By Saphia Suarez
This past July, Tracy Rabin, MD, SM, and Sheela Shenoi, MD, MPH, were appointed director and associate director of the Department of Internal Medicine’s Office of Global Health.
This exciting change to all-female leadership came with another surprise—the rise of COVID-19.
“COVID-19 made it clear that we could no longer simply do what our Office has been doing so well for so long,” said Rabin, associate professor of medicine (general internal medicine). “That we need to think in different ways about engaging in capacity building with our partners and providing global health education for our trainees.”
In light of the pandemic, Rabin and Shenoi revisited the very mission of the Office of Global Health and the scope of its work.
“We’re asking, how can we best serve our partners?” said Shenoi, assistant professor of medicine (infectious diseases). “How can we best serve the mission of the university and the School of Medicine?”
Rabin and Shenoi asked their five international partner sites—located in Uganda, South Africa, Indonesia, Rwanda, and Colombia—what the Office can do to support them. They did this through a survey, the results of which continue to come in. And they had similar conversations with colleagues at their partner sites in the U.S. as well.
In the meantime, Rabin and Shenoi focused on transforming the office’s global training program.
“There were three Ugandan faculty who were supposed to be here right now – one with the Section of Hematology and two with the Section of Pulmonary, Critical Care, and Sleep Medicine,” said Rabin. “They were supposed to be doing six-month in-person observerships, which all went on hold. But what was wonderful was that the leadership of the sections (Drs. Stephanie Halene and Naftali Kaminski, respectively) were very enthusiastic when we reached out to them to ask, ‘How can we start these training relationships virtually?”
And that’s exactly what they did.
“This is part of our formal program, and we were able to get net IDs and Yale email addresses for the Ugandan observers,” said Laura Crawford, programs administrator in the Office of Global Health. “So they have been able to tap into our educational offerings in Yale Box, make use of the Cushing Library and its databases, and join case conferences and noon discussions.”
Of course, the capacity-building strategies varied from partner-to-partner. “Our partner site in South Africa has regular power outages, so it’s not one of these places that can just hop on Zoom for a lecture from the U.S. in real time,” said Shenoi. “So we've recorded and sent them lectures. And they've been overall very well received.”
Shenoi says they are also starting to resume non-COVID medical education. “And as our needs assessments come back, we’ll put together a summary and design of what we need based on what the individual sites are telling us.”
Rabin and Shenoi still plan on hosting the Ugandan faculty as planned when safe to do so. And in some ways, the pandemic has offered the visiting faculty a head start.
“The goal is to set them up so that when they are able to come, they're ready to get to work,” said Rabin. “They will already have a sense of the Yale faculty, be connected with mentors to work with, and will know exactly what it is that they want to have exposure to, so they can make the most of their time. Usually when faculty come here for training they'll spend the first month or two getting the lay of the land. But if you can do some of that ahead of time it should allow them to accomplish a lot more when they are finally here in person. So it may be that even once COVID is no longer a barrier, this form of virtual observership or the addition of a virtual phase to this training may stay with us.”
Rabin also stressed that the success of this program lies in the eagerness that Yale faculty have to mentor trainees. “We have been so fortunate that the faculty have, without hesitation, said yes when we have approached them over the years about serving as mentors for visiting international observers. Our collaborations have been able to contribute so much to the educational and clinical capacity at our partner sites, in large part because the Yale faculty enjoy their role as teachers and mentors,” she said, “and importantly, the Yale community has benefitted from the opportunity to learn from our visitors as well.”
Likewise, the success of the Office of Global Health seems to lie in the flexibility with which leaders like Rabin and Shenoi innovate. Although the risks associated with the pandemic ultimately led to the cancellation of scheduled international and domestic clinical global health resident electives, this provided an opportunity to work with other colleagues in the Department of Internal Medicine and in the community to develop a robust New Haven-based global health elective. Through this elective, residents explore a core set of global health educational competencies through a mixture of clinical, community service, and online experiences. It was successfully piloted in November and will run in two additional cycles this academic year.
“The opportunity to work with Sheela and Laura and to be pushed to innovate in this way, it's been really exciting,” said Rabin. “It's actually been a lot of fun. Although you might think that we're sitting around thinking, ‘This is a rotten situation,’ honestly, I can't think of a time when that has crossed my mind because we have been so focused on the mission of our Office and asking ourselves, ‘ How can we continue to fulfill this mission in the context of these external challenges?’”
She added that the Office’s success is also dependent on its institutional support.
“So much credit goes to the educational leadership in the Department of Internal Medicine and Yale New Haven Hospital,” says Rabin. “Because even at the highest level, at the level of Dr. Desir, Dr. Quagliarello, and the residency program directors, as well as Dr. Huot and the Yale New Haven Hospital leadership, there is this fundamental understanding that global health education can contribute in important ways to developing the perspective and skills of our trainees. And ultimately these lessons will positively impact the way that they care for patients, and the way that they think about their roles as physicians in the global community.”
The Department of Internal Medicine at Yale is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators and educators in one of the world's top medical schools. To learn more, visit Internal Medicine.