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Now. So we've got an up update in RCP Global. Um And we've got two speakers for the next session. So the first is doctor, he's the RCP Global Vice President and the associate director. He's an honorary senior clinical lecturer at Kings College, London Slightly for the quality improvement and evidence based practice model. He's currently training program director for the endo endocrinology and diabetes high specialist training program. And he also co-chair a simulation faculty at King's College of London. He's a member of the RCP Speciality Advisory committee. Joining us virtually is Doctor Tamari Fry. Doctor Fry is the president of the Malawi College of Physicians and a consultant in internal medicine based in Malawi. She was a visiting lecturer on the Masters in Global Health and Infectious Diseases course at the Kolk Institute and has been examined with an L SHTM diploma in topical medicine and hygiene. She needs a specialist training program for doctors in Malawi to specialize in internal medicine along with partner institutions in Kenya, Zambia, Uganda, Zimbabwe and Tanzania under the East Central and Southern African College of Physicians. What happened to you? That is good. It's good. Oh, thank you very much. It's a pleasure to be here. Thank you for the invite. It's good to see you. So your face here. Um So I'll be covering uh a bit about the R CPS uh global activities um uh around the world. Uh So, those are my two objectives. Uh So we were going to discuss what we're doing and we were thinking about how we're formulating our objectives are relevant to global and UK needs. Um So the RCB overall arch overarching strategies is about education, improving and influence how health care is uh designed delivered and um and assessed. Um and that we use that as our means of designing our global strategy. So, the current global strategy centers around those three strategic aims and, and that and, and the RCB strategy as well covers the different stages of careers. Um uh uh medical career starting from medical school all the way to physician uh training and um fellowships for more uh established uh consultants and the, and the activities span across from these um stages in career training. Um uh So the strate as I said, the global strategy which currently runs till this year. Um centers around those three things, the education and improving and influencing our healthcare is delivered. And from those you can see the activities I'll come and describe some of those if I briefly describe the, the, the overall things. So in education, you have the CPD type activities, uh meetings, conferences events, workshops, faculty development is a big component of the R CPS uh offer uh and also promoting uh diversity in membership and fellowship as well as uh from a global perspective, the CT Scheme Medical Training Initiative Scheme that the RCB runs, which I'll come to in more detail, the influencing arm covers wide variety of activities spanning across collaborations with international partners, international agreements. Anything that the RCP tends to do globally uh comes through that arm but also within the UK, things like talking to um government and nothing going to me. But that's part of the um overall um er er RCP role in that influencing policy, er responding to consultations. For example, G NT consultations, the specialty societies, linking with specialty societies and the improving has the clinical care delivered and care improvement. So, for example, from that comes the ACC program. So a few of gastroenterologists, you probably know about jag the ait for endoscopy in diabetes. We're just starting a new program on inpatient diabetes and a whole host of other things including designing an outpatient strategy with the new strategy coming out and there's a new website for the RCP. So you'll find a lot more content in there. Uh We are currently working on the 2025 2028 strategy and some of you who were in the conference uh attended uh one of our sessions to engage with us to try and understand what's how we do things uh for moving on from 2025 learning from our activities in the past, obviously, with COVID that uh our global activities had to evolve and develop in a different way. We have a lot more engagement with technology, let's travel. But e embracing the hybrid environment, hybrid education as you see in, in your uh in your event is one of our main themes um our global network. So where we sit is uh reporting director of the PRE RCP president uh and as a, as global Vice President, uh there is a network of associate global directors covering the regions of the world um as well as a specific associate global director whose main role is to support international medical graduates through uh for example, our N TI program, which I'll come to in a second. Now, linking to that is a wide network of international advisors um spread across the world where we have activities. Um And on the website, there are details of all the international advisors and I'm delighted to have one of our international advisors here today from Iraq and Professor Safa, who chairs our RCP network, which I'll come to you in a second. Oops, right? Um And from those activities that I mentioned, there are things that are very specific to the three strategic aims for education, improving innovation. There are some that cross the three sections. So for example, the Global Women's Leaders program aims to develop leadership in around the world. Uh taking some of the principles from some of the courses in education and improvement uh to deliver meaningful and sustainable change. Uh Globally, the pilot site was in first in Pakistan and there was a new pilot site in Jordan. And we're in discussions through um my colleague Montas Patel, the Vice President for Education uh in Iraq and other other countries around around the world. Um Doctor will speak to you about exac but in brief, uh this is a one of the strategic er projects that the college is engaged with in, in developing physicians, globally, supporting a new organization exop in Sub Saharan Africa. Currently, there