MEDICAL EDUCATION

ACCOMPLISHMENTS

· Tbilisi State Medical University completed a review of medical school curricula and made revisions to its curriculum, particularly after training exchanges with leaders in curriculum development, pathology and anatomy.
· An ongoing program of medical school exchanges was established between Emory University School of Medicine and academic medical leaders in Georgia, including training exchanges completed in psychiatry and neurology.
· An ongoing program of medical student exchanges was established between Emory University School of Medicine and Tbilisi State Medical University. Thirty medical students from TMSU have spent four to six months on clinical clerkships at Emory. Twenty Emory students have spent one month each in Tbilisi, each with a specific health care project. E.g., assessment of iodine deficiency in newborns, prevalence of HIV in patients with tuberculosis, technical support for the legal basis of medicine, etc.
· The Dean and three Executive Deans of Emory have visited Tbilisi, and the Dean and Associate Deans of TMSU have visited Emory School of Medicine.
· The association with Tbilisi State Medical University made modest accomplishments in curriculum reform. There were changes in course content in the courses whose directors visited Atlanta, and in general curriculum requirements. E.g., the curriculum was enlarged to include humanities and other subjects recommended by the national study of general medical education in the U.S. some years ago. The name of the medical school was in fact changed to reflect this: Tbilisi State Medical University, rather than 'medical school'.
· Plans are now underway to establish a new medical school at Tbilisi State University, modeled exactly after U.S. Medical schools, specifically Emory University School of Medicine.

An excerpt from the report of a senior medical student who spent a month in Tbilisi in 1997:

The obvious allure of this program is the opportunity to send a handful of 4th year medical students to Georgia to immerse them in a totally foreign culture. To this end, the program already works perfectly. There has yet to be a student who has traveled to Tbilisi and not been impressed by the richness of the culture, the beauty of the land, and the warmth of the people. Home stays arranged by willing and eager hosts allow the students to truly experience and appreciate everyday life in Georgia. The lessons learned both confirm and refute all that we (as Western students) have ever learned about communism and the former Soviet republics. The politics and economics of a struggling newly founded democracy are fascinating to observe in action. Potholes larger than automobiles, shoddy construction materials and techniques, and completely unreliable power sources are juxtaposed on a vibrant population that is generous and amiable and ready to celebrate anything at the drop of a hat, even if it means they must write off work for the rest of the day. The Georgian table is the traditional celebratory feast and is an event not to be missed. Georgian hospitality is legendary for good reason; tradition mandates that the guest is literally sent from God and must be treated as such. Never have I been so pampered in my 26 years of modern Western convenience. The cumulative experiences of the Emory students in Georgia are so varied and rich that in some senses they literally defy description; you simply have to be there. Even if this program accomplished nothing else, it would still represent an exchange experience par excellence.

It is understandable, however, that Emory University might not be so hot on subsidizing a travel exchange for students with no tangible benefits. Fortunately, this program also offers the opportunity to enhance the medical training experiences of the students, the University, and Georgia. For the students, the program presents the chance to take a small research project and handle it almost completely independently. The students can conceive of an idea, pursue their own advisors and sponsors for guidance, construct a model for the study, collect materials, organize resources, and then carry out the study to the best of their ability while in Georgia. This is truly independent research, and not just running scut on some hotshot's grant proposal. In addition, the lack of structure in the program allows the students to select topics either within their fields of interest or completely separate from them. Rare is the time that a medical student is blessed with the opportunity to undertake an endeavor without some hidden agenda attached to it. Its a sure thing that 10 years from now, the program students will all remember their individual Tbilisi projects far more vividly than any other research they undertook at Emory. Some of these projects carry great weight and are quite useful and meaningful to the Georgian medical community.

