Working with trainees to treat non-communicable diseases
Mark Clarfield, MD, FRCPC, is working to find practical and affordable ways to treat non-communicable diseases (NCDs) in a project undertaken together with Royal College Fellows from Montreal and Israel, as well as colleagues from the University of Gondar Hospital in Ethiopia.
“One frustration in countries such as Ethiopia is that resources and infrastructure limit what highly trained physicians can accomplish,” says Dr. Clarfield, the Toronto-born, recently retired director of Ben-Gurion University’s Medical School for International Health in Israel. “Physicians in Ethiopia have abundant knowledge. What we’re doing is finding approaches where they can combine their advanced knowledge with the limited resources at hand to diagnose and treat their patients.”
A two-pronged approach
Dr. Clarfield’s International Development, Aid and Collaboration-funded project has two main goals. The first is to increase capacity by training physicians to use point-of-care ultrasound (POCUS) as a primary imaging tool (work led by Jonathan Houle, MD, FRCPC), and by teaching the appropriate use of bone marrow biopsy via simulation training (work led by Ora Paltiel, MD, FRCPC). This project will enhance diagnostic skills to aid clinical decision-making. “With POCUS, we have a tool that physicians can put in their pockets and use as needed rather than sending patients to radiology,” says Dr. Clarfield. “POCUS is doing for medicine what the invention of the stethoscope did 200 years ago.”
The second goal involves the team working with Ethiopian physicians to find practical, affordable treatments for NCDs – ones that would otherwise be untreatable due to either a lack of infrastructure or the high cost of pharmaceuticals, especially those required for treating complex chronic diseases.
The development of resource-adapted yet evidence-based care presents a major challenge. This effort, including educational programs to enhance NCD treatment, will be led by Dr. Clarfield in Israel and Ning Zi Sun, MD, FRCPC, and Louise Pilote, MD, FRCPC in Montreal.
“The point is not to be fatalistic about outcomes when resources are limited,” says Dr. Clarfield. “We’re focused on finding practical, effective clinical solutions, even if they’re not always those currently used in Canada.”
Soliciting input from trainees
Dr. Clarfield says that finding alternative therapies can be ethically complex, because some developing countries have experienced experimentation on local populations without their consent. To manage ethical issues, this project will work together with trainees to find solutions using a “flipped classroom” approach where learners receive key information before class and then use class time to pursue higher-level thinking.
The project will provide learners with in-person OSCEs and deliver an e-lecture series produced at McGill University. Each lecture has an individual channel enabling learners to interact with the lecturer and includes course notes, presentation slides and pertinent readings.
Participants will complete pre-training evaluations and surveys, and repeated testing will measure their improvement and retention. “We will know we’ve succeeded if we’re able to learn together,” says Dr. Clarfield. “We have a lot to teach our trainees and they have a lot to teach us, especially about the approaches that will work in their local contexts.”