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UK benefit of KTSP

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UK benefit of KTSP Promotion of International Health Teaching at KCL School of Medicine Oliver Johnson Online survey assessing student interest in global health ... – PowerPoint PPT presentation

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Title: UK benefit of KTSP


1
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2
UK benefit of KTSP
  • Promotion of International Health Teaching at
    KCL School of Medicine
  • Oliver Johnson

3
Online survey assessing student interest in
global health teaching
  • Global health increasingly a priority issue for
    the UK government and the NHS
  • now taught to med students in most UK
    universities
  • Kings has no known strategy to implement at
    present
  • student interest previously unknown
  • 310 respondents (13 response rate)

4
Online survey assessing student interest in
global health teaching
  • Global health increasingly a priority issue for
    the UK government and the NHS
  • now taught to med students in most UK
    universities
  • Kings has no known strategy to implement at
    present
  • student interest previously unknown
  • 310 respondents (13 response rate)

5
Low satisfaction with current teaching and high
enthusiasm to study in the future
6
Greater interest in medical rather than
socioeconomic issues
Comment We get taught a lot about the most
up-to-date techniques (which we're not going to
use until we're consultants - should we ever use
them). I'd much rather learn how to do the best
I can in a resource-poor setting, which is where
I'd prefer to end up Year 5 student
PMLRE Practising Medicine in a Low Resource
Environment
7
Preferred delivery through iBSc, core curriculum
and taught SSMs
  • but iBSc in addition - not instead of - core
    teaching

Comments The International Health BSc at UCL
is very popular with Kings students, so why
cant Kings run their own?? ...This is one area
I think we really miss out on. Year 2
student Intercalated BScs restrict teaching to
those who are non-graduates Year 2 student
8
Years 2, 3 and 4 are popular stages for teaching
global health
Comments Introduction can be done in the first
or second year, and third year should offer the
opportunity to deepen the knowledge Year not
given I think it should be a continuous theme,
not something talked about once in a five year
degree then ignored Year 4 student
9
Healthcare issues in a poor resource setting
TAUGHT COURSE
  • Year 2 medical students
  • overview of the major global health issues, e.g.
  • burden of disease in the developing world
  • access to healthcare and medicines
  • sustainable capacity building
  • faculty drawn from NHS, KCL THET
  • suitable for multidisciplinary teaching in future

10
Clinical challenges of practising medicine in a
poor resource setting lessons from partnerships
in Somaliland and Zimbabwe
TAUGHT COURSE
  • clinically focused, contextualised pre-elective
    course, including
  • Communicable non-communicable diseases
  • Surgery critical care
  • Public, child, maternal mental health
  • faculty drawn mainly from NHS clinicians
  • suitable for Year 4 medical students undertaking
    an elective in such a setting

11
Medsin student survey identifies substantial
interest in global health teaching
  • Recommendations
  • Specific teaching on tropical diseases and
    communicable disease threats
  • A range of Year 2 taught SSMs
  • A pre-elective Year 4 taught SSM
  • A Kings intercalated BSc on global health issues
  • A Department of Global Health at Kings
  • A Kings Global Health Forum

12
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13
UK benefits of links
  • Growing Links movement
  • Increasing numbers of institutional links between
    the UK and developing countries
  • Overseas experience also encouraged through
    organisations like VSO, International Health
    Partnerships
  • Recent policy changes to reflect increasing
    interest in developing health capacity overseas

Need for evidence
  • Monitoring and evaluation is a THET priority
  • More systematic evaluation of health links is
    required in the link country and the UK

14
Overview of study
  • Evidence from a wide variety of sources
  • 1 Qualitative interviews
  • staff with overseas experience (16)
  • managers (2)
  • executive (3)
  • 2 Quantitative questionnaire (26 to date)
  • 3 Case study showing the impact of changing a
    service

15
Participants
  • 21 interviews between December 2007 and June 2008
  • 16 staff members who had spent time overseas
  • 3 board members
  • 2 managers (1 clinical and 1 general manager)
  • 23 countries
  • Median time at Kings 6 years

