As part of their ongoing effort to improve pediatric healthcare in Bulgaria, eleven Bulgarian physicians participated in an intensive observation program at Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York from March 31 to April 4. The visit, hosted by one of the United States' premier medical institutions, provided participants with firsthand exposure to advanced pediatric care practices and marked the first phase of a broader three-part initiative aimed at strengthening child healthcare in Bulgaria.
The initiative, developed in partnership with Weill Cornell Medicine's Department of Pediatrics and the institution's Office of International Affairs, aims to introduce modern approaches to pediatric care delivery in Bulgaria through a blend of immersive learning and broader educational outreach. Following the observership, the second phase will involve an e-learning series focused on key topics such as quality improvement, patient safety, and patient- and family-centered care, expanding access to healthcare professionals across Bulgaria. The final phase will bring the collaboration home with an in-person workshop in Sofia, where participants will explore how to apply insights from the earlier phases within the Bulgarian medical system.
During Phase I of the program, the Bulgarian physicians were paired with host U.S. physicians from Weill Cornell Medicine. They shadowed attending physicians, residents, fellows, and trainees across a wide range of pediatric specialties and clinical settings, including the neonatal intensive care unit and the pediatric intensive care unit, as well as pediatric surgery, cardiology, neurology, genetics, radiology, and among others that provide care to newborns and infants.
The Bulgarian delegation included Dr. Blagomir Zdravkov, Director of the "Prof. Ivan Mitev" Specialized Hospital for Active Treatment of Children's Diseases in Sofia, named for the well-known Bulgarian pediatrician, and the heads of several pediatric clinics in the hospital. Prof. Dr. Ivan Litvinenko, head of the Bulgarian Pediatric Association, who also leads the Pediatric Neurology Clinic at the "Prof. Ivan Mitev" Hospital and chairs the Public Council for the Construction of a National Children's Hospital, also attended, along with Assoc. Prof. Dr. Yordanka Uzunova, Head of the Pediatrics Clinic at the "Lozenets" University Multiprofile Hospital for Active Treatment, Dr. Stamen Pishev, Deputy Director of Diagnostic-Consultative Center I in the southeastern city of Burgas, and other physicians from the city.
The need for improved pediatric care in Bulgaria is pressing. Despite recent improvement, Bulgaria continues to grapple with the highest infant mortality rate in the European Union, estimated at approximately 5.3 deaths per 1,000 live births in 2024, significantly above the EU average of 3.4. Bulgarians also suffer from a high rate of premature births, elevated rates of disabilities and chronic illnesses among children, and widespread childhood obesity. To help address these issues, Burgas, Bulgaria's fourth-largest city, is building a municipal children's hospital, set to open early next year. And Bulgarian authorities and parent groups have renewed efforts to establish a standalone national children's hospital in Sofia.
The one-week immersion at Weill Cornell Medicine allowed the visiting Bulgarian physicians to observe the multidisciplinary approach to pediatric care and how quality and patient safety, as well as patient and family-centered care, are embedded in medical practice. Facility highlights include private patient rooms equipped to accommodate family members overnight, family lounges with kitchenettes and quiet rooms, and playrooms that provide spaces for interaction, play, and distraction to help reduce the emotional toll of hospitalization.
"For years, my team and I have been committed to improving pediatric care and patient safety in Bulgaria," said Dr. Zdravkov, director of the "Prof. Ivan Mitev" hospital in Sofia. "This requires a shift in mindset and culture within the healthcare system. Learning from our colleagues at Weill Cornell—one of the world's top institutions—was invaluable. Their pediatric department offered deep insights into clinical processes and healthcare delivery organization."
Dr. Zdravkov added: "We've built meaningful connections that I hope will grow into lasting professional partnerships. To truly meet public expectations, Bulgaria must transform its pediatric healthcare—and gaining expertise from the best is a vital step forward."
Bulgarian physicians learned that Family Centered Rounds are the gold standard for rounding in pediatrics. This is in accordance with the American Academy of Pediatrics (AAP) recommendation, where families are invited to participate in rounds with medical staff. Weill Cornell Medicine also has a Patient and Family Advisory Council (PFAC), which allows families to join the discussion in shaping policies and services around the delivery of pediatric care. PFAC is a group of patients, families, caregivers, hospital staff, and faculty to work together on issues related to patient and family-centered care.
"Reflecting on the entire hospital visit—from lectures and discussions to meeting the Family Advisory Council—what stood out most was the deep commitment to placing the patient and their entire family at the center of care," observed Prof. Dr. Litvinenko. "Every hospital room, including those in neonatology, is designed to accommodate both parents, unlike the situation here. Staff members show remarkable patience and thoroughness in addressing parents' questions, down to the smallest detail."
"The culture of mentorship and openness among the faculty at WCM was truly inspiring. The way attendings engaged learners, encouraged questions, and promoted a growth mindset created an enriching educational environment," added Dr. Stamen Pishev. "I appreciated the balance between clinical excellence and compassion in patient care, which is something I hope to carry forward in my own practice and teaching."
Building on the successful visit to New York, which was facilitated by the America for Bulgaria Foundation, the U.S.–Bulgaria partnership continues with the next two phases set for October—a multi-course eLearning program developed by Weill Cornell Medicine and an in-person workshop in Bulgaria.
The ongoing collaboration between Bulgarian healthcare leaders and Weill Cornell Medicine is one of mutual growth and innovation, and represents a physician-led effort to improve pediatric care in Bulgaria and improve the quality of life for the nation's children.
