The International Partner as Invited Guest: Beyond Colonial and Import-Export Models of Medical Education

The dominant model of international collaboration in medical education, both currently and in the past two centuries, is one of foreign (i.e., Euro-American) ownership and control. In this Invited Commentary, the authors provide a brief selected history of such international partnerships. They then focus on recent partnership models that have alternative structures. One of these is the collaborative partnership between Addis Ababa University (AAU) and the University of Toronto. This partnership is known as the Toronto Addis Ababa Academic Collaboration (TAAAC). From the inception of this partnership, the TAAAC has aimed to be relational and has firmly placed ownership of the codeveloped curriculum at AAU. Other explicit aims of the TAAAC are to help AAU develop culturally appropriate programming that is sustainable with local resources and to develop capacity-building, coteaching models. In seeking potential precedents to the TAAAC, the authors have explored archives in Ethiopia, Canada, and the United Kingdom. They found that invited foreign guests have played a role in the development of educational systems in Ethiopia since the 1940s. The authors believe that by paying close attention to the language used to describe the nature of a relationship, medical educators may be able to move toward more collaborative, capacity-building international partnerships.

The evolution of the medical workforce in Cape Verde since independence in 1975

BACKGROUND

Cape Verdean doctors have always graduated abroad. The first experience of pre-graduate medical education in Cape Verde begun in October 2015. Counting how many doctors Cape Verde has, knowing who they are, and knowing how they are distributed are very important to help fine-tune the medical training. The aim of this study is to analyze the evolution of the medical workforce in Cape Verde to support medical education implementation.

METHODS

Secondary data on doctors, from July 1975 until December 2014, collected from the Ministry of Health, were entered into an SPSS 20 database and studied by a simple descriptive statistical analysis.

RESULTS

The database included data on 401 medical doctors. There was a predominance of females (n = 218; 54.4%). The overwhelming majority (n = 378; 94.3%) graduated from 5 of the 17 countries that contributed to the training of Cape Verdean doctors. All the islands of this archipelago country contributed to the 324 (80.8%) doctors born in the country. Of the 272 doctors still active in December 2014, 119 (43.6%) were general practitioners and 153 (56.4%) had specialized in one of the 31 specialties. The national ratio of doctors per 10 000 inhabitants was 5.25, but the reality varied significantly among islands. About one third of the doctors (n = 86; 32%) were at the primary care level, 38 (14%) at the secondary care level, and 144 (52%) in central hospitals. In 2053, all active physicians in 2014 will already be retired.

CONCLUSIONS

This is a unique study of the evolution of the medical workforce of a country over 40 years, from the first day of independence. The study illustrates the importance of international collaborations, particularly of Cuba, in sustaining the medical workforce in Cape Verde. It is an example of how this collaboration was used to equip the country with doctors in an increasingly more equitable distribution across all islands. The study further illustrates the progressive feminization of the medical workforce. The study clarifies the effort required from the emerging medical faculty to supply the national health system with the needed number of doctors.

"One and the Same the World Over": The International Culture of Surgical Exchange in an Age of Globalization, 1870-1914

This paper examines the international exchange in surgery in the decades before World War I, a period of growing globalization in communication and transport. Focusing on Europe and North America, it looks first at the various means of exchange, especially surgical travel and the culture emerging around it and follows specific directions of exchange, from France and Britain, first to the German-speaking countries and finally to North America. Subsequently, the account turns to international organizations as an important means of exchange in this time period. The International Society of Surgery, in particular, provided a forum for a vivid internationalist discourse, which, however, stood in tension with simultaneous nationalist tendencies leading up to World War I. The paper finally discusses how the international exchange and communication at the time can be seen as an instance of modern surgeons claiming-and simultaneously trying to create-the global universality of surgical knowledge and practices, making sure that surgery is the same the world over.

Internal medicine in the United States and Germany: mutual influences from 1870 to today

Over the past 140 years, the close academic and clinical interactions in Internal Medicine between German-speaking countries and the United States have been through three distinct stages. From 1870 until the First World War, German medical research, teaching, and university organization served as a model for U.S. medical schools and practice. However, after World War I, medical education reforms were implemented in the U.S., and due also to radical economic and political changes at home, German medicine lost its pioneering role. Furthermore, many scientists and clinicians were forced to emigrate in the face of racial and political persecution in Germany and Austria. Since the Second World War, American medicine has grown further to become the world leader in research, training, and clinical practice. The earlier trend of American physicians studying abroad was thus reversed, with many of today's foremost German physicians completing clinical and research training in the United States.

A dozen years of American Academy of Sleep Medicine (AASM) International Mini-Fellowship: program evaluation and future directions

Sleep medicine remains an underrepresented medical specialty worldwide, with significant geographic disparities with regard to training, number of available sleep specialists, sleep laboratory or clinic infrastructures, and evidence-based clinical practices. The American Academy of Sleep Medicine (AASM) is committed to facilitating the education of sleep medicine professionals to ensure high-quality, evidence-based clinical care and improve access to sleep centers around the world, particularly in developing countries. In 2002, the AASM launched an annual 4-week training program called Mini-Fellowship for International Scholars, designed to support the establishment of sleep medicine in developing countries. The participating fellows were generally chosen from areas that lacked a clinical infrastructure in this specialty and provided with training in AASM Accredited sleep centers. This manuscript presents an overview of the program, summarizes the outcomes, successes, and lessons learned during the first 12 years, and describes a set of programmatic changes for the near-future, as assembled and proposed by the AASM Education Committee and recently approved by the AASM Board of Directors.

CITATION

Ioachimescu OC; Wickwire EM; Harrington J; Kristo D; Arnedt JT; Ramar K; Won C; Billings ME; DelRosso L; Williams S; Paruthi S; Morgenthaler TI. A dozen years of American Academy of Sleep Medicine (AASM) international mini-fellowship: program evaluation and future directions.

Beyond dark and bright: towards a more holistic understanding of inter-group networks

Networks are becoming a popular organizational form for structuring human activities. To date, scholars have addressed networks in a variety of fields, including sociology, economics, public administration, criminology, political science, and international security. However, little has been done so far to systematically examine the similarities, differences, and connections between network forms of organization across different academic disciplines. This has important implications for both theory and practice. The lack of attention paid to organizational similarities and differences prevents the exchange of knowledge developed across fields. In turn, policy-makers cannot take full advantage of existing research, and may miss opportunities to improve the work of some networks and combat that of others. To address this gap in the literature, this paper uses the combination of organizational environments and organizational goals to develop a new typology of inter-group networks, and thus improve our understanding of how human behaviour is coordinated through networks.

[Study on the history of exchange in pharmaceutical science between Japan and Korea after the Modern period: focus on Korean students sent to Japan with expenses funded by the Japanese government]

According to an old historical text, Nihonshoki [Chinese and Korean characters: see text]), there are records of medical doctors ([Chinese and Korean characters: see text]) and herbal pharmacists ([Chinese and Korean characters: see text]) being dispatched to Japan as early as 554 A.D. ([Chinese and Korean characters: see text]). More recently, a clinic ([Chinese and Korean characters: see text]) for Japanese residents in Pusan was established in 1877. Advanced modern pharmacy from Japan began to be introduced to Korea after 1909. Based on an agreement between the Korean and Japanese governments, Korean students sent to Japan with expenses funded by the Japanese government became a systematic program after 1965. As a result, Koreans who earned Ph.D.s from Japanese universities became a majority in the faculties of Korean schools of pharmacy. However, this trend drastically shifted in the years after 1990, at which time the primary nation for earning Ph.D.s became the United States; the number of students studying in Japan has become very low recently. In this study, six ex-students who studied in Japan were interviewed and the results were analyzed. Furthermore, the past, present and future perspectives of Korean students in Japan were discussed while focusing on the system of Korean students being sent to Japan with expenses funded by the Japanese government.

[Corporate defense, xenophobia and anti-semitism in the medical environment. The "Romanian privilege", 1930-1940]

Because of an agreement between the two governments ("the Romanian privilege"), a large number of students, most of them Jews, were allowed to study medicine in France after the first World War. This situation fed into medical xenophobia and antisemitism and lead up to Vichy laws.

From Neuroendocrinology to Neuroimmunomodulation - a tribute to Prof. Dr. Samuel McCann

One of the leading experts in the field of Neuroendocrinology and Neuroimmunmodulation, Samuel Mac Donald McCann, known by all his friends as 'Don', passed away in 2007. This article pays tribute to his outstanding scientific contribution and a glimpse on his fascinating personality. A member of the National Academy of Sciences of the United States and pioneer in the field of neuroendocrine regulation, he identified numerous hormones and peptides and set the stage for basic concepts in physiology and clinical medicine.

Cherishing the past: 100 years of nursing education at the American University of Beirut

This article describes the foundation and the development of nursing education at the American University of Beirut, the first professional school in the country and the region, across 100 years (1905-2005). It talks about the early years, pioneering achievements (1905-1940), the school's leadership in nursing from 1940 to 1976, the war years from 1976 to 1993, and postwar global vision (1993-2005). Furthermore, it gives special tribute to the dedication and hard work of the founders, Ms. Jane Elizabeth Van Zandt and Ms. Mary Bliss Dale, and all the directors whose endeavors and wisdom have helped the development of the school from diploma to bachelor and master's programs.

