|Year : 2008 | Volume
| Issue : 2 | Page : 230
Making a Difference: An Interview with Camilo Osorio Barker Enhancing Medical Education in Colombia
Associate Editor, Education for Health, USA
|Date of Web Publication||12-Jan-2013|
7840 SW 86th Street - # 23, 33143-6862, Miami - FL
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Westberg J. Making a Difference: An Interview with Camilo Osorio Barker Enhancing Medical Education in Colombia. Educ Health 2008;21:230
Camilo Osorio Barker, MD, is Dean of the Faculty of Medicine of the Universidad de La Sabana in Chia, Colombia, just north of Bogotá. This edited, abridged interview is based on an interview with Dr. Osorio Barker in September 2007 at the Network: TUFH meeting in Uganda as well as follow-up email communications.
Associate Editor, Education for Health
What drew you into medicine?
In high school I decided to go into medicine, but I didn't tell my parents about my decision because my grandfather was a doctor, a politician, and an educational leader in my city, and I didn't want my parents to think it was my grandfather's decision. It was my decision. I realized medicine is a very broad profession. All is possible in medicine. Medicine is a science, a technique, and an art. Essentially medicine is a social profession.
What was your pathway?
In 1978, when I was 17 years old, I began studying medicine at the Universidad Pontificia Bolivariana in Medellín [Colombia].
What was the curriculum like?
The curriculum was traditional but we had contact with patients in our first year. When I was in my third month of my first year, I had two great experiences that marked me for all time. The university sent me to a rural basic hospital for a week with two other students. In one night I saw my first birth, and I saw the death of a woman who was in a diabetic coma.
Every semester during the six years of medical school, the other students and I were sent to a rural hospital for one week. In addition, during our first, second and third year, we went to an urban health community center two or three days a week. At the centers, they taught us how to do some of the nurses' work, like preparing the beds or giving vaccinations. We also witnessed medical consults with general doctors. We spent a couple of months at one center and then a couple of months at another, so we were able to experience continuity of care.
In the first year we also worked with firemen for a full 24 hours every three months. When there was an emergency, we went out with the firemen.
Our school of medicine was new. It began in 1976. We were the third class. It was like an experimental curriculum. We had many contacts with the community and with patients in rural areas.
When did you decide that you wanted to be a surgeon?
It took me a long time to make a decision. I liked many areas, such as public health, internal medicine, and surgery. When I finished my internship, I thought about anesthesiology, but when I spent time in a rural area, I changed to surgery.
What happened that caused you to choose surgery?
After the internship, we had to spend a year in a rural practice. I went to a small hospital in rural mountains in my region. I was the director of the San Antonio Hospital in the little town of Caramanta. There were about 7000 people in the area, half in the village, half in the rural area. We had to supervise the sanitation system, including animals. The hospital had 30 employees, including two doctors, an administrator, and nurses. I was the youngest person (23 years old), but I was the boss. During that time I married a nurse, Olga Lucia Gonzalez Restrepo.
Was your wife one of the nurses at the hospital?
No, she had been my girlfriend during her last year and a half of nursing school. Our relationship continued when she worked in a regional hospital in Yarumal, 100 km from Medellín.
What kind of surgery did you do?
I did cesarean sections for the area that had a population of about 15 000 people. The other hospitals in the neighboring towns didn't have surgery rooms. My wife helped me (with no wages). Both of us had had training in C-sections.
The national organization for coffee (Federación Nacional de Cafeteros de Colombia) paid to help upgrade the surgical room. I invited my surgical professor to come to Caramanta to do surgery with me. After that we started a program in which he came once a month and stayed at our house for a weekend. During those weekends, he and I did 10 to 15 surgeries. My professor did all of these surgeries at no cost to the patients. That's when I decided to become a surgeon.
The next year the governor asked me to direct a bigger hospital, Santa Sofia de Fredonia. There were about 100 employees and more equipment.
In the two years, when I was at the two different hospitals, I worked very hard in the communities. We created health committees in every village in the countryside. Twice a week we traveled two to three hours in each direction by horseback to visit the villages. It was like an expedition because a nurse, a dentist, and someone who did vaccinations accompanied me. We went to every community.
