How we can help Russian physicians help themselves
A new College effort will teach doctors how to treat chronic diseases that plague their country
From the September 1998 ACP-ASIM Observer, copyright © 1998 by the American College of Physicians-American Society of Internal Medicine.
By John Noble, FACP
One of the first things you notice while visiting Russia is that the country looks like it has survived a recent war. The disastrous condition of the country's infrastructure, from its roads to its factories, reveals the consequences of diverting critically needed funding from communities to support military expansion during the country's communist days.
The Russian health care system is no exception. Life expectancy for men has declined from an average of 67 years to 57 years, and drug-resistant strains of tuberculosis are epidemic. To make matters worse, Russia has the highest incidence of myocardial infarction and stroke of all industrialized nations, with a stroke rate reportedly five times that of comparable industrialized nations.
For the last year, the College's Board of Regents has been considering ways to expand its international activities and improve health care in other countries. Toward that goal, ACP-ASIM will launch the Eurasian Medical Education Project at the end of this year. The project, which was proposed by Richard G. Farmer, MACP, Edward Burger, MD, and William A. Reynolds, MACP, will strive to give Russian physicians the training and tools they need to treat three major diseases: hypertension, diabetes mellitus and tuberculosis.
Completely funded by the United States Agency for International Development (USAID), this ambitious project will teach Russian physicians how to use up-to-date protocols and information to care for these diseases. The program will use the "train-the-trainer" model, in which physicians show other physicians how to serve as teachers. To date, almost all successful collaborative education programs in the Russian Federated Republics have used this model.
As part of the College's project, outstanding educators in internal medicine are already working with Russian educators to define the content and structure of a state-of-the-art curriculum. Later this year, U.S. trainers will use that curriculum to educate three to five Russian trainers at each of four pilot sites: Tula, which is just south of Moscow; Kazan and Ekaterinburg, which are in the middle of the country; and Khabarovsk, which is located in the far east. Once this first phase is complete, the trainees will go on to teach other Russian teachers as well as Russian physicians participating in regional CME programs.
One holdover from the Soviet era promises to make this daunting task a bit easier. The Russian Academy of Postgraduate Medical Education, responsible for providing Russian physicians with CME credits, oversees a network of educational facilities and educators throughout the country. Every three to five years, Russian physicians must get CME credits at these academies to maintain their medical licensure. This system of mandatory education will enable the College's program to reach as many as 400 physicians a year at each of the four sites. By January of next year, Russian physicians in these cities will be taking CME courses based on the project's curriculum.
A critical element of the project is the collaboration between ACP-ASIM educators and Russian physicians. In addition to working with top Russian educators to develop the curriculum that will be used to train local educators, we intend to forge closer relationships between Russian and ACP-ASIM clinician educators. Our educators will participate in the courses and in local academic and clinical activities such as grand rounds, case conferences, and clinical and educational consultations at each site two to three times each year.
Outcome measures built into each curriculum will enable us to assess the project's effectiveness. John M. Eisenberg, MACP, and Gregg S. Meyer, ACP-ASIM Member, of the Agency for Health Care Policy and Research, are developing these measures in collaboration with the College, the USAID-sponsored Access to Quality Health Care Project, and the Russian Federation Ministry of Health. The goal is to encourage Russian physicians to monitor their progress in treating disease.
When treating patients with hypertension, for instance, Russian physicians will be encouraged to maintain records of blood pressures. For diabetic patients, they will track changes in glycolsylated hemoglobin, and for patients in their polyclinic practices, they will attempt to identify tuberculin status and new cases of tuberculosis.
If outcome measures prove that the program works, we will have an excellent chance to secure financial support from other resources. The deputy governor of the Khabarovsk region, Irina I. Strelkova, has already expressed interest in seeking support for the program because, as she said, "It will clearly improve the health of our people."
And there is a good chance that this project will work. Many leaders in Russian medicine, from the Moscow Academy of Medicine and the Russian Ministry of Health to the Moscow Office of the USAID, are supportive of the project. Medical educators in each of the four cities have also expressed great interest in participating.
The program also offers an important benefit for ACP-ASIM. We have created a model for targeting CME on critically important medical problems and are providing a focused state-of-the-art curriculum for upgrading quality of care. These curricula will be a valuable resource for medical education in other parts of the world, in all of our ACP-ASIM chapters and in our clinical practices, including my very own.
Dr. Noble is an ACP-ASIM Regent and Chair of the College's International Subcommittee.
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