In this issue:

  Videoconferences help HMI faculty connect with Indian health care providers to share knowledge

  In Zimbabwe, nurses prepare to welcome hospital’s first patients

  Dresden medical educators celebrate success—and plan future progress

  HMI Bookshelf: Recent publications help spread knowledge

  AMC nurses build skills during visit to Harvard-affiliated hospitals

  New executive education program to address European health care policy and management

Videoconferences help HMI faculty connect with Indian health care providers to share knowledge
Indian physician observes advances in radiology in Boston

Harvard Medical International and Sri Ramachandra Medical College and Research Institute are separated by over 8,000 miles, with a time difference of ten and half hours. But this geographical divide has not kept the long-time partners from maintaining their close and productive relationship. In the past year, they have held videoconferences that allow physicians and educators in the Harvard Medical School community to communicate advances in primary care to interested health care providers in India.

In October, Dr. Marvin Harper of Children’s Hospital presented on the topic of pediatric respiratory illness.

To date, five videoconferences have taken place, with HMS-affiliated physicians presenting information on a range of common problems faced by generalists and specialists in the region, including HIV care, obstetric medicine, cardiovascular disease, and pediatric respiratory infection. The topics are chosen based on the interests of the physicians there and the community’s needs. “Each of the programs has been held in conjunction with a local professional society representing a medical specialty,” said Dr. Krishna Seshadri, assistant professor of medicine at SRMCRI and a key driver of the program. The speaker’s voice and image are projected to India via inexpensive IP-based videoconferencing equipment, while both the lecturer and the audience in India follow a PowerPoint presentation provided by the speaker. The lectures usually run for 45 to 60 minutes and are followed by a question-and-answer session and a discussion of cases provided by the audience in Chennai. It is a didactic session that allows seamless interaction across the continents.

Seshadri said the programs have been extremely well received. “The quality of the presentations, the case-based format, the high-technical quality of the program, and the lack of commercial bias have received special praise from the participants.”

Dr. Harvey Makadon, HMI vice president for health systems, points out that videoconferencing helps save both time and money, and the presentation format is efficient and informative. “Our partners in Chennai are very appreciative of this program and its effectiveness, and the Harvard-affiliated faculty who have participated have enjoyed the opportunity to learn more about the challenges facing their counterparts in India,” he said. “Of course, this program depends on technical coordination on both ends, and that support has been excellent. We hope to develop more low-cost, high-impact learning experiences that can help increase the value of our partnerships.”

Dr. P.M. Venkata Sai, associate professor of radiology at Sri Ramachandra Medical College (SRMCRI) in Chennai, India, visited Boston in December in the capacity of a visiting professor and learner at Brigham and Women’s Hospital (BWH). Under the direction of Dr. Carol Benson, professor of radiology and co-director of ultrasound at BWH, Sai observed and studied advances in the applications of ultrasound technology for the evaluation of high-risk pregnancies and the use of interventional procedures for the management of related disorders and complications.

Dr. Sai developed and is currently director of the ultrasound unit in Sri Ramachandra Hospital. He hopes that his experience at BWH will help him to foster improvements in and to expand the capabilities of the diagnostic and interventional obstetric ultrasound service in the medical center at Ramachandra. “In India we have been planning for long time to do interventional procedures, and I was excited to see it is done in a matter of minutes at BWH,” he said.

Dr. Sai’s visiting professorship was sponsored by the academic alliance of SRMCRI and Harvard Medical International, and is a product of the long-standing interinstitutional agreement to collaborate in teaching, learning, and research. The agreement was ratified in 1997 and then extended in 2002 without limit of time.

In Zimbabwe, nurses prepare to welcome hospital’s first patients
Ekusileni Medical Centre (EMC) in Bulawayo, Zimbabwe is readying its programs, staff, and health systems for a phased opening set for early 2004. In November, a team from HMI that included Elizabeth Brown, RN, MSN, HMI director of clinical services, visited the new hospital to conduct a series of training sessions.

In November, a team from HMI visited Zimbabwe to work with the growing EMC staff to prepare the hospital.

Like many other countries, Zimbabwe is experiencing a nursing shortage, and the profession itself suffers from a lack of prestige and recognition, despite the efforts of nursing professionals to advance their learning and expand their roles in patient care. Brown, working with Rosemary Chitura, EMC chief of patient care services, and Becky Ndubiwa, director of nursing, delivered a one-day interactive workshop for EMC’s newly recruited nursing staff. As Chitura said, the goal of the workshop was to “infuse hope and empowerment in a group that has felt depleted by a mass exodus of nurses out of the country, and help the nursing department of EMC identify how they will translate the mission, vision, and goals of EMC into their patient care practice.”

