Global health training: the consultant supervision perspective
Dr Georgina Phillips, Emergency Physician and Coordinator of International Programs, St. Vincent’s Hospital, Melbourne; Deputy Chair, International Emergency Medicine Special Interest Group, Australasian College for Emergency Medicine
Interest in global health (GH) and providing health care for those living in countries where medical services are often limited and basic is an ethical and educational imperative for doctors concerned with justice and equity.
Enabling junior doctors to have meaningful and rewarding experiences in such environments can lead to a lifelong commitment to global health practice and advocacy that benefits both resource rich and poor partners alike.
An example of a successful partnership for GH practice and training is the Visiting Clinical Lecturer Program (VCLP) at the Divine Word University (DWU) and Modilon Hospital in Madang, Papua New Guinea (PNG).
The program was set up in 2010 during a six-month sabbatical I had at DWU, and it drew on a longstanding network of emergency medicine (EM) support between Australia and PNG.
It enables advanced emergency medicine trainees to live at DWU and provide academic, clinical and bedside teaching for rural health students, and to work alongside PNG colleagues in the emergency department of the hospital.
The VCLP has been recognised as a valid site of training in emergency medicine by the Australasian College for Emergency Medicine (ACEM) when the placement lasts at least three months.
So far, six advanced trainees with the ACEM have completed accredited rotations to Madang, and a seventh is there now, prompting the ACEM to contemplate the possibility of more permanently acknowledging this PNG placement as an accredited site of EM training.
Of course, undertaking rotations in resource poor settings such as PNG comes with plenty of challenges.
Below are some of the key principles and lessons learnt in establishing and maintaining the VCLP, and how they relate to contemporary approaches and recommendations regarding global health practice and education.
Long term partnerships are crucial
One of the most significant aspects of the VCLP is the fact that the ACEM has recognised the hospital’s PNG-trained emergency medicine specialist as appropriate local supervisor of Australasian advanced trainees.
This acknowledgement of, and respect for, the local specialist has arisen out of a long-term relationship that has formed between the PNG and Australasian academic and emergency medicine communities, and which includes peer support, professional development, EM teaching and training, clinical exchange, research support, conference participation, exam preparation and co-assessment.
For the VCLP, the local PNG EM specialist co-supervises each trainee in conjunction with a remote Australasian FACEM, who has weekly web-based input.
The VCLP program is also a long-term capacity-building project, with a clear framework that trainees can contribute to over time.
Trainees benefit from clinical exposure, enhance their teaching and leadership skills, and gain crucial insights within a clear structure. For their part, the host organisations appreciate the practical assistance, the fresh educational exposure, and a growing body of teaching tools provided within a sustainable and consistent framework.
The importance of trainee selection, preparation and supervision
Careful selection of trainees, through recommendations, references and interviews, is crucial to ensure a successful placement.
Briefing should include not just practical information, but should also stimulate self-reflection, challenge preconceived notions, and refresh attitudes, to ensure an informed, compassionate and open-minded approach.
Structured learning objectives and a clear plan for local and remote supervision are essential, and in the VCLP these have been refined over time.
Trainees are regularly challenged clinically, professionally and personally when practising and living in PNG. Careful and thoughtful supervision is paramount to ensuring meaningful outcomes and an overall positive learning experience for the trainee.
Personal networks aid complex logistics
Investment in relationships at DWU and the Modilon Hospital with regular visits is crucial to obtaining necessary logistic support.
Practical considerations such as securing accommodation, transport and other matters consume time and energy, yet questions of lines of responsibility and risk management can remain difficult. For example, if ACEM is accrediting the rotation, who is responsible for an adverse event?
Recently, a three-way partnership has developed between the ACEM, the PNG hosts and Australian Volunteers International, which has incorporated the VCLP into an Australian Volunteers for International Development-supported position. This provides a far greater structure of support, administration, cost-bearing and risk management than was previously available, and has addressed some of the more difficult logistic issues.
Appreciation of global health educational value and outcomes
Trainees learn about global health through the direct experience of working and living in PNG.
Often more questions than answers arise out of a VCLP placement, stimulating deep, reflective thinking. Emergency medicine trainees who have come through the VCLP have acted to enhance their global health skills and knowledge through self-directed learning and by participating in international emergency medicine (IEM) networks. Providing a structured framework of global health learning around the actual, practical experience is the next step for the ACEM in curriculum development and IEM training.
Increasing opportunities for trainees to participate in meaningful, sustainable global health activities while ensuring there is support for appropriate preparation, as well as safe environments for effective practice and frameworks for valuable educational outcomes, is the challenge for all Australian professional training institutions in the future.