Harvard Medical School Global Mental Health:  Trauma and Recovery Course: What is the Global Impact? Three Year’s Results

Richard   Mollica; Giovanni  Muscettola; Eugene Augusterfer; Qiuyuan Qin; Fanny Cai

doi:10.56508/mhgcj.v7i1.186

Authors

Richard F. Mollica, M.D., M.A.R. Harvard Medical School; Massachusetts General Hospital https://orcid.org/0009-0003-8990-4240
Giovanni Muscettola, MD University Medical School “Federico II", Naples, Italy https://orcid.org/0009-0001-8699-3925
Eugene Augusterfer Harvard Global Mental Health Program; Massachusetts General Hospital https://orcid.org/0009-0007-0298-2916
Qiuyuan Qin University of Rochester https://orcid.org/0000-0002-5587-9177
Fanny Y. Cai, B.S. Massachusetts General Hospital https://orcid.org/0009-0009-0890-477X

DOI:

https://doi.org/10.56508/mhgcj.v7i1.186

Keywords:

psychiatry, mental health, medical education, trauma, recovery, training, international

Abstract

Purpose: This paper describes and documents an innovative blended learning Global Mental Health: Trauma and Recovery certificate training course. This course combines a two-week face-to-face training in Orvieto, Italy with a five-month follow-up online virtual training as a learning experience for global health care practitioners. Continuing medical education (CME) accreditation is offered upon completion. This course utilized an innovative blended learning model with a community of practice approach, a combination of lectures and discussions, and online in-depth group case study discussions.

Methodology: Data was collected by self-reported anonymous evaluation by participants of three continuous years of the CME Global Mental Health: Trauma and Recovery certificate training course sponsored by Harvard Medical School. One hundred fifty-five participants (n= 39 in 2011; n = 57 in 2012; n=59 in 2013) underwent a pre- and post-course evaluation to determine sustained confidence in performing medical and psychiatric care to traumatized patients and communities, as well as to determine their learning of the Global Mental Health Action Plan (GMHAP).

Results: Over the course of three independent years, a total of 155 participants were evaluated. There was evidence for significant improvement in their confidence levels in all clinical areas (diagnosis; treatment of trauma; use of psychotropic medication) when comparing baseline to completion of the six-month course. All ten dimensions of the GMHAP and nine medical and psychiatric aspects of treatment revealed significant improvement in confidence levels. Regression analysis also indicated similar results after the adjustment of demographic covariates. Physicians and participants with mental health and social work background had significantly higher confidence. Participants who were MD’s or psychiatrists had higher confidence in most of the categories of confidence except for self-care, understanding culture, collaboration, and policy and financing. The model showed no difference in learning based upon gender and level of development of country of origin.

Conclusion: The evaluation of this blended learning CME program provides evidence of significant enhancement of clinical practice and planning skills in health care practitioners working with highly traumatized patients and communities worldwide. This successful training over the past 18 years has gone far to achieve the health and mental health capacity building as requested by the Ministers of Health from post-conflict societies in the historic Rome meeting in 2004.

Author Biographies

Richard F. Mollica, M.D., M.A.R., Harvard Medical School; Massachusetts General Hospital

Professor of Psychiatry at Harvard Medical School and is the Director of the Harvard Program in Refugee Trauma at Massachusetts General Hospital.

Giovanni Muscettola, MD, University Medical School “Federico II", Naples, Italy

Emeritus Professor of Psychiatry, University Medical School “Federico II,” Naples, Italy.

Qiuyuan Qin , University of Rochester

PhD candidate, Health Service Research and Policy Department, University of Rochester, Rochester, New York.

Fanny Y. Cai, B.S., Massachusetts General Hospital

Program coordinator and research coordinator at the Harvard Program in Refugee Trauma, Massachusetts General Hospital.

References

Bloom BS. Effects of continuing medical education on improving physician clinical care and patient health: A review of systematic reviews. International Journal of Technology Assessment in Health Care. 2005;21(3):380-385. Doi:https://doi.org/10.1017/s026646230505049x DOI: https://doi.org/10.1017/S026646230505049X

Borba CPC, Gelaye B, Zayas L, et al. Making Strides Towards Better Mental Health Care in Peru: Results from a Primary Care Mental Health Training. International Journal of Clinical Psychiatry and Mental Health. 2015;3(1):9-19. doi:https://doi.org/10.12970/2310-8231.2015.03.01.3 DOI: https://doi.org/10.12970/2310-8231.2015.03.01.3

Cervero RM, Gaines JK. The Impact of CME on Physician Performance and Patient Health Outcomes: An Updated Synthesis of Systematic Reviews. Journal of Continuing Education in the Health Professions. 2015;35(2):131-138. doi:https://doi.org/10.1002/chp.21290 DOI: https://doi.org/10.1002/chp.21290

Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Internet-Based Learning in the Health Professions. JAMA. 2008;300(10):1181. doi:https://doi.org/10.1001/jama.300.10.1181 DOI: https://doi.org/10.1001/jama.300.10.1181

Davis DA, Thomson MA, Oxman AD, Hayes RB. Changing Physician Performance. JAMA. 1995;274(9):700-705. doi:https://doi.org/10.1001/jama.1995.03530090032018 DOI: https://doi.org/10.1001/jama.274.9.700

Davis DA, McMahon GT. Translating evidence into practice: Lessons for CPD. Medical Teacher. 2018;40(9):892-895. doi:https://doi.org/10.1080/0142159x.2018.1481285 DOI: https://doi.org/10.1080/0142159X.2018.1481285