Brown said that EMC, because it is not attached to legacy nursing systems and practices, has a great opportunity to be proactive in creating innovative patient care models and an attractive work environment for nurses in Zimbabwe. And there is more good news: this positive tone is being set at the highest levels of hospital management. “EMC’s top leadership is well aware of what it will take to keep nurses in Zimbabwe. The nurses they have recruited thus far are well trained, but EMC understands that these nurses will look to the hospital for professional development opportunities,” Brown said. “Therefore EMC has clearly established that education is one of their core values. They want the nurses who come into this hospital to know that they have a voice, and that their concerns will be heard.”

EMC’s nursing staff is being developed around some core competencies of patient care. HMI is helping to identify and prioritize the training programs that will be needed, and working with EMC to develop a cohesive organizational structure to guide this development. The HMI team and their colleagues from EMC also used mock patient exercises to examine the flow of patient care, identify weaknesses in the system, and help the nurses become accustomed to the policies and procedures being set in place.

There is much work to be done, but as Brown pointed out, EMC has already taken a bold step forward by recognizing the importance of its nursing staff. Chitura, who is responsible for nurturing this staff, said that she believes EMC can “be a magnet for both nurses and patients in Zimbabwe.”

Dresden medical educators celebrate success—and plan future progress

Dr. Elizabeth Armstrong (center) said that these medical educators truly have reason to celebrate.

During a three-day education program in November, members of the medical faculty of Carl Gustav Carus Technical University Dresden gathered to celebrate their achievements in curriculum reform—and to continue the work that has garnered high praise in Germany.

Dr. Elizabeth Armstrong, HMI director of education programs, participated in Dresden’s first school-wide medical education symposium, an event that brought together faculty members who had played a part in the development of TUD’s new educational model, called DIPOL (Dresden Integrative Problem/Praxis/Patient-Oriented Learning). The symposium participants, including both course directors and tutors, reflected on what has already been accomplished during this period of reform. Armstrong said, “The program had three purposes. First, to give all of the people who have worked so hard on these initiatives an opportunity to celebrate. Second, to reinforce the sense of community that has flourished among the medical educators here. And finally, to talk about what the DIPOL curriculum is doing now, in terms of how the courses have evolved, how assessment has changed, and what the plans are for the future.”

The next two days of the program were devoted to a workshop on the newly designed “Practical Year” of the TUD medical curriculum. TUD invited clinical faculty from the university’s nine affiliated teaching hospitals, with the goal of introducing the whole TUD medical curriculum, as well as the new features of the Practical Year that will help them create a systematic approach to educating students during the critical sixth year. The Practical Year should include Balint groups for students (discussions regarding the emotional or psychological factors related to care, named for the psychoanalysts who developed the concept), case supervision by senior faculty, and clinical reasoning sessions—all scheduled throughout the clinical experiences in the nine affiliated hospitals and the Dresden University Hospital.

As Armstrong said, this workshop on the Practical Year was the culmination of work done by TUD faculty at the Harvard Macy Institute in early 2002. “The Dresden faculty have been working to create innovations across all six years of the medical curriculum, and they are now putting the new sixth year in place.”

HMI Bookshelf: Recent publications help spread knowledge
The Harvard-Munich Alliance for Medical Education, a long-term collaboration between Harvard Medical International and Ludwig Maximilians University, has resulted in a newly published book that teaches medical students how to perform physical examinations and record the history of their patients. Anamnese und körperliche Untersuchung (History Taking and Physical Examination) synthesizes best practices from a number of health care environments to present a unique approach to these fundamental medical skills.

Julia Seiderer and Angelika Schlamp, the co-authors, both studied at Harvard Medical School in 2001 as part of the two partners’ exchange program. Dr. Frank Christ, the secretary of the Harvard-Munich Alliance, reported that in the few weeks since the book’s publication, it is already outselling other textbooks on this subject.

Dr. Tom Aretz, HMI vice president for education, writes in his foreword to the book, “The most fundamental, intimate, and revealing interchange between physicians and patients takes place during history taking and the physical examination. It is during this interaction that patient-doctor relationships are forged, trust is built, and the groundwork for further diagnostic and therapeutic interventions is laid . . . Given the increasing mobility of patients and health care providers, and the increasing trend towards health care delivery by teams of experts, these rather subjective findings need nonetheless be communicated and documented in a reproducible and systematic fashion.”

HMI is pleased to announce the publication of a special Indian version of the book HIV, a clinical practice manual aimed at primary care physicians that covers some of the basic facts about HIV infection, the natural progression of AIDS, common clinical symptoms, and opportunistic infections and cancers. Published by the American College of Physicians in the U.S., HIV is co-edited by Dr. Harvey Makadon, HMI’s vice president for health systems, and Dr. Howard Libman, both of whom are Harvard Medical School associate professors of medicine at Beth Israel Deaconess Medical Center.

Dr. Mannu Setia, a specialist in sexually transmitted diseases in Mumbai, India, spent two weeks in Boston as an HMI fellow, working on the special Indian edition. Setia provided a practical perspective on the realities of medical practice in India to help develop a chapter entitled “HIV Infection in India,” which specifically addresses care of the disease in his country.

