Global Health Pathology Elective

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Global Health Pathology Elective

Background

Global health is defined as service and training aimed at addressing health problems that transcend national boundaries, disproportionately affect the resource poor, and can be managed by multidisciplinary solutions. There is often too little attention given to the clinical laboratory which can aid clinicians in patient care, provided the laboratory offers accurate information.

Pathology expertise is lacking in developing countries. For example, there are approximately 75 pathologists on staff at Weill Cornell Medical College (WCMC) alone, while the entire country of Tanzania only has 15 pathologists serving a population of 51 million (Rambau 2011).

By participating in a global health laboratory medicine rotation, residents can gain direct experience that can foster interest in neglected diseases, public health issues, and the pathology of global health issues. Pathology trainees often arrive with some prior experience or interest in global health and wish to continue their involvement in pathology overseas in their professional career.

Map of Tanzania
Mwanza, Tanzania

Tanzania is located on the eastern coast of sub-Saharan Africa, and the rotation will take place in Weill Bugando University College of Health Sciences (Weill Bugando) and Bugando Medical Centre (BMC) in the Mwanza region on the shores of Lake Victoria. The mission of Weill Bugando is to strengthen medical education. Bugando Medical Centre is a 900-bed regional referral and teaching hospital employing approximately 950 people and serving approximately one-third of the country's population. The hospital is staffed by full-time Tanzanian physicians, nurses, and technicians, with three WCMC faculty members also based in Mwanza. The partnership between Weill Cornell and Weill Bugando is of mutual benefit for both institutions - through training the next generation of Tanzanian physicians and by expanding the awareness and skills of Weill Cornell faculty, residents, and students as they work in a resource-poor setting.

Rotation Summary

This 8-week structured rotation for PGY-3 or PGY-4 residents will focus on a laboratory management, process-related project with the aim of improving laboratory services and patient care. The quality improvement project will be defined by the resident, in consultation with the BMC laboratory staff leadership and WCMC faculty members, in formal proposal prior to the rotation.

An example of a previous laboratory quality improvement project undertaken by a resident is the improvement of blood culture efficiency, both in obtaining results and in communicating them to clinicians. The project was undertaken in an effort to improve turnaround time within the laboratory and also in the time taken to communicate results to the ordering physicians. In addition, nurses and physicians were taught proper blood culture collection and transport techniques in order to improve quality of the cultures and to decrease contaminants. On this rotation, the resident will not be directly signing off on reports but will be present in an advisory role.

The reviewing in Zambia of laboratory techniques

Objectives

  • Improve pathology and clinical laboratory services in developing countries
  • Focus on quality control and standardization efforts, and quality assurance and monitoring
  • Work in a collaborative fashion between departments
  • Provide education and teaching
  • Experience laboratory management, test validation, and implementation in a resource-poor environment

Application Requirements

The program will be restricted to New-York Presbyterian Hospital/ Weill Cornell Medical College pathology residents at the PCY-3 level of training or higher. The resident must be in good standing and must contact Dr. Hsu within the first two years of pathology training to begin discussions of appropriate projects and timing of future Global Health rotations.

Curriculum

The rotating resident will participate in a range of activities, including teaching and observation. The majority of clinical experience will take place in the inpatient setting. The resident will attend rounds with the clinical teams, provide laboratory and other diagnostic consultative services to the clinical staff, and also participate in pathology sign-out activities. A quality-related laboratory project will be decided upon before arrival and completed by the resident under the guidance of Cornell and Bugando faculty during the rotation period. The resident will also conduct several instructive presentations on a variety of laboratory and diagnostic-related subjects which will be determined before or upon arrival, based on perceived need.

Dr. Hsu in Haiti with laboratory staff

Mentors

Yen-Michael Hsu, MD, PhD, is an Assistant Professor of Pathology and Laboratory Medicine at Weill Cornell Medical College. He obtained his MD/PhD degrees at The University of Texas Medical School and MD Anderson Cancer Center. Subsequently, he completed the Clinical Pathology residency training at Washington University in St. Louis School of Medicine (WUSM) and the Blood Banking/Transfusion Medicine fellowship training at The University of California San Francisco Medical Center. Dr. Hsu has a strong interest in the education and the laboratory medicine outreach at developing/underdeveloped countries. He was the first resident at WUSM who designed the trainee curriculum to learn laboratory practices and management in resource-poor foreign laboratories. Dr. Hsu was later awarded the full American Society for Clinical Pathology (ASCP) Resident Subspecialty Council Grant in 2012 to fund his effort with Project Medishare for Haiti (a non-profit medical organization that shares human and technical resources in Haiti). There, he established a coagulation testing platform and trained the Haitian technologists to perform these clinical tests for the patients at Hospital Bernard Mevs. Dr. Hsu is interested in promoting blood transfusion safety practice in Tanzania.

References

  • Weill Cornell Bugando Program
  • Arthur MA, Battat R, Brewer TF. Teaching the basics: core competencies in global health. Infect Dis Clin North Am 2011; 25: 347-58.
  • Center for Global Health, Division of Infectious Diseases. Orientation Booklet for WCMC Residents Visiting Tanzania. Available at the Center for Global Health, WCMC. Updated annually.
  • Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, Wasserheit JN; Consortium of Universities for Global Health Executive Board. Towards a common definition of global health. Lancet 2009; 373: 1993-5.
  • Rambau PF. Pathology practice in a resource-poor setting: Mwanza, Tanzania. Arch Pathol Lab Med 2011;135:191-3.

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