16
Personal benefits
Personal benefit Number of participants
personal satisfaction 13
learning about different cultures 10
appreciate what we have in the UK 6
increased self confidence 4
opportunity to travel 4
good experience for the whole family 2
learning new languages 2
meet inspiring people 2
acceptance of own limitations 1
made new friends 1
new found faith in own religion 1
satisfy long term ambition 1
sense of humour 1
I got a lot of personal satisfaction and I feel
good about helping other peopleby nature I would
like to help people
17
Clinical professional benefits
it really honed my clinical skills which I then
translated into teaching here. The trainees are
really reliant on the monitors and it is good to
take them back to basics. I found that absolutely
invaluable
Clinical Professional benefits Number of participants
improves understanding of patients from that part of the world 11
hones clinical skills 8
get back to basic clinical skills 7
increased exposure to pathology unfamiliar in the UK 6
improves ability to care for patients 4
improves understanding of basic clinical medicine 3
18
Non-Clinical professional benefits
Non-Clinical Professional benefits Number of participants
improved teaching skills 17
increases resourcefulness and avoidance of waste 11
interpersonal skills 11
ability to adapt to new settings 10
increased motivation 10
an opportunity to learn about other areas of clinical practice 9
management and leadership skills 9
provides a challenge 9
awareness of the wider context of health 7
increased confidence 7
provides research and collaboration opportunities 4
new job opportunities 3
improves research skills 2
19
Institutional benefits
Institutional benefits Participants
improve King's reputation 15
increased job satisfaction and motivation 10
increase staff retention 8
attracts talented staff to Kings 7
better management of resources 7
improve relations with local communities 7
increase staff appreciation of King's 7
adds to King's brand as a centre of excellence 5
contributes to corporate social responsibility 5
give staff another dimension to their career 5
improve research and audit in the UK 5
improve the quality of training for staff in the UK 5
counteracts the ethical problem of recruiting staff from other countries 4
improved patient care 4
networking within Kings 4
team building 3
in terms of Kings in the public domain, it
sounds like a good place because it has this
fantastic link for sure. As an institution people
will be happier in their jobs, have a sense of
pride whereas before I would consider jobs
elsewhere it makes me want to stay here
20
Nationwide benefits
The UK through the British Council, through
postgraduate training, through our link and other
IDU links and similar schemes keeps good links
with other countries. Whenever you give you get
something back and I think it is really important
to maintain this and I hope that those in
government see this too
Nationwide benefit Number of participants
encourage a more open culture 8
fosters a positive view of Britain overseas 6
improve community relations nationally 3
improve services in the UK 3
strengthen other areas of international co-operation finance trade etc 3
opportunity to give back 2
research collaboration 2
attract overseas students 1
21
Potential disadvantages
Potential Disadvantages Participants
 institutional disadvantages 17
providing cover while people are away 12
costly for the trust 6
distracts staff from work at Kings 4
potential security concerns 3
 personal disadvantages 15
exhaustion, feeling overwhelmed or stressed 8
burden on family or friends 6
takes up annual and study leave 5
getting ill 4
lack of support overseas 2
 professional disadvantages 3
difficult for career in the UK 2
Missing out on conferences/meetings in the UK 2
22
Selected quotes
I got a lot of personal satisfaction and I feel
good about helping other peopleby nature I would
like to help people
it really honed my clinical skills which I then
translated into teaching here. The trainees are
really reliant on the monitors and it is good to
take them back to basics. I found that absolutely
invaluable
in terms of Kings in the public domain, it
sounds like a good place because it has this
fantastic link for sure. As an institution people
will be happier in their jobs, have a sense of
pride whereas before I would consider jobs
elsewhere it makes me want to stay here
The UK through the British Council, through
postgraduate training, through our link and other
IDU links and similar schemes keeps good links
with other countries. Whenever you give you get
something back and I think it is really important
to maintain this and I hope that those in
government see this too
23
Summary qualitative interviews
  • In-line with existing literature
  • Benefits outweigh disadvantages on the whole
  • Personal, professional, institutional benefits
  • Professional benefits mainly non-clinical
    skills (teaching, management of resources and
    interpersonal skills)
  • Disadvantages mainly personal
  • Networking seen as benefit of institutional links

