Faculty and Resident Information

Situated in the horn of Africa, Ethiopia has a population of approximately 77 million people; with a growth rate of 2.4%; the population is estimated to be 110 million by the year 2020. Up until 2003 there were only nine practicing psychiatrists in the country, all of whom had been trained abroad, and three of whom are on faculty in the Department of Psychiatry at Addis Ababa University. The need for more psychiatrists has been recognized for the last 10 years and due to the remarkable ability, energy and determination of our Ethiopian colleagues, the psychiatry residency program opened in January 2003 to seven incoming residents. 

The Toronto Addis Ababa Psychiatry Project (TAAPP) was created to meet the educational needs of this new three-year training program as well as the need of the Department of Psychiatry in Toronto, Canada to develop international educational outreach expertise. The letter of agreement between the two universities was signed in the summer of 2003, and the first University of Toronto educational month-long visit took place in November 2003. Currently, the residency training program has completed its fifth year. The first seven Ethiopian psychiatry residents graduated in 2006, a further seven graduate in 2007, and thirteen Ethiopian psychiatry residents are currently registered in the program.  

TAAPP is charged with bringing an academic syllabus of contextually relevant seminar and clinical material from the University of Toronto to teach to the residents in Addis Ababa. Guided by the original curriculum developed for the program by the Ethiopian faculty, the Toronto syllabus responds to the subsequent needs of the program as it continues to evolve. The syllabus is devised sequentially with each educational trip flexibly pre-negotiated between the two departments and organized to include time for the on-site clinical supervision of the Ethiopian psychiatry residents by the Toronto team in the wards, clinics and emergency department in Addis Ababa.

From November 2003 until April 2007, TAAPP has recruited and put together over 10 teaching teams, each one consisting of two members of the University of Toronto psychiatric faculty and one University of Toronto psychiatry resident. Each team visits Addis Ababa for a one-month period; there have been three trips a year. 

At the end of three years, TAAPP was considered sufficiently successful by both departments of Psychiatry to expand the original mission to a TAAPP Phase Two. This extends TAAPP for a further three years (for a total of six years) and has two goals.  First, it will continue to supplement the residency training as originally negotiated for TAAPP Phase One, by providing two, not three, month-long educational trips a year. Second, it will enable three new faculty members drawn from the graduating Ethiopian residents to acquire postgraduate training as leaders and educators in their profession. This component of Phase Two will involve the new faculty in both in-country and out-of-country training. With regard to in-country training, the new junior faculty members will work closely with the visiting University of Toronto faculty members to develop, plan and co-teach the Addis residents for the month-long TAAPP visit twice a year.  With regards to out-of-country training, each new junior faculty member will travel, in turn, to Toronto for a 12 month educational block at the University of Toronto. This out-of-country module will aim to provide clinical training in the specialty areas of their choice and will focus as well on the theory and skills involved in research, leadership, teaching and advocacy appropriate to the predicted needs of psychiatry in Ethiopia.
       
A further development following the successful involvement of TAAPP in the psychiatry residency training program has been a recognition and exploration of the Ethiopian psychiatric nursing needs. The University of Toronto nursing program has been asked to develop a similar project with the Addis Ababa Psychiatric Nursing Program to train BSc Psychiatry nurses and to assist the current psychiatric nurses at the Amanuel Hospital (the only inpatient psychiatric facility in the country and the main site of TAAPP) to explore a nursing role expansion. A preliminary visit to set this program up was undertaken in October 2005 and the first nurses’ training trip took place in July 2006. Regular teaching trips are planned twice a year.  

The unique features of the arrangement between the two departments of psychiatry, in Toronto and Addis Ababa, which contribute to its creativity and innovation are