The American International Health Alliance (AIHA) has published its second edition of the Basic Infection Control Manual, a manual developed to support the work of hospital epidemiologists, medical educators, physicians, nurses, and health care administrators responsible for infection control and prevention at institutions in Central and Eastern Europe and Eurasia. Topics covered include organization of infection control programs, basic epidemiology of nosocomial infections, surveillance, prevention of major types of infections, handwashing, disinfection and sterilization, rational use of antimicrobial agents, and more.

HMI’s Dr. Edward O’Rourke collaborated with AIHA and members of the Department of Epidemiology of Mechnikov St. Petersburg State Medical Academy to bring together international authorities on the topic. O’Rourke, an HMI director, co-edited the manual with Dr. Nina Semina of the Central Epidemiology Research Institute (Moscow) and Dr. Ludmila Zueva of Mechnikov St. Petersburg State Medical Academy.

Advanced Disaster Medical Response, a manual for emergency medical teams published by Harvard Medical International’s Trauma and Disaster Institute, is now available for purchase through Amazon.com. The manual has thus far received high marks from professionals in emergency preparedness and response. Susan M. Briggs, MD, MPH, FACS, assistant professor of surgery at Massachusetts General Hospital, co-edited the manual with Kathryn Brinsfield, MD, MPH, FACEP, associate medical director, Boston EMS.

Funding for Advanced Disaster Medical Response was generously provided by the Flatley Company in honor of the late Thomas Durant, MD, humanitarian and Harvard Medical School professor of surgery at Massachusetts General Hospital.

Single copies may be purchased through Amazon, or through Professional Books at www.professionalbooks.com.For information about volume discounts, please email briggs.susan@mgh.harvard.edu. For information about disaster preparedness training workshops, please email hmi@hms.harvard.edu.

AMC nurses build skills during visit to Harvard-affiliated hospitals
Two nurses from Asan Medical Center (AMC) in Seoul, South Korea visited Boston in October for a two-week clinical observation program. Ms. Jee Yoon Kim and Ms. Sung Reul Kim, both registered nurses, participated in discussions and instructional sessions with nursing leaders at Brigham & Women’s Hospital (BWH), Massachusetts General Hospital (MGH), and Beth Israel Deaconess Medical Center (BIDMC). The visit was part of the International Nursing Studies Collaborative, a program coordinated by the Institute for Nursing Healthcare Leadership (INHL).

The program covered a range of topics related to nursing professional development, from the basics of the admitting process, to using online resources to educate patients and families about health issues. The INHL also arranged for each nurse to observe practices related to each’s own specialty. Jee Yoon Kim, who routinely cares for diabetic patients at AMC, visited endocrinology clinics at MGH and BIDMC, and participated in a diabetes teaching session. Sung Reul Kim is a specialist in neurology nursing, and her itinerary included observations in the neurology intensive care unit and pituitary clinic of BWH, as well as interactions with nurses working with sufferers of Parkinson’s disease and a physical therapist who cares for patients with movement disorders.

Jee Yoon Kim noted one difference between the nursing practices she observed in Boston and her own experiences. “Although the working hours are not different between the two countries, the number of patients treated by nurses differs sharply—four to five patients per nurse in Boston, and fourteen to fifteen per nurse in Korea,” she said. She was impressed with the emphasis placed on patients’ rights in the Harvard-affiliated hospitals she visited. “The ethical service and working attitude, imbued in all of the medical staff, demonstrated the high value the hospitals place on patients’ rights.”

Asan Medical Center remains committed not only to enhancing the quality of its nursing care, but also to creating professional development opportunities for its staff. Nurses from AMC periodically visit Harvard-affiliated hospitals to examine advanced practice roles, management styles, and updates in clinical practice. The INHL’s Kathleen Scoble, EdD, RN, working in close collaboration with HMI director of clinical services Elizabeth Brown, RN, MSN, has been instrumental in driving this program.

New executive education program to address European health care policy and management
HMI and the Institute of Health Economics and Management at the University of Lausanne in Switzerland are partnering to deliver the first of a series of executive education programs aimed at European health care leadership in both the public and private sectors. The five-day program, entitled “Your Future in Health Care: Matching Costs and Benefits,” is designed to provide leaders with the necessary knowledge and skills to better understand the changing health care industry, drive innovation, and lead change in health care policy and management. Taught by distinguished experts from leading academic institutions in Europe and the United States, the program offers participants a unique opportunity to interact with other professionals from a range of backgrounds. Dr. Miles Shore, HMS professor of psychiatry and a senior consultant for HMI, will co-direct the course, along with Dr. Alberto Holly of the University of Lausanne. The program will take place May 10-14, 2004 at the University of Lausanne. For more information please contact: Nathalie Horvath, Institute of Health Economics and Management, via email at executive.health@unil.ch, by telephone at +41(0)21 314 39 89 , or by fax at +41(0)21 314 29 11.

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