Money is one factor, says Alan Robin, MD, associate professor of international health at the Bloomberg School of Public Health at Johns Hopkins University and associate professor of ophthalmology at Johns Hopkins’ Wilmer Eye Institute. With costly medical school tuitions, sometimes students from other countries can more easily afford to pay for their education—or have their government pay for it, as is common in countries like Saudi Arabia. Participating schools from the United States and from host countries typically negotiate to earn a percentage of the tuition paid, Dr. Robin says. He has worked with a number of international studies and collaborations.
However, there are other motivations for opening international campuses or forging similar partnerships, says John Prescott, MD, chief academic officer for the American Association of Medical Colleges, based in Washington, D.C. The collaborations “add to prestige, provide research connections, and help others learn from colleagues around the world,” Dr. Prescott says. “It reflects the globalization trend seen in many other areas, including business and education.”
Depending on the setup, research collaborations can enable physicians usually based in the United States to study conditions more common in the host country. For example, says Dr. Robin, it may be easier to study an ophthalmic condition called pseudoexfoliation syndrome in a country like India, where approximately 30,000 cases associated with cataracts are seen in each year—a much larger number than in the United States, Dr. Robin says. In rheumatology, diseases such as familial Mediterranean fever are more commonly seen abroad. A partnership with a local university makes that study all the more easier. “Participants see diseases and patients they have only heard about or read about in a textbook,” Dr. Prescott says.
Access to international universities also makes it easier to study drugs that may not be approved yet in the United States, he adds.
There is also good will spread by these collaborations, says rheumatologist Edward J. Parrish, MD, assistant professor of medicine at Weill Cornell Medical College. “For the United States, we are exporting something that will benefit everyone—we’re not exporting guns or Coca-Cola. We are exporting health,” says Dr. Parrish, who has taught at Cornell’s Qatar campus.
The host countries also benefit from the partnerships, Dr. Prescott says. The schools help to address physician shortages seen in a number of countries. And, despite criticisms of American education, the standard curriculum used in American schools still is in demand, he adds. “There is a need to educate physicians in their own country. Sometimes the countries ask for these [partnerships],” he says. Such partnerships can lead the schools to attract large conferences, bringing yet more attention to the schools and the area, Dr. Parrish says, citing the Qatar’s campus hosting of the Drugs Affecting Lipid Metabolism XVII International Symposium earlier this year.
Certain countries are looking to establish more infrastructure, Dr. Robin says. For instance, some countries well known for oil production are now building more college campuses, hospitals, and other facilities, yet another reason for the increasing number of global medical school partnerships, he explains.
“I think the benefit is to educate students and the next generation of physicians in what we perceive to be the state of the art in medicine, including rheumatology,” says Allan Gelber, MD, associate professor of medicine and director of the Rheumatology Fellowship Program at Johns Hopkins.
In 2013, Dr. Gelber will assist in teaching second-year students at Perdana University Graduate School of Medicine, which is opening this fall in Malaysia and is the product of a collaboration between Johns Hopkins and a private development company based in Kuala Lumpur. “We’re educating them in what we think is state of the art, and this improves knowledge, which leads to improved patient care, earlier intervention, and better outcomes in arthritis,” he says.
At the same time, faculty and students from the various countries involved can learn new best practices from each other. “I don’t think the welcome mat would be out long if someone said, ‘This is the only way to do this,’ ” Dr. Prescott says. “It’s a two-way street for learning.”
Here are some details on the international medical school campuses operated by Weill Cornell, Duke, and Johns Hopkins—and the role of rheumatology in each program.
Weill Cornell Medical College-Qatar
Weill Cornell Medical College in Qatar has been in existence longer than the Duke and Johns Hopkins international campuses, having admitted its first class in 2002. At that time, 25 students made up the inaugural class. By 2007, the school had more than 200 students from 30 countries.
Some students take part in a two-year, pre-med preparation program at the school, where they hone their English and academic skills so they are better prepared for the medical program, Dr. Parrish says.
The students follow a curriculum identical to that studied by students at the New York campus, Dr. Parrish notes. As part of the second-year curriculum, students learn about diseases and have a two-week block dedicated to rheumatology. Sometimes, one rheumatologist from the New York faculty teaches the two-week block, says Dr. Parrish. Other times, there are two people.
