The lower one third – Aspire to reach a higher

level– Needs are

overwhelming

What are Some of the Needs in the Least Affluent One Third?

What is the Need for Medical Personnel in the World? Africa

– 11% of the world’s population

– 24% of the global burden of disease

– Has 2-3% of the world’s health care workers

– Uses 1% of the world’s health care dollars

– 40% of the hospitals in Africa are mission hospitals

– 60% of the health care is given in mission hospitals

Why Aren’t There More National Doctors?

THE BRAIN DRAIN!– Zambia has retained <10% of the 600

doctors trained between 1978-1999– Ghana lost 630 doctors between 1993 –

2002 and over 11,000 other healthcare professionals

– A recent survey of Nigerian medical students showed that >60% plan to emigrate

– In 2007, 17,620 African doctors and nurses joined the National Health Service in the UK

OPPORTUNITY!

What would you do if:

You only made $1000/month or less? You had to worry about your personal safety

and that of your family on a daily basis? The only job available when you finish training

would be a small hospital in Churchill, Manitoba?

When you go to work, basic medicines and surgical supplies are not available?

A recruiter from the US offers you a job that solves all these problems?

Would you or I stay?

How can Training Health Care Workers be Translated to Missions?

You can multiply your hands Demonstrate the Love of Christ

– Attitude in patient care– How you treat others – patients, nurses,

cleaners We can teach medicine, but nationals

may be better able to reach their own people for Christ because they know the culture and the language

How can Training Health Care Workers be Translated to Missions? Why not just do

direct patient care?– Rewards are

more tangible– Instant

gratification– But what

happens when you leave?

– In teaching you can do both!

How can Training Health Care Workers be Translated to Missions?

Medical missions can be an iffy business– If you are the only physician at a

mission hospital what happens when you go on furlough, leave the field or retire?

– What if your visa is not renewed?– What if there is civil unrest and you

have to leave?

Where Am I Coming From? Peace Corps doctor

in Kenya Academic staff at

OHSU Visiting Professor at

the National University of Singapore

CMDE conference MEI

Opportunities

Most countries will welcome teachers who are willing to share knowledge– Closed or creative

access nations– Short term – 1-4

weeks

Opportunities

Most countries will welcome teachers who are willing to share knowledge– Medium term – 2-

12 months– Long term – 1

year or longer– Invited Speaker

Opportunities

Medical Schools/Training Programs– Basic Science– Research– Clinical– Students– Residents/

trainees Specialties Family Practice

Opportunities

– New Medical Schools – few or inexperienced teaching staff

– Special needs Curriculum

development Problem Based

Learning

Opportunities

Medical Schools/Training Programs– CME

ACLS and ATLS Lectures to

National Physicians

Leaving a legacy…

PAACS Graduates

Nineteen thus far & more in 2011

All are practicing in Africa

Two are being trained as pediatric surgeons

We have 34 training in 6 hospitals at present

Goal – To train 100 surgeons by 2020

Individuals involved

Jim Jewell – Thoracic surgeon

Jana Bacote – Head of Surgery, Aga Khan Hospital in Nairobi, Kenya

Bill Bevins – Head of Family Medicine Department, Kabul, Afghanistan

Opportunities

Paramedical Fields– Nursing –

Education specialists

– Village Health Workers

– Emergency Medical Technicians

– First Responders

Opportunities

Paramedical Fields– Audiology

Opportunities

Paramedical Fields– Speech Therapy– Physical Therapy– Occupational

Therapy

Preparation

When should I do this?– Student?

Preparation

When should I do this?– Resident?

Preparation

When should I do this?– Early Career?

Preparation

When should I do this?– Mid Career?

Preparation

When should I do this?– End of Career?

Preparation

Specialty Training?– Credentials

Board certified Academic position

– Education courses

– Practice! Practice! Practice!

Preparation

Missions– May require theological or biblical

training– Short term trips– Read biographies of missionaries– Get involved with your church

mission board– Attend mission conferences

Cultural Considerations Short term vs long term You may be viewed as a threat “You are eating out of my rice

bowl” Cachet of being a foreigner Losing face Visas and medical licenses Teaching may be acceptable

Cultural Considerations How can I

overcome potential negative impressions?– Remember God

has given us so much

– Be thankful– Share– Don’t have a

superiority complex

Cultural Considerations

Be sensitive to your hosts– Culturally

Respect their taboos

Respect government prohibitions

Cultural Considerations Be sensitive to

your hosts– Medical

knowledge – may be inferior to ours, but?

Lack of or outdated texts available

Poor teaching techniques

Lack of experience

Paucity of equipment

Cultural Considerations

What can I do?– Start small– Ask a lot of

questions– Learn from and

observe what your hosts do

Cultural Considerations

What can I do?– Don’t be critical

of their techniques

– Develop trust and be truthful

– Acceptance and respect will come

What Do We Have to Offer in Medical Education Attitude – servant

model, approachable

Interact with students in class room and patient care

What Do We Have to Offer in Medical Education Encourage

questions Allow hands on

not just observation

Demonstrate a methodical and evidence based approach

What Do We Have to Offer in Medical Education

Model patient care

Demonstrate and help residents with patient care

What Do We Have to Offer in Medical Education Encourage

residents to ask for help

Make friends of students, residents and faculty outside the hospital

REWARDS!

REWARDS!

Opportunities to show Grace Opportunities to show the Love of

Christ Students and residents will be more

likely to ask about your beliefs Influence the next generation of

physicians– Medical knowledge– Caring attitude for patients

Model teaching as a worthwhile career

What Can We Learn From Scripture?

“The harvest is plentiful, but the workers are few. Ask the Lord of the harvest, therefore, to send out workers into his harvest.”

Matthew 9:37-38

What Should be Our Motive?

Our overriding reason is to show the love of Christ

I Peter 3:15 – Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have. But do this with gentleness and respect.