Medical Education Partnership Research Articles

Challenging the ordinary: A healthcare education partnership between universities in the UK and Egypt

Introduction: In 2016, a new university opened in Egypt that sought to ‘challenge the ordinary’ in a country with a long and rich heritage of knowledge production. Newgiza University (NGU), located adjacent to the ancient pyramids of Giza outside Cairo, launched with a foundational focus on health sciences, through undergraduate courses in medicine, dentistry, and pharmacy. Each programme was co-developed through an academic collaboration with University College London (UCL), a high-ranking, research-intensive, UK university. Methods: As the collaboration passes a key juncture of graduating the first cohorts of doctors, dentists, and pharmacists from these courses who embark on their professional careers, we examine and reflect on the journey to date. In particular, this article reviews the growing academic literature about international partnerships in medical education, describes how curricula, assessments, and management structures in the three NGU healthcare courses were adapted and finessed to fit the Egyptian context, and shares the lessons learnt by the academic leadership teams responsible for this challenging but stimulating collaboration project. Results: The collaboration between NGU and UCL is an example of an international education partnership approach that seems to be growing in popularity globally. The overriding importance of building trust and respect between partners was clear in this collaboration, as was the need for clear communication channels to guide the necessarily complex decision-making that underpinned it. Conclusion: Given inevitable power imbalances in such collaborations, critical examinations of their impacts on organisations, staff, and students are an important research priority in the future.

Global “systemness” in medical education: A rationale and framework to assess performance

Healthcare is global. The challenges of the “triple aim” – achieving high-quality healthcare, maximal value, and an excellent patient experience and outcomes – are universal. Medical education is similarly global with worldwide efforts towards competency-based reform, the adoption and adaptation of accreditation standards, and the expansion of international collaborations between healthcare organizations (HCOs). The focus of many of these efforts centers around recognizing education as a talent pipeline to serve local and global healthcare needs. Accordingly, many U.S.-based academic medical centres are pursuing an increasingly global footprint by developing international partnerships between HCOs. The educational leadership at the Cleveland Clinic (an HCO that has ventured internationally in Canada, the United Kingdom, and the United Arab Emirates) has adopted a “systemness” approach to medical education collaboratives. Systemness describes the ability of academic health systems to leverage existing structures, expertise, and other resources to address broadly shared educational needs across geographies, disseminate best practices, and ultimately improve the care that is delivered. The rationale for systemness, a concept derived from the healthcare administration and business world, affords the opportunity to achieve educational outcomes through synergy that exceeds the capability of any single component of a system. In this perspective, we posit a “systemness” taxonomy to be used to assess the performance and success of international collaborations in medical education and provide examples of its application to existing international partnerships in medical education. This framework is grounded in developmental assessment approaches, akin to those used in assessing learner performance, and defines levels of educational collaboration proficiencies, ultimately towards the alignment of these efforts with the health needs of the communities they serve. As global medical education collaboratives advance, ongoing assessment of existing partnerships and further research will be needed to define competencies and integrative activities that define high-performing medical education partnerships.

PEM Pandemic Pivot: A Hybrid Approach to Pediatric Emergency Medicine Training in Thailand Allows for COVID-era Flexibility.

Introduction:The COVID-19 pandemic poses challenges in maintaining global medical education partnerships, with travel restrictions and infection control concerns forcing program adaptation. The Pediatric Emergency Medicine Specialty Training and Accelerated Review (PEM-STAR) program is one such international collaboration which addresses education and training gaps in emergency care for children within Thailand. As an assessment of PEM-STAR’s ability to deliver consistent outcomes despite COVID-19 constraints, we compared program results for Cohort #1 (2018-2019, pre-pandemic) and Cohort #2 (2019-2021, spanning pandemic).Method:Oregon Health & Science University and Bangkok Dusit Medical Services implemented the PEM-STAR tandem physician-nurse curriculum in 2018. The cornerstone of the year-long course is a set of 22 PEM-specific topic modules, incorporating remote-accessible voiceover slide lectures, quizzes, and scholarly references to teach pediatric emergency medicine essentials. Content is reviewed via monthly teleconferences. Baseline and final assessments include written knowledge tests and high-fidelity simulation cases led by physician-nurse teams. Cohort #1 simulations were performed with evaluators in-situ using critical action checklists and validated teamwork assessment tools. Due to COVID-19 restrictions, Cohort #2 final assessments were hybrid; students completed Thailand-based simulations while Oregon leaders assessed and debriefed teams via videoconference.Results:Written exam scores for pre-pandemic Cohort#1 improved from 48.6% (95%CI 40.30-56.9) to 92.0% (95%CI 88.1-95.9) (p< 0.001). Cohort #2, during the pandemic, had scores improve similarly from 48.5% (95%CI 40.1-56.9) to 96.4% (95%CI 94.8-98.0) (p< 0.001). One-hundred percent of physician-nurse teams from both Cohort #1 and Cohort #2 achieved the program’s established passing score on final simulation testing: performing >85% of critical action items and scoring > 85% on the teamwork tool.Conclusion:The PEM-STAR design, with its emphasis on videoconferencing, web-based content, and asynchronous learning, required minimal modifications to maintain satisfactory knowledge and skill acquisition during the pandemic. Educational partnerships emphasizing these features have distinct sustainability advantages in times of global disorder.

