Global Health Scholars Program - Cali, Colombia

Global Health Scholars Program - Cali, Colombia

Goals and Objectives

Site: Cali, Colombia

Director:Deborah D. Proctor, MD

I. Introduction

By placing physicians in the developing world, we hope to instill a sense of global citizenry...

The Yale University International Health Program was founded in 1981 by Drs. Michele Barry and Frank Bia in an attempt to inspire a more global vision of health care in a traditional internal medicine residency program. By placing physicians trained in the US face-to-face with the broad range of health care needs in the developing world, the Yale International Health Program (IHP) hoped to instill a sense of global citizenry and create local and international community activists in health.

The Yale/Johnson & Johnson Physician Scholars in International Health Program was conceived in 2001 with the goals of expanding the existing Yale IHP to physicians in residency training from leading U.S. hospitals and universities, and offering overseas opportunities to more experienced career physicians.

With the move from Yale to Stanford of Co-Director Michele Barry, the Yale/Stanford Johnson & Johnson Global Health Scholars Program now selects the most promising residents and career physicians, primarily from Yale and Stanford, to rotate to one of six carefully selected sites overseas. The Program focuses on building educational capacity with these partners.

In addition, this program maintains a strong alumni network to promote future partnerships between host countries, universities and physician scholars in international health.

These rotations offer unusual opportunities for residents to enrich their knowledge and practice of medicine in settings with few resources. A study of Yale graduates of this program confirmed that IHP physicians were more likely than their counterparts to demonstrate social concern within their clinical practices as measured by their commitment to serve poor and immigrant populations.

[Global Health Scholars Program, accessed April 8, 2014.

II. Overall Roles and Expected Duties of the J&J Global Health Scholar

1. The overall roles and expected duties of the visiting J&J Scholars to the Cali, Colombia site is to provide clinical care and to provide medical education to the local practitioners. Therefore, the Scholars' primary roles are as clinicians and educators.

2. Scholars will be based primarily in a hospital setting caring for inpatients and secondarily in outpatient clinic settings. J&J Scholars work side-by-side with experienced clinicians who are immediately available to answer questions.

3. J&J Scholars will give at least two formal lectures over the course of the six-week rotation, as well as have many more informal discussions on rounds and on the wards.

4. Although most of the physicians in Cali, Colombia speak English, patient care and ward rounds / discussions are in Spanish, so the J&J Scholar needs to be fluent in Spanish for this rotation.

III. Overall Goals and Objectives of the Rotation

1. To learn how medicine is practiced in international settings.

2.To gain clinical experience with diseases that are commonly evaluated and managed in Colombia, including, but not limited to the following:

Tuberculosis

Malaria

Other tropical diseases

Autoimmune disorders

These illnessesoccur in a higher prevalence in the Colombian population as well as with different manifestations and present at more advanced stages of disease.

IV. Specific Goals and Objectives of the Rotations

I. Internal Medicine Residents

A.Hospital Universitario (Hospital del Valle)

This is a large, tertiary care general hospital that is the main teaching hospital for the Universidad de Valle (HUdV) and is located in Cali, Colombia. The J&J Scholar will spend the majority of his/her six-week rotation at this institution.

1.Sala de Hombres / Sala de Mujeres

These are two open bed wards, one for men (hombres) and one for women (mujeres). The main focus of the Scholars' rotation on these inpatient units is on patients with infectious diseases, including tropical diseases, and autoimmune disorders.

The J&J Scholar is expected to follow in depth 5-6 patients each day, including, but not limited to the evaluation and management of these patients, including writing notes in the patient records. Patient care is under the direct supervision of an attending physician.

The J&J Scholar is expected to participate in the discussion about each patient on the wards and in depth about the patients he/she is following.

The J&J Scholar should plan on spending two weeks on one of these wards. Ward rounds start at 7:00 AM Monday - Friday and the Scholar is expected to be on time. Rounding occurs mainly in the morning, leaving the afternoon to admit patients and/or attend an outpatient clinic, e.g., Tuesday afternoon resident clinic.

2.Medico Intermedio

This is an inpatient ward that is equivalent to the YNHH step-down unit. It houses approximately 21 patients. The acuity of disease is higher in the Medico Intermedio and there tends to be more patient turnover. The main focus of the Scholar's rotation on this unit is on patients with infectious diseases and other tropical diseases as well as general medical illnesses in sicker patients, e.g., diabetes.

The J&J Scholar is expected to follow in depth 3-4 patients each day, including, but not limited to the evaluation and management of these patients, including writing notes in the patient records. Patient care is under the direct supervision of an attending physician.

The J&J Scholar is expected to participate in the discussion about each patient on the wards and in depth about the patients he/she are following.