In addition to the research experience, the students can get some clinical experience. No one can debate the utility of exposure to new clinical settings and techniques in the development of medical knowledge. The lessons one can learn in the Tbilisi hospitals can be stunning. Operating rooms with no monitors, ICUs with no heat or air conditioning, variable power supply, and useless support staff represent just a few of the many pitfalls of the practice of medicine in Georgia. However, despite the shortage of financial support and cutting-edge technology, health care is delivered. Clinical skills are emphasized and exploited to the max when technology is expensive and unavailable. The Western practice of lab medicine does not exist in Georgia. It is a great lesson for the students to see that private American university hospitals are not necessarily the standard of care around the world. If nothing else, a healthy appreciation will develop for Western standards of technology and training, by the time I left Tbilisi, I felt as though Grady Memorial Hospital might well be a palace. We can all acknowledge that this particular sentiment is about as rare as seeing as an orthopedist carrying a stethoscope.

The Emory students are also thrust into a leadership role. As ambassadors both of Western medicine in general and Emory University specifically, Emory students become the focus of scrutiny and admiration from their Georgian peers. On my trip alone, we were asked to speak to the younger Georgian medical students several times in public forums. For many Emory medical students, this will be the first opportunity to project an image as a health care professional and as a community leader. Georgians of all ages listened attentively when we spoke about the American medical education system, the evolving techniques and technologies, and the ever-changing health care delivery system. This experience can help Emory students grow and develop into the leaders they need to be even as they prepare to venture out into the broader medical proving grounds.

Emory University and the School of Medicine benefit from the program in several ways, too. First, Emory has become intimately involved with a number of research projects and development initiatives. Emory staff can pursue individual professional interests in the relatively virgin venue of a newly founded emerging democratic republic. Projects are not merely limited to medical initiatives, either. Political scientists, economists, accountants, engineers and many others can discover exciting and challenging projects. In this way, the University bolsters its research output and projects an international medical presence. Though costly, many of these humanitarian efforts continue to contribute to the improvement of daily life in this developing country. Many of the employees of the Georgian health care industry are aware of the presence of Emory University faculty, staff, and financial support. No institution can purchase the positive public image Emory projects due to efforts like this. The symbolic value of the Emory presence in Tbilisi is inestimable.

From a more focused perspective, the School of Medicine also reaps major benefits from the program. First, it allows students to participate in freeform research, as discussed above. More importantly, Tbilisi can be a forum for Emory to showcase a few of its students as thinkers and leaders. It is a chance to illustrate the excellence of the medical school's curriculum and faculty through the abilities of its imminent graduates. Emory shines through the goodwill and example of the students it sends. In fact, Emory has become a kind of blueprint for the foundation of the first true Western-style medical school in Georgia. One of the many factors leading to this situation has to be the sporadic presence of proficient Emory graduate~ and faculty in and about the Tbilisi medical community.

Finally, the Georgian medical community also derives tremendous benefit from the presence of Emory medical students. We help to lend a certain validity to our hosts. It seems that they consider it a great honor that we choose to visit them and work with them in their own facilities. In fact, there were more than a few political consequences within the Georgian medical community that stemmed directly from the decision of which facilities we attended and which we did not. Furthermore, the Emory students are portrayed as role models by the Tbilisi medical school deans and faculties to their students. The Tbilisi students benefit from the exposure to peers who have trained in a completely foreign environment. Some of the Georgian students volunteer to get involved in the research projects and thus avail themselves the opportunity to work on some independent, Western- style research. Finally, the Georgians reap the same cultural exchange benefits that the Americans enjoy

FUTURE PLANS

·Work to modernize the curriculum of Tbilisi State University School of Medicine

FUNDING

Emory University School of Medicine

MORE INFORMATION

H. Kenneth Walker <kwalk04@emory.edu>

Jonas Shulman <jshulman@medadm.emory.edu>

Archil Kobaladze <askobal@nilc.org.ge>

LINKS

Emory University School of Medicine
[ /index.html ]

Tbilisi State Medical University [http://www.tsmu.edu/index.htm]

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Last Update: June 7, 2001