Ten Years of a Trans-Pacific Medical Education Partnership—Training Globally to Serve Locally

Ten Years of a Trans-Pacific Medical Education Partnership—Training Globally to Serve Locally

Community partnerships in medical education: Narratives of medical students

AbstractWhile medical education has traditionally been designed, led and delivered exclusively by clinicians and academics, there has been an increasing shift towards diversifying actors involved in training future generations of health professionals. Public and patient involvement in learning increases the likelihood that learning is relevant to the communities we purport to serve. This article explores the experiences of medical students who were partnered with a community‐based organisation (CBOs) as part of the intercalated Global Health BSc at Imperial College London. Students involved in this programme highlight opportunities to understand the needs of communities they were placed with, beyond what is possible to understand in clinical practice; this is essential to support them in becoming holistic, patient‐centred practitioners. Students also found this opportunity helpful to gain insight into the role and value of the voluntary sector in healthcare and develop transferrable skills in project leadership and management. It is hypothesised that the benefits of this partnership extend to community‐organisations; they gain experience working with students, who provide an external view of their services and may be helpful in the delivery of quality‐improvement projects. Communities could also benefit from interactions with students by sharing insight into their needs and priorities, and in turn, shaping students’ priorities as future health professionals and co‐designers of voluntary‐sector initiatives within the community. Whilst the establishment of these partnerships does not come without its challenges, this article also highlights lessons for students and institutions undergoing similar programmes, including clarification of goals, stakeholder consultation, sustainability of interventions, voicing the community, timetable flexibility and funding.

Virtual Faculty Development in Simulation in Sub-Saharan Africa: A Pilot Training for Pediatricians in Kisumu, Kenya.

IntroductionSimulation is an effective educational tool increasingly being utilized in medical education globally and across East Africa. Globally, pediatric patients often present with low frequency, high acuity disease and simulation-based training in pediatric emergencies can equip physicians with the skills to recognize and intervene. Northwestern University (NU) in Chicago, IL, USA, and Maseno University (MU), in Kisumu, Kenya launched a predominantly virtual partnership in 2020 to utilize the Jaramogi Oginga Odinga Teaching & Referral Hospital (JOOTRH) simulation center for MU faculty development in simulation based medical education (SBME) for medical students.Materials and methodsEducational goals, learning objectives, and educational content were collaboratively developed between MU and NU faculty. Virtual sessions were held for didactic education on simulation pedagogy, case development, and debriefing. Mixed educational methods were used including virtual mentored sessions for deliberate practice, piloted case facilitation with medical students, and mentored development of MU identified cases. Trained faculty had the summative experience of an intensive simulation facilitation with graduating MU students. MU faculty and students were surveyed on their experiences with SBME and MU faculty were scored on facilitation technique with a validated tool.ResultsThere were four didactic sessions during the training. Seven cases were developed to reflect targeted educational content for MU students. Six virtually mentored sessions were held to pilot SBME with MU students. In July 2021, fifty students participated in a week-long SBME course led by the MU trained faculty with virtual observation and mentorship from NU faculty. MU faculty reported positive experience with the SBME training and demonstrated improvement in debriefing skills after the training. The overwhelming majority of MU students reported positive experiences with SBME and endorsed desire for earlier and additional sessions.Discussion and conclusionsThis medical education partnership, developed through virtual sessions, culminated in the implementation of an independently run simulation course by three trained MU faculty. SBME is an important educational tool and faculty in a resource constrained setting were successfully, virtually trained in its implementation and through collaborative planning, became a unique tool to address gaps for medical students.

