Above: Participants at IMELF 2017 in Quebec City, Que., included representatives from 19 countries.
We feel privileged to be in a position to help global partners working in medical education, by sharing our knowledge, experience, best practices and standards.
Over the years, I’ve encountered both support and enthusiasm, but also some false perceptions, about the Royal College’s international work. While I’ve responded individually to these queries, I wish to reaffirm some of my previous positions and use this message as an opportunity to debunk some common misunderstandings I’ve heard voiced by Fellows.
I hope that, in doing so, you will come to share my excitement about these efforts.
Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer
- Myth 1: Our international work is entirely funded by Fellow dues.
- Myth 2: We are biased in our selection of global partners.
- Myth 3: We turn a blind eye to human rights abuses in partner countries and we neglect domestic issues.
Myth 1: Our international work is entirely funded by Fellow dues.
While this is a longstanding belief, it does not tell the full story. The Royal College’s international outreach services are managed by Royal College International, a wholly-owned not-for-profit subsidiary of the Royal College. From the outset of our international expansion, we took the position that our international consulting activities would be structured using a cost-recovery business model to ensure member dues do not fund this work. With the success of our engagements to date, we are now entering a phase of our international operations where this model is a reality. Royal College International has paid off all of its start-up loans and will inject a small surplus into the Royal College reserves in 2017 and into the foreseeable future based upon our forecasting. We are looking at those funds to also support growth in our international development and collaboration activities, targeting low and middle income countries.
Myth 2: We are biased in our selection of global partners.
Our international efforts take two forms: international consulting (e.g. our work in China, Latin America and the Middle East) and international development and collaboration (e.g. our work in Haiti, Nepal, Senegal, etc.). To date, most of our partners have reached out to us because of past exposure to, or experience with, our Canadian postgraduate medical education system. We have always evaluated opportunities presented to us against a set of criteria that includes whether our prospective partners’ goals are aligned with both our organizational and Canadian values, and fall within our educational mandate. In fact, we are formalizing “engagement criteria” that will provide further guidance and direction for our future consulting and developmental projects.
I believe that our International Medical Education Leaders Forum (IMELF) series of regional meetings, more than anything else in the next few years, will also serve to not only facilitate dialogue across and between regions, but also open up extended collaborations. We have IMELF meetings planned next year in Kuwait, Australia, South Africa, Sweden, China and Mexico.
Myth 3: We turn a blind eye to human rights abuses in partner countries and we neglect domestic issues.
At issue here is discomfort with the countries in which we are working (Saudi Arabia and China are primarily called into question). I’ve also heard the reverse claim that we prioritize global solutions and neglect domestic ones (in particular, the plight of Indigenous people and their health inequality). I’d like to address both aspects, starting with our global partners.
Canada’s borders have long been open to the free flow of knowledge and people — including medical graduates and physicians. Data from the Canadian Institute for Health Information in 2015 found that there are about 82,000 physicians in Canada — 26% of whom are international medical graduates. As many of you know, I have also benefitted from global mobility. I lived in Riyadh with my family and practiced hematology at King Faisal Specialist Hospital and Research Centre for 15 years (1978-1993). This is a reality that we must recognize and work within. Closing our borders and insulating ourselves is both impossible and rarely serves anyone well in the long term.
Some members feel that we should not be working in countries where human rights are challenged, but to them I say: consider the positive influence of our Canadian Fellows working alongside medical faculty and patients in these countries.
I’ll use Saudi Arabia as an example.
Canada has been the preferred location for residency training for at least 4000 Saudi physicians for 40 years. These physicians return home with their families and a stream of new ideas and experiences. It is these same individuals who reach out to us for assistance in influencing their institutions’ training standards and integrating Canadian learnings.
We have more than 300 active members working in Saudi Arabia. While we began our international work in Saudi Arabia in response to an invitation, we have rapidly expanded to China and South America and will expand more in the future.
I don’t believe that quality care should be dependent on where you live. Globally, we talk a lot about education diplomacy: the idea that education is a human right and that education facilitates the attainment of other basic needs, not to mention positive change and innovation. To many, education and health are seen as basic human rights. It is in this spirit that we endeavour to be an enabler: that through shared learning on how we operate in Canada, global partner institutions can adapt their training to better service their population needs. It is no different than sharing how to perform a new surgical technique or medical procedure or treatment. Patients benefit exponentially. We also learn a great deal from our global partners, take key learning home and benefit from these exchanges.
At the end of the day, we are about people. We are about education. We are about capacity-building. We are about care.
On the question of why do we work internationally when there are lingering issues here at home, I say that’s a simplistic view. It’s not one thing over the other. While I firmly believe in the value of our global efforts, I am equally passionate about Canadian health care and training; that is the Royal College’s primary focus day-in-and-day-out.
We recently announced a ground-breaking decision to move forward with integrating Indigenous health curriculum into postgraduate medical education, to try and influence greater consideration of cultural safety and respect of Indigenous values in the provision of health care services. We use our Dr. Thomas Dignan Indigenous Health Award to raise the profile of such work. We are also working tirelessly in our health human resource data collection, specialist employment study and related efforts to help us highlight needs and gaps, and influence dialogue on better access to necessary care (whether urban, rural or remote). All of this work is ongoing and I am heartened by the many partners and collaborators we have in our efforts.
To summarize, our international presence is complementary to our national initiatives. In many ways, this work informs and energizes our domestic activities.