Behind the Scenes of the JGME International Supplement: An Interview with Dr. Halah Ibrahim

In August, the Journal of Graduate Medical Education (JGME) published its first International Supplement. It highlights the successes and challenges of meeting today’s global health priorities and provides a forum for research and learning in post-graduate medical education (PGME) around the world, fostering further research and dialogue.

We talked with Halah Ibrahim, MD, MEHP, who, along with Sophia Archuleta, MD, and Nicholas Chew, MD, served as guest editors for the supplement. Dr. Ibrahim provided insight into the process of working with researchers and writers from across the world, and how the research and ideas presented can apply to the domestic and international learning community alike.

Dr. Ibrahim is an internist and educator involved in postgraduate and undergraduate medical education in Abu Dhabi, United Arab Emirates (UAE). She was the founding designated institutional official, and is the former internal medicine residency director and Chair of Academic Affairs, for Tawam Hospital in the UAE. In these roles, she spearheaded the institution’s accreditation by ACGME International (ACGME-I). She is a member of several regional and international advisory committees for medical education and served as an original member of the Review Committees-International. She is an associate editor for JGME. Her research interests include medical professionalism, international PGME reform, and gender issues in international academic medicine. Dr. Ibrahim is a native New Yorker. Prior to moving to Abu Dhabi in 2008, she was employed as a clinician educator in lower Manhattan. She completed her internship and residency at The New York Hospital-Cornell Medical Center (currently New York Presbyterian University Hospital of Columbia and Cornell). She is a graduate of the Mount Sinai School of Medicine.

How did you become interested in medicine, and in academic medicine in particular?
I don’t recall a certain moment or time period when I made a conscious decision to pursue medicine. I’ve been interested in medicine for as long as I can remember. My real involvement in academic medicine came later in my career. I spent the first decade of my career working in teaching hospitals in New York City. When I first arrived in the UAE [United Arab Emirates], dealing with a new country, a new hospital, and a different health care system was a bit nerve-wracking. But interacting with residents and medical students felt familiar and, in many ways, comforting. I began implementing some elements of my own training, including Morning Report Conferences and resident continuity clinic. Within a short period of time, I became the Internal Medicine Residency Program Director. This was around the same time that the ACGME-I [ACGME International] was established and I was fortunate enough to be appointed as the founding DIO [designated institutional official] for my institution and to help lead the transition to competency-based medical education and international accreditation.

You and your co-authors write you have experienced massive changes in PGME in your countries of professional practice, Singapore and UAE. Can you give an example of these changes? How have these changes affected you personally and in your work?
Like Singapore and other countries, the UAE underwent a wide-scale reform of its PGME system from a time-based model to competency-based medical education, and was successfully accredited by ACGME-I in 2012. This transition occurred over the course of just a few years and required incredible amounts of time and manpower. Imagine a complete overhaul of an educational system—from rotations and curricula to educational activities and assessment methods. And, we needed the faculty development to implement and maintain the new system. We had a remarkable group of program directors, core faculty members, program coordinators, and residents who were passionate about education and committed to getting it done. It was a tremendous amount of work, but we were all fueled by each other’s commitment and support. Not only did we all learn and grow professionally from the process, but we created lifelong bonds and friendships. I look back at this transition period as one of the highlights of my personal life and professional career.

You also write about some of the challenges that international authors face in publishing including writing in a language that isn’t the author’s primary language and lack of access to funding and research support. How were you able to address or take into account these challenges?
Medical education journals, even those that are international, include predominantly Western perspectives. I viewed this special issue as an opportunity to give a voice to educators from academically peripheral or underrepresented countries. For example, we wanted the “New Ideas” section to include both new ideas and international adaptations. Implementing an OSCE [objective structured clinical examination] or the one-minute preceptor in a different social and cultural context may have its own challenges and sharing those may help others in similar situations. Also, we have several articles from low and middle income countries. Their contributions can help all educators to do more with less.

Many authors who submitted to the supplement were not native English speakers and a number of the manuscripts required several rounds of editing and back and forth with the authors, sometimes even before the manuscript went out for peer review. Journals generally do not have the resources to do this, but we decided that we would not let writing be the reason a manuscript was not accepted. If we felt that there was a rigorous study design and important outcomes, we worked with the authors to present it succinctly and academically before it went out for peer review. I hope that this was a valuable learning experience for the authors as well.

Were there any surprises or unexpected trends that you discovered while going through the process of editing for this supplement?
I was surprised at how many of the manuscripts truly resonated with me. Despite vast distances and different languages, there are so many shared experiences among international educators. There was a familiarity in the issues raised, regardless of whether the institution was located in Haiti, India, or the Ukraine. For example, the importance of the clinical learning environment was a common theme. There were also several manuscripts on developing non-clinical competencies in residents, including leadership, research, and teaching skills. These topics are timely and relevant to educators worldwide.

For those not directly involved in international PGME, what kinds of insights would an American audience gain from the research presented?
Globalization is affecting all aspects of medicine. I think it is important for educators to have a general understanding of what is happening in education worldwide as we will likely interact with learners, educators or patients from international health care or medical education systems.

Also, although the country or context may differ, there are universal issues and concerns. We are all working to train competent physicians who can work effectively in interprofessional teams and provide care to a multicultural and diverse patient population. There’s so much we can learn from each other.

What would you most like to see happen next as a result of the research and dialogue fostered here?
As I mentioned earlier, we wanted the supplement to give a voice to educators worldwide. I would love for these conversations to continue. Many of the submissions were from single residency programs or single institutions, which limits generalizability. It would be great to see these authors reach out to each other and participate in multi-institutional and even multinational collaborations. The sharing of resources and expertise will help facilitate large-scale studies of the patient care and population health outcomes of educational reform and innovation, with the ultimate goal of improving patient care worldwide.

What advice would you give to international programs that are considering ways to improve education as they work to meet today’s global challenges?
I hope that international academicians and clinician-educators realize that they are not alone. The international medical education community is a great resource with many colleagues who are willing to lend their expertise to help and to problem solve. There is always someone who has faced a similar challenge and can offer resources, expert opinion, or even personal advice. Medical education conferences are an excellent venue for hearing new ideas, networking, and getting advice from peers and experts alike. I would also recommend attending the international sessions at the ACGME Annual Educational Conference. They cover many topics that international educators may face. I met a few physicians working internationally at an ACGME conference back in 2010 and reached out to them a couple of years later with a research proposal. We are now working on our third multinational PGME study (and collaborated to write the rip-out section on successful multinational medical education research collaboration for the supplement).

Is there anything else you would like to add that we haven’t asked about? 
My recent research has focused around the role of women in international medical education and how society and culture impact female physicians. As women have played a large role in this global PGME movement, it is important to understand the personal and professional challenges they may face. Realizing the full potential of both male and female physician educators will only improve the quality of international GME.