Implementing Interprofessional Global Health Education at a Systems

Implementing Interprofessional Global Health Education at a Systems Level: Lessons Learned Samuel C. Matheny, MD, MPH, F&CM Susan Carvalho, Ph. D, Associate Provost for International Programs Andrea Pfeifle, Ed. D, F&CM Maria Gabriela Castro, MD, F&CM University of Kentucky

Purpose • Describe the process by which one university attempted to develop a strategic plan for internationalization, and the challenges and successes of integrating the College of Medicine AND primary care/family medicine into a universitywide strategy.

Some Facts about the University of Kentucky • • • Land grant institution, founded 1865 27000 students 813 house staff 4. 7% international students $2. 2 billion budget, 34% Health affairs 20 schools/colleges, all health sciences colleges except veterinary

Benchmarking institutions University of of Illinois - Urbana. Champaign University of Iowa University of Maryland - College Park University of Michigan - Ann Arbor University of Minnesota - Twin Cities University of North Carolina - Chapel Hill University of Virginia University of Washington University of Wisconsin - Madison Michigan State University North Carolina State University Ohio State University Pennsylvania State University Purdue University Texas A&M University of Arizona University of California - Los Angeles University of Florida University of Georgia

Factors at play • Increased focus on internationalization for University as whole • College focus on interdisciplinary education • Two College of Medicine departments’ history of service learning, international clerkships (Family Medicine and Pediatrics)

This is to be viewed as a case study in an developmental stage of internationalization of a University, not the finished product

Objectives 1. Discuss some of the opportunities and challenges when aligning program-specific and institutional goals. 2. Discuss some of the opportunities and challenges when integrating college specific global health education programs with others in the University. 3. Describe lessons learned from the process of integrating program or college specific global health programs at a systems level.

What does an internationalized university look like? Integration of global strategies across campus: • International webpage with a link from the home page • A single gateway that links international partnerships, grants, International Office services to students/faculty/staff, study abroad opportunities, curriculum, international engagement • A senior international officer (SIO) who reports directly to the Provost or President • An inclusive framework for highlighting strategies and achievements

Internationalization Task Force Membership Co-Chair- Beth Barnes (Communications) Co-Chair- John Yopp (Associate Provost) Sharon Brennan (Education) Dorothy Brockopp (Nursing) Carey Cavanaugh (Diplomacy) Ann Dickson (Design) Ellen Furlough (Arts & Sciences) Michael Healy (Law) Eeva Hoch (Libraries) Claudia Hopenhayn (Public Health) Nancy Jones (Fine Arts) G. T. Lineberry (Engineering) Sam Matheny (Medicine) Mike Reed (Agriculture) Melody Ryan (Pharmacy) Marie-Antoinette Sossou (Social Work) Sharon Stewart (Health Sciences) Suzanne Waldrop (Business & Economics) Juan Fernando Yepes (Dentistry) Other experienced faculty and administrators appointed to the Task Force: Kwaku Addo (Graduate School) David Bettez (Intl. Affairs) Susan Carvalho (Asst Provost) Ted Fiedler (Modern Languages) Beth Goldstein (Asia Center) Diana Rast (Business & Econ. ) John Roark (Sponsored Prog. ) Sue Roberts (Geography) Doug Slaymaker (Modern Languages) Linda Worley (German) Tom Young (Pediatrics) Student Representative: Nirmal Ravi, M. D. /Ph. D. student (medicine/biomedical engineering)

Working with ACE Internationalization Laboratory (www. acenet. edu) • • Access to resources – publications, data Buy-in from university leadership Timeline and focus on task Shared best practices Peer institutions Campus legitimacy Clarifying questions to resolve differences Exit review and external recommendations

American Council on Education Contact Information: www. acenet. edu ACE Center for International Initiatives http: //www. acenet. edu/Content/Navigation. Menu/Program s. Services/cii/current/networks/International_Lab. htm Dr. Barbara Hill, barbara_hill@ace. nche. edu

www. uky. edu/ITF

Subcommittee Charges – 1 Research/Engagement Subcommittee Charge • Examine current status of UK research involving international focus • Articulate objectives to increase international research activity, in ways congruent with departmental, collegiate or professional-program objectives and missions as outlined in the strategic plans, and outline strategies for assessment • Identify opportunities and barriers to expanded international research, including availability of resources • Recommend structures/mechanisms to encourage or support international research and engagement, including awards/recognitions for global research or global engagement; the recognition of international work in annual merit review and assessment; etc. • Assess the incorporation of faculty research/engagement work with undergraduate research opportunities, or opportunities for graduate/professional students • Assist Inventory subcommittee in planning the gathering and input of research data • Produce intermediate report (for January Task Force meeting) and final recommendations/goals (by May)

Subcommittee Charges— 2 International Exchanges and Collaborations Subcommittee Charge • Gather data on existing programs across the University • Work with Inventory group to include this information in database • Examine programs at other institutions that foster or support faculty/program exchanges • Articulate objectives for faculty/program international exchanges, consistent with student learning outcomes, and strategies for assessment • Identify opportunities as well as barriers to faculty/program exchanges at UK, including availability of resources • Address issue of “memoranda of understanding" • Produce intermediate report (for January Task Force meeting) and final recommendations/goals (by May)

