INTEGRATED PLANNING OF INTERNATIONAL MEDICAL CLERKSHIPS:

THE ROLE OF THE UNIVERSITY

Silke AT Weber, Karina Chamma, Silvana S SchelliniInternational Office Botucatu Medical School, UNESP, Brazil

UNIVERSIDADE ESTADUAL PAULISTA UNESP UNIVERSIDADE ESTADUAL PAULISTA UNESP

BOTUCATU MEDICAL SCHOOL

� 2 Undergraduate Programs- Medicine - Nursing

� 10 Graduate Programs- Anesthesiology- General Bases of Surgery- Tropical Diseases- Nursing- Physiopathology in Internal Medicine- Gynecology, Obstetrics and Mastology- Pathology- Collective Health- Research and - Development in - Medical Biotechnology

Teaching Stages

University Hospital

70,000 m2 area417 beds52 ICU beds18 surgical rooms198 medical offices31 specialized rooms3 obstetric rooms

Hospital 2ary level

Basic Healthcare Units

Family Units

Municipal emergency (children and adults)

Internationalization

The promotion of global collaboration between and among educational institutions

� Enlarges educational and research scope and environments� Fosters the knowledge and tolerance of diversity� Fosters innovative thinking� Fosters cultural humility to improve health care to diverse populations� Improves international visibility and profile of the university� Attracts patients, students, residents, professors, researchers etc� Improves access to resources

� It should support institutional learning and growth (mission alignment)

Medical curriculum: facilities and difficulties for exchange programs

• Medical curriculum structured in 3 blocks:- basic sciences: 2 years- pre-clinical studies: 2 years- clinical rotationships (clerkships): 2 years

shift to short-term and faculty-led clerkships (learning abroad)

At Botucatu Medical School , UNESP- 5th year offers a period for optional programs- 6 blocks of clinical rotations 6 periods for exchange (1 /group)

Difficulties for mobility programs in medicine

� Legal aspects for clinical activities (“observer“ vs learning process)

� Accreditation of the activities realized in other institutions

� Language competencies (lectures/ clinical discussions; interaction with the patient)

� Costs/tuition fees for international programs (almost no fundings for short-term programs for under-graduates)

Exchange programs in medicine:what do we want to achieve and how?

http://www.psy.lmu.de/ffp_en/publications/ag_mandl/chapters/index.html

Six- Step Approach to Curriculum Development

Kern DE, 1998

•Step 1 Problem Identification and General Needs Assessment •Step 2 Needs Assessment for Targeted Learners •Step 3 Goals and Objectives•Step 4 Educational Strategies •Step 5 Implementation•Step 6 Evaluation and Feedback

• Step 1 Problem Identification - start international exchange for medical undergraduate students

• Step 2 Needs Assessment for Targeted Learners - recognize partner universities and bilateral tutors, study plans, find fundings, human resources

• Step 3 Goals and Objectives- integrate students in different health systems, promote integration of medical curricula/teaching scenarios, improve language skills, improve contact to research centers

Step 4 and 5 Implemented strategies

� Selection of partner intstitutions and tutors previously contacted , joint elaboration of teaching programs

� Assurance of accreditation of the activities

� Distribuition of the cooperation programs during the year for each goup having a chance of going abroad

� Financial support by the university (partial or complete funding, based on selection)

� Previous evaluation of English competencies

Partner institution-selection criteria

Required standards

�Ethics - good practice - patients safety (clinical, research), - student´s safety

�Quality assurance�Shared standards

- facilitate exchange/ acceptance- competencies defined clearly- transparent system- flexible interpretation

Outcomes

� 42% students exchange internship

� Long-lasting partnership s (longest program 5 years duration)

� Students experienced different cultures, including integration with foreign visitor students (housing, party, travelling etc)

� Students more open-minded for new models/experiences

� Students more motivated for new learning and long-life learning

� Familiarization with Medical English

� Incoming students increased 3 folds, coming from all over the world, not only partner universities

� Offering opportunities for African students, professors and residents for specific areas

A specific survey for incoming and outgoing gave feedback to theuniversity.For outgoing students:Previous advising improved with alumni involvement from 53.8% to73% (country) and 38.4% to 61% (exchange activities).Almost all learned about a different health systemAlmost all evaluated their language skills (English) as good, with no improvement or learning of local languageBut: No integration of curricular competenciesNo improvement of local languageNo patients interactionFew contact to local students

Step 6- Evaluation and Feed Back

The continuum of the clerkships strengthened the integration of the curricula; most programs are currently in their 5th year of application.

Universities have to constantly support and assess their academic exchange programs.

Faculdade de Medicina de Botucatu