Did your wife go with you as the nurse?
Only occasionally, because she is afraid of horseback riding.
Every Sunday morning, first at the Caramanta hospital and then at the Fredonia hospital, we taught health classes for community leaders. People came to the market on Sundays. When they finished shopping, they'd come to the hospital for a two to three hour class on various health topics. This was my idea.
I bought vegetable seeds, live fish, and live rabbits. My wife and I gave local people seeds to plants and rabbits to raise for meat. We put fish in the local lakes.
Were you concerned about the diets of the local people?
Yes, their diet was insufficient. They ate lots of beans and potatoes but no vegetables. Meat was very expensive. If they had 10 rabbits, they could have protein for the year. My wife and I worked hard. She didn't have a salary. The communities got two people for one salary.
After working two years, I went back to my university [Universidad Pontificia Bolivariana] for four years as the first-ever general surgical resident. This was a very stressful, unpleasant time.
What made your residency stressful?
It's not good to think about it. It was very hierarchical. This made it difficult to have a friendly atmosphere in which to work as a team. Since that experience, in every place that I've worked, I've tried to create a more collaborative atmosphere. Now at the Universidad de la Sabana, I'm trying to create a collaborative atmosphere with the help of the faculty and staff.
In my last year of residency, I decided to have training in thoracic surgery. I went to the Hospital de la Santa Creu in Sant Pau in Barcelona. When I returned to Colombia in 1990, I was invited to work at my university, first in the internship program and then in the surgical residency program. It was a transition time in the school. The new dean, who was an internist, asked me if I wanted to work with him as head of the internship program. I accepted. I tried to raise the scientific level at the university. The students were given exams in every clinical rotation. They didn't like it.
I also practiced as a surgeon, especially in trauma, at another big public hospital. It was a sad time of violence in Medellín. Many people died. There was often an explosion of a big bomb. One time we received 20 people who had been injured by a bomb. There were burns and shotgun wounds. We made surgical advances and innovations because we had to be resourceful. During those four very difficult years, I learned a lot.
In 1993, I began working to create a university hospital. We didn't have one at that time. Our rector thought it was necessary. I worked for seven years on that project. I was involved in all phases of hospital from its conceptualization to the equipment and personnel. I even worked with the architects. My father is an architect. I liked working in that area. During those seven years, I also had a private practice in a Clínica Soma in Medellín.
In 2000 I had a big argument with the new rector of the university. I decided to leave. It was a big decision because my grandfather was one of the founders of the university. My father was a professor in the school of architecture. It was like my life. But there was a philosophical problem with the rector, so I left.
I worked just in my private practice. I decided that for the rest of my life I wouldn't have a boss and I wouldn't organize anything. That lasted for only one year.
What brought you back to the world of medical education?
In 2001 I was asked to be dean of the University of La Sabana, which had been established in 1994. (The university is close to Bogotá and 450 km from my city, Medellín). I was reluctant but saw that the university had an incredible program and a clear future, so I accepted.
What did you like about the program?
The general idea was to create leaders of change - a new style of medical doctor who thinks of patients as whole people. There was an attempt to understand human beings not only from a scientific point of view but also from an anthropological point of view. Francisco Lamus Lemus, a family physician faculty member, was working in the community.
I liked the campus and the people. We have problems but the style of dealing with problems is constructive.
Did you and your colleagues have any special goals or challenges?
My three goals were to get accredited, to get the rest of our funding, and to consolidate the academic program, which meant developing graduate programs.
Accreditation is voluntary but we felt it was very important. There are more than 50 schools in Colombia, but only 13 are accredited. When we were only 10 years old we became the youngest school of medicine in Colombia to be accredited. Now we have re-accreditation for six more years.
One of the most important challenges has been establishing our special identity. We want our graduates to be known not only as well educated in medicine, but as physicians who have a special relationship with their patients and understand their patients' problems in the context of the patients' family and community.
What is the curriculum like?