24
Online questionnaire
  • Developed using themes identified in the
    literature and the interviews
  • 69 statements with 5 point Lickert scale
  • Demographic details/volunteering information
  • The link was sent to interview participants and
    to the mailing list of the IDU

25
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26
Participants
  • 26 people
  • 9 original participants
  • 17 others
  • 11 ongoing overseas work
  • 4 previously worked overseas
  • 9 one off volunteering

27
Online questionnaire examples
28
Results summary score
29
Summary online questionnaire
  • Qualitative findings replicated in quantitative
    study
  • Larger and more diverse participant group
  • Strengthens the claims in the qualitative
    questionnaire
  • Roll out across all Links?

30
STUDY 3 CASE STUDY 1
  • Participant in study 1 identified that he had
    changed his outpatient services following
    involvement with a TB program overseas.
  • TB service at Kings used to be consultant lead
  • In rural Zimbabwe, TB service is nurse led, with
    doctors only making the initial diagnosis

31
Changes to practice at Kings
  • On his return he set about changing the service
    at Kings
  • Prescribing for nurses
  • Training
  • Transformation of the outpatient service

32
Case study changes to TB clinic practice
Consultant-led
  • Nurse-led
  • training
  • prescribing
  • consultants only required for diagnosis and
    problems with management
  • consultants more time with patients
  • nurses more responsibility
  • saves PCT money
  • Decrease in consultant clinic attendances
  • No change in treatment outcomes

33
  • it has benefited everyone the patients are
    happier because they dont have to wait at
    endless clinic appointments just to pick up
    drugs, the outcomes are the same and the clinics
    are happier places because the doctors have more
    time and can spend more time with the patients,
    the nurses are happier because they have more
    professional responsibility. We are saving the
    PCT money because the trust charges for the
    outpatient appointment to the PCT so if the
    patient is not coming back then they are not
    being charged. That is a practical example of
    seeing how it works there a model that is
    learned abroad and brought back. That is a
    powerful example

34
Decrease in clinic attendance
35
Measurable changes
  • Statistically significant decrease in the number
    of clinic visits (Mann Whitney U 14737, p lt
    0.001)
  • Mean clinic attendance 6.04 (SD 2.7) pre nurse
    led follow up.
  • 3.75 (SD 2.4) post nurse led follow up.
  • Changing service halved clinic attendance

36
Treatment outcomes
?2 (1) 0.68, p 0.4 Outcomes remain the same
37
Impact
  • Saves the trust money
  • Decreases consultant workload, freeing them up to
    focus on complicated cases and other activities
  • Further work assess patient satisfaction and
    nurse job satisfaction.

38
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39
How much does Kings benefit from staff trained
overseas?
  • Kate Bankhead
  • 26/01/2008

40
Staff Survey rationale and content
Focus global crisis in human resources for
health and our responsibilities to address this
within the Health Workforce Decade (20062015)
Overseas Trained Staff at KCH
Volunteering at KCH
  • Extent Profiles of overseas trained staff
  • Years worked in country of training
  • Years worked in UK
  • Motivations for working in UK
  • Extent of volunteering activities
  • Profiles of volunteers
  • Volunteer destination countries
  • Participate in further research

