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CAEP FEI | The Global Health Emergency Medicine Organization

In Featured, Featured Education Innovations (FEI) by Cheryl HunchakLeave a Comment

Natasha is a third year Emergency Medicine resident who has a passion for travel and tropical diseases. She has heard of other recent graduates of her training program pursuing additional training in global health. She has always felt drawn to a career in global health but is overwhelmed by the options available online. She wishes there was an organization at her institution that can help her navigate the process. 

This Feature Educational Innovation (FEI), titled, “Establishment of the Global Health Emergency Medicine Organization at The University of Toronto to Facilitate Academic Careers in Global Health for Faculty and Residents” was originally posted by the CAEP EWG FEI Team in 2018 and answers the question: “How can we encourage residents to pursue a career in global health?” A PDF version is available.

Description of Innovation

Demand for training in global health emergency medicine (EM) practice and education across Canada is high and increasing. Unfortunately, for faculty with advanced global health EM training, EM departments have not traditionally recognized global health as an academic niche warranting support. To address these unmet needs, expert faculty at the University of Toronto (UT) established the Global Health Emergency Medicine (GHEM) organization to provide both quality training opportunities for residents and a collaborative academic home for faculty in the field of global health EM.

The GHEM was developed at The University of Toronto, Division of Emergency Medicine. Approximately 40 EM faculty affiliated with the Department of Family and Community Medicine and the Department of Medicine working in six academic and four community teaching hospitals around Toronto are actively engaged in GHEM projects as well as 22 residents from both the FRCP and CCFP-EM training programs.

Required Resources

Six faculty with training and experience in global health EM founded GHEM in 2009 at a University of Toronto teaching hospital, supported by the leadership of the ED chief and head of the Divisions of EM. This initial critical mass of faculty formed a governing body and was granted seed funding from the affiliated hospital practice plan. A five-year strategic academic plan was developed. Since then, operational and project specific funding has come from a variety of sources, including practice plan contributions, departmental funding, grants and in-kind donations. They have a full-time Program Manager who works with the GHEM members on a variety of GHEM projects and initiatives.

GHEM has flourished at UT with growing membership and increasing academic outputs. Five governing members and 10 general faculty members currently lead 18 projects engaging over 60 faculty and residents. Formal partnerships have been developed with institutions in Ethiopia, Congo and Malawi, supported by five granting agencies. Fifteen publications have been authored to date with multiple additional manuscripts currently in review. Twenty-two FRCP and CCFP-EM residents have been mentored within three global health pillars: clinical practice, research and education. Finally, GHEM’s activities have become a leading recruitment tool for both EM postgraduate training programs and the EM department.

Lessons Learned:

In establishing GHEM at UT, the authors have learned several valuable lessons, including the importance of champions in leadership positions at the hospital, departmental and divisional levels. These champions were invaluable in the early stages of establishing the organization with respect to funding, hiring and retention of faculty with expertise in global health EM, and the creation of physical space for the organization to function.

In the ensuing eight years the authors have learned the tremendous importance of cohesion and collaboration among the GHEM members, of seeking expert advisors during strategic planning and execution, and of developing a consistent and compelling narrative for contributors and donors based on the GHEM mission and vision.

Benefits of the Innovation:

The initiation and structure of GHEM has allowed numerous benefits for individual faculty, trainees and the university. First, the unique structure of GHEM has allowed faculty members with relevant interest, training and expertise to develop and maintain a career in global health EM with formal peer and departmental support. Secondly, the concentration of experts in global health EM and the creation of the GHEM community has channeled myriad individual global health interests into several collaborative and successful projects at the UT Divisions of EM. The largest of these projects, the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM), has been particularly valuable for city-wide collaboration and GHEM community building. Third, GHEM faculty have been able to provide unique and highly structured elective training opportunities for UT EM trainees in global health EM.1 Finally, the GHEM organization has allowed Canadian involvement in key endeavours to reach the worlds’ vulnerable and under-resourced. While this impact is difficult to quantify, GHEM members have been instrumental in bringing local EM training leadership to low-resource settings2–7, have participated in various emergency missions in refugee camps and conflict zones8–11, have supported Canadian NGOs in developing key research findings relevant to health systems strengthening in developing countries12–17, and have identified knowledge gaps in global health among Canadian EM physicians18 .

Bottom Line

GHEM is the first supported academic group in global health EM within an EM Division or Department in Canada. The productivity from this collaborative framework has established global health EM at UT as a relevant and sustainable academic career. GHEM can serve as a model for other faculty and institutions looking to move global health EM practice from the realm of ‘hobby’ to recognized academic endeavour, with proven academic benefits conferring to faculty, trainees and the institution.

How does your institution support members interested in global health emergency medicine? What are common barriers and enablers?

Would a GHEM organization be feasible at your institution?

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More about CAEP FEI

This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Feature Educational Innovations project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive FEI each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.

