10/26/2010 PAEA Annual Forum October 2010 Abraham K, Carlson R, Quincy B, Schempp A, Trompeter J Shenandoah University Winchester, Virginia Describe the process of developing and organizing a university-sponsored medical mission trip. Outline the goals of the medical mission trip for the program, students, and patients. Delineate the roles of the different program faculty and d students t d t Discuss the effectiveness of the interprofessional approach in the clinic setting Identify the common challenges encountered in international medical mission trips The birth of an idea In 2005, campus chaplain communicated a desire for a health professions mission trip Meetings began in September 2005 for a trip in May 2006 Chaplain had a contact with El Ayudante, a missions agency in Nicaragua 1 10/26/2010 Initial goals Students evaluate patients with faculty oversight Include pharmacy students and faculty Planning g Process Recruited PA and pharmacy students, faculty and community physicians Consulted with NGO regarding the common types of health problems and the medications needed Lessons learned Need 9 months of planning Need for leadership team Fundraising challenges Specify medicine and supply donations Given the opportunity, students rise every time! Pre-trip Meetings à Information session Distribute applications & covenants à Team Lessons on Nicaraguan culture & language Medical training Team building Medications and Supplies à Inventory donations and make purchases à Packing day 2 10/26/2010 Execution Divided into 3 teams of 16 or 17 à 8 PA students; 2 pharmacy students; 2 PT students à 1 PA, 1 Pharmacy and 1 PT faculty member à 1 physician and 1 pastor Transported medications and supplies via individual suitcases El Ayudante planned the schedule and provided food, lodging, interpreters and ground transport Lessons learned Students do not like paperwork Collect money before committing to airline tickets Collaboration among students benefits all experience levels Organize every detail but be flexible Cooperation with Ministry of Health requirements aids with Customs clearance 3 10/26/2010 Provide quality health care and patient education Provide personal and professional growth Utilize faculty role-modeling Foster interprofessional approach Enhance cultural competence Promote sustainable change through preventative health education Maintain collegial relationship with El Ayudante Enhance the standing of El Ayudante with the y community Support El Ayudante’s bridge with Nicaraguan Ministry of Health Inspire life-long service to underserved populations Exposure to epidemiologic variations in low resource settings Provide quality healthcare to patients with limited access Benefit from faculty role-modeling role modeling Increase their understanding of the role of other health care disciplines in the health care team Increase confidence in their knowledge base and clinical skills Build lasting relationships with peers and future colleagues 4 10/26/2010 Be received with dignity and compassion Receive accessible health care at no cost Receive education on preventative measures to improve health To have positive interaction with health care providers Shenandoah University is United Methodist Affiliated Affiliation with El Ayudante One spiritual life leader for the trip Universal inclusion Pre-trip planning Ice breakers, thought provoking questions During trip Facilitate reflections, personal development and processing Devotions 5 10/26/2010 Pre-trip planning Fundraising Events Educate participants during pre-trip meetings ti Packing Day One PA faculty member per team Pre-trip planning Overall organization and supply order, coordination with NGO During trip Team T leadership l d hi Clinic logistics Coordinate with the interpreters, pharmacist Supervise/precept the PA Students Facilitate debriefing sessions One pharmacy faculty member per team Pre-trip planning Oversee packing day, medication order, formulary During trip Supervise pharmacy and pharmacy students Monitor medication needs between teams Purchase medications in country Coordinate treatment plans 6 10/26/2010 One PT faculty member for trip Pre-trip planning Application Process, order PT supplies During trip Supervise/precept PT students Coordinate with NGO for clinic locations Provide training for local healthcare personnel Facilitate debriefing sessions Coordinate treatment plans Prior to Trip During the trip Raise funds, packing day, pre-trip meetings Provide p patient care Support peers Participate actively in all activities Physician Assistant 3 Pairs of 1st and 2nd year Triage & direct patient care Pharmacy 2-3 students per team Dispense medication & therapy education Physical Therapy 6 students per trip Provide therapy in hospitals, schools for children with special needs, and medical teams Provide education for local healthcare personnel 7 10/26/2010 INTERPROFESSIONAL CLINICAL EDUCATION Collaborative approach to health care practice will improve health care delivery One way to accomplish this: Integrate g additional interprofessional p training g opportunities in education for health professionals à Institute of Medicine, 19881 à Shugars et al., 19912 à Council on Graduate Medical Education, 19943 à American Association of Colleges of Nursing, 19954 Simulate and facilitate interprofessional practice Promote awareness/understanding of other health professions’: Roles R l and d responsibilities ibiliti Scopes of practice Educational preparation Promote appropriate professional interactions Expand critical thinking skills/abilities 8 10/26/2010 Difficult to coordinate courses/schedules across programs Multidisciplinary ≠ I t Interprofessional f i l Difficult to simulate clinical environment in the classroom Courses Patient-Centered Cases à Western University of the Health Sciences, Pomona, CA à Rosalind Franklin University of Medicine and Science, Chicago, IL Basic B i Science S i and d Research R h courses Interdisciplinary Patient Care Experiences Community Health Centers/Free Clinics Mission Trips à Wachs et al, 1998; Brown et al, 2003; Goodrow