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Education
The William J. Harrington
SCHOOL OF MEDICINE Medical Training Programs for Latin America
UNIVERSITY OF MIAMI
HISTORY
The William J Harrington Medical Training Programs for Latin America (TPLA) at the University of Miami School of Medicine are an extension of the age-old tradition of providing state-of –the-art medical education to those students and physicians from other nations with lesser resources and opportunities. Thirty nine years ago medical education in Latin America and the Caribbean was largely ignored by medical schools in the rest of the world. Dr William Harrington felt a sense of responsibility to develop a program in which highly selected physicians and students from Latin America would come to our institution for training, then return home to influence their medical communities through education and leadership.
In 1964 Dr. Harrington joined the University of Miami as Chairman of the Department of Medicine. He immediately began laying the groundwork for the TPLA by establishing contacts with respected faculty members at medical schools throughout Latin America. By 1967 he was ready to accept the first participants in the program.
The program, originally called the Latin America Training Program (LAPTA), began slowly and cautiously with great emphasis on the quality and dedication of the participants.
Three physicians were accepted in 1967. (The first participant in the program was a woman, underscoring Dr. Harrington’s progressiveness.) The number of PGY-1 positions dedicated to LATP increased significantly in recent years as the success and value became evident, and additional programs tailored to accommodate visiting medical students and physicians were established.
THE INTERNAL MEDICINE RESIDENCY PROGRAM
This is the original model and remains the core of the TPLA. By flexible agreement with the Department of Medicine approximately 30% of Internal Medicine categorical PGY-1 positions are dedicated each year to applicants who apply specifically to the TPLA. Selection criteria include academic excellence as demonstrated by medical school records and strong letters of recommendation written by our adjunct faculty in the home country, proven compassion and dedication to patients care, fulfillment of all Educational Commission for Foreign Medical Graduates (ECFMG) requirements for training in the U.S.A., and most important, a strong desire to return to the home country upon completion of training.
Three hundred and twenty six Latin American physicians have participated in our Program. At any given time we have a total of thirty six residents in training selected through our Program. An increasing number of residency positions have been filled by TPLA applicants in recent years, and the majority of participants continue with subsequently training resulting in a total training time of 6to 7 years in the U.S.A. Consequently a large percentage of the program’s total participants since its inception are currently in training in this country.
Medical residents in the TPLA are encouraged to enter subsequently fellowship so that they will upgrade medical care underserved area of their countries.
Their choices for subspecialty training are broadly represented although
Hematology/Oncology, Cardiology, Pulmonary, GI/Hepatology, Endocrinology, Infectious Diseases, and Nephrology account for the majority.
Highly Trained subsepecialists are needed in many parts of Latin America, unlike the oversupply of subspecialists presents in most U.S. cities. It makes sense for our subspecialty training programs to emphasize the training of physicians from underserved areas as opposed to the current practice of selecting primarily those individuals who will remain in practice locally in the United States.
The primarily mission of the TPLA is to benefit the home country. Of course, in the process the trainee is benefited by the expanded opportunities for education. The University, the Dade County Public Health Trust, the Miami Veterans Medical Center, and the Department of Medicine likewise benefit from the work produced and the patient care delivered by these superb clinicians. Nevertheless, the emphasis remains on the benefit to the home country and the ultimate success of the TPLA hinges upon the trainees returning home after completing training.
Even though most of our trainees sincerely intend to return home, many are faced with temptations to remain in the USA. Factors include attractive job offers, deteriorating economic and political conditions back home, the expected difficulty establishing an academic and/or private practice upon return, and personal factors(such as getting married or having children here). Consequently, many of our medical school faculty express doubt that the mission of the Program can be accomplished.
The majority of our trainees have returned to their country upon completion of training.
The most important yield of Dr. Harrington’s program is not as easily expressed or measured. It would require a case by case description of the impact each of our trainees has made after returning home. Even though this is “invisible” to most of us in Miami, it is nevertheless significant and growing in importance with each passing year. In addition, the TPLA participants invariably remain proud and dedicated alumni, and served as “ambassadors” for the University of Miami and Jackson Memorial Hospital. Contact with our graduates in Latin America is maintained through the TPLA office, and relationships forged with UM/JMH physicians during the period of training often leads to referrals of patients with particularly challenging problems to our tertiary care center.
THE MEDICAL STUDENT PROGRAM
Established in 1975, the medical student program of the TPLA offers an opportunity for qualified foreign nationals students enrolled in Latin American medical schools to spend one to six months at the University of Miami/Jackson Memorial Medical Center. Numerous educational opportunities are available. The most popular courses are the clinical electives offered by 16 departments, including 23 internal medicine, 13 pediatric, 13 surgical, 4 orthopedics, 6 obstetrics and gynecology, 5 psychiatry, 2 pathology, and 3 radiology subspecialties.