[Yale anesthesiology: a reflection on Professor Kitahata's days]

Professor Luke Masahiko Kitahata was a professor of anesthesiology, Yale University in the United States of America. He had been employed in Yale University for 33 years, from 1964 to 1997, and acted as the chairman of the department of anesthesiology from 1973 to 1982. He endeavored not only to achieve his academic career but also to educate his juniors. The number of Japanese fellows who were trained by Professor Kitahata is more than sixty. He rendered many services for the development of anesthesiology in Japan.

The academic lineage of Sir John Carew Eccles (1903-1997)

This report reviews the academic lineage of Sir John Eccles; who trained him, whom he then trained and with whom he collaborated, and the subsequent impact of his trainees and collaborators on neuroscience and other areas. In a post-training career at five institutions in four countries (Great Britain, Australia, New Zealand, back to Australia, USA) and during retirement in Switzerland, Eccles trained and collaborated with over 180 people (mostly neuroscientists) from 21 countries. Most of them have had stellar research and training records that span the cellular-behavioral-philosophical spectrum of neuroscience, with a focus from peripheral neuromuscular issues to the forebrain. Some have been equally distinguished in other areas of biomedical science. Eccles' academic contributions and lineage are a valuable colloquium topic in a neuroscience training program. His experimental work spanned much of the 20th C before the recent emphasis on the application of the techniques of molecular biology. He continually sought to integrate information from the cellular to the systems and behavioral levels of analysis and synthesis. He also devoted a substantial amount of his intellectual effort to the mind-brain and other philosophical issues. Eccles' prodigious working hours and enthusiasm for his projects were a role model for such trainees. Hard-working trainees often ask how can they retain their all-round interests, and indeed their humanity and citizenry, as they focus more and more on their necessarily narrowly focused neuroscience research. Again, Eccles' writings and overall behavior show that it can indeed be done, but only by the application of extraordinary effort and dedication.

Inhibitory circuits in the thalamus and hippocampus—An appraisal after 40 years

After scientific successes in the study of synaptic activation and inhibition of motoneurons and unraveling mechanisms underlying presynaptic inhibition, Sir John Eccles was interested in studying synaptic mechanisms governing the activity of neurons in the brain stem, cerebellum, and various cortical areas. In this new arena, his group discovered several principles, which have later been shown to generalize across brain structures and have substantial functional significance. Among these were the first identification and location of inhibitory synapses in the cerebral cortex and recurrent inhibitory systems in the hippocampus, cerebellum, and thalamus.

Daisy Ayris Lecture. Looking back, looking forward

This was the second time that Mary Spinks, a former Chairman of NATN, has given the Daisy Ayris Lecture. This unprecedented move indicates the Association's respect for Mary's influence and commitment to patient care in her current role as Director of the Florence Nightingale Foundation. Her address, given below in full, covers key themes of education, reasoning and communication.

Venny Snellman, Finnish nurses, and Rockefeller Foundation support, 1929-1956

This paper describes how the Rockefeller Foundation finally came to take an interest in Finland. All sources point to the same conclusion: it was the Finnish nursing leader Venny Snellman who opened the door for the cooperation between Finland’s healthcare organizations and the Rockefeller Foundation.

Brief history of endoscopic transsphenoidal surgery--from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery

Since its inception, one of the major issues in transsphenoidal surgery has been the adequate visualization of anatomical structures. As transsphenoidal surgery evolved, technical advancements improved the surgical view of the operative field and the orientation. The operating microscope replaced Cushing's headlight and Dott's lighted speculum retractor, and fluoroscopy provided intraoperative imaging. These advances led to the modern concept of microsurgical transsphenoidal procedures in the early 1970s. For the past 30 years the endoscope has been used for the treatment of diseases of the sinus and, more recently, in the surgical treatment of pituitary tumors. The collaboration between neurological and otorhinolaryngological surgeons has led to the development of novel surgical procedures for the treatment of various pathological conditions in the skull base. In this paper the authors review the history of the endoscope--its technical development and its application--from the first endoscope described by Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery held in 2005 in Pittsburgh, Pennsylvania. Specifically, in this review the history of endoscopy and its application in endonasal neurosurgery are presented.

Challenges and Opportunities of International Clinical Practica

International clinical practica are a strategy to integrate a global dimension in nursing curricula and achieve culturally sensitive nursing practice. In this paper, a review of the history and development of international practica for nursing students is presented, and research evaluating the effectiveness and impact of international experiences is analyzed. A description of experiences working with Canadian nursing students is used to highlight the challenges and opportunities inherent to international clinical practica. International student experiences involving clinical practica pose challenges that are additional to, and often more complex than, those faced in traditional international, course-based exchanges. The significant opportunities, however, continue to make international student practica a desirable and positive experience for Canadian nursing students.