et al, 2008 Students/professionals: observed other disciplines providing patient management performed patient examinations collaboratively communicated regarding most appropriate interventions for specific patients shared cases during debriefing sessions socialized during travel, meals, accommodations, cultural activities, etc. 9 10/26/2010 Participants had an improved awareness of/respect for the unique skills and scope of practice of each discipline “I really understand what it is that a PT has to offer offer” “I was so thankful to have the pharmacists there to check my dosing. I was really impressed with how they made drug substitutions based on availability and even compounded right there in the middle of nowhere ” Participants had increased comfort level with interprofessional communication “Traveling to Nicaragua with multiple disciplines made me realize how important it is to work together to fulfill the patients’ needs. As we worked k d side id b by side id with i h the h PA students, it made it easier to refer patients as well as discuss possible diagnoses in order to quickly develop a plan of care. The PA and pharmacy students took the time to teach me about examinations and how to decide on the different forms of medication appropriate for each patient.” Participants were more likely to make appropriate referrals. “I was challenged with opportunities to intervene with physical therapy that I would never have thought of if I had not been working side by side with my peers in that specialty.” “I am very thankful to have had the opportunity to work so closely with PT students and pharmacy students, and I hope that I am more aware of when a referral would be appropriate.” 10 10/26/2010 Patients received more comprehensive care “My experience with the PT and pharmacy students in Nicaragua allowed me to observe first hand how integrated our approach can be when choosing treatment options for patients. As a second year PA student, I had focused on more medical care up until that point. I felt that we were able to give more complete care to the people of Nicaragua, whereas years before, all we could offer for back pain or other orthopedic injuries was NSAIDs and counseling.” Cost Time Logistics 11 10/26/2010 Financing8-11 Accepting health risk9 Managing stress9 Accepting limitations8,9 g appropriate pp p Utilizing skill set, experience, responsibility8,9 Overcoming language and cultural barriers9 Accepting direct and indirect costs9 Ensuring improved care for host community9 Maintaining moral obligation and ensuring “First Do No Harm”9,10 Addressing gaps in local healthcare9 Maintaining standards of care in community11 Understanding limitations of acute focus11 Understanding the training level and experience of providers9 Coordinating logistics9 Facilitating orientation of participants9 Explaining mutual expectations8-11 Providing chronic disease management and follow up care11 12 10/26/2010 Ensure health disparities are not exacerbated or exploited9 “Patients must always be treated as ends in themselves, h l not means to another h end” d”10 Maintain goal of truly benefiting host and evaluate whether that is being achieved8,10 Promote partnering with community rather than medical tourism10,11 Work with existing medical and public health infrastructure10,11 Develop long-term partnerships with locals who want to help and need external help to function10,11 Find “local champion”10 Encourage mutual and reciprocal benefits9,11 Promote stability: faculty, host, location8 Reevaluate frequently:8 Are goals still being reached and how? 13 10/26/2010 1. 2. 3. 4. 5. 6. 6 7. 8. Using guiding principles and defined goals helps overcome the challenges and involved process of developing a successful medical mission trip. An interprofessional team approach h provides d better b patient care within h the limited scope. The end result is a mutually beneficial experience to patients and participants. Institute of Medicine. The future of public health. Washington, DC: National Academy Press;1988. Shugars D, O’Neil E, Bader J. America: Practitioners for 2005, An Agenda for Action for US Health Professions Schools. Durham, NC: The Pew Health Professions Commission; 1991. Council on Graduate Medical Education, US Department of Health and Human Services. Recommendations to Improve Access to Health Care Through Workforce Reform. Washington, DC: Health Resources and Services Administration; 1994. American Association of Colleges of Nursing. Position statement on interdisciplinary education and practice. Washington, DC.; 1995 Wachs J, Goodrow B, Olive K. Community partnerships: Education of health science students, service to the community. In B. Behringer (Ed), Involvement of Communities in Health Professions Education: Experiences from the Community Partnerships for Health Professions Education Programs, 1991 – 1997. Battle Creek, MI: W.K. Kellogg Foundation; 1998. Brown D, D Behringer B, B Smith P, P Townsend T, T Wachs J, J Stanifer L, Goodrow B. Graduate health professions education: An interdisciplinary university community partnership model. Education for Health.2003;16(2), 176 – 188. Goodrow B, Scherzer G, Florence J. An Application of Multidisciplinary Education to a Campus-Community Partnership to Reduce Motor Vehicle Accidents. Education for Health. 2004; 17 (2), 152 – 162. Suchdev P, Ahrens K, Click E, Macklin L, Evangelista D, Graham E. A model for sustainable short-term international medical trips. Ambulatory Pediatrics. 2007;7: 317-320. 14 10/26/2010 9. Crump JA, Sugarman J. Ethical considerations for shortterm experiences by trainees in global health. JAMA. 2008;300(12):1456-1458 (doi:10.1001/jama.300.12.1456) 10. Wall LL, Arrowsmith SD, Lassey AT, Danso, K. Humanitarian venture or ‘fistula tourism?’: the ethical perils of pelvic surgery in the developing world. International Urogynecology Journal. 2006;17:559-562. (doi:10.1007/s00192005-0056-8) 11. DeCamp M. Scrutinizing global short-term medical outreach. Hastings Center Report 37. 2007;6: 21-23. 15
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