are six countries but they are more interest in joining and tomorrow will give you more brief into that. And one of the things we support is communities of practice is a principle of bringing people together and a certain aims and objectives, working together towards a common goal, using communal resources to achieve certain things or outcomes. And I'll start you on the RCP network which uh hi has started in Iraq in 2020 going from strength to strength. Um It started as a as virtual members and fellows of the RCP met, try trying to answer some of their questions, some of their needs. So started delivering and desi designing and delivering courses specific to their needs. And you can see this is from the 2022 program rising. Um number of courses, the the projects are developing and evolving. I was just having discussions with, hi this morning about their plans for this year and next year around bringing colleagues together forming networks. So for example, medical education educators uh faculty development, we're partnering with universities in Iraq now as a result of that, we, we, we uh when we are observing, we're seeing increasing numbers of, of members and fellows coming together and that's reflected in our membership figures. And there's a widespread uh presence in uh on social media and websites and engagement with that. Um in education, I've come to the MTI, but we have a wide variety of offers through our other departments within the college. Um So the MTI scheme is uh so the, the term MTI is a set of standards issued by the Academy of the Medical Royal Colleges. The RCP took those principles as other colleges have and we have our own N TI scheme that we deliver. Uh It started in 2009. Uh anything from six months to 24 months for any international trainees or specialists coming to train within the UK. Um Roughly speaking in every year, in, in any year, you have about 200 plus um uh spread across uh the UK. Um And the panels uh and the and the posts are quality assured and accredited by a panel of fellows um with within the, within global. So it, it aims to bring uh Marlo's expertise available in the UK, with trainees abroad who may not have access to such opportunities and provide them with the support. Uh What in their time in the, in the UK? Uh the rouge to join the scheme there used to be two. So one of them was direct interviews that the college used to go and do. Um But that has that, that has involved in COVID and really it's the candidates, for example, finding their roles within the UK or if they are self, if they are funded by governmental bodies and we have to put them in touch with, with uh organizations in the UK government post. The provides the Chinese with uh G sponsorship and visa where, where required and the team within the MGI er support them through the different stages of the application. Um And more in the last couple of years centered around providing the support package for the scheme, uh the ba the induction, the and now we there's a new conference every year to bring these people together and uh regular touch points through virtual events in uh for example, MDI Mondays is for current and prospective candidates who would like to know more about this. It happens as social media to to be able to join in it, open to supervisors as well as interested candidates. Um We engage with a number of partner to co co or or design some of their events, uh CD, etcetera and you can see it's uh a mix of online in person or hybrid. Um now RCB London is one of three colleges or two sister colleges north of the border, uh form the Federation of the Medical World uh colleges and they're responsible for other functions. Some of it has a global element to it. So for example, there are international centers for M RCP specialty certificate exam. There is the European exam which UK partners in and then obviously you have the training in the UK, the jail CPT B uh in charge of specialty training in the UK. There are some sites of UK training abroad. So for example, there's an I scheme in Iceland. Uh and there is an I in India uh in certain centers and that they are, they run central from the Federation and obviously the federation, the other big role of it is to provide to the how you get involved. Um others providing posts or being supervisors for trainees coming from uh countries around the world initiating or supporting our existing networks and cross specialty projects. There's loads of education activities that we would like you to get involved uh with. Uh and for any projects, we'd like specific aims and objectives, deliverable outcomes, but also measurable and we can help you with the stakeholder engagement. Thank you. I'm sorry. I'm just wait to get to join online. I wonder if anyone has any questions for that. But in the meantime, while we get, get from, I'm Medical Fellowship. Um Can you comment on um of positions in the UK international medical graduates and the challenges that um international medical graduates face of? How can we? Thanks for supporting Im GS. Thank you. I don't have the exact figures um of Harry, but there is um if you look at the GMC figures, the the fastest growing group of doctors is local doctors and many of them are international medical graduates. And from a specialty training perspective, there is, there's a good proportion of that I don't have the exact thing. And there is in terms of support, I think the that depends on where the, where the doctors are. So for example, the biggest challenge for colleagues coming immune to it is actually getting to know who's who, where, what do I do? Where and getting familiar with everything else. The other challenge actually is getting colleagues who are trainers to actually know what the needs of, of colleagues coming from other countries and their perspectives, their capabilities and what they can contribute. So I think it's a two way, it's a two way street. Um There are a number of good initiatives around. Uh so for example, in there was a scheme um led by on, on induction packages and how to standardize those packages. Uh And we're, we're doing a piece of work to try and bring all of these