We had a traditional curriculum. Now we have a classical structure but we are working to integrate the basic sciences and clinical medicine. We have a competency-based program that is seven years long, including the internship. Most schools in Colombia are only six years long, but we want students to have time to develop a humanistic perspective.
At what stages in their education do your students spend time in the community?
Currently we are in the process of curricular reform. Until one year ago, fourth year students, who had just completed the three years of basic science, had a whole semester dedicated to family and community medicine. They were posted in a neighborhood and worked in a primary care hospital in a family practice consultation with family medicine professors. In parallel, as part of the Healthy School Initiative, they did a community health approach based in schools (largely primary schools but also a couple of high schools). They had to establish a relationship with the school's community. Then, in partnership with the community, they did a community assessment, selected a problem and formulated and implemented a project to improve the health problem. Community members were involved in designing and guiding the process, even redirecting it, if necessary. At the end of the semester, students evaluated their projects and presented their results to community members and academics. They made poster presentations and wrote papers, some of which were published in our faculty journal.
We still have a semester dedicated to family and community medicine, but now students will have this experience in their twelfth semester. Students will be given opportunities to work in the schools, but they will also be able to choose to work in other community settings.
Why was the community program moved to the last semester?
Because we think that if students have had time to develop basic competencies in various clinical areas, they will be able to get more out of their community experience. At the same time, we think they will be able to provide better services to the community.
Under this change in the curriculum, do the students get out into the community before their final year?
The curriculum is hospital-centered. However, during the obstetrics and gynecology semester, students go with our professors to first level health centers. Also, in internal medicine, obstetrics and gynecology, surgery and pediatrics, there are activities in community hospitals that create the possibility of opportunities for students in primary care level diagnosis and treatment.
In addition, we are developing elective opportunities, for example, a program with vulnerable populations, including internal refugees from the war. This is for students in the second, third and fourth and sixth semester. We will give them an opportunity to connect with one displaced family.
What proportion of the students' time is spent in the classroom?
In their first four semesters, students spend all their time on the campus in classrooms and labs and in academic tutor meetings. In the clinical semesters (5 to 12) students have two weeks of classroom work at the beginning of the academic periods followed by 16 to 18 weeks during which they work four days a week at the clinical practice and one day a week on campus in classrooms and academic tutor meetings. During semesters 13 and 14 (the internship) students spend all their time in clinical practices.
Do you have any new projects underway?
We are working hard on developing the residency (postgraduate) programs. We have residency programs in radiology, family medicine, intensive care, rehabilitation medicine, pediatrics, pulmonology, internal medicine and general surgery. In addition to clinical training, residents study research strategies, communication skills, ethics, management and culture. Residents are an important part of our academic structure. They promote research and train undergraduate students.
On another front, we are working on higher-level research in all areas. We want to publish in international journals.
We have an interesting university clinic with 110 medical doctors and 40 beds. It is little but we are building other services to create a real university hospital. I am the president of the board of the university clinic.
Another interesting program is the academic success and retention of the students. Most of the university students in Colombia are smart, but many high schools don't do an adequate job of helping them develop the skills they need. When we accept a student, we feel it is our responsibility to take the student all the way through the academic process as opposed to giving the student all the responsibility for overcoming all of the barriers. So in the first three semesters we help students raise their skill levels.
I understand that your school promotes international education.
In this modern world, we can't be isolated from the rest of the world. We like for our students to spend three, six or 12 months in medical education programs in Europe, the United States, Japan or elsewhere in South America. We also like to receive students from other countries. We've developed relationships with Maastricht University in the Netherlands and with others schools around the world. We've had students from the Netherlands, England, the United States, Japan, Australia, Argentina, Venezuela, Panama, Mexico and Peru.
What are your hopes and dreams for medical education and health care in Colombia?
Our big dream is to prepare new medical professionals who have the skills and tools to improve the health of our communities in our country and all of Latin America. The new medical professionals must be medically competent, but they also need to be committed to treating people with dignity and seeing them as part of the family and community. Medical doctors must recover their historic role as positive leaders of society.
Thank you for sharing your experiences. Best wishes with your important work.