The J&J Scholar should plan on spending two weeks on the Medico Intermedio. Rounds start at 7:00 AM Monday - Friday and the Scholar is expected to be on time. Rounding occurs mainly in the morning, but given the higher acuity of illness in the patients on this unit, it is unlikely that the Scholar will be able to attend an outpatient clinic in the afternoon.

3.Consulta Externa (Clinic)

This is a general medical outpatient clinic that residents attend on Tuesday afternoons. The J&J Scholar will be expected to attend this clinic when he/she is on the Sala de Hombres / Sala de Mujeres rotation, but not when on the Medico Intermedio rotation (unless there is time to do so).

This clinic occurs in the Hospital Universitario's (Hospital del Valle) main building. The J&J Scholar will be expected to evaluate 3-4 patients in an afternoon under direct faculty supervision.

4.Medicine Urgencias (Emergency Room for IM patients)

This is a very busy emergency room where internal medicine patients are triaged for their care. The patients can stay in this unit for a short time (and be admitted urgently or discharged home), or more commonly stay for extended lengths of stay as they wait for an open bed on one of the medical units.

The J&J Scholar will take overnight call here - once a week and for two weekend days during the six-week rotation.

The J&J Scholar will evaluate patients in a timely fashion that he/she is comfortable with doing in order to deliver safe and appropriate medical care. Patient care is under the direct supervision of an attending physician.

5.Rheumatology Elective

Inpatient rheumatology consults onthe general medicine wards, medical ICU, and step-down unit take place daily in the morning. The J&J Scholar is expected to follow in depth 5-6 patients each day, including, but not limited to the evaluation and management of these patients, including writing notes in the patient records. Patient care is under the direct supervision of a rheumatology attending physician. The J&J Scholar is expected to participate in the discussion about each patient on the inpatient service and in depth about the patients he/she is following.

Rheumatology outpatient clinic takes place two afternoons per week. The J&J Scholar will be expected to evaluate 3-4 patients in an afternoon under direct faculty supervision.

6.Education

a. Formal Presentations:

The J&J Scholar is required to give at least two formal presentations during their six-week rotation in Cali, Colombia. This will consist of a PowerPoint presentation on a topic relevant to local Colombian medical practice. In addition, presentations to nurses and other auxiliary staff are encouraged and welcome.

b. Informal Presentations:

The J&J Scholar is expected to participate in the discussions that occur on daily rounds as well as give informal discussions to other residents and medical students on the ward teams.

B.Fundacion Valle de Lili

This institution is a private tertiary care hospital located in Cali. Transplantations - bone marrow, liver, heart and kidney - are all performed here. The J&J Scholar may choose to rotate here, but should do so for no more than one week.

The main focus of the Scholar's rotation at this hospital is on patients with infectious diseases. The Infectious Disease service is a consult service and rounds on 20-30 inpatients per day in the mornings. There is an afternoon clinic dedicated to patients with infectious diseases.

The J&J Scholar is expected to participate in the discussion about each patient on the inpatient service and in depth about the patients he/she is following.

C.Hospital Duarte Cancino (HDdC)

This is a small modern hospital located in a very poor section of Cali. The patients receive primary care and some secondary care here. There is a large outpatient and emergency department. The main focus of the Scholar's rotation at this hospital is on providing primary care to patients.

The Scholar's rotation will be combination of inpatient and outpatient care under the direct supervision of an attending physician. The Scholar may choose to rotate here, but should do so for no more than one week.

D.DIME Clinic

This institution is a private referral clinic / hospital located in Cali. The main focus of the Scholars' rotation at this clinic is on patients with cardiac and neurologic disorders as well as interventional radiologic procedures. The J&J Scholar may choose to rotate here, but should do so for no more than 2-3 days. Patient care is under the direct supervision of an attending physician.

II. Emergency Medicine Residents

A.Hospital Universitario (Hospital del Valle)

This is a large, tertiary care general hospital that is the main teaching hospital for the Universidad de Valle (HUdV) and is located in Cali, Colombia. The J&J Scholar will spend all of his/her six-week rotation at this institution.

1. Emergency Department

There are several separate, very busy emergency units where patients are triaged for their care - medical, surgical, etc. The surgical / trauma emergency unit is further subdivided into blunt vs. penetrating trauma.

Patients can stay in these units for a short time (be admitted urgently, go to the operating room, or be discharged home), or more commonly stay for extended lengths of stay as they wait for an open bed on one of the inpatient units.

The J&J Scholar will evaluate patients in a timely fashion that he/she is comfortable with doing in order to deliver safe and appropriate medical care. The J&J Scholar is expected to participate in the discussion about each patient on the unit and in depth about the patients he/she is following. Patient care is under the direct supervision of an attending physician.

