Tuesday, December 2, 2008

Day 3: Presenting in Cuba: A Digression on Medical Education

There is a maxim that I need to source one of these days: “all systems are perfectly designed to achieve the results that they actually achieve”. (Internet is $10/hour here in Cuba, so I may save the research until later). The conference is fabulous and oversubscribed (> 700 attendees), but the facility is not perfectly designed for such a number. So it is sometimes a little crowded; they didn’t make arrangements for such a number to tour hospitals and the medical school, and I was unable to get my name on the proper list to have that opportunity. Still, the atmosphere is electric. People from all over the world (I heard 22 countries, but I have no official word on who is here) are gathered to discuss the complexity of integrating social medicine (for want of a better word) into the lexicon of medical education. Each country faces challenges consistent with the way in which their health care system is designed. Cuba excels at this stuff: the Cuban schools are full of examples of students getting out there and helping folks throughout the island. Mexico, Philippines, Salvador, Argentina; all have curricula that enables medical trainees to engage communities in improving their own health. They are dealing with levels of poverty and access to resources at such low levels that we would find them unfathomable in the context of the United States. It is actually possible to measure some change in health outcomes as a result of the student’s activities in some cases. In many of the programs presented, they simply don’t have the time to gather much data. The is simply too much to do. (The picture is of Valerie getting ready for our presentation)
Our session is opening late, and will begin with a discussion of “Training of Trainers at the Higher Institute of Medical Sciences in Havana”, followed by three talks about the Cuban system: “The National Diploma Course in Medical Education”, “Public Health History Course for the History of Medicine Course” and Drug Abuse Prevention Strategy of the Medical Sciences University of Havana”. I am not sure how we fit into that context, but it will be interesting. I’ll post our presentation later, but I will try to capture the flavor of the three talks (in Spanish) that precede it.
We begin: “Project Majesterio” is PAHO project of the Union of Universities of Latin America to teach how to teach in collaboration with the School of Education. They noticed that the quality of teaching in medical school suffered because professors had not undergone training in how to teach. He pointed out that high school teachers had more training in how to teach than did the medical school faculty. Their project had three principles including a commitment to teaching humanism and social justice (if I caught the translation accurately). The training is rolled out throughout Latin America, with “sub-leaders” in various parts of South America. They are using internet and tele-training to make all of this happen. One of the sites for this work is in Ecuador; where they actually have separate tracks for treachers and what we would call educational scholars- folks who do evaluations of educational interventions. What is interesting to me is how our Faculty Development and Educational Scholars programs mirror this work. We also heard from Mexico, who emphasized their connection and the need for support from Cuba to make this curriculum happen in a real way. There they are trying to start a Masters program in Medical Education, to help them to establish a reputation in a country with a large number of other Universities that have focused primarily on research. In El Salvador, Nicaragua, Honduras and Panama have a collaborative approach to their faculty development, and again speak of the social problems of Central America in the mission of their organization. They ran their first course with the folks from Havana in 2002, and have had 24 graduates for far. They use a Virtual Platform that sounds a lot like our Virtual Learning Platform”, and have expanded out from El Salvador to the other 4 countries. Interesting, they have not spoken much abouthte specific curriculum: I wonder if they focus on the teaching of science or the teaching of communication skills, as we do in a lot of our work with the Clinical Faculty Development Center?
So adding it up, they have trained more than 500 faculty members throughout Latin America. (and 34 folks have traveled to Cuba for the same training), and now have a Center for Academic Development in Health, which has online courses. Impressive program, little data presented that show efficacy of the results.(they have a system in place, that collects a lot of information of people within Cuba, but less information is available in the other countries)
The first speaker was not present, but the second one went on. She described the development of a curriculum on the history of public health for the local medical school. They used this to help doctors develop a sense of their roles in an ongoing and proud tradition, both in European and Cuban medicine. The book that she developed sounds really interesting; I am often impressed by the ahistorical nature of our more science-based education.
After that we heard of about a drug prevention curriculum in the Cuban Medical school, that was developed because of concerns that the massive drug trade from South America to “El Norte”. Apparently, the problems with which they actually deal are addiction to cigarettes and rum (similar to what we were told many years ago), they screened, found more problems than they thought, and had reasonable success (self-report) in treating them. I was interested to hear that they have expert committees on drug abuse at all of the medical schools, when it sounded like they really done have much clinical experience in the problems.
Our talk was well received, and I got a certificate; that one gets framed. About 40 people in the audience- given that it is a nice day outside, we didn’t do so badly. (THe picture is of me presenting, and we heard nice things from a number of folks afterwards, so that was good)
After us, we heard from a fellow American about the barriers to care experienced by the African-American community in the United States, which was really more of an opinion piece than a curriculum. Following him was a great speaker from Brazil who involved high school students in a community based participatory research project. She billed it as a way to promote social cohesion, and she actually measured the elderly folks response to show that they felt more integrated after working with adolescents. Nice little study, but I wasn’t sure what it had to do with Medical Education.
So overall, the session was quite similar to a meeting in the United States. The striking difference was the lack of questions; I asked one (in Spanish), but noone else did. We were running close to 50 minutes behind schedule at the start, so perhaps people were reluctant to question so that we could get back on schedule. Also, two of the eight speakers weren’t present- not sure why. But the nature of the presentations was quite similar to other medical education meetings that I have attending; a strong emphasis on program description, and little data to show the effectiveness of the intervention. Our work in the Educational Scholars program in of critical importance. I think that I will close here, although there are more presentations coming. This post has grown long enough. More tomorrow, hopefully of more relevance to mental health services.

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