Springboard for further research
41
Survey Design
Distribution
Data Analysis
Sample Population
Data Entry
Development
  • Methodology
  • Desk Research
  • Brainstorming
  • IDU Team
  • THET
  • Other external experts
  • Pilot
  • ALL KCH HCW on HR database 3893 staff
  • (excludes surveys not delivered due to staff
    leaving)
  • (includes any other undelivered surveys, where
    reminder was not returned as undelivered)
  • Hard copy by internal mail
  • Included introduction letter, IDU annual report
    return envelope
  • Staff given 1 month to respond
  • Reminder sent out after 2 weeks
  • 1284 responses entered in database
  • Double data entry on 2/3 of all surveys
  • Sample compared to total population by
  • Age
  • Gender
  • Occupational group

HCW Health Care Workers (Nurses Midwives
Medical Dental Allied Health Professionals
Scientific Technical)
42
Survey
43
Survey
44
World Health Organization regional groupings
45
Critical Shortage Countries
  • WHO Definition
  • Threshold in workforce density below which high
    coverage of essential interventions, including
    those necessary to meet the health-related
    Millennium Development Goals (MDGs), is very
    unlikely
  • Density 2.1 HCW per 1000 population
  • 57 countries with critical shortages
  • 1/4 of all countries
  • Sub-Saharan Africa is the greatest hit

Source WHO (2006). The world health report 2006
Working together for health. Geneva, World
Health Organization. Healthcare workforce (HCW)
defined as doctors, nurses and midwives
46
57 countries have a critical shortage of
healthcare workers
Source WHO (2006). The world health report 2006
Working together for health. Geneva, World
Health Organization. Workforce defined as
doctors, nurses and midwives
47
Least Developed Countries
  • UN definition
  • Low income
  • Human resource weakness
  • Economic vulnerability
  • 50 countries are classed as LDCs
  • 1/4 of all countries
  • Sub-Saharan Africa is the greatest hit

Source UN-OHRLLS http//www.un.org/special-rep/o
hrlls/ldc/list.htm
48
Sample Characteristics
  • 1284 respondents
  • 33 response rate
  • sample is representative
  • Largest occupational groups
  • nurses/midwives
  • medical/dental

49
Sample is representative of the total population
of Kings HCW
Age
Gender
Occupational Group
NM - Nurses Midwives MD - Medical Dental
AHP - Allied Health Professionals ST -
Scientific Technical
50
Top 4 overseas regions account for 90 of total
overseas
Sample (n1284)
51
Top 6 countries per occupation group
NM (n249)
MD (n106)
Country Number of respondents
Philippines 76
South Africa 28
India 21
Nigeria 20
Ghana 11
Zimbabwe 10
Country Number of respondents
India 27
Ireland 8
Australia 6
Germany 6
Pakistan 6
Nigeria 5
52
125 staff (10) trained in countries with
critical shortages of HCWs
  • 57 nurses/midwives
  • 35 medical/dental

Source WHO (2006). The world health report 2006
Working together for health. Geneva, World
Health Organization. Workforce defined as
doctors, nurses and midwives
53
11 staff (1) trained in LDCs
  • 9 of the 11 staff are nurses/midwives

54
Years worked in UK
Top regions
N
53
82
109
120
55
How much does Kings put back?
  • 62 staff (5) volunteer in or for overseas
    countries in a healthcare capacity

56
The medical/dental group are much more likely to
volunteer
57
Most medical/dental volunteers were consultants
58
Volunteers are older
59
Volunteers are disproportionately male
60
Most volunteers worked in one country
n62
61
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62
UKs approach to global health issues emerging
policy
Policy document/statement Who When
Global Health Partnerships The UK contribution to health in developing countries The Government response DH/DfID March 2008
Joint statement on International Health Partnership Gordon Brown and Angela Merkel August 2007
Health is Global - Proposals for a UK Government-wide strategy Sir Donaldson, DH March 2007
Global Health Partnerships - The UK contribution to health in developing countries Sir Nigel Crisp February 2007
Working together for better health DfID June 2007
Working together for health - The World Health Report 2006 WHO 2006
G8 Summit, Gleneagles UK Presidency 2005
International Humanitarian and Health Work Toolkit to Support Good Practice DH July 2003
Millennium Development Goals UN 2000
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