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Luaces MA, Cochran MS, Finocchario-Kessler S, Connelly K, Polivka B, Young R, Anguyo G, Nwobu C, Evert J. Impacts, Learner Diversity, and Curricular Framework of a Virtual Global Health Elective Catalyzed by the COVID-19 Pandemic. Ann Glob Health 2023; 89:32. [PMID: 37252336 PMCID: PMC10215996 DOI: 10.5334/aogh.4060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/30/2023] [Indexed: 05/31/2023] Open
Abstract
Background Place-based international electives that build global health competencies have existed for decades. However, these electives require travel and are infeasible for many trainees around the world, particularly those with insufficient financial resources, logistical complexities, or visa limitations. The emergence of virtual approaches to global health electives, catalyzed by the travel pause related to the COVID-19 pandemic, necessitates the exploration of learner impacts, participant diversity, and curricular frameworks. Child Family Health International (CFHI), a non-profit global health education organization that partners with universities to expand immersive educational offerings, launched a virtual global health elective in 2021. The elective drew on faculty from Bolivia, Ecuador, Ghana, Mexico, the Philippines, Uganda, and the United States. Objective This study aimed to describe a newly developed virtual global health elective curriculum and evaluate the demographics of and impacts on trainee participants. Methods Eighty-two trainees who were enrolled in the virtual global health elective from January to May 2021 completed both 1) pre- and post-elective self-assessments of domains of competency mapped to the elective curriculum and 2) free text responses to standardized questions. Data were analyzed through descriptive statistical analysis, paired t-testing, and qualitative thematic analysis. Findings The virtual global health elective had 40% of its participants hail from countries other than the United States. Self-reported competency in global health broadly, planetary health, low resource clinical reasoning, and overall composite competency significantly increased. Qualitative analysis revealed learner development in health systems, social determinants of health, critical thinking, planetary health, cultural humility, and professional practice. Conclusion Virtual global health electives effectively develop key competencies in global health. This virtual elective had a 40-fold increase in the proportion of trainees from outside the United States, compared to pre-pandemic place-based electives. The virtual platform facilitates accessibility for learners from a variety of health professions and a wide range of geographic and socioeconomic environments. Further research is needed to confirm and expand on self-reported data, and to pursue approaches to greater diversity, equity, and inclusion in virtual frameworks.
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Affiliation(s)
- Maria Alonso Luaces
- Department of Family Medicine and Community Health, Director-Office of Diversity and Inclusion, University of Kansas School of Medicine, Kansas City, KS, US
| | - Michelle S. Cochran
- Clinical Assistant Professor, University of Kansas School of Nursing, Kansas City, KS, USA
| | - Sarah Finocchario-Kessler
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kimberly Connelly
- KUMC Senior International Officer, Director of the Office of International Programs, the University of Kansas Medical Center, Kansas City, KS USA
| | - Barbara Polivka
- School of Nursing, the University of Kansas Medical Center, Kansas City, KS USA
| | - Robin Young
- Executive Director, Child Family Health International, US
| | | | - Charles Nwobu
- Director ICATCH AAP & Global Health projects, Princess Marie Louise Children’s Hospital, Accra and Medical Director for Ghana, Child Family Health International, US
| | - Jessica Evert
- Assistant Clinical Professor, UCSF Department of Family and Community Medicine, Global Medical Director, Child Family Health International, US
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Muacevic A, Adler JR, Spicer DB, Campos E, Erbs NC, Furst JW, Williams MD. Raising Capacity to Address Mental Health Concerns in Costa Rica. Cureus 2022; 14:e32481. [PMID: 36644071 PMCID: PMC9836016 DOI: 10.7759/cureus.32481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/14/2022] Open
Abstract
Background A family medicine team based out of Mayo Clinic, Rochester assembled in 2019 to provide home visits and direct care to underserved populations of patients in La Cruz, Costa Rica. In addition to the provision of direct patient care, our team was interested in conducting a community needs-based assessment to identify an area for provider education efforts and the local providers on a chronic health issue using local feedback and physician data. Suicide awareness and prevention were identified as a priority based on rising suicide rates as well as limited psychiatry services in the area, with some major providences having ~0.60 psychiatrists available per 100,000 people. Our group provided a half-day educational course on mental health topics related to suicide awareness for local health workers. The primary objective of this study was to evaluate any lasting changes in practice, confidence, and knowledge among local health workers attributable to our training and add to the limited research on this topic. Methods Two groups of participants (81) from local hospitals were recruited via local providers and divided into two morning and afternoon groups on a single day. Each group comprised primary care providers, nurses, social workers, and finance officers. Both were given the same educational presentation that could be broadly applied to each various role. Our team provided lectures on mental health, as well as how to improve personal resilience. Locally medically trained translators were used. Pre and post-lecture surveys gathered demographic data, experience with these mental health issues, and confidence in addressing mental health concerns. Pre and post-lecture surveys, including open-ended as well as Likert scale and multiple-choice questions, were handed out at the beginning and end of each lecture to all participants. A four to six months follow-up survey was delivered by email using SurveyMonkey to evaluate retention and impact of educational materials. Results The initial two groups of participants (n = 81) were aged 23-60 years (mean: 43), and 67% (39) were female. Work experience ranged from 0 to 37 years (mean: 14) with 64% (37) doing direct patient care. Preliminary lecture content data from participants (n = 44) demonstrated an overall increase in correct responses by +15.4% from the pre-test (percent correct, 38.1%) to post-test (53.5%, p < 0.01). Individuals (n = 55) with past exposure to suicide were much more likely to report asking patients about suicide than those with no prior exposure (56.3% vs. 8.3%; p < 0.01). At the six-month follow-up with participants (n = 11), when asked about their confidence in learning objectives from the lecture given prior, the rates of low confidence decreased as well as the level of high confidence improved but was not statistically significant. The rate of low confidence of respondents' confidence in asking about mental health concerns decