Apr 18, 2011

Experience of a global health resident at the International Forum April 5-9th 2011

My name is Narath Carlile. I’m a Global Health and Social Equity and Internal Medicine resident at the Brigham and Women’s Hospital in Boston. I had the chance to go to this year’s BMJ/IHI International Forum in Amsterdam, and I wanted to share with those of you who could not make it some reflections on the Forum, why you should go (if you can) and a little of what you can expect if you get to go.

First off, I would say the forum is about connecting! Any of you who have experienced the IHI conferences in the United States know that these are collections of amazing, motivated people interested in improving things! It’s hard to imagine a place with more positive energy when you are there. The international forum is perhaps even more so, since there are people from all of the world here, interested in, studying, and doing improvement work. The diversity of the environments and challenges they are working to overcome is truly impressive.

A typical day will start with you walking through the poster hall, coming across a poster from New Zealand where they have managed to reduce errors by 28% with a structured communication training program with such things as relaxation and increasing assertiveness. Dr Peter Lee (whose poster it is) is there and is very interested in you, and your residency/medical school program. How is it for you, what could be better? He gives you his contact information, you promise to email him, and he promises to send you more information and looks forward to keeping in touch. You grab your coffee and head over to the student/faculty morning session.

The student/faculty sessions are a great resource for medical students, residents, and faculty. It’s our own space with sessions designed to inspire, touch on the basics, and share with us what is possible at any level of training. Here you join students, residents, and junior doctors from the Netherlands, Denmark, Norway, Sweden, Germany, Scotland, and the US. They are without fail, inspiring colleagues, who are traveling a similar road to you, in very different countries, and healthcare systems. They have all struggled with many of the same issues that you do, with how to positively interact with a system in which you see problems, how to inspire others and yourself to be better in a system that already demands so much of you. And you are often amazed by the creative solutions, and the dedication that you see in them.

You’ve all started the week with an amazing session on the Fives Alive project in Ghana where they are making great strides in reducing morbidity and mortality in under 5 year olds, using simple change-packets and short PDSA cycles. During the next morning you “competed” against each other in the marshmallow challenge. Today however we are the envy of many of the attendees here, since we have a small intimate gathering with Dr Paul Batalden from Dartmouth, a very influential figure in QI, who has synthesized the core of QI teaching into a very easy to understand session. He’s very approachable and walks with you to the keynote session, and as you walk there you have the feeling of accompanying a rock star - he gets such warm greetings from all who pass.

The keynote sessions are grand and inspiring, and today it is Jim Easton who discusses Improvement’s greatest challenge, from which I get that there are 3 generational challenges facing healthcare (cost, information technology, and the improvement movement), and that in order to improve we are going to have to address each of these, including improving improvement. “What we do is important, so doing it well is really important!”

The events are very well produced, and keep you flowing, past the free coffee, tea and biscuits to your next session. Today you learn how to turn the world upside down through the creation of global learning network. During the session the idea of linking together those involved in local improvement emerges. This would allow lessons and particularly ideas that work in a local context to be shared with those who might benefit the most i.e. your neighboring hospital/clinic. Turns out the IHI has already been thinking of this and at the next forum you can expect to have a morning or afternoon session dedicated to regional Quality and Innovation Center discussion!

The time for the session seems to short, but you are already on the move to your next - 4 fascinating discussions about the treatment of HIV and AIDS in resource poor settings, from Haiti, Mozambique and Uganda, each struggling with ways of extending and improving care in very challenging situations. The discussions after raise interesting questions many of which you have been thinking as you listen to the sessions (“why don’t we just ...”). Almost always, these are met with considered replies - those in the field, in these countries have very often thought of many of the armchair solutions we consider from afar, and have keen insights into why and why not they would work! Invaluable lessons from experience!

Later in the day, you’ll play some serious games like the medical areas in Second Life, or the bio-feedback driven Air Medic One, watching one of your colleagues desperately try to relax in front of a “live studio audience” and almost succeeding! In the end you will see John Moore from
MIT’s New Media Medicine present a session on some of the future tech of medicine, and you’ll be amazed at how much of it is centered on communicating more effectively, improving technology to allow more meaningful human to human interaction and less human to screen interactions.

And with that, I have to encourage you all, as we sit in front of our screens to (as another attendee said) do “less talk, more walk.” I highly recommend that when the next forum comes, that you join your fellow students, residents and faculty. You will leave energized, committed, supported, and empowered with new knowledge, new ideas and new friends that will help sustain you in the challenges which lie ahead!

- Narath Carlile, Global Health and Equity/Internal Medicine Resident, Brigham & Women's Hospital