The J&J Scholar should plan on spending two weeks in one or more of these units and in fact may choose to spend the entire six-week rotation in the different emergency units. Rounds start at 7:00 AM Monday - Friday and the Scholar is expected to be on time.

The J&J Scholar will take overnight call here - once a week and for two weekend days during the six-week rotation.

2. Orthopedics

There are orthopedic units dedicated to the care of patients with orthopedic problems, both trauma and non-trauma related. The main focus of the Scholar's rotation on these inpatient units is on patients with orthopedic disorders.

The J&J Scholar is expected to participate in the discussion about each patient on the wards and in depth about the patients he/she is following.

The J&J Scholar may choose to rotate on one of these wards (or one of the surgical wards), but should do so for no more than two weeks on one of these wards. Ward rounds start at 7:00 AM Monday - Friday and the Scholar is expected to be on time.

3. Surgery

There are surgical units dedicated to the care of patients with different surgical problems, including appendicitis, diverticulitis, trauma, etc. The main focus of the Scholar's rotation on these inpatient units is on patients with these surgical disorders.

The J&J Scholar is expected to participate in the discussion about each patient on the wards and in depth about the patients he/she is following.

The J&J Scholar may choose to rotate on one of these wards (or one of the orthopedic wards), but should do so for no more than two weeks on one of these wards. Ward rounds start at 7:00 AM Monday - Friday and the Scholar is expected to be on time.

4. Education

a. Formal Presentations:

b. Informal Presentations:

The J&J Scholar is expected to participate in the discussions that occur on daily rounds as well as give informal discussions to other residents and medical students on the ward teams.

III. Pediatric Residents (or Med-Peds)

A.Hospital Universitario (Hospital del Valle)

This is a large, tertiary care general hospital that is the main teaching hospital for the Universidad de Valle (HUdV) and is located in Cali, Colombia. There is a well-established pediatric residency program (nine residents per year) and infectious diseases fellowship at this hospital. The J&J Scholar will spend all of his/her six-week rotation at this institution.

1.Pediatric Infectious Disease Ward

This is an inpatient, 14-bed ward that is staffed by pediatric interns, residents, and fellows under the direct supervision of two pediatric infectious disease attendings. Patients are admitted to this ward after being stabilized during an initial admission to the Pediatric Urgent Care Ward. Admissions commonly present with diagnoses of HIV, tuberculosis, parasites, or other infections or tropical diseases not responding to standard management in the Urgent Care Ward.

The J&J Scholar is expected to participate in the discussion about each patient on the wards and in depth about the patients he/she is following.

Teaching sessions take place daily in the afternoon. The J&J Scholar is expected to be on time for rounds in the morning and afternoon teaching sessions.

2.Pediatric HIV Clinic

Pediatric patients with congenital HIV are cared for in this clinic staffed by attendings and fellows. Care in the clinic is multidisciplinary with social workers, therapists, and pharmacists on site. Clinic takes place every weekday afternoon. The J&J Scholar will participate in this clinic during the rotation in the Infectious Disease Ward. The J&J Scholar will be expected to evaluate 3-4 patients in an afternoon under direct faculty supervision.

3.Pediatric Urgent Care Ward

Pediatric patients initially present to the hospital through this unit. They are managed here unless they require an intensive level of care. Patients are admitted hereand can stay in this unit for a short time (and be admitted urgently to the hospital or discharged home), or more commonly stay for extended lengths of stay until a bed is open and/or they are stable for admission to the Pediatric Inpatient Ward or the Pediatric Infectious Disease Ward.

The J&J Scholar will take overnight call here - once a week and for two weekend days during the six-week rotation.

4.Pediatric Intensive Care Unit

This unit cares for pediatric patients who typically require intensive care. [As of August 2014, none of our J&J Scholars have rotated here, so no further comments can be made.]

5.Pediatric Inpatient Ward

This is an inpatient ward that cares for pediatric patients. [As of August 2014, none of our J&J Scholars have rotated here, so no further comments can be made.]

6. Education

a. Formal Presentations:

b. Informal Presentations:

The J&J Scholar is expected to participate in the discussions that occur on daily rounds as well as give informal discussions to other residents and medical students on the ward teams.

IV. Other rotations

The J&J Scholar may choose to rotate on one of the other units in the Hospital del Valle, such as toxicology. If the Scholar wants to do so, this will need to be discussed with Dr. Proctor before going to Cali and appropriate contact physician established.

V. Evaluations

1. The J&J Scholar will be evaluated by the faculty at each of the hospitals and clinics that he/she rotates in. A composite evaluation will be submitted by Dr. Jaime Holguin, or one of his designates, to the J&J Global Health Scholars Program Office upon completion of the six-week rotation in Cali, Colombia.