Transparency of Process www. uky. edu/ITF

UK’s Internationalization Strategic Plan • Goal 1: Enhance international educational opportunities for students at the University of Kentucky. • Goal 2: Enhance the presence of international students at the University of Kentucky at the undergraduate, graduate and professional levels. • Goal 3: Broaden and deepen University of Kentucky partnerships with international institutions, including the establishment of joint/double degrees, student and/or faculty exchanges, and research collaborations. • Goal 4: Enhance globally focused research and engagement at the University of Kentucky. • Goal 5: Coordinate and facilitate internationalization at the University of Kentucky. • Goal 6: Implement an assessment system that tracks both the quantity and the efficacy of the various internationally focused initiatives. • Goal 7: Provide leadership within the Commonwealth of Kentucky to strengthen a culture of global awareness and appreciation for international perspectives.

Strategic Plan (sample) GOAL 4: Enhance globally focused research and engagement at the University of Kentucky Objective 4. 1: Foster the development of globally focused research and engagement, with particular emphasis on those projects that involve international collaborations. Metric 4. 1: Number of applications for globally focused research grants will increase in each unit. • • • Strategy 4. 1. 1: Seek promising international grant opportunities that focus on international research, and in particular those that would maximize our existing research strengths Strategy 4. 1. 2: Facilitate multi-college research projects that maximize faculty expertise and that offer the potential for grant opportunities; utilize the International Council to facilitate applications for multi-college grants. Strategy 4. 1. 3: Seek matching grants or seed funding for international research. Objective 4. 2: Enhance recognition within the university for globally focused research and engagement. Metric 4. 2: Achievements in globally focused research and engagement will be routinely publicized to internal and external constituencies. • • Strategy 4. 2. 1: Explore ways of ensuring that excellence in international scholarship is appropriately recognized in the evaluation of faculty performance. Strategy 4. 2. 2: Ensure that the Communications division of the Office of International Affairs is linked both to UK Public Relations and to the International Council representative from each College, in order to increase the visibility of globally focused research and engagement activities.

White Paper Why, in a state with so many challenges, does our mission need to “go global”? Can we afford it? These questions must be addressed by university president and leadership, repeatedly and in a variety of contexts. UK White Paper on Internationalization (excerpt): “The University of Kentucky Strategic Plan includes within its institutional mission the goal of service to a global community. At the same time that we fulfill our land-grant mission to the Commonwealth of Kentucky and to our nation, UK is dedicated to promoting human well-being and economic development in a global context. ”

Looking Forward • Development of Senior International Officer Role • Formation of the International Advisory Council • Inventory of International Activity

“I am very pleased that the Internationalization Strategic Plan has been completed. It is thoughtful, thorough, comprehensive and fiscally responsible. In my opinion, the drafting of this Internationalization Strategic Plan is a critical step in charting UK’s path to achieving its Top 20 mandate. I will now send the documents to all deans and provost’ s staff. I am truly grateful to the Task Force members for their time and devotion to this effort. Given its broad representation from all sectors of the university, I have no doubt this Plan will enjoy campus-wide support. ” Kumble Subbaswamy, Provost University of Kentucky

Related Initiatives: Interprofessional Education

Inter-professional Education (IPE) • “Occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care. ” Center for the Advancement of Inter-professional Education (CAIPE) 1997, 2005 • Not the same as – Interdisciplinary – Multidisciplinary – Transdisciplinary

Why Interprofessional Education (IPE)? • Institute of Medicine Reports ▫ To Err is Human: Building a Safer Health System ▫ Crossing the Quality Chiasm: A New Health System for the 21 st Century ▫ Recreating Health Professional Practice for the New Century • Pew Health Professions Committee ▫ New vision for health professions education: all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team…

Goal of IPE • Create holistic decision-making by teaching and empowering learners to solve complex problems and address issues that surpass the scope of any one profession. Ø This approach to problem-solving has been recommended as a means by which to improve our healthcare quality outcomes, so much so that the Joint Commission has stated that safe, effective clinical care depends on it.

Relationship to UK Strategic Plan (2009 -2014) • Objective 4. 3 Enhance campus/community collaborations in areas where opportunities exist to build diversity and increase inclusion.

Impact of Global Health Initiative on IPE at UK • Prior to 2005, Interdisciplinary Education – Kentucky January/May – Center for Interdisciplinary Education in Allied Health – Informal interdisciplinary education interest group • Since 2005 – Inter-professional Healthcare Education Working Group – Provost support for service learning activity. S 2 S

Interprofessional Healthcare Education Working Group - Colleges Represented • • • Arts and Sciences Dentistry Education Health Sciences Law • • • Medicine Nursing Pharmacy Public Health Social Work

Interprofessional Healthcare Education Working Group • Vision: All people will receive high-quality health care through interprofessional practice. • Mission: Develop, validate, and promote interprofessional education and care among health students and health professionals to achieve optimal health maintenance and quality patient care.

