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From the Prairie to Persia

Aug 25, 2016 09:00AM ● By MED Magazine

By Mark Huntington, MD, PhD


In April 2016, along with Dr. Stephen Schultz of the University of Rochester (NY), I traveled to the Islamic Republic of Iran at the invitation of the Ministry of Health and Medical Education as consultants on the development of graduate medical education in Family Medicine in the country.


Iran has a primary health system based upon community health workers (behvarz) that has made significant strides in improving the public health of the nation over the past quarter century. At the next level of care, the healthcare system was organized in the mid-1980s to fully integrate healthcare with medical education, stressing that “community needs must be given primary consideration in the context of training medical manpower.” 


Though Iran has well-established physician subspecialty training programs, historically, a majority of care has been provided by “general practice physicians”, i.e. medical school graduates without postgraduate residency training.


The Iranian health system faces many of the same challenges as the US system: lack of access, technology-driven rising costs, fragmentation of care, and a focus on episodic disease-centered care rather than continuity and prevention.  In an effort to address these challenges, the development of Family Medicine as a specialty has begun.  After studying a variety of models of Family Medicine around the world, the Ministry determined that the US model of the discipline best met their national needs.  This spring, eight Family Medicine residency programs, enrolling a total of 60 physicians, were started.


We were asked to present a day-long workshop as part of the annual National Medical Education Congress.  We also visited several of the new residency programs in Tehran and Isfahan, meeting with faculty and resident physicians.  Discussions were held with Ministry officials tasked with the development of the educational program, and a final meeting was held with the Deputy Minister. 


During these sessions, a wide range of topics were addressed. This included current Family Medicine graduate medical education practices in the US (both the more urban-focused in NY and the more rural-focused in SD), ranging from curriculum and faculty development to recruiting and pedagogical methods. Current experiences and historical lessons from the establishment of Family Medicine as a specialty in the US on issues such as certification exams and maintenance of certification, “grandfathering” mechanisms, continuing professional development, financing of graduate education, and others were presented. 


Ongoing consultation is planned, including return trips to Iran and visits by faculty of the Iranian residency programs to US residency programs to see first-hand the logistics of training Family physicians.


In addition to the consulting work, we were taken to see some of the cultural, religious, and historical sites of the nation, including the National Carpet Museum (Iran is where Persian rugs originate), palaces of the former kings of Persia/Iran, and several religious shrines.  As a history buff, it was fascinating to experience a nation with such a long and rich history (and one which has preserved its heritage following the 1979 collapse of their 2500 year old, multiple dynastic monarchy).


What was most delightful about the trip were the people of Iran.  In stark contrast to what is often portrayed by our media and politicians, the Iranians were very warm and welcoming. Grand hospitality is an integral part of the culture, and we certainly benefitted from that!  The professional colleagues and governmental officials with whom we met were extraordinarily gracious and appreciative; the random people we met on the street reacted with pleasure when they heard we were from the US.  We left the country having made many new friends.


Mark K. Huntington, MD, PhD, FAAFP, is Director of the Center for Family Medicine and the Sioux Falls Family Medicine Residency Program, and Professor at USD Sanford School of Medicine.  He has been involved in global health and medical education for many years and serves on the Advisory Board for the American Academy of Family Physicians’ Center for Global Health Initiatives.