Many Stanford faculty who have conducted research in low-resourced environments point out lack of reciprocity as one of their biggest challenges. They often find it challenging to invite their collaborator from developing countries due to economic disparity. Among its eleven recipients, the Office of International’s seed grant enabled ten Stanford faculty members across disciplines to invite their collaborators from low and middle-income countries in 2014 and 2015. Alex Macario, a professor of anesthesiology, perioperative and pain medicine, and a principal investigator for thecollaboration in Zimbabwe for anesthesiologist training and education research, is an award recipient. Dr. Rebecca McGoldrick, a clinical instructor of anesthesiology, perioperative and pain medicine, is one of the key participants on the project, and shares how inviting a collaborator from Zimbabwe helped them move forward.
Q: What is the scope of your and Dr. Macario's collaboration with the University of Zimbabwe College of Health Sciences (UZCHS)?
RM: The anesthesia departments at Stanford and UZCHS, partnered through a grant from the National Institutes of Health (NIH) to strengthen medical education, collaborated last year to research the flipped classroom technique with the anesthesia registrars (residents) in Zimbabwe. My global health fellowship with the Stanford anesthesia department allowed me to conduct a research project in a low-resource environment and I was able to travel to Zimbabwe to implement an educational intervention.
Q: Can you explain what "flipped classroom" is and why it was important in strengthening your collaboration with UZCHS?
RM: The flipped classroom, or blended learning, serves to repurpose class time so that students can learn in a more interactive environment. It often combines video lectures outside of the classroom with an in-class activity such as games, discussions, or simulations. This allows the student to learn at his or her own pace and then reinforces that knowledge in the classroom with teacher and peer interaction.
During our needs assessment for the Zimbabwean anesthesia registrars, UZCHS showed a strong interest in video lectures. Based on that, we created interactive online educational resources for them. The video topics focused on anesthetic emergencies, which were combined with a classroom activity. With easy access to the instructive videos, the students were not only exposed to different styles of learning but also immersed with a flexible learning environment. As you can imagine, easy access to the educational material is critical in low-resource setting.
Q: What was the biggest challenge that you encountered while designing or presenting the flipped classroom in Zimbabwe?
RM: The biggest challenge was trying to present learning material in an environment with vastly different resources. I was able to travel to Zimbabwe a few months prior to implementing the blended learning project to become familiar with their anesthetic drugs, monitoring capabilities, and other resource availability. We wanted to design educational material that would be both relevant and adaptable to their clinical environment. Survey results from the blended learning modules demonstrated increased feelings of preparedness and knowledge from the registrars after the videos. However, questions on relevance and adaptability of the information presented indicated a need for improvement. We concluded that hosting a UZCHS faculty member at Stanford would help identify areas in the medical curriculum to focus on for future collaborative efforts.
Q. Based on the conclusion, you invited Dr. Farai Madzimbamuto, Chair of Health Professions Sciences at UZCHS, to Stanford last year. What did he do while on campus and how do you anticipate the visit would be beneficial to your collaboration with UZCHS?
RM: Through an OIA grant, we hosted Dr. Madzimbamuto for two weeks at Stanford in August 2015. During that time, he attended grand rounds, resident didactics, educational committee meetings and participated in simulation training courses at the VA Simulation Center. He also met with several faculty members involved in resident education and global health and shadowed them in the intensive care unit, pediatric operating rooms, and obstetric anesthesia. Our goal was for our partners to have a better understanding of our clinical and educational resources, including the structure of the resident and fellowship rotations, to help better direct future collaborative efforts. As you can see, the OIA seed grant aided our UZCHS colleagues to direct future endeavors in our mutually beneficial collaboration to prioritize clinical education and promote global patient advocacy.
Q: What is the ultimate goal of the collaboration with UZCHS and how do you measure the impact of your work?
RM: The NIH MEPI (Medical Education Partnership Initiative) grant aims to expand and strengthen medical research capacity and educational modules in sub-Sahara Africa. Both Stanford and UZCHS sites desire a mutually beneficial partnership that shares knowledge and resources.
In the past, we focused on providing the anesthesia residents with increased educational resources in topics where they received little training, such as transthoracic echo training and use of ultrasound. We also assisted them with developing a regional anesthesia curriculum through video lectures, as well as research mentorship.
With the blended learning method, we evaluated the impact by conducting knowledge tests and surveys to find out changes in levels of preparedness in certain clinical situations. However, using standardized test scores and measuring clinical outcomes are not always possible. Besides, most of our analysis is based on continual feedback from the UZCHS anesthesia department and trainees as to what they perceive as a gap in their training curriculum and the type of topics and teaching methods they prefer.
"OIA seed grant aided our UZCHS colleagues to direct future endeavors in our mutually beneficial collaboration to prioritize clinical education and promote global patient advocacy."
Q: What would be the next step for your collaboration with UZCHS?
RM: Our faculty and residents will continue their trips to Zimbabwe so that they can give lectures, hold workshops, and mentor the registrars’ research projects. Ideally, we would like to host more faculty or registrars from UZCHS. Two of their recent graduates are hoping to set up a pain and regional anesthesia service. We are hoping to immerse them in established fellowships and resident rotations in those specialties so that we can help them determine what they need to adapt for their hospital’s environment and resources. Other potential areas encompass setting up obstetric anesthesia and pediatric anesthesia fellowships and continuing the video lecture blended learning style in specific topics they would like covered.
See our full list of OIA’s grant winners from 2013 to 2016.
If you would like to see other news, events, courses and research projects about Zimbabwe, explore our map on GoGlobal.