together to make it available more the other the other group of doctors was a small minority refugee doctors and we're doing scoping work around that. And we, there's very few in that. I think the did have a scheme, the medical support work, but I don't think it's swimming anymore. Oh, that's good. Thank you. And so I think we've got Doctor Fry back on the screen now. Uh I'll just check that she can hear us. Hi, Doctor Barry. Can you hear us? Yes, I can hear you. Perfect. Um The stage is yours. We have to you. Thank you so good afternoon, everyone and thank you for inviting me uh into this meeting. I'm going to spend a few minutes talking about um fairly new physicians college that has been set up in Sub Saharan Africa um over the last nine years and I'll just talk through the process of how that came to be and also how far we've gone so far. So I am speaking from Malawi where I am the president of the physicians in Malawi. Uh but today I am speaking to you on behalf of um OC where I am the registrar for the East Central and Southern Africa College of Physicians. So this college um is currently existing in six African countries which are Malawi, Zambia, Zimbabwe, Tanzania, Kenya and Uganda, and just a bit of background about this region. So we've got a population of about 200 million people. Uh We've got a huge burden of disease. From both infectious and non infectious diseases. Um but also very few doctors and even fewer specialists that are trained uh to look after these patients. Um However, we have a lot of people that are keen uh to get trained and to get um exposure. Uh but we've not been able to meet, to meet this need um in full. So, in general, um before exacor, if one wanted to become a physician, there were a couple of paths that you could take. Um So starting with your undergraduate degree, uh quite a lot of people would then have to travel uh to go um to one of the high-income countries and then get their training there as a specialist and then hopefully some of them would return. But from experience, a lot of people did not return back home. So after that, after a number of people had been trained and had come back home, several of these countries started running their own specialist training programs and the most uh popular one that uh was existing before Exop is a master's in internal medicine program, which is a four-year training program. Um More recently, we've started having blended training where we get uh people to start their training within their country and then spend the second half of their training um in another uh world resource setting so that they can get um exposed. So that's in general how we've been getting physicians. Um But the problem with this is that this path has been taking very long uh because it depends on the availability of funds and scholarships for people to train. And because of that, we've had very, very few physicians trained for the region, but just to give you some numbers. So these six are the countries where um exacor is currently existing. And you'll see that in Malawi, for example, with a population of 19 million, there are only 41 physicians for this whole 19 million people. Um It's better in some countries uh than others. But still, if you look at those numbers and the needs that is there, those are very, very few uh people that are available to, to, to offer their services as physicians. So through the programs that have been running um at, at present, um before Exacor started that a program would graduate five physicians per country or 20 physicians per country. And if you go by those small figures, it would take us 100s of years for us to get to the ideal number of physicians that each of these countries needs. So that's where came in so that we can start um training more physicians and focus on training people within their countries. So what are the main reasons why we don't have enough physicians in this region? So one is the training opportunities are quite limited. There's more people that want to train than the there's positions for them to train uh are available and then also there are problems in getting enough people that are committed to training, who are also experts in the fields that they are training. And not only that you also need appropriate medication, appropriate resources for people to train properly. Um There's a huge cost that's involved in running these training programs and especially if they would need to travel uh to train elsewhere. And another big, big problem has been that a lot of people that have gone to train elsewhere have not come back and their countries have actually lost out. So Exacor started uh with a very ambitious goal to double the number of physicians uh by 2030. And Exacor only started in 20 in 2015. And the idea was to build on resources that were already present. Um The training started in hospitals which already had physicians working in those hospitals. And uh by combining the six countries, we expanded the pool of experts that we could draw from as trainers, but also to set the foundations for the program. The other good thing is that this region has got very similar disease patterns, very similar social and cultural trends, uh which makes the sharing of knowledge and exchange very, very easy because the people sort of understand where they're coming from. And uh one important thing that emphasizes on is that physicians should train at their place of work. So they don't need to leave um the places where they are employed, they can continue to get um their, their salaries but also be on a training program and stay with their families in the areas where they are trained. So as I said, um these are the six countries that are currently running um the program uh Riat in Uganda uh where it's housed in the Infectious Diseases Institute. Uh This is within Makerere University in Kampala in Uganda. Exac cop is part of a bigger uh East African health community which has uh nine countries. Uh Only six of these are currently training, but we are looking into expanding into more countries. And Ex A Corp is just one of the several colleges, specialist colleges that are running in