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The Journal of Health, Population and Nutrition
icddr,b
ISSN: 1606-0997 EISSN: 2072-1315
Vol. 28, Num. 6, 2010, pp. 533- 536
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Untitled Document
Journal of Health Population and Nutrition, Vol. 28, No. 6, December,
2010, pp. 533-
536
COMMENTARY
Global Health Education: International Collaboration at
ICDDR,B
Omar A. Khan1, Mark Pietroni2, and Alejandro Cravioto2
1Department of Family Medicine, University of Vermont College
of Medicine, Burlington, Vermont 05405, USA and 2ICDDR,B, GPO Box 128, Dhaka
1000, Bangladesh
All correspondence should be addressed to: (Reprints are not available from
the authors) Dr. Omar A. Khan Department of Family Medicine University of Vermont
College of Medicine Burlington, Vermont 05405 USA Email: omar.khan@uvm.edu
Fax: 802-656-3353
Code Number: hn10069
ABSTRACT
The purpose of this commentary is to provide an overview of the growing interest
in global health education at ICDDR,B and to review examples of how this
has grown from public-health research and education to include clinical
education
(medical and nursing) as well. This parallels the growth of the institution,
with an increased focus on educational linkages within and beyond Bangladesh
and the rise in interest in global health at western medical schools. Specific
collaborations, their setup and structure are described. This is presented
as a model for other centres of excellence in developing countries to engage
their partners in the South and North on matters of education and research
for mutual cooperation and benefit.
Key words: Collaborations; Health education; Public health
The global nature of public health has been recognized for decades, if not
centuries. ICDDR,B, based in Dhaka, Bangladesh, has played a significant role
in research and innovation in the global public-health arena, historically
in the areas of child health and diarrhoeal diseases, and more recently in
broader care, including maternal and child health and HIV/AIDS. There has,
in recent years, been an increasing emphasis on clinical care delivered at
the institution as well, primarily through the main hospital. To parallel this
change, there is unprecedented interest in clinical global health at U.S. medical
schools and for the desire to seek international medical electives in the developing-world
setting.
Most U.S. physicians will either serve international patients through travel-related
medical needs and/ or work directly with those who do not reside permanently
within the country (1). Coupled with increasing globalization, this presents
an opportunity
for clinical practice outside one’s borders—both geographical and
the boundaries of traditional medical training, which typically deal with the
diseases of the surrounding community. Meanwhile, interest in global health
among U.S. medical students has increased dramatically. The percentage of medical
students participating in international electives has increased from 6.4% in
1984 (2) to 23.1% in 2007 (1). Due to expanding undergraduate opportunities,
matriculating medical students increasingly have prior international experience,
and 20-30% of medical students go overseas (3). Of 116 United States allopathic
schools surveyed in 2010, 79 had active student interest groups pertaining
to global or international health (4).
According to the Consortium for Universities in Global Health, “[t]he
last 20 years has seen an unprecedented interest in global health among faculty
and students in North American universities. The response of universities could
not keep pace with the level of enthusiasm and demand …” (5).
ICDDR,B hosts a number of well-established programmes, including Fogarty
scholarship recipients, which bring students from the USA and other countries
to conduct
research for Masters and PhD programmes, usually in collaboration with institutions
in the students’ home countries. However, until recently, there have
been no similar programmes in clinical medicine.
RECENT DEVELOPMENTS IN
EDUCATIONAL COLLABORATION
As the institution has increased in size and scope, so have its educational
collaborations in the country and the region. A significant change has come
about in engaging
those at the training phase of their career. As an example, a linkage with
the Bangladesh-based James P. Grant School of Public Health of BRAC University
has
been formalized, and the ICDDR,B’s Executive Director serves a dual role
as the School’s Associate Dean. This enables the institution’s staff
to teach courses in their area of expertise at the School, in areas such as epidemiology,
clinical trials, and health policy. In this sense, the partnership mirrors that
of the U.S. Centers for Disease Control and Prevention and nearby Emory University.
Public-health practitioners, by taking on a faculty role, remain engaged in an
intellectual activity while engaging with learners and faculty members in an
academic environment. Clearly, the students benefit greatly by learning from
those in practice.
Within its hospital, ICDDR,B has recently established formal residency-style
training programmes for its junior medical and nursing staff with the aim of
improving the quality of clinical care and growing ‘in-house’ the
next generation of senior staff. Such programmes are unique in Bangladesh and
now take their place alongside the institution’s equally unique research
training activities.
Simultaneously, formal and informal arrangements with international universities
have been developed. One such example is the close collaboration with an
American university, i.e. the University of Vermont College of Medicine (UVM).
Faculty
members at UVM were familiar with the work of ICDDR,B through their own training
and work there. As such, the institution was an ideal location to form a
relationship with due to its presence in the capital city of Dhaka; the clinical
volume
available; the opportunities for mentorship and teaching; and language not
being a significant
barrier.
