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Stanford University School of Medicine

Providing medical, educational and technological tools in Zimbabwe

Medical missions can provide immediate relief after a natural disaster or support for local doctors in low-resourced countries. But global health efforts that involve education and training for medical students and residents may build a community’s capacity to be self-sufficient over a longer term. One example of this type of intervention – enhancing technological competency – can further help sustain medical care and research for populations in need from within a community.

Stanford’s Center for Innovation in Global Health, led by Senior Associate Dean Michele Barry, MD, FACP, is in the fourth year of a five-year, 10 million dollar NIH Medical Partnership in Innovative Education (MEPI) grant with the University of Colorado, Denver aiming to strengthen medical capacity in the University of Zimbabwe College of Health Sciences, the country’s primary medical school. Barry wrote in an e-mail that the effort, part of the Novel Education Clinical Trainees and Researchers (NECTAR) Program, has three goals:

1. Enhance Zimbabwean faculty development, update technology and develop a competency based curriculum

2. Train future educators and support and develop faculty medical specialists

3. Mentor future researchers

Why Zimbabwe? Barry explains the country’s particular needs and how MEPI has helped:

Zimbabwe is a country of 12 million people that saw a massive brain drain of physicians due to economic issues and political instability. A total of only 998 doctors were left practicing when the grant started, with two adult cardiologists available for the entire population. Only 39 percent of the 314 faculty positions at the medical school were filled.

Since the grant began there has been a 152 percent increase in enrollment in the medical school, from 92 students to 237, and that was felt to be due to the excitement this grant has generated. Zimbabwean students and faculty have had opportunities to come to both Stanford and University of Colorado to learn specific skills and exchange knowledge. More than 75 faculty from the partner universities have rotated to Zimbabwe to teach and fill gaps in the curriculum.

When MEPI began, Barry says, the University of Zimbabwe’s medical school had no Internet connectivity. Last summer, specialists from the Stanford Graduate School of Education’s IT department visited to set up several e-learning systems and train local staff to maintain new software, and they’ll return early next year to enhance them and pilot an additional program. I spoke with Noah Freedman, a tech support associate and lead technical advisor for the SMILE Consortium, who helped adapt resources from Silicon Valley to function in Zimbabwe. He worked with David Katzenstein, MD, an HIV research specialist and professor of immunology, and Michelle Cook, a computing support analyst for the School of Medicine, to identify and address needs in this low-resourced area.

“We have all this free education content available,” Freedman said, noting that Stanford as well as Khan Academy provided learning materials (check out Khan Academy Lite to read more about how the organization is providing open-access materials with little Internet), and he and his team uploaded the entire English-language Wikipedia onto offline servers. “The challenges are distributing it.”

Among the obstacles, Freedman said, are a shortage of power; poor access to Internet and low bandwidth, causing delays; and design fluency and learning styles different from those of the Stanford and Silicon Valley regions where the programs were created, rendering some materials irrelevant.

One solution regarding power and bandwidth scarcity was to use smaller computers and offline servers, which could be updated during non-peak hours of Internet usage, to store e-learning content. The MEPI team worked with SMILE Consortium’s technologies, designed to build a learning environment with all students connected to computers or mobile devices in a classroom. A device called SMILE Plug – a portable, wireless server that hosts content without an Internet connection for up to 60 users –will be piloted in Zimbabwe during the team’s next trip.

SMILE’s open-source development software allows students to create multiple-choice questions for their peers to answer on a topic they're all studying. The high-level critical thinking skills and active participation demanded by this process, Freedman said, help to develop context-relevant content. “You can’t just duplicate what’s used in the U.S. or at Stanford,” Freedman said. “‘Intuitive’ and ‘common knowledge’ are not universally defined.”

Previously: Internet’s role in providing basic human necessitiesIt’s a small world after all: Global health field takes off in the U.S.Combining online learning and the Socratic method to reinvent medical school courses and A plan to expand educational offerings to “anyone, anywhere”

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