Core IPE Content Areas • • • Teamwork Quality and Safety Professionalism Service Learning Public Health

Interprofessional Education at UK: Next Steps • Center for Interprofessional Healthcare Education, Research, and Practice

Related Initiatives • Shoulder-to-Shoulder

Shoulder to Shoulder International partnerships for community development through service learning and global health education

Our Mission: Service to the Poor improve health outcomes in poor communities through primary health care, public health, dental care, nutrition and education Work With Community Leaders develop collaborative health teams who share common values; community assumes ultimate responsibility for all projects in that community Sustainable Community Impact a long-term sustainable relationship; continuity of care, health promotion and disease prevention

How does Shoulder to Shoulder (S 2 S) fit with the Plan for University Internationalization? • Education • Service • Research “The University plays a critical leadership role for the Commonwealth by contributing to the economic development and quality of life within Kentucky's borders and beyond. The University nurtures a diverse community …”

What are the Common Goals of S 2 S and the University Plan for Internationalization? • Enhance educational opportunities: • Strengthen partnerships with international institutions • Strengthen the culture of global awareness at UK

What are the Common Goals of S 2 S and the University Plan for Internationalization? • Enhance educational opportunities: “foster exposure to global topics and perspectives throughout the curriculum” “ expand promote the study and use of world languages” “opportunities for education abroad” “increase competitiveness for international study abroad scholarships” • Strengthen partnerships with international institutions joint / dual degrees student / faculty exchanges research collaborations • Strengthen the culture of global awareness at UK

How has S 2 S Created the Opportunity to Meet These Goals? • Enhanced educational opportunities: International rotations (medicine, pharmacy, nursing, PA curriculums) Global and Community Health Rotation ( Dept of Family Medicine) Certificate of Global Health (Dept of Public Health) Publications / presentations with data collected from S 2 S brigades • Strengthened partnerships with international institutions: Faculty appointments / exchanges Scholarly activity / international presentations on community health and academic / community partnerships in health promotion • Strengthened the culture of global awareness at UK Increasing interest among students, residents and faculty has made possible 3 annual brigades and has garnered university support

Educational and Professional Activities • Hopenhayn C, Young T. Shoulder to Shoulder Ecuador: a University-Community Partnership for Health. Presented at Unite for Sight-5 th Annual International Health Conference: “A Weekend of Ideas and Exchanges of Best Practices to Improve Public Health and International Development”, April 12 -13, 2008; Yale University, New Haven, Connecticut. • Roccanova J, Young T, Hopenhayn C, Mc. Cormick K. International Community Development through Community Engagement and Service-Learning. Presented at the NAFSA Regional Conference, November 8 -11, 2008, in Lexington, Kentucky. • Olges JR, Murphy BS, Young TL, Hopenhayn C. Factors Associated with Knowledge of HIV among Rural Patients in Ecuador. To be presented at the 2009 Southern Regional Meetings, Center for Continuing Education, February 12 -14, 2009 in New Orleans, Louisiana. • Jonat A, Hopenhayn C, Barry A. Cervical cancer screening knowledge, practices, and attitudes in a Santo Domingo, Ecuador clinic population. Presented at the Global Health Education Consortium Conference, April 3 -5, 2009, in Seattle, Washington. • • Tovar JV, Gonzalez A, Tovar EG, Young TL, Hopenhayn C, The development of educational opportunities via multidisciplinary international medical brigades in underserved communities of Ecuador. Presented at the Global Health Education Consortium Conference, April 3 -5, 2009, in Seattle, Washington. • Hopenhayn C, Rinsky J, Mc. Cormick, K, Roccanova, J. Evaluation of International Medical Brigades to Improve Global Health Educational and Service-learning Opportunities. Presented at the Global Health Education Consortium Conference, April 3 -5, 2009, in Seattle, Washington

University Support Integral to the sustainability of S 2 S as a community service and interdisciplinary learning experience. • Faculty release time • Travel funding for residents • Administrative support (as of 2009) • AV equipment for teleconferencing

The Success of S 2 S in Garnering University Support has been a result of Collaboration and Alignment of Goals and Mission

Lessons Learned

Lessons Learned – White Paper for Internationalization • Need for short paper to explain the purpose of internationalization and how it fits in with a land grant university’s strategic plan. Ø Probably should have been done up front rather than at the end of the process Ø (fewer but deeper)

Lessons Learned ØDevelop partnerships that are appropriate for the institution. ØAwareness of the type of institution and making sure that there is institutional alignment with International Goals & Objectives. ØLet programs sell themselves rather than providing dictates in a hierarchical fashion; provide time and effort for buy-in.

Lessons Learned ØAwareness and respect of differences in academic cultures when working outside of medicine. ØIssues of centralization versus decentralization: • Awareness that some things work well in centralization as an example, standards for use of international office for developing standards, applications and protocols for students to travel. • Decentralization in unique issues of medical students with rotational needs.

Ongoing Challenges q Finances and funding for faculty, staff and students. q How to handle different requirements in different colleges for course activities. q Issues in International Externships of liability coverage for students and faculty. q Scheduling needs are different across programs.

Questions/Comments?