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References

1.
Tubman M, Maskalyk J, Mackinnon D, et al. Tackling challenges of global health electives: Resident experiences of a structured and supervised medicine elective within an existing global health partnership. Can Med Educ J. 2017;8(2):e4-e10. [PubMed]
2.
Teklu S, Azazh A, Seyoum N, et al. Development and implementation of an emergency medicine graduate training program at Addis Ababa University School of Medicine: challenges and successes. Ethiop Med J. 2014;Suppl 2:13-19. [PubMed]
3.
Meshkat N, Teklu S, Hunchak C, TAAAC-EM and. Design and Implementation of a postgraduate curriculum to support Ethiopia’s first emergency medicine residency training program: the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). BMC Med Educ. 2018;18(1):71. [PubMed]
4.
Landes M, Venugopal R, Berman S, Heffernan S, Maskalyk J, Azazh A. Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre. Afr J Emerg Med. 2017;7(3):130-134. [PubMed]
5.
Stachura M, Landes M, Aklilu F, et al. Evaluation of a point-of-care ultrasound scan list in a resource-limited emergency centre in Addis Ababa Ethiopia. Afr J Emerg Med. 2017;7(3):118-123. [PubMed]
6.
Debebe F, Woldetsadik A, Laytin A, Azazh A, Maskalyk J. The clinical profile and acute care of patients with traumatic spinal cord injury at a tertiary care emergency centre in Addis Ababa, Ethiopia. Afr J Emerg Med. 2016;6(4):180-184. [PubMed]
7.
Salmon M, Landes M, Hunchak C, et al. Getting It Right the First Time: Defining Regionally Relevant Training Curricula and Provider Core Competencies for Point-of-Care Ultrasound Education on the African Continent. Ann Emerg Med. 2017;69(2):218-226. [PubMed]
8.
Maskalyk, J. Six Months in Sudan. [online] Sixmonthsinsudan.com. Available at: http://www.sixmonthsinsudan.com/page/blog/.
9.
Out at sea: One Canadian’s experience on board The Responder – Canadian Red Cross Blog [Internet]. Red Cross Canada. 2017. Available from: http://www.redcross.ca/blog/2017/7/out-at-sea–one-canadian-sexperience-on-board-the-responder.
10.
Venugopal R. A Day in the Life of a Doctor Without Borders [Internet]. HuffPost Canada. 2013. Available from: http://www.huffingtonpost.ca/dr-raghu-venugopal/medecins-sans-frontieres_b_3345444.html.
11.
Zewdie A, Debebe F, Azazh A, Salmon M, Salmon C. A survey of emergency medicine and orthopaedic physicians’ knowledge, attitude, and practice towards the use of peripheral nerve blocks. Afr J Emerg Med. 2017;7(2):79-83. [PubMed]
12.
Vogel J, Moore J, Timmings C, et al. Barriers, Facilitators and Priorities for Implementation of WHO Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity. PLoS One. 2016;11(11):e0160020. [PubMed]
13.
Puchalski R, van L, Makwakwa A, et al. The impact of a knowledge translation intervention employing educational outreach and a point-of-care reminder tool vs standard lay health worker training on tuberculosis treatment completion rates: study protocol for a cluster randomized controlled trial. Trials. 2016;17(1):439. [PubMed]
14.
Dovel K, Yeatman S, van O, et al. Trends in ART Initiation among Men and Non-Pregnant/Non-Breastfeeding Women before and after Option B+ in Southern Malawi. PLoS One. 2016;11(12):e0165025. [PubMed]
15.
Landes M, Sodhi S, Matengeni A, et al. Characteristics and outcomes of women initiating ART during pregnancy versus breastfeeding in Option B+ in Malawi. BMC Public Health. 2016;15:713. [PubMed]
16.
Hunchak C, Teklu S, Meshkat N, Meaney C, Puchalski R. Patterns and predictors of early mortality among emergency department patients in Addis Ababa, Ethiopia. BMC Res Notes. 2015;8:605. [PubMed]
17.
Salmon M, Salmon C, Bissinger A, et al. Alternative Ultrasound Gel for a Sustainable Ultrasound Program: Application of Human Centered Design. PLoS One. 2015;10(8):e0134332. [PubMed]
18.
Meshkat N, Misra S, Hunchak C, Cleiman P, Khan Y, Puchalski R. Knowledge gaps in the diagnosis and management of patients with tropical diseases presenting to Canadian emergency departments: are the gaps being met? CJEM. 2014;16(6):458-466. [PubMed]

Cheryl Hunchak

Cheryl Hunchak is an Assistant Professor in the Department of Family and Community Medicine at the University of Toronto. She is currently the Assistant Program Director for the CCFP-EM training program at the University of Toronto.

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Megan Landes

Megan Landes is an attending staff physician in the Emergency Department of the University Health Network (UHN) in Toronto. She has worked clinically in Lesotho, Malawi and Ethiopia in both emergency medicine and HIV services.

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James Maskalyk

James Maskalyk practices Emergency Medicine at St. Michael’s hospital and is a celebrated author. He has been active in global health work since 2001.

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Lisa Ritchie

Lisa Puchalski Ritchie is an emergency physician practicing at University Health Network. She is a founding member and Research Director of the Global Health Emergency Medicine Group at the University of Toronto.

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Margaret Salmon

Margaret Salmon is an attending Emergency Physician at the University Health Network and is an Assistant Professor at the University of Toronto.

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Chirag Bhat

Chirag Bhat is an Emergency Medicine resident at the University of Ottawa. He has interests in medical education and toxicology. He is a basketball fan and cheers for the Toronto Raptors.