Fostering Sustainable Biomedical Research Training in Mozambique: A Spin-Off of the Medical Education Partnership Initiative.

Background:The further development of research capacity in low- and middle-income countries is critical to the delivery of evidence-based healthcare, the design of sound health policy and effective resource allocation. Research capacity is also critical for the retention of highly skilled faculty and staff and for institutional internationalization.Objectives:We summarize the accomplishments, challenges and legacy of a five-year program to train biomedical researchers entitled “Enhanced Advanced Biomedical Research Training for Mozambique (EABRTM)”.Methods:A program conducted from 2015–2021 built upon the Medical Education Partnership Initiative to develop research capacity at Eduardo Mondlane University (UEM) and allied institutions. The project included design and implementation of postgraduate training programs and bolstered physical and human research infrastructure.Findings:The program supported development and implementation of UEM’s first doctoral (Bioscience and Public Health) and master (Biosciences) programs with 31 and 23 students enrolled to date, respectively. Three master programs were established at Lúrio University from which 176/202 (87.1%) and 107/202 (53.0%) students obtained a Postgraduate Diploma or master’s degree, respectively. Scholarships were awarded to 39 biomedical researchers; 13 completed master degrees, one completed a PhD and five remain in doctoral studies. Thirteen administrative staff and four biomedical researchers were trained in research administration and in biostatistics, respectively. A total of 119 courses and seminars benefited 2,142 participants. Thirty-five manuscripts have been published to date in peer-reviewed international journals of which 77% are first-authored by Mozambicans and 44% last-authored by Africans. Sustainability was achieved through 59 research projects awarded by international agencies, totaling $16,363,656.42 and funds ($ 7,319,366.11) secured through 2025.Conclusions:The EABRTM program substantially increased research and mentorship capacity and trained a new generation of biostatisticians and research administrators. These programmatic outcomes significantly increased the confidence of early stage Mozambican researchers in their ability to successfully pursue their career goals.

Prioritizing Asian Americans, Native Hawaiians, and Pacific Islanders in the U.S. Health Equity Agenda.

Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations are growing rapidly in the United States, yet AANHPIs remain understudied, overlooked, and misunderstood. During the COVID-19 pandemic, themes from the tragic history of anti-Asian bias and marginalization have resurfaced in a surge of renewed bigotry and xenophobic violence against AANHPIs. In this commentary, the authors discuss the role of medical schools in combating anti-Asian sentiment as an important step toward achieving health equity. Based on their collective expertise in health disparities research, medical education, and policy, they offer suggestions about how to disrupt the pattern of invisibility and exclusion faced by AANHPI populations. They consider ways that representative data, leadership in medical education, research funding, national policies, and broad partnerships can help address AANHPI health disparities.

The Opioid Awareness and Support Team: an innovative example of medical education and community partnership.

Implication StatementThe Opioid Awareness and Support Team (OAST) at the Memorial University Faculty of Medicine is a novel student-led initiative designed to supplement medical student learning related to opioid use disorder and the opioids crisis. OAST has focused on grounding educational initiatives related to opioid use disorder in the local community context, working with community partners, and bringing in individuals with lived experience. We present initial findings from an Opioid Education Day that suggest student-led supplemental education for medical students can improve student knowledge surrounding opioid use.

Teaching the social determinants of health through medical legal partnerships: a systematic review

BackgroundUndergraduate and graduate medical education often includes the social determinants of health, but questions remain regarding how best to ensure that trainees become empowered to take action on the social determinants of health in their future practice. The authors conducted a systematic review to better define the impact that educational programs centered on medical legal partnerships have on trainees’ knowledge, attitudes and future practice.The authors sourced data from PubMed, Web of Science, Index to Legal Periodicals, LegalTrac, Google Scholar, Academic Search Complete, Business Source Complete, SocINDEX, SSRN, and Proquest Social Sciences. Selected studies included those centered on Medical Legal Partnerships in undergraduate or graduate medical education and that measured outcomes of the participating trainees. Two abstractors independently extracted information about the study population, setting, design, intervention and outcomes.ResultsSix out of 483 studies met the inclusion criteria. One study highlighted four different MLPs, thus nine total MLP programs were included. Trainees included medical students as well as interns and residents from pediatrics, family medicine and internal medicine. Interventions ranged from didactic sessions, to advocacy projects, to hands-on community-based learning, to poverty simulation trainings. Benefits to trainees were wide in scope but all programs showed improvements in participants’ understanding, comfort, confidence, and/or abilities in identifying and intervening on the social determinants of health in their patients.ConclusionAs medical schools and residency programs are increasingly considering how to effectively teach trainees to understand and address the social determinants of health, the findings in this systematic review suggest that inclusion of Medical Legal Partnerships into training programs is an effective approach.

