British Medical Journal Helping Georgian Doctors

Exclusive Interview

We spoke to two representatives from the British Medical Journal (BMJ): Clinical Director of BMJ Learning and BMJ Best Practice, Dr Kieran Walsh, and Head of Strategic Partnerships for Global Health and Global Health Security, Mitali Wroczynski, both of whom discussed BMJ’s Clinical Decision Support Training Initiative to improve the detection, diagnosis and management of infectious diseases and dangerous pathogens, which supports efforts to prevent and contain future outbreaks in Georgia and across the region.

TELL US ABOUT THE INITIATIVE. HOW DID IT START? HOW IS IT IMPLEMENTED?

MITALI WROCZYNSKI: The Initiative fits within the context of new and emerging diseases which are a big risk, not only in Georgia and the region, but globally. We’ve recently seen the emergence of Ebola, Middle East Respiratory Syndrome, and pandemic influenza and this program is all about making sure we can detect new infectious diseases as quickly as possible to prevent their spread, not only within the country; but outside of the country too.

It began a couple of years ago with a training workshop we delivered jointly with the NCDC [National Center for Disease Control and Public Health in Georgia] to 20 to 30 healthcare professionals who work across public health and infectious diseases. We introduced them to two of our products: BMJ Best Practice and BMJ Learning. BMJ Best Practice is a clinical decision support tool which helps doctors at the front-line when they’re assessing, diagnosing, and managing patients. Doctors can use it to check their clinical practice and decisions, or to answer any questions they may have while they’re seeing a patient. It’s a second opinion for doctors. The other resource we made available was BMJ Learning which contains about 800 online learning modules. Together, they cover about 95% of the most commonly presented conditions in primary and secondary care in Georgia.

Our focus has been primarily on helping doctors and other healthcare professionals to better manage infectious diseases and dangerous pathogens that are capable of causing epidemics and pandemics. However, because of the breadth of our content, BMJ Best Practice and BMJ Learning will also help doctors across Georgia with non-communicable diseases. More broadly, they help people practise evidence-based medicine, and they support continuing medical education and professional development.

KIERAN WALSH: Through the BMJ’s Clinical Decision Support Training Initiative, doctors can stay continually updated in their practice so they’re in line with the latest international guidelines. The BMJ offers practical help as well as evidence-based help: the content is based on the most recent scientific literature. Our focus is helping doctors to recognise, report, and refer patients with infectious diseases; from diseases that are common like hepatitis C and tuberculosis, to other diseases that can cause epidemics like influenza and anthrax.

MW: This is a three’-year program and it launched just over a year ago. Over the last year we’ve been focusing on engaging with healthcare professionals across Georgia to recruit as many people as possible onto the program. We have also been translating the content into Georgian and Russian.

VERY DIFFICULT, WE IMAGINE…

MW: Yes. It’s very hard and Georgian is a beautiful but complex language, particularly the medical language: we’ve had to establish an English-Georgian medical glossary and dictionary. We will have translated about half of our content by the time we finish, which equates to about 5 to 6 million words.

HOW DO YOU GO ABOUT IT?

MW: We’ve been working with a translation company and we have translation expertise in-house, but we’ve also been working with local clinicians whom we have trained as quality assurance editors to make sure the translation is of the highest possible quality.

WHAT IMPACT DO YOU PREDICT?

KW: In terms of impact, we’re keen to provide more than just the resources on their own. We’re keen to follow up with individual doctors who are in primary or secondary care and find out what they’ve been doing with them: how they’ve improved their practice; how they’ve spread the word to members of their team; how they’ve instituted quality improvement initiatives to help embed better practices within their institutions. We plan to do more and more of that in the future.

IT’S EARLY DAYS, BUT WHAT RESULTS HAVE YOU SEEN THUS FAR?

MW: We have had feedback that people have improved the way that they diagnose respiratory diseases: that they’ve improved investigations into diseases like TB. We’ve had feedback that practice is improving, particularly relating to doctors following international guidelines.

The first year is always focused on raising awareness: building up the number of people engaged in the program, and from there I think we can get more detailed impact evaluations.

HOW DO YOU EXPECT THE WARDROP STRATEGIC DIALOGUE TO AFFECT THINGS?

MW: We were very privileged to have been invited to the Dialogue by the Ambassador of Georgia to the UK, Her Excellency Tamar Beruchashvili. We participated in the people-to-people dialogue and for the first time, I believe, health was on the agenda. We gave an overview of the program and talked about the value that it can add not just to clinical practice, but also to medical education. Due to the fact that we will have the ability to show users the English-language and Georgian-language content side-by-side, one of the things it’s also doing is improving the English language skills of doctors in the country. This is a key priority of the British Council and was a topic of discussion at the Wardrop Dialogue; it is also a priority for the First Deputy Minister for Health of Georgia.

Our program has received political support at the highest levels in the US, UK and Georgia; we hope that we can engage with more partners within Georgia, and really embed what we’re doing to ensure the long-term sustainability of the program; this will be our key focus going forwards

WHAT’S NEXT?

Our priority is to make sure that the program is as sustainable as possible, so we want to find ways to integrate what we’re doing within the infrastructure of Georgia across medical education and clinical practice, and to find partners who will help us make it financially sustainable to continue the program beyond the initial three years. We’re actively looking for partnerships from anyone who has an interest in healthcare. Whether organizations are from the public or private sector, we’re interested to hear from people who share our goals for supporting healthcare professionals and improved clinical outcomes in Georgia: so please do get in touch.

Contact details:

Mitali Wroczynski: mwroczynski@bmj.com

Dr Kieran Walsh: kmwalsh@bmj.com

Robert Edgar, London