• The close involvement of the relatively resource-rich University of Toronto (800 faculty and 130 residents) with the considerably smaller, less resourced Department of Psychiatry at Addis Ababa University (six local faculty and 13 residents) to directly supplement the educational needs of the new Ethiopian residency training program.  TAAPP enabled the Ethiopian residency training program to open and function and will continue to provide on-site teaching and clinical supervision as well as resources for selected graduates to train as new faculty. They, together with the current Ethiopian faculty, will provide a full strength local residency teaching staff.
• The direct relevance that educational involvement in Ethiopia as a low income country has for the Department of Psychiatry in Toronto. This enables the latter to begin to build a template for educational involvement in other Departments of Psychiatry in other countries requesting assistance.   In time we expect that the Department of Psychiatry in Addis will be sufficiently resourced to provide similar consultation to nascent departments of Psychiatry in other countries as well.
• TAAPP’s recognition that, despite the differences between the cultures and resources, the similarity and mutual learning possibilities between the two faculties and residents in a transcultural learning experience is equally relevant to both countries. This experience becomes translated into an increased capacity to improve understanding and treatments for the mixed ethnic communities of both Addis Ababa and Toronto as Ethiopia has 80 different ethnic groups with over 200 dialects and languages and Canada is becoming increasingly multicultural, with recent immigrants constituting 52% of the present population of Toronto.
• The direct experience of teaching and training between the different cultural contexts of Toronto and Addis Ababa draws attention to the otherwise invisible cultural biases and basic assumptions in western psychiatric training models and content. We want the TAAPP initiative to creatively and usefully challenge the relative cultural isolation of western models of psychiatry in academic debate.  This becomes possible as increasingly more University of Toronto faculty and residents, through TAAPP, have educational immersion experiences in a different cultural context. In addition, TAAPP encourages a thoughtful look at the relevant University of Toronto residency core curriculum in light of the development of the Ethiopian psychiatry curriculum. TAAPP has recently influenced expansion of the core curriculum of the University of Toronto from six hours of cultural psychiatry to 18 hours.
• The needs of both departments of Psychiatry in Addis Ababa and Toronto, in well-considered three-year steps designed to maintain the educational usefulness of their mutual involvement, while promoting the increasing independence of the Ethiopian Program from the direct educational support of the University of Toronto. As this occurs and enduring bonds are made between these two departments, it is hoped that their relationship will continue in line with the needs of both programs to develop and grow.

TAAPP addresses the following educational issues

• The promotion of cultural competence in psychiatry
• Teaching methodology as it relates to culturally distinct trainers and trainees.
• The determination of core content in a psychiatry residency training program curriculum in both high and low income countries.
• Curriculum development in light of evolving health care needs in Canada and Ethiopia.
• The continuing awareness, endorsement and integration of the importance of the CanMEDS roles in psychiatry residency programs. That is, the residents at both the University of Toronto and Addis Ababa University are trained not only to be clinically proficient psychiatrists (Medical Experts) but also to be competent as Communicators, Collaborators, Managers, Health Care Advocates, Scholars and Professionals. In Ethiopia these roles are still being negotiated and are likely to be more streamlined and adapted to the unique cultural context there. A possible configuration will be a reduction to five roles: Clinical Expert, Leader, Educator, Advocate, Scholar to be named EthioMEDS.

Teaching in Addis

The main focus of the University of Toronto’s  teaching trips to Addis is to share the huge load of teaching and clinical supervision with the Ethiopian faculty, freeing them up to fulfill their various other professional responsibilities.  As invited guest faculty, we are relieved of the responsibility of passing or failing residents and of any major evaluation of them.  We are welcome and honoured guests, but we need to be mindful that we are strangers to the Ethiopian culture and context and have much to learn. 

We are now in TAAPP Phase Two and have an additional focus of facilitating the new faculty's role as educators. Each trip will thus incorporate a new faculty member from Addis in the planning stage by email and in co-teaching once we are in Addis.

Teaching the residents in the Addis program can be compared usefully to teaching psychiatry to GPs in Canada. The psychiatry residents in Addis have worked for a minimum of four years as general practitioners and benefit from a teaching approach geared to adult learners. Unless a patient is admitted to Amanuel Hospital, he or she may only be seen as an outpatient one or two times. Brief models of consultation and psychotherapy are useful. Toronto faculty who have worked in Baffin Island or in other outreach centers in Canada are often familiar with effective one to three visit models of outpatient treatment.

It is hoped that many of the University of Toronto faculty who participate will return to Addis again. The consensus is that it is easier to teach and learn once a relationship is established, so the development of long term educational relationships is encouraged.  Many of the returning University of Toronto faculty have become long distance supervisors of the Addis residents' research projects.

We have no clinical license to practice psychiatry in Ethiopia and our teaching does not involve treating patients. 

Teaching Psychiatry in Ethiopia: Slide lecture by Dr. Sam Law

Educators Without Borders: Slide lecture by Dr. John Teshima

Cross-Cultural Differences in Teaching and Learning: Lecture by Dr. Daniel B. Pratt