David Katzenstein and James Hakim-In Memoriam.

The world lost two wonderful doctors who devoted their lives to the fight against HIV/AIDS in Africa. Ironically, they both died of COVID-19 within hours of each other in late January in Zimbabwe. David Katzenstein, MD, began his career in the early 1980 s working with underserved populations at a Native Tribal clinic in New Mexico and with persons suffering from AIDS at the Haight Ashbury Clinic in San Francisco, conducted CMV research at the University of Minnesota, and then took a position working as a microbiologist at the University of Zimbabwe in Harare between 1985 and 1987. In 1989, David joined the faculty at Stanford University where he remained until his retirement in 2017. Dr Katzenstein, led many important clinical and translational research studies related to HIV. With his colleagues in the AIDS Clinical Trials Group (ACTG), he led studies that resulted in the approval of life-saving antiretroviral medications. David dedicated a major portion of his academic endeavors to study HIV drug resistance, serving as director of one of the Virology Specialty Laboratories for the ACTG for many years. He was a protocol team member and leader on several ACTG studies and served on numerous ACTG committees, including the Performance Evaluation Committee and the original Virology Committee. He was co-chair of ACTG 384 that dealt with protease and/or non-nucleoside reverse transcriptase inhibitors, and was one of the first investigators to call attention to the issues of drug resistance in Africa. Recognizing the disparate impact of HIV in resource limited settings, David was a pioneer in Global HIV Research, in the fields of perinatal HIV transmission prevention, and studying different approaches to optimize antiretroviral treatment and laboratory monitoring in various settings around the world. He worked diligently to bring laboratory technology to Zimbabwe. Following his retirement from Stanford in 2017, David became the director of the Biomedical Research Training Institute in Zimbabwe where he led the molecular diagnostics laboratory to support laboratory monitoring of community-based treatment programs. In all his work, David engaged researchers and trainees from different parts of the world. Generous with his time, effort and ideas, David was a cherished mentor for many young and mid-career physicians and scientists, now scattered throughout different academic institutions and agencies in the U.S. He nurtured careers of clinicians, basic and social scientists, while encouraging multidisciplinary efforts to tackle the global HIV pandemic. He worked tirelessly and with great joy, giving of himself without reserve. James Gita Hakim, MRCP-UK, Professor of Medicine, University of Zimbabwe College of Health Sciences, to COVID-19. Dr Hakim was an accomplished investigator who made seminal contributions in HIV treatment and prevention research. He was known internationally for his accomplishments as a research leader, a builder of African research capacity, a leader of modernizing medical education in Africa, and as a mentor of young African investigators. Dr Hakim was at the forefront of clinical research on HIV/AIDS in Africa for over 20 years. He founded the University of Zimbabwe Clinical Research Centre (UZ-CRC) in 2001 as a site for international clinical trials on HIV treatment and prevention. He was a leader in pivotal international clinical trials including the landmark HIV ‘treatment as prevention’ trial HPTN 052, the MRC-funded “Development of Anti-Retroviral Therapy in Africa” (DART) trial, and the ACTG “Prospective Evaluation of Antiretroviral Therapy in Resource Limited Settings” (PEARLS) study. These studies contributed to the knowledge needed for successful implementation of antiretroviral therapy in southern Africa. Dr Hakim was as Principal Investigator of the University of Zimbabwe's program, the Medical Education Partnership Initiative (MEPI) which serves as a model for medical education in Africa. He was as a representative on the International AIDS Society (IAS) Governing Council from 2016 to 2020 and on the World Health Organization Guidelines Review Committee, the UNAIDS Advisory Committee, and on program committees for IAS Conference on HIV Science, the Conference on Retroviruses and Opportunistic Infections (CROI). Dr Hakim was Co-chair of the World AIDS Conference, Amsterdam, Netherlands in 2018. James Hakim's life demonstrated how investment in biomedical research and modern medical education can pay large dividends and be transformative for Africa. The world is better for the lives you lived, David and James. May light perpetual shine upon you.

