The Global Challenge of Teaching Clinicians to Be Teachers

by JHI Staff on March 24, 2013

I was just in Istanbul at the “Leading Change in Emerging Health Markets” conference that Johns Hopkins Medicine International co-sponsored with the International Finance Corporation, a subsidiary of the World Bank. One of the topics that was on a lot of people’s minds there—as it often is on mine and those of my colleagues and our collaborators—is what it takes to help a country develop a sufficiently large, skilled pool of clinicians (nurses and physicians). When building a hospital or health care system in emerging markets, project architects often rely too heavily on recruiting clinicians from other regions of the world.

Looking regionally or globally to find talent is often necessary, and can provide a workable solution to local shortages of clinicians. We do exactly that with many of our projects around the globe. But it’s neither a complete nor a long-term solution. A sustainable, high-quality, safe health care system requires access to home-grown clinicians. Countries that rely too heavily on importing those skills for too long will risk chronic shortages of talent, higher costs, and less-than-perfect matches between local culture and the sort of care provided by the system. This approach can cause us to miss out on meeting one of our main objectives—sustainability.

Ideally, every country would have good schools of medicine and nursing, as well as good opportunities for residency, fellowships, mentoring and ongoing education. We’re trying to help Malaysia establish exactly that sort of pipeline with our Perdana University project. In countries where academic medical centers aren’t yet fully developed, we enlist a variety of approaches to try to close the gap, including sending our faculty to our collaborations around the globe to participate in everything from grand rounds to workshops to teaching in a formal class setting. We supplement those efforts with videoconference education and meetings, and we bring clinicians from our affiliates to Baltimore for weeks or even months of exposure to our education and hospital practices.

But in the end, if we really want to do a good job, we have to go beyond educating clinicians. We have to help clinicians become educators who later help others become good clinicians. We have to train the future trainers, to ensure sustainable results and improvements. That’s one of the most important things we do, and that any health care system can do.

I think an article by Richard Gunderman in The Atlantic online a few months ago got at this issue very nicely. Gunderman, an astoundingly multi-credentialed physician-researcher at Indiana University, noted that even in the U.S. medical schools don’t always fully succeed in transmitting the necessary passion for education to doctors in the making. As he puts it:

A school can provide the perfect curriculum, state-of-the-art instructional methods, and unimpeachable testing, yet do a poor job of educating future physicians....One ingredient missing from this account is the creativity, commitment, and inspiration of medical educators....Like the practice of medicine itself, great education means establishing a relationship between human beings.

We try very hard to help our collaborators build health care cultures that foster these sorts of mentoring relationships between experienced clinicians and those who need training. It’s an ongoing challenge, and though I’m proud of what we’ve accomplished so far, I hope we keep getting better and better at it.

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