GENERAL STRATEGY
The ESCOME eventually will be available to any developing country within the mission scope as capacity allows, however the initial pilot phase will concentrate on China. With the guidance of the Global Health Institute, the Advisory and Medical Boards, cities for initial partnerships will be identified with at least 2 partner surgeons in each location to foster exchange. Surgeons to be trained will be carefully selected with input from the China Advisory Board and local health ministries. It is mandatory that highly skilled, dedicated, and ethical physicians be the ones to benefit from this program with the intent that they will become future leaders in spine care in their home countries.
In China, governmental approval at the national level will be completed with the assistance of the Georgia China Alliance and the Carter Center. It is anticipated that both the Ministry of Health and Ministry of Education of the People’s Republic of China may need to support this program, with additional input from leading Chinese spine surgeons and the COA. Key assistance of National Health Ministries will be essential (e.g. Craig Shapiro, Executive Health Attaché U.S. Embassy, Beijing, China), and Senator Johnny Isackson's office is serving as an ESCOME liaison in Washington.
1) Training:
The education is divided into three sequential steps:
Step 1: Web-based standardized core curriculum (4 months)
Step 2: US visitation – Emory lab time and mentor site visits (2 months)
Step 3: China visitation – Follow up weekly computer links and 4 visits by mentor to China (2 years)
The core curriculum will be available via a secured Emory site for the partner surgeons to study several months before visiting the US. Language testing will be included in this process. This ensures a solid foundation of fundamental knowledge before starting the technical training.
Two partner surgeons will be paired with each mentor surgeon. Together, the partners (12 per course) will spend three weeks in Atlanta at Emory University in an intense, certified educational experience, stressing skill transfer and surgical techniques. Both Advanced and Basic courses are offered. Initially, training will focus on Advanced course candidates who are the emerging leaders in spine care in China. These partners will be instrumental in later training for Tier 2 facilities. All fundamentals and principles of surgical and non-surgical care will be covered, and advanced techniques will be addressed depending on the experience level of the partnering surgeons. Physicians will live with local Atlanta host families, and the formation of these new international relationships is an important byproduct of the ESCOME course. Following the lab training, the partner and mentor surgeons will travel to the mentor’s hospital in the United States for another 2-6 weeks of education in the mentor’s operating room and clinics. This time together will emphasize the art of diagnosis, outpatient care, and surgical technical details.
After the US-based training is completed, the partner surgeons will return home to commence spine care in their own cities and universities. There is then the need for crucial ongoing growth and supervision as each physician matures, and unique obstacles are encountered with each practice development. To provide for this, the mentor and partner will have a secured computer link for video conferencing, where the mentor is available weekly to discuss cases, problems, and questions. In addition to the weekly computer links, the mentor will travel regularly to the partnering surgeon’s facility in China for one-week visits. These visits (4 over 2 years) will allow the mentor and partner to see patients together in clinics, discuss cases, and operate together as the partner surgeons mature in their own abilities.
Throughout the process, feedback and research data from the mentors, partnering surgeons and hospitals will be analyzed to ensure maximal outreach impact and clinical outcomes. During the entire 2½ year educational cycle ESCOME, the Medical and Advisory Boards and the China Advisory Board will monitor partner physician and site activities to ensure that responsibilities are met by all parties and the care is high quality. At the end of three years, the partner surgeon should be self-sufficient, and a new center will have been developed that provides high quality spine care and fosters further local training, especially in a university setting. It is expected that doctors who complete the Advanced course will become leaders in the field, and teachers for others at home (Tier 1 and Tier 2) after a few years. It is also expected that partner surgeons will work within their local socioeconomic realities to provide care to marginal populations who would otherwise be un-served. ESCOME courses will be held three times per year, based on the core curriculum. Additional training based on specific local needs (unique infections, requested advanced techniques, etc.) can be addressed. Throughout the project, collaborative research will be performed in education, clinical outcomes, and healthcare delivery.
2) Funding:
The funding strategy for ESCOME recognizes that high caliber education is expensive and that true partnership is essential, with all sides contributing, sharing risk and sharing benefit. The 3-phase 10-year funding strategy provides for a steadily increasing contribution from China, to a point 10 years from now when ESCOME in China is fully supported by resources within China and US resources can be redirected to other developing countries (Brazil, India, etc.).
Phase 1: Proof of Concept
The first phase (year 1-3) involves refining concepts, establishing infrastructure and curriculum, running pilot courses, and evaluating initial mentor effectiveness and program impact. Funding for Phase 1 is primarily required from Emory (in kind and direct), industry, and private philanthropy. China is also contributing in an escalating fashion to cover 1/3 of the budget by the end of Phase 1. Phase 1 will mostly include Advanced courses, and provide initial outcomes data on effectiveness which will enable Phase 2.
Phase 2: Major Ramp Up
Funding for years 4-6 will rely primarily on major foundations. By this point, proof of concept is complete, and initial outcomes and impact analysis will allow for appropriate competitive requests to major foundations including Gates, Clinton, etc. China will continue an increasing total responsibility with 2/3 of program cost born by China at the end of Phase 2 (private and government sources). This period will maximize Advanced course volume and initiate Basic courses and evaluate outcomes for those in Tier 2 areas of China.
Phase 3: Transition to Basic Courses, and Outreach Centers
Primary funding in Phase 3 (years 7-10) is from China (private and government), with some major foundation support as partners trained in Phase 1 are now becoming teachers. Major centers in China are fostering new self-sustaining centers with a further emphasis on outreach and providing care to marginal populations where possible.
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