The relationship between ICDDR,B and UVM was formalized via a Memorandum
of Understanding (MoU). The application process is formalized as well and
consists
of the potential
trainees completing the standard ICDDR,B application for short-term training.
Faculty members at both institutions review the applicants and select the
ones most likely to be prepared for and to benefit from the experience;
3-4 students
a year are selected for a one-month clinical elective. Trainees are usually
at the end of their medical school education and about to enter residency
training, usually in family medicine or paediatrics. Pre-rotation preparation,
education,
and logistics are coordinated by the global health curriculum director
at UVM while in-country arrangements are organized by the Student Welfare Officer
at
ICDDR,B.
OPPORTUNITIES
In general, the collaboration on clinical education has worked well. As one
example of a collaboration between a centre of excellence in a developing world
(ICDDR,B)
and a western university (UVM), the initial preparation and formalization were
conducted in a thoughtful and transparent manner. Much of the success can thus
be attributed to (a) process factors and (b) personnel factors.
In terms of process, having a uniform and standard MoU at the outset is useful
and establishes trust. Mutual agreement on selection criteria for students
and the roles and responsibilities of each institution need to be clarified
well
before the first student applies. Similarly, the application process requires
coordination between the host institute’s (ICDDR,B’s) training
or education division, counterpart directors at either end, student coordinator
at the host centre, and the applicant. We have found a standard pre-elective
checklist to be very helpful, and this has, in fact, been refined and modified
with the experience of each successive student.
In terms of personnel, establishing a working relationship between the counterpart
faculty and course directors is essential. ICDDR,B has been a home, at some
point or another, to a large cross-section of those working in global health,
wherever
they may currently be based. As such, these relationships can be harnessed
for maximum effect for the benefit of educational programme development. In
the case
above, the key personnel involved are in touch with all critical points relating
to students’ participation. This carries over into the post-elective evaluation
where a candid appraisal of the experience, from the mentor’s and the student’s
perspective, is important for maintaining high quality and continuous programme
improvement.
Potential issues and barriers should make themselves visible to be solved
quickly. As an example, until ICDDR,B had an on-site student coordinator, this
role
was handled by the counterpart directors, individual preceptors, and training
division
personnel. In reality, the presence of a student coordinator is one we would
highly recommend. This
individual serves as a pre-arrival liaison and a critical coordinator of the
experience once the student starts. Issues addressed can include housing, where
to meet for rounds, and what research opportunities might exist. This tends
to make the experience a great deal more uniform across students; it also can
identify
issues before they arise.
In any collaboration involving trainees in a developing setting, security
concerns inevitably arise. ICDDR,B has the good fortune to be located in an
area of
relative peace and calm; certainly no worse than any megacity in the developed
world.
It also hosts many western expatriates, working and living alongside their
Bangladesh-based colleagues. This environment presents inherent advantages
and has helped sustain
trainees’ interest despite conflicts elsewhere in the South Asia region.
In our experience, the combination of an excellent professional experience
and a well-coordinated programme are key to an overall successful rotation;
this
has been observed elsewhere as well (6,7).
FUTURE DIRECTIONS
Building educational collaborations in clinical care has been an important
step for an institution classically steeped in a research tradition. It has
also facilitated
the global health education of successive cohorts of medical students from
the University of Vermont and elsewhere. This collaboration has allowed ICDDR,B
to
expand a ‘culture of education’ in clinical staff, which remains
a work in progress. At the same time, while the majority of work at ICDDR,B
may remain in research activities, it is likely that this will, in the near
future,
more equally balance the classic academic tripod of research, teaching, and
service (i.e. clinical work).
The advancement of the size and scope of the ICDDR,B hospital have facilitated
medical educational opportunities mentioned above. An additional and important
area is nursing, a critical health profession which Bangladesh is in short
supply of. The institution has established a similar international link with
the Faculty
of Nursing Education at Trondheim University, Norway, under which around
10 nursing students spend a month at ICDDR,B each year.
From the developed-country perspective, increasing global engagement means
a greater emphasis on global health education and service (8). This has
positive implications for further intellectual and financial support of such
initiatives,
which are likely to grow in the near term (9).
CONCLUSION
Educational collaborations, whether South-South or North-South, hold great
potential for all parties involved. This commentary highlights some points
of importance which made this collaboration succeed. It also suggests that
no one area progresses in isolation: as ICDDR,B’s mandate has grown overall,
so have its interests in education and clinical care grown, along with its
historic excellence in research. This has fortuitously paralleled the interest
at UVM and elsewhere in global health. Thus, the formation of such collaborations
can actually serve as a lens through which to view such progress as a whole,
to the mutual benefit of the partner institutions, the trainees, and ultimately
the communities they serve.
ACKNOWLEDGEMENTS
The authors thank Dr. Beth Kirkpatrick, University of Vermont College of
Medicine, USA, for her valuable comments on a draft of this manuscript.
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