Design and Implementation of Postgraduate Programs in Health in a Resource-Limited Setting in Mozambique (The Lúrio University).

PurposeTo describe the strategies used to design and implement three postgraduate programs at Lúrio University (UniLúrio), a resource-limited setting, in northern Mozambique.MethodsWe conducted a longitudinal, descriptive case study from 2011 to 2018 in two phases: 1) needs assessment (2011–2012), 2) implementation strategies (2013–2018), taking into account innovations whenever necessary.ResultsSeveral obstacles and barriers to the establishment of postgraduate programs were identified. These included a lack of a core curricula aimed at postgraduate programs, shortage of human resources for teaching and mentorship, limited teaching and research infrastructures, limited financial resources, and lack of administrative capacity. With the support of the Medical Education Partnership Initiative (MEPI), three Master degree programs were designed and implemented. During the period of 2013–2018, UniLúrio enrolled 202 students, distributed as follows: Master degree in Tropical Medicine and Global Health (55), Master degree in Health Professional Education (99), and Master degree in Nutrition and Food Security (48). Of those, 152 (75.2%) obtained a Postgraduate Diploma as they did not present a master dissertation, 89 (44.0%) obtained their Master degree, 30 (14.8%) dropped out, and 20 (9.9%) are awaiting decision. UniLurio’s staff trained a Master’s degree or a Postgraduate Diploma in 34 (16.8%) and 15 (7.4%), respectively. Our strategies allowed us to improve research capacity building, and set the basis for long-term sustainability by allowing for the establishment of other postgraduate programs, and offered UniLurio a strong role in its internationalization.ConclusionBy sharing multiple resources, long-lasting partnerships were established with multiple institutions, and competency-based training and postgraduate studies management were developed. Research and eLearning were leveraged, retention and faculty development was enhanced, and some inequalities within the country were reduced. These strategies and innovations can be applied to other resource-limited settings, allowing the scaleup of health professional’s training and research capacity building.

Utilizing Virtual Exchange to Sustain Global Health Partnerships in Medical Education.

Integrating global health (GH) training in medical education has become prevalent in the United States over the last two decades. Many medical school graduates participate in some type of international learning experience during their undergraduate/graduate training, with plans to make this a part of their life-long learning experiences. Recognizing this trend, many pediatric national organizations, such as the American Academy of Pediatrics, the Association of Pediatric Program Directors, and the American Board of Pediatrics, have developed initiatives integrating GH education into existing curricula. We report our experience with using virtual learning on a cloud-based platform to remain connected with our GH training partners, and utilize this opportunity to further strengthen our existing relationships during the ongoing COVID-19 pandemic. Overall, our experience thus far shows that this is an effective way to maintain communication even when international travel is not possible. It allows for the ongoing exchange of ideas and the development of long-term sustainable relationships. There are many important lessons our trainees can learn from such partnerships.

Developing Graduate Medical Education Partnerships in American Indian/Alaska Native Communities.

Developing Graduate Medical Education Partnerships in American Indian/Alaska Native Communities.

Workplace-Based Assessment in Cross-Border Health Professional Education

Construct: The globalization of healthcare has been accentuated by the export of health professional curricula overseas. Yet intact translation of pedagogies and practices devised in one cultural setting may not be possible or necessarily appropriate for alternate environments. Purposeful examination of workplace learning is necessary to understand how the source or “home” program may need adapting in the distributed or “host” setting. Background: Strategies to optimize cross-border medical education partnerships have been largely focused on elements of campus-based learning. Determining how host clinical supervisors approach assessment in experiential settings within a different culture and uphold the standards of home programs is relevant given the influence of context on trainees’ demonstrated competencies. In this mixed-methods study, we sought to explore assessor judgments of student workplace-based performance made by preceptors sharing a pharmacy curriculum in Canada and Qatar. Approach: Using modified Delphi consensus technique, we asked clinical supervisors in Canada (n = 18) and in Qatar (n = 14) to categorize trainee performance as described in 16 student vignettes. The proportion of ratings for three levels of expectation (exceeds, meets, or below) was calculated and within-country group consensus achieved if the level of agreement reached 80%. Between-country group comparisons were measured using a chi-square statistic. We then conducted follow-up semi-structured interviews to gain further perspectives and clarify assessor rationale. Transcripts were analyzed using thematic content analysis. Results: The threshold for between-country group differences in assessor impressions was met for only two of the 16 student vignettes. Compared to Canadian clinical supervisors, relatively more preceptors in Qatar judged one described student as meets rather than exceeds expectations and one as meets rather than falls below expectations. Analysis of follow-up interviews exploring how culture may inform variations in assessor judgments identified themes associated with the profession, organization, learner, and supervisor performance theories but not their particular geographic context. Clinical supervisors in both countries were largely aligned in expectations of student knowledge, skills, and behaviors demonstrated in patient care and multidisciplinary team interactions. Conclusions: Our study demonstrated that variation in student assessment was more frequent among clinical supervisors within the same national context than any differences identified between the two countries. In these program settings, national sociocultural norms did not predict global assessor impressions or competency-specific judgments; instead, professional and organizational cultures were more likely to inform student characterizations of performance in workplace-based settings. Further study situated within the specific experiential learning contexts of cross-border health professional curricula is assuredly warranted.

