Kassam Faazil, Damji Karim F, Kiage Dan, Carruthers Chris, Kollmann K H Martin
University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
Acad Med. 2009 Aug;84(8):1152-60. doi: 10.1097/ACM.0b013e3181acf95c.
Health care systems in many developing countries are rapidly evolving to respond to urbanization and shifting epidemiological profiles, creating an environment favorable for subspecialty development. The struggle for developing nations to train and retain highly skilled clinicians within academic institutions has highlighted the need for creative approaches to subspecialty education in these regions. The "Sandwich fellowship" is an educational model in which a fellow completes rotations at an academic institution in the developed world as well as in his or her home environment. An important component of the model is the expansion of institutional capacity at the fellow's home institution to create an enabling environment to practice newly acquired skills. The fellowship provides experience in diverse geographic and cultural contexts under the guidance of a preceptor from an institution in the developed world who teaches in both settings. Preceptors are given opportunities to continue professional growth and gain from exposure to pathology not commonly seen at home. Successful pilots of a Sandwich fellowship took place in ophthalmology and orthopedic surgery at the University of Ottawa in 2007-2008 and required funding from multiple sources with bilateral institutional support. Emphasis was also placed on teaching, leadership, management, and research so the fellows could return home and lead the development of their subspecialty areas. Early contact between administrations enables the model to serve as a gateway to a long-term partnership between developed world academic establishments and developing world institutions. Such a relationship yields a mutually beneficial exchange of knowledge and skills. Beneficiaries include the hospitals, their staff, and patients at both institutions.
许多发展中国家的医疗保健系统正在迅速发展，以应对城市化和不断变化的流行病学特征，创造有利于亚专业发展的环境。发展中国家在学术机构中培养和留住高技能临床医生的努力凸显了在这些地区采用创新方法进行亚专业教育的必要性。“三明治奖学金”是一种教育模式，即学员在发达国家的学术机构以及其本国环境中进行轮转。该模式的一个重要组成部分是扩大学员本国机构的机构能力，以创造一个能够实践新获得技能的有利环境。该奖学金在来自发达国家机构的带教老师的指导下，在不同的地理和文化背景下提供经验，这位带教老师在两种环境中都进行教学。带教老师有机会继续职业发展，并从接触本国不常见的病理学中获益。2007 - 2008年，渥太华大学在眼科和整形外科成功开展了三明治奖学金试点项目，该项目需要来自多个来源的资金以及双边机构的支持。同时也强调教学、领导力、管理和研究，以便学员回国后能够引领其亚专业领域的发展。管理部门之间的早期接触使该模式能够成为发达国家学术机构与发展中国家机构之间长期合作关系的桥梁。这样的关系会带来知识和技能的互利交流。受益者包括两家机构的医院、其工作人员和患者。
