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AAMC Reporter: October 2007Viewpoint:
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There is a new program in academic medicine aimed at advancing students and furthering global health.
The National Institutes of Health (NIH) Fogarty International Center has awarded a five-year grant to Vanderbilt University School of Medicine. The school, in partnership with the AAMC, is using this grant to establish the Fogarty International Center Clinical Research Scholar Program (FICRS). This exciting new program will provide intensive mentored overseas clinical research training for American medical and doctoral-level health sciences students. We are very enthusiastic about both the valuable experience FICRS will provide to many of our future clinical investigators, and the opportunities it affords for studying specific health challenges faced by developing nations around the world.
Initiated in 2004 with support from the Ellison Medical Foundation, the NIH's Fogarty International Scholars program is currently recruiting its fourth cohort of trainees. One of the most gratifying aspects of this program to date has been the steady increase in the number and diversity of applicants from academic medical centers across the country, and the remarkable enthusiasm and altruism that they display. Aron Primack, M.D., and Kenneth Bridbord, M.D., are the key program officials at the Fogarty International Center who founded the program in 2004. Former center director Gerald Keusch, along with Pierce Gardner, M.D., and the late Alistair Clayton, M.D., also helped get this program off the ground. To date, 94 U.S. scholars and nearly that number of foreign nationals have gone through the program. The new FICRS program here at Vanderbilt reflects the Fogarty Center's intention to maintain its commitment to international research training through at least 2012.
So what is the experience like for FICRS participants? After intensive orientation at the NIH campuses in Bethesda, Md., each participant spends at least 10 months "training by doing" in supervised clinical research settings at one of the many NIH-funded research centers around the world. (As of September, there were 16 such centers in 14 African, Asian, Latin American, and Caribbean nations.) Although most trainees to date have been medical students, scholars have also included doctoral-level students from other health professions, primarily public health. The Association of Schools of Public Health (ASPH) is partnering with Vanderbilt and the AAMC in reaching out to students in schools of dentistry, nursing, optometry, osteopathic medicine, pharmacy, public health, and veterinary medicine.
In addition to sending American students abroad, the program works the opposite way as well, by supporting foreign nationals who wish to train in America. Funds permitting, coordinators hope to eventually expand the entire program to offer comparable experiences to residents and fellows.
Vanderbilt and the AAMC have created a new support center to oversee FICRS program management, information dissemination (in concert with the ASPH), applicant selection, communications, program coordination and logistics, program monitoring and evaluation, organization of educational programs and conferences, direct support of fellows, support of in-country partners and host nation fellows through subcontracts to the U.S. affiliated institutions, and maintenance of program alumni relationships.
By working through existing international health research collaborations in the developing world, FICRS mentors seek to help tomorrow's researchers understand and address global health problems. So far, students have studied malaria, diarrheal diseases, tuberculosis, respiratory diseases, STD and HIV/AIDS, and other infectious disease clinical research topics.
FICRS' benefits both to the trainees and to the foreign populations in which they train is evident in the program's research findings from the 2005-06 and 2006-07 program years in Zambia. Paul Kelly, M.D., and Isaac Zulu, M.D., of the University of Zambia School of Medicine supervised a project that enabled Harvard Medical School student Sylvia Aparicio and Zambian physician-registrar (similar to a resident) Edmond Sinkala to study gastrointestinal tuberculosis. The students found the disease had a very high frequency among HIV-infected Zambians with chronic diarrhea—a fact previously overlooked or unreported by the local health care community.
University of Pennsylvania School of Medicine student Jason Goldman investigated the question of whether using viral load testing improved HIV outcomes in a clinical trial in Zambia's Lusaka Urban Health District clinics. Jason spearheaded the clinical trial from its inception to near completion and also conducted a study of the utility of pharmacy-based adherence to predict viral load rebound for HIV. Since there are few current data regarding viral hepatitis-HIV co-infection in Zambia, these and other studies like it are helping to shape current policies on HIV health care in this nation.
Last but certainly not least, University of Pittsburgh School of Medicine student Krista Pfaendler used her time as a FICRS participant to expand a cervical cancer screening program. What started with only 150 HIV-infected Zambian women blossomed to include more than 6,000 women in the first year of Krista's involvement. She is staying a second year in Zambia and has developed proficiency at cervical disease screening and treatment befitting the daily volume of disease that is being remediated.
In 2008, FICRS will expand to include chronic disease research themes, which we feel is appropriate given the epidemiological transition being experienced in many middle-income countries in the developing world. AAMC member institutions will wish to alert their students about this exciting, career-defining opportunity. All medical and graduate-level health sciences students from accredited institutions in the United States are eligible to apply.
For more information, visit NIH/Fogarty International Clinical Research Scholars Program or Fogarty International Center Clinical Research Scholars.
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