A customized adherence enhancement program combined with long-acting injectable antipsychotic medication (CAE-L) for poorly adherent patients with chronic psychotic disorder in Tanzania: A pilot study methodological report

Chronic psychotic disorders (CPDs) occur worldwide and cause significant burden including reduced quality of life and functional impairment. Care for CPD includes psychosocial and pharmacologic interventions (i.e. antipsychotic drugs) and ongoing health monitoring. This is challenging in resource-limited settings where staff are sparse and/or undertrained. Importantly, mental health human resource needs predict continued deficits compounded by increasing disease burden. A U.S. team recently developed and tested a CPD treatment approach that combines the use of long-acting antipsychotic medication (LAI) with a brief and practical customized adherence enhancement behavioral intervention (CAE-L). This report describes the methodological details of an ongoing, first-ever refinement and preliminary testing of CAE-L in poorly adherent patients with CPD in Tanzania. Additional innovative elements include: 1) a manualized curriculum that targets specific barriers and facilitators to medication adherence in Tanzanians with CPD, and 2) targeting known, high-risk individuals with CPD (those who miss ≥20% of prescribed antipsychotic medication). The study procedures are intended to pave the way for implementing a large-scale intervention trial for CPD in the Tanzanian setting. An important component of this project is capacity building to help form the next generation of care providers. Visit exchanges modeled on a successful NIH-funded Medical Education Partnership Initiative (MEPI) template will also use the U.S. and Tanzanian teams to share expertise, problem-solve, and plan iterative refinements of project deliverables. Taken together, this project has potential to advance the care of people with CPD in Tanzania and has high generalizability to Sub-Saharan Africa and other lower-resource settings.

OC 8566 THE UNIVERSIDADE EDUARDO MONDLANE AND UNIVERSITY OF CALIFORNIA SAN DIEGO PARTNERSHIP, A PARADIGM FOR INSTITUTIONAL AND HUMAN RESOURCES CAPACITY BUILDING

BackgroundCollaborations between lower- and middle-income countries (LMICs) and high-income countries (HICs) are often scientifically and structurally driven by the HICs. Here we aim to describe a paradigm shift in collaboration, exemplified by the collaboration between the Universidade Eduardo Mondlane and University of California, San Diego through the Medical Education Partnership Initiative (MEPI), in which the formulation of priorities and administrative infrastructure reside in the LMICs.MethodsWe outline critical features of the MEPI partnership and compare with traditional models of collaboration, key features of success, lessons learned and the way forward.ResultsLMIC programme partners translate broad programme goals and define metrics into priorities tailored to local conditions. Programme funds flow to a LMIC-based leadership group that contracts with HIC-based peers to provide technical and scientific advice and consultation in a reverse funds flow model. Emphasis is placed on strengthening administrative capacity within LMIC institutions and on creating communities of practice with common goals that resulted in expanded collaboration with European, Latin American, and African institutions. A rigorous monitoring and evaluation process modify programme priorities based on evolving opportunities to maximise programme impact.Over five years, more than 63 research projects were designed, 19 of which received external funding and more than 40 manuscripts were published. Mozambican first-authored publications rose from 29% in 2001–2010% to 38% in 2011–2013.Eighteen (18) residents completed internal medicine specialty training between 2010 and 2014. This represents a fourfold increase from over 1991 to 2000. Three (3) Master’s programmes were created at Lurio University and 50 students successfully finished dissertations.ConclusionVesting LMIC partners with the responsibility for programme leadership and building administrative capacity in LMIC institutions substantially enhances programme relevance, impact and sustainability, and facilitates continuing acquisition of research and training funds to support professional development and institutional capacity building.