Anne Bass, MD, associate professor of clinical medicine, Weill Cornell Medical College and Rheumatology Fellowship Program Director, Hospital for Special Surgery, New York, has taught twice at the Qatar campus. Although the curriculum and school set up are identical, there were some classroom differences. At the Qatar campus, the student body was 100% Muslim, with students from all around the world. Students attending the school from Qatar have their studies paid by the government but are usually expected to work in the country’s hospitals once their studies are completed, Dr. Parrish says.
A range of dress is seen on campus, from native Qatari women who fully cover their body and face to women of Persian descent who grew up in Canada and wear jeans. Otherwise, the campus has the feel of an American school, Dr. Bass says.
Qatar has fewer than 300,000 native citizens but a total population of 1.5 million, with the majority of the non-native citizens coming from Southeast Asia and doing contract work in the country, say Drs. Bass and Parrish.
Because students from the Qatar campus do their third-year rotations in the United States, Dr. Bass says it was a pleasant surprise to see some of her students on the New York hospital ward.
The Hamad Medical Corporation, the medical center that works with the Qatar campus to provide residencies, is expected to receive accreditation for its residency programs from the American Council of Graduate Medical Education International in the summers of 2012 and 2013, says rheumatologist Thurayya Arayssi, MD, associate professor of medicine and associate dean for graduate medical education at the Qatar campus.
Duke-National University of Singapore (NUS) Graduate Medical School
Twenty-four students graduated as part of the first class of Duke-NUS in July of this year. Originally, 26 students began with the program in August 2007. The school was born from a government initiative in 2001 to establish a graduate medical school that would help develop physician-scientists to support the Biomedical Sciences Initiative, under which three billion Singapore dollars were earmarked to be spent making the country a biotechnology hub of Asia. Government and National University of Singapore representatives visited Duke in 2002, and plans began in 2003 to establish the country’s first graduate medical school.
Under the school’s curriculum, students devote one year to study an area of research interest. Although the school’s curriculum is modeled after Duke’s, there is a greater emphasis in Singapore on small-group learning, says John Sundy, MD, PhD, a rheumatologist who is associate professor of medicine, pulmonary, and critical care medicine at Duke. The small group focus is popular with students, Dr. Sundy says.
Graduates now are beginning a residency program created by SingHealth and the National Healthcare Group. This program was developed in consultation with the Accreditation Council for Graduate Medical Education. Graduates are training in specialties such as internal medicine, emergency medicine, pediatrics, and psychiatry.
Dr. Sundy, who serves as a leader at the Duke campus for a variety of rheumatology-related clinical projects, says the partnership with Singapore is enabling both campuses to take a larger role in early clinical trials. “For rheumatology, we are just starting to build relationships for this and work on collaboration,” he says. For example, one area of future collaboration may be within osteoarthritis research, he notes.
In his two visits to the Singapore campus, Dr. Sundy says that despite cultural differences, he has been surprised by how similar the rheumatology world is in Singapore and the United States. “A lot of the clinical challenges and uncertainties are the same,” he says. “Most of the rheumatologists there are busy and have plenty of patients, like in the U.S. People work hard to maintain funding.”
Perdana University Graduate School of Medicine
About 20 to 30 students should begin at Perdana this fall. Perdana is located in Serdang, Selangor, Malaysia, about 25 minutes by car from Kuala Lumpur. The school will operate with a curriculum and model that follows that of Johns Hopkins College of Medicine. An accompanying 600-bed teaching hospital is being constructed for eventual collaboration with Perdana, and Johns Hopkins leaders are also providing feedback for the development of the hospital.
Faculty at Johns Hopkins will have the chance to teach for six months to two years at Perdana, participate in research collaborations, or assist in other curriculum development. As with the Duke and Weill Cornell campuses, classes at Perdana will be taught in English.
Dr. Gelber says he will teach in Malaysia in 2013 when the inaugural class is in its second year. As part of Johns Hopkins’ Genes to Society curriculum, which includes component units such as cardiology, immunology, and microbiology, there is a final section on musculoskeletal diseases. Dr. Gelber will teach that portion, which outlines pathophysiology, genetics, and the societal impact of musculoskeletal diseases.
“The curriculum that we teach in Baltimore is what we will teach in Malaysia,” Dr. Gelber says.
Vanessa Caceres is a freelance medical writer in Bradenton, Florida.
