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A Voyage of Discovery
BUILDING ACADEMIC HEALTH CENTER INFRASTRUCTURE WORLDWIDE
Strategic Partnerships between U.S. and Chinese Academic Health Centers
Xian Wang, MD, PhD, vice president for education, Peking University, Health Science Center
Dr. Wang addressed strategic partnerships between U.S. and Chinese academic health centers and changes in medical education. Chinese expectations about their health system have grown rapidly as developments have expanded life spans and improved communication has raised awareness of the potential of medical care. Ensuring access to health care will require a significant increase in physician capacity, especially in rural and urban areas.
China’s medical education system, which was essentially shut down during the Cultural Revolution, was reestablished in the late 1970’s, and the process of reform was accelerated in 1999 with the creation of a comprehensive university in Peking.
The current state of Chinese medical education:
- Various education programs and degrees exist, engendering confusion and making it difficult for many graduates to find employment.
- Teaching models and approaches at Chinese medical schools are less advanced than those in other countries.
- Standards for evaluation have not been adequately developed.
- Funding for education is insufficient.
- Increased enrollment in recent years.
Planned educational reforms include:
- Redesign of the medical education curriculum
- Implementation of newer and more advanced teaching methods, including problem-based learning
- Increased focus on scientific research training for students
Roundtable on Educational Issues
L. Maximilian Buja, MD, executive vice president for academic affairs, University of Texas-Houston Health Science Center
R. Sanders Williams, MD, senior vice chancellor of academic affairs, dean, Duke-National University of Singapore, Graduate Medical School Singapore
Faculty-driven initiatives
- Dr. Buja highlighted international educational activities driven primarily by faculty members. The school has established its initiatives through less-formal agreements of cooperation as well as formal written program agreements.
Accreditation and GME
Both panelists called attention to:
- GME policy in the U.S., which limits residency training slots for international medical graduates
- The lack of accreditation mechanisms for international education programs
- The need for a serious debate on these issues
Establishing Partnerships
Dr. Williams described Duke University’s activities in Singapore, addressing why a major U.S. academic health center became involved in an overseas venture of such magnitude and depth.
Duke entered into its partnership to:
- Extend its brand to another part of the world
- Differentiate Duke from other outstanding academic health centers through the quality and scale of its international engagement
- Facilitate some of the school’s research goals
Singapore’s goals included:
- Establishing a knowledge-based industry in health care
- Developing the health workforce—specifically physician-scientists and physician entrepreneurs
- Increasing prestige of academic medicine in Singapore
Other benefits have also been realized:
- The Singapore program provided an opportunity to experiment with educational methods and institutional structures.
- Duke decided not to create departments in the traditional sense, but instead organized the faculty around an “educational team” and “signature research programs” in major disease areas.
- The development of new models in Singapore has allowed some transfer of methods back to Duke’s program in the U.S.
Roundtable on Clinical Issues
Bradford C. Berk, MD, PhD, senior vice-president for health sciences, chief executive officer, Medical Center and Strong Health System, University of Rochester
Arthur S. Levine, MD, senior vice chancellor for health sciences, dean, school of medicine, University of Pittsburgh
Andrea P. Summer, MD, assistant professor of pediatrics, Medical University of South Carolina
The University of Rochester’s goals for its international activities include:
- Expanding interaction with rest of the world
- Taking advantage of clinical opportunities, such as new technologies developed outside of the U.S. and the emergence of new diseases
- Staying in the forefront of globalization
The nursing school has a number of international initiatives and led the way on global activities. The nursing school has a strong program in clinical trials education, helping to train and certify health care providers in other countries.
Rochester is noted for its work on infectious diseases, and has created models for vaccinations and immunizations in the case of epidemic outbreaks.
The medical school has partnered with the Gates Foundation to create training networks for prevention of HIV and other STDs.
Twenty percent of Rochester’s medical students go overseas. The school hopes that once students become more comfortable in the international environment, the institution will be able to transform its training programs into more comprehensive clinical endeavors.
Medical University of South Carolina
When setting up global programs, Dr. Summer noted the importance of:
- Working within a country’s local infrastructure
- Adhering to local regulations
- Establishing formal agreements with international partners
- Implementing methods to assess efficacy and sustainability
Multi-professional initiatives may be necessary to support many international programs.
International programs should:
- Be mindful of global workforce issues
- Strengthen existing primary health care services
- Enhance the performance of local workers
- Avoid pulling skilled workers from established hospitals and clinics
- Decrease attrition rates and strengthen workforce capacity in rural and other underserved areas
- Manage expectations
The University of Pittsburgh
UPMC’s global activities are premised on the concept of “doing well while doing good.” Programs include a transplant center in Sicily, a hospital in Palermo, an effort to provide emergency services and training in Qatar, and several programs in Ireland. Levine also addressed the financing and returns on investment of UPMC ventures.
The market for health care in the Pittsburgh area has become constrained by economic and other factors. Health care is less geographically restricted than other industries. UPMC recognized an opportunity to extend its activities and enhance its financial situation from opportunities overseas.
UPMC manages a hospital in Palermo (the only institution in the region providing tertiary and quaternary care) which attracts patients from Europe and the Middle East. The Italian government has provided a significant amount of funding for UPMC to establish a basic biomedical research center near Palermo, with the long-term goal of creating a biotech industry in Southern Italy.
Factors contributing to the success of UPMC’s international programs include:
- Location in regions that want to have state-of-the-art tertiary and quaternary care
- Partner countries that have the financial resources to afford state-of-the-art care and the infrastructure to support it
- The programs have been financially viable, providing money to reinvest in the clinical care mission in Pittsburgh
- Research opportunities
- A focus on integration of informatics and technology
Cautions and Recommendations:
- Carefully study sites
- Make sure the institution can afford the program
- Make sure sites are non-competitive
- Make sure there is an opportunity for financial viability and sustainability