Bidirectional, Global Education Receives a Thumb’s Up
But how do we get there?
Bidirectional, global education within otolaryngology has garnered overwhelming support, but the roadmap for achieving it still needs work. During Wednesday’s session, “Expanding Humanitarian Medical Educational Outreach Using Bidirectional Approaches,” panelists will outline a path forward.
Session moderator Gregory J. Basura, MD, PhD, associate professor of otolaryngology at the University of Michigan School of Medicine in Ann Arbor, offers both hope and caution as the specialty moves forward.
“Bidirectional opportunities are critically important parts of effective medical partnerships,” Dr. Basura said. “If done well, they can serve generations of individuals and all involved. But if not carefully planned and clearly constructed, they can be detrimental.”
Historically, global training has created collaborative medical education programming that includes opportunities for trainees to receive experiences outside the usual confines of their home training program. Newer, bidirectional efforts between home and collaborative countries are rapidly on the rise. However, most lack clear processes, expectations, and competency metrics. As such, panelists will explore strategies for gauging education needs in global programs, discuss the pros and cons of the bidirectional approach, and share implementation tips.
In Dr. Basura’s case, his team engaged in medical outreach in Ghana for many years. That partnership, he said, allowed him to bring several Ghanaian physicians back to the University of Michigan to participate in its week-long temporal bone dissection course and to observe in the clinics and operating room.
“My current work is in Cape Town, South Africa, where we have established the first dedicated otology surgical training fellowship in Africa. I travel there twice per year and conduct weekly (every Friday) Zoom lectures with the fellow and the Cape Town residents to teach,” he said. “I am in the process of bringing the otology fellow here for a temporal bone course at the University of Michigan. These are examples of a bidirectional approach. This dynamic is common in many outreach initiatives across the globe where individuals go to a location and have providers from that location come to their home institutions to observe and train.”
Is it effective? Without competency metrics, Dr. Basura said measuring success is, “anecdotal and varies from initiative to initiative.” Yet, it does offer a new perspective.
“In my own experiences, these types of ‘trainee swaps’ provide an enhanced perspective on medicine, patients, the logistics of medical practice, and most importantly, a deeper understanding of cultural variety,” he said. “The impact that these programs make is not exactly measurable, but it certainly enhances the perspectives and skills of all involved.”
The session will offer attendees multiple tips for developing and managing bidirectional trainee programs, including gauging education needs. According to Dr. Basura, needs are typically determined by effectively communicating with the involved parties and seeing the needs first-hand with a visit. Dr. Basura said initial site visits are critical to appreciate what the primary needs and goals are on both sides and to generate a strategic plan to meet them.
“The needs must be clearly communicated first and then after a thoughtful needs assessment is established, an honest conversation about what is realistic in meeting those needs through outreach and bidirectional training can then take place,” he said.
In assessing the pros and cons of bidirectional education opportunities, Dr. Basura said this type of approach enhances experiences, builds deeper relationships, and improves skills and knowledge. Unfortunately, the downside is cost, possible “brain drain” with providers leaving their home country for a period of time, sustainability, and creating a relationship that is too dependent.
In offering a solution for sustainability, Dr. Basura said effective communication is crucial. He recommends outlining short-, mid-, and long-term goals for the project and highlight end goals.
“At that time, one must consider the financial costs and how to meet them and to identify what the end goals are,” he said. “You have to be careful not to promise too much and then not deliver on both sides and avoid creating a potential dependent relationship where costs and supply chain become expected. Goals and the endgame have to be clearly established.”
Participating panelists include Mark E. P. Prince, MD, Brent A. Senior, MD, and Merry E. Sebelik, MD.