these exa countries. So I'm speaking on behalf of the physician's college, but before we started, uh there's already a college of surgeons which has been training surgeons for over 20 years. There's a college for Nurses uh for ophthalmologists, oncologists, pathologists and uh pediatricians and a couple of new colleges that are just about to start training as well. So just to walk you through the path that we've taken. So we were ratified by Ministers of Health, representing the six countries who agreed with their governments that they would uh support this training program within their countries. And then in 2016, uh that is when the college was launched uh in Zimbabwe. This is the very first group of um physicians that came together from the six countries to start off um the college. And then after that, we started developing a training curriculum, uh which is now being used. We also had to um develop some assessment tools uh especially for continuous assessment. So we worked through this between 2016 and 2017. Uh we also got uh trained in how to set up and how to run um exams. And then we also needed to train the physicians who are going to be trained us for OC so that they understand what this training program is about and what our curriculum is about. And this uh clinical supervisors uh trainings have been running since 2017 in the different countries. Um After that, uh we started accrediting uh training sites which are hospitals that are certified to run the OC training programs and inspections took place in several hospitals across um these six countries. Uh These pictures are just from three of the hospitals in Zambia, Uganda and Malawi on the days that they were being inspected by AO. Um And then we also had set up an internal um team that was going to assess our standards. Uh This is called the Academy of Educators. Uh This is a group of physicians that have been selected from the region uh who are checking that we are doing what we say we would be doing uh through the Exacor program. So what have we done to get? Um So starting with training uh we've got a training model um that starts with the trainees uh at the training units and then the trainees um at each unit have got a represented um that represents them within the local training unit. And the training unit has got clinical supervisors. Uh These are the trainers and one of the clinical supervisors is a training director who oversees the training within that local training unit. And then each of those um training units are represented on the national um training board where each of the training directors from, each of the training units is a member. And then each of these countries is now represented on the regional Training Committee where you've got representation from the six countries that are running the A program. This is how our recruitment has been going. We started uh training in 2018 and since then, we've s um steadily increased. The number of uh trainees that have signed up for the A four year training program. Uh Our largest recruitment was last year when we had 43 new trainees start on our training program. Um So currently, uh we have um training in multiple sites in these countries and Tanzania is just about to get certified to start um training. Um We've got 19 accredited training sites across the different countries. The majority of these training sites are in Kenya. Um We've been training faculty to train uh these uh of trainees and these are done through a two day train, the trainer course and this rotates uh, within the different countries. And after the two day training, um, the, the physicians are certified as trainers. Um, we've also got a few, um, trainers, uh, within ex, who are master trainers who can run, uh, this train the trainer program independently. So, since, um, 2017, in total, we've trained 243 physicians as of trainers. And of these, we have three who've um now taken up the role of master trainers, they can run their own, uh train the trainers within the different um countries. We've so far um inspected 22 sites and accredited them, but only 19 are now training and we've also got site accreditation which is going on for sites which have been operating for more than four years. Now. Um These are the sites that were inspected last year. Uh All of these are based in Kenya and these are three separate uh hospitals there in terms of our training. So part of our training is done online, we have that shared curriculum and our teaching is delivered. The didactic teaching sessions are done uh online. So all our students join at the same time. Uh We've got a virtual learning platform which we use um to deliver this online training and we invite experts from within the region but also outside, we will then um do the, the classes for our, our trainees um they've also got a lot of case based uh discussions uh which are student l and then within the accredited hospitals, that's where the onsite uh hands on training happens at the um with the inspection of the clinic or supervisors in each of those training sites. And um they have case based learning and um assessment, ongoing assessments that take place at those sites. Um So this is a, a um website uh where our students and also our trainers and our fellows um can log in to access um the different resources and see um they can also upload their logbooks, the trainers can see what the trainees have been doing uh over the course of their training program in terms of exams. Um We are very, very um uh keen on assessing uh their, their competence rather than just having once off examinations. So they have continuous assessment throughout the training. Um They have a written and OS exams at the end of year two and year four of training. Um This is just an example for the part one exam at the end of uh year two. So these are run within the different uh countries. Uh So for example, this was uh last year, uh this was one of the examination sites um in Kenya. Uh But there were also other sites uh within the countries that were running these um exams. And then for the part two, which is the exit exam uh this is done um in one country. Uh Usually