Davis D, O’Brien MAT, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of Formal Continuing Medical Education. JAMA. 1999;282(9):867. doi:https://doi.org/10.1001/jama.282.9.867 DOI: https://doi.org/10.1001/jama.282.9.867

Davis DA, Thomson MA, Oxman AD, Hayes B. Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA. 1995;274(9):700. doi:https://doi.org/10.1001/jama.1995.03530090032018 DOI: https://doi.org/10.1001/jama.1995.03530090032018

Fordis M, King JE, Ballantyne CM, et al. Comparison of the Instructional Efficacy of Internet-Based CME With Live Interactive CME Workshops. JAMA. 2005;294(9):1043. doi:https://doi.org/10.1001/jama.294.9.1043 DOI: https://doi.org/10.1001/jama.294.9.1043

Henderson DC, Kapetanovic A, Culhane MA, et al. Building primary care practitioners’ attitudes and confidence in mental health skills in post-conflict Bosnia and Herzegovina. International Journal of Culture and Mental Health. 2008;1(2):117-133. doi:https://doi.org/10.1080/17542860802456653 DOI: https://doi.org/10.1080/17542860802456653

Henderson DC, Mollica RF, Tor S, Lavelle J, Culhane MA, Hayden D. Building Primary Care Practitioners’ Attitudes and Confidence in Mental Health Skills in a Post-Conflict Society: A Cambodian example. Journal of Nervous & Mental Disease. 2005;193(8):551-559. doi:https://doi.org/10.1097/01.nmd.0000172869.01711.33 DOI: https://doi.org/10.1097/01.nmd.0000172869.01711.33

Johnson SC. Global Mental Health: Trauma and Recovery Mastery Certificate Program: Assessment of the Impact of the Community of Practice on Learning. Proquest Dissertations Publishing. Harvard University. 2009.

Kanouse DE, Jacoby I. When Does Information Change Practitioners’ Behavior? International Journal of Technology Assessment in Health Care. 1988;4(1):27-33. doi:https://doi.org/10.1017/S0266462300003214 DOI: https://doi.org/10.1017/S0266462300003214

Liu Q, Peng W, Zhang F, Hu R, Li Y, Yan W. The Effectiveness of Blended Learning in Health Professions: Systematic Review and Meta-Analysis. Journal of Medical Internet Research. 2016;18(1): e2. doi:https://doi.org/10.2196/jmir.4807 DOI: https://doi.org/10.2196/jmir.4807

McMahon GT, Asthagiri AR, Khalessi AA. The Changing Role of CME. In: Congress Q.; 2019:14-15.

Mollica RF, McDonald L. Project 1 Billion. Health Ministers of Post-conflict Nations Act on Mental Health Recovery. UN Chronicle. 2003;40(4):56.

Mollica RF. Textbook of Global Mental Health: Trauma and Recovery, a Companion Guide for Field and Clinical Care of Traumatized People Worldwide. Lulu.com; 2012.

Mollica R, Cardozo BL, Osofsky H, Raphael B, Ager A, Salama P. Mental health in complex emergencies. The Lancet. 2004;364(9450):2058-2067. doi:https://doi.org/10.1016/s0140-6736(04)17519-3 DOI: https://doi.org/10.1016/S0140-6736(04)17519-3

Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Services Research. 2011;11(1). doi:https://doi.org/10.1186/1472-6963-11-273 DOI: https://doi.org/10.1186/1472-6963-11-273

Rayburn WF, Regnier K, McMahon GT. Comparison of Continuing Medical Education at U.S. Medical Schools, and Other Accredited Organizations. Academic Medicine. 2020;95(4):623-628. doi:https://doi.org/10.1097/acm.0000000000003043 DOI: https://doi.org/10.1097/ACM.0000000000003043

Shaw T, Long A, Chopra S, Kerfoot PB. Impact on Clinical Behavior of Face-to-Face Continuing Medical Education Blended with Online Spaced Education: A Randomized Controlled Trial. Journal of Continuing Education in the Health Professions. 2011;31(2):103-108. doi:https://doi.org/10.1002/chp.20113 DOI: https://doi.org/10.1002/chp.20113

Smith RC, Lyles J, Mettler J, et al. The Effectiveness of Intensive Training for Residents in Interviewing. Annals of Internal Medicine. 1998;128(2):118. doi:https://doi.org/10.7326/0003-4819-128-2-199801150-00008 DOI: https://doi.org/10.7326/0003-4819-128-2-199801150-00008

Wenger E, McDermott RA, Snyder W. Cultivating Communities of Practice: A Guide to Managing Knowledge. Harvard Business School Press. 2002.

Wenger E. Communities of Practice: Learning as a Social System. The Systems Thinker. 1998;9(5):2-3. doi:https://doi.org/10.1177/135050840072002 DOI: https://doi.org/10.1177/135050840072002

Wickstrom GC, Kelley DK, Keyserling TC, et al. Confidence of academic general internists and family physicians to teach ambulatory procedures. Journal of General Internal Medicine. 2000;15(6):353-360. doi:https://doi.org/10.1046/j.1525-1497.2000.04109.x DOI: https://doi.org/10.1046/j.1525-1497.2000.04109.x

Wickstrom GC, Kolar MM, Keyserling TC, et al. Confidence of graduating internal medicine residents to perform ambulatory procedures. Journal of General Internal Medicine. 2000;15(6):361-365. doi:https://doi.org/10.1046/j.1525-1497.2000.04118.x DOI: https://doi.org/10.1046/j.1525-1497.2000.04118.x