Formation of Primary Care Competencies in the Ukrainian Evangelical Medical Project.

Abstract

Over the past 50 years, a number of residency programs have been established with medical missionary involvement in low- and middle-income countries across the globe. Current evidence supports the idea that faith-based organizations continue to play a part in health provision, especially in emerging economies and fragile health care systems.In Ukraine, income levels are among the lowest in Europe at approximately US $110 per month. Ukrainian family physicians have insufficient training in practical skills, holistic care, and evidence-based medicine, and less than 1% of family physicians are proficient in English. In 2017, only 3% of young physicians succeeded in passing a standardized Western-style examination.The Ukrainian Christian Mobile Medical Team (UCMMT) is a faith-based medical ministry that has been operating in Ukraine since 2002 under the umbrella of the international humanitarian aid organization “Hope in Action.” During this period, teams have conducted 300 outreach events across Ukraine, caring for approximately 80 000 patients. Currently, around 200 volunteers are involved with UCMMT, including 60 physicians. Assets of the program include 3 mobile units with medical equipment, including diagnostic ultrasound, a mammogram unit, an x-ray unit, and a laboratory providing hematological and biochemical analysis.UCMMT's priorities include assisting remote, poor, and underserved communities and caring for populations in areas affected by war and the Chernobyl nuclear accident. In collaboration with local health authorities and the Ministry of Health of Ukraine, UCMMT empowers local physicians through education and medical seminars. In addition, a curriculum has been developed to provide more formal education for team members who wish to attend educational activities on a regular basis. Assistance in the educational efforts has been provided by Radiologists without Borders, a US organization that provides radiology equipment and training to developing economies, and In His Image International, a family medicine residency in Tulsa, Oklahoma, whose leaders assist medical residencies internationally, and which recently accepted the Ukraine program into its core group of 10 residency programs the organization supports worldwide. The International Classification of Primary Care and the WONCA Global Standards for Postgraduate Family Medicine Education are used as curriculum resources.Since early 2018, 5 Ukrainian physician trainees are mastering 150 competencies in 30 areas of medical science with the goal of improving their performance on standardized tests by at least 20% compared to baseline. During outreach activities, these trainees evaluate 12 patients per day under the preceptorship of a senior physician. Problem-oriented learning and evidence-based medicine are used to facilitate professional growth. Trainees attend an average of 20 full clinic days per year, 5 hours of formal lectures and didactic activities per month, and an additional 15 hours of self-education per month.Due to the lack of financial support, only 30% of trainees can attend all available educational activities. A more formal scholarship award is being considered to sponsor some of the most active participants. The lack of a stationary clinic and an inpatient facility remains a barrier to broader educational opportunities for trainees. The funding of the existing work is sporadic and dependent on donations and grants from individuals and organizations.This formal education program for family medicine trainees, with support from US medical outreach efforts, has been effective in enhancing the professional development of a small group of physicians, with intended benefits for patient care and population health in a nation with a fragile health care system.