that's the country that's hosting our annual conference. Uh This is last year's uh exam which took place uh in Zambia. And we had 10 trainees who start uh that exam. Um The Royal College uh has been involved in us developing the program, but also they are a part of our examination team as um external examiners together with the West Africa College of Physicians. Um So this is a graduation that took place uh immediately after the exam that we had last year, all 10 candidates passed and then graduated from the program. Um We've got internal and external uh quality assessors. Um As I mentioned, the Royal College is involved, we have our own Academy of Educators and the West Africa College of Physicians, uh also does some of our assessments um as well. And we've got um regular planning uh for exams to train more people to run as exop examiners so that they are familiar with the exam uh system. Um One of the main reasons the college exists is for us to network. Um So every year we've had an annual general conference that brings together about 200 physicians from Africa and beyond. And we kept on having these conferences even through COVID uh where we had uh virtual uh conferences. And the last conference was in Zimbabwe. And this year the conference is going to Uganda. Um We've got a base of fellows, 489 who are our founding fellows. These are physicians that were present before Exacor started and they were uh given an honorary fellowship um within Exacor um as we were starting our training program. And then now we have fellows who have joined after qualifying and passing the exams in total. We have 15. So we've had two graduations so far. Our first graduation was in 2022 and our second graduation was last year in Zimbabwe. Um We've opened our fellowship to people outside the OC Corp region uh for physicians that would want to become Exor fellows. Uh We've opened new fellowship uh categories. It is a fellowship by nomination uh for physicians who didn't join us, founding fellows, but also physicians that are outside Africa in the diaspora. They can join as fellows by association. Um OK, I'm about to wrap up. So um we've got other countries that would like to join uh also within the African region and also in the diaspora and we are entertaining uh those uh discussions with them. We've got a number of collaborators which includes the Royal College of Physicians and um the British Infection Association, the World Health Organization, um as well as uh other colleges within Africa. Uh So far, our success have been using the regional expertise and collaboration, using preexisting structures and collaborating with our governments uh within the region. Um We've had a lot of challenges already one has been the finances to make sure that we are a sustainable college. Um making sure that we can keep incentivizing and supporting our trainers uh but also expanding our secretariat um activities. So right now, we are strengthening our secretariat working on income generation and also making ourselves more uh visible. And I would like uh to acknowledge these different partners uh including the different physician associations within the six countries. You are up on the ground. Thank you very much and a question. Thank you for the excellent succinct brief. Do you have any measures or incentives that you have put in place to retract or benefit from those you have lost to your brain drain or retain those who remain committed to working in your region? Um Thank you. So that's something that we've discussed um extensively uh on how to make sure that um we are making the environment uh conducive for people to come back, but also for them to be interested in um in, in contributing to what's going on within the region. And one of the things that a lot of people have uh been attracted by is to see the success um that the program are actually up and up and running and also seeing the quality of people that have been trained through the program. So we actually have already uh got quite a bit of support from physicians who left um Africa, but now want to be involved either as trainers. Uh some of them are sending funding support and we hope that some may actually come and uh get involved on the ground. So it's a slow process. Um But I think uh the more people see the fruits, the more they get interested to be low. Thank you. And uh second question is um a que comment as well. Thank you, Doctor Fry for this awesome talk with the digitization of medical education. Do you foresee more of an update in physician trainees or what other barriers to overcome? Um So we've had um actually the, the, the digitization has been one of our advantages uh because it's allowed us to operate um across borders uh because people can interact and they can learn uh at the same time. Um at the same time, it's also helped us to partner with institutions outside our region and benefit from their expertise which they can give uh virtually. And also that has been one of the main attracting things about the college in comparison with preexisting trainings, which are just done within the country. So the fact that everything is digital now, people now get a lot more um exposure uh through programs like ours. And we really are keen on continuing to leverage on this because it's just opened up uh opportunities that we didn't have before Doctor Fry. Thank you so much for joining us. Firstly, today, um Any questions we've got, uh we've got space for one question before next session. Uh We've got Doctor Must here in the room for anyone who wants to ask the question. Mhm. And is there an opportunity or a space for remote me? And I guess that the you some information in that? Um Thank you so much. What I mentioned. Yeah. Yeah. II we don't have that in this yet, but it's certainly something that we have, for example, with the network, we colleagues that not specifically with students, but we help them to do their projects and how they did that obviously. Um And I think those that can be trans into other project. Um Thank you. That's all we have time for, for this session. Thank you, Doctor F for joining us from Malawi. And thank you, Doctor.