Closing the Gaps on Medical Education in Low-Income Countries Through Information & Communication Technologies: The Mozambique Experience.

Medical training in developing countries has continuously faced challenges to produce the needed number of cadres and maintain the needed quality standards. Mozambique, a low-income country in Southern Africa, has a major disparity in distribution of medical doctors in the country and only a small proportion are trained as specialists and/or retained as faculty. In this context, we thought that Information and Communication Technologies (ICT) are an attractive tool to support expansion of medical training and residency programs and designed a strategy for its use to promote changes in the learning environment of a university teaching hospital in this country. Beginning in 2010-under the Medical Education Partnership Initiative between Universidad Eduardo Mondlane, Mozambique, and University of California San Diego, United States of America - we conducted extensive interviews to 21 UEM faculty and medical trainees to assess barriers to education and medical care at the major referral hospital in Mozambique. Then, changes were made to address the issues raised mainly through building an ICT infrastructure to improve connectivity, improving access to medical information, distributing communication and mobile medical devices, as well as fostering exchange between students, residents and faculty members. These changes were tracked years after to evaluate adoption. Internet access with large bandwidth and devices such as tablets and computers were distributed to increase access to medical information. The students: resident ratio improved from 13:1 to 5:1 at the end of the project. Additional 25 new faculty members were involved in clinical training, mainly through incentives such as faculty development courses and research training. Teleconferences and other exchanges using ICT have evolved from being used as a platform for weekly clinical rounds and case discussions, to become a day-to-day tool for implementation of quality improvement processes and research projects. New exchange programs between local and foreign institutions were fostered to create a growing network with over 20 institutions at the end of the program. Importantly, these changes persisted beyond the project, and constituted a driver for transformative education and distance learning. Context-tailored use of ICT and mobile medical devices transformed medical education by improving the learning environment, addressing scarcity and low quality of trained doctors in a low-income setting of Africa. This strategy has the potential to reduce health disparities and contribute to achieving universal health coverage. Efforts to guaranty sustainability and health professional's retention are warranted.

Making the Learning Continuum a Reality: The Critical Role of a Graduate Medical Education-Continuing Medical Education Partnership.

A true continuum of learning in physician education, envisioned as the seamless integration of undergraduate, graduate, and continuing medical education that results in lifelong learning, has yet to be realized. Rapid clinical change, evolving systems of health care, and a shift to competency-based training make the continuum and lifelong learning even more critical. Because they function independently, the efforts of Graduate Medical Education (GME) and Continuing Medical Education (CME) have fallen short of the integrated ideal. The complementary threads of accreditation requirements, expertise, resources, and scholarly activities provide an opportunity for GME and CME to operate in a more integrated and coordinated fashion. Our local GME-CME partnership model demonstrates that these complimentary threads can be tied together to effectively facilitate lifelong learning and promote an integrated learning continuum.

The Medical Education Partnership Initiative: Strengthening Human Resources to End AIDS and Improve Health in Africa

Faced with a critical shortage of physicians in Africa, which hampered the efforts of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Medical Education Partnership Initiative (MEPI) was established in 2010 to increase the number of medical graduates, the quality of their education, and their retention in Africa. To summarize the accomplishments of the initiative, lessons learned, and remaining challenges, the authors conducted a narrative review of MEPI—from the perspectives of the U.S. government funding agencies and implementing agencies—by reviewing reports from grantee institutions and conducting a search of scientific publications about MEPI. African institutions received 11 programmatic grants, totaling $100 million in PEPFAR funds, to implement MEPI from 2010 to 2015. The National Institutes of Health (NIH) provided an additional 8 linked and pilot grants, totaling $30 million, to strengthen medical research capacity. The 13 grant recipients (in 12 countries) partnered with dozens of additional government and academic institutions, including many in the United States, forming a robust community of practice in medical education and research. Interventions included increasing the number of medical school enrollees, revising curricula, recruiting new faculty, enhancing faculty development, expanding the use of clinical skills laboratories and community and rural training sites, strengthening computer and telecommunications capacity, and increasing e-learning. Research capacity and productivity increased through training and support. Additional support from NIH for faculty development, and from PEPFAR for health professions education and research, is sustaining and extending MEPI’s transformative effect on medical education in select African sites.