One thousand five hundred eighty medical from Latin America have participated in our Program. Space is limited and most positions are filled months in advance. Each department or division voluntary participates and determines how many positions will be provided for TPLA students. (By necessity, priority is always given to our own University of Miami medical students.) Participation in the program requires permission from the applicant’s medical school as well as fulfillment of the other entry criteria.
The TPLA medical student program has been extremely successful and popular. Some of our adjunct faculty have stated that the importance of this program equals or exceeds that of the medicine residency program. The students return home with new perspectives and knowledge to share and have heightened enthusiasm. Likewise, while these students are in Miami their presence allows our own students to learn how medicine is practiced in other parts of the world with emphasis on difference in epidemiology of disease, diagnostics approaches and therapy.
ELECTIVE PROGRAM FOR LATIN AMERICAN PHYSICIANS
Seven hundred ninety six physicians and faculty from Latin America have come to the University of Miami/Jackson Memorial Medical Centre, from twenty three Latin American countries, since 1967 to learn via training programs tailored to their individual needs. This program is much more flexible than the medical student or medical residency programs with regard to design and duration. The opportunity to learn alongside a specific University of Miami faculty member in clinical medicine or basic research, to observe new technique, and to expand one’s knowledge are the usual reasons for enrolling.
Each participating arranges his or her own program through the TPLA office.
ADJUNCT FACULTY
The TPLA adjunct faculty from throughout Latin America and the Caribbean are the cornerstone of the entire program. They communicate information about the program to candid appraisals, and they are the “eyes and ears” of the program, keeping us abreast of the changes in local medical education and politics. The recruitment of our 62 adjunct faculty representing 23 countries has been slow and difficult but it is the true secret to the success of the TPLA.
The adjunct faculty is willing to work hard to assist the TPLA primarily because they believe it will benefit their country. It is essential that we remain true to the mission of the completion of training. To do otherwise would jeopardize our relationship with our adjunct faculty and compromise the integrity of the Program.
Having this stated philosophy and a track record spanning 36 years makes us unique among medicals schools and residence training programs.
THE WILLIAM J. HARRINGTON FELLOWSHIP
Following the death of Dr. Harrington in September 1992, his son, William Jr., proposed the establishment of a fellowship position in his father’s name. The endowed position will supported the work of a scientist from Latin America or the Caribbean working on a health related area relevant to the developing world. Many such individuals exist but are struggling to do their work, hampered by limited resources and lack of access to new technology.
The fellow will have a junior faculty position. A network of collaborating institutions both here and abroad is being developed so that the fellow will receive specialized training in his or her specific area of research.
Efforts are currently underway to raise sufficient funds through donations and grants to supports such a scientist working on promising research. We hope to be able to select our first Harrington Fellow in the near future.
THE TPLA OFFICE
The program office is located at Jackson Medical Towers. Lina Navarro, Assistant Director; Barbara Berto, Assistant to the Assistant Director and Arlene Hernandez, Medical Clerkship Coordinator, handle the numerous functions vital to the program, including processing of applicants, communication with our applicants and adjunct faculty, scheduling individuals participants in courses and clinical rotations, and keeping track of the progress of our various students and physicians during and after their training. A critical functions of the TPLA office is helping in the day to day problems faced by our participants such as arranging housing, transportation, deal with the various embassies and consulates. Without such assistance, many of our students and physicians would find the relocation process overwhelming and the program would suffer as a result.
FUTURE DIRECTIONS
The TPLA must remain dedicated to Dr. Harrington’s philosophy that our efforts, through education and research, are aimed at benefiting the people of Mexico, Central, South America and the Caribbean. Renewed emphasis will be placed on selecting those individuals who, we believe, are most likely to return home after training and make meaningful contributions.
Efforts are being made to identify and develop adjunct faculty in areas currently underrepresented.
The Harrington Fellowship in basic medical sciences as described previously will be an important addition to the TPLA and is expected to result in valuable contributions, both in terms of the research projects and the training of the fellows.
In addition, the TPLA is currently developing collaborative efforts in research between established scientists currently working in Latin America and the Caribbean and their counterparts at the University of Miami.
Finally, a TPLA newsletter is being developed to keep our Adjunct Faculty, Residents in training and Residents returned abreast of the Programs’ latest news regarding participants’ accomplishments in Miami as well as their extra curricular activities representing the University of Miami Medical School and their home countries Medical Schools.
We sincerely hope that the above additions helps to solidify our mission of facilitating medical education and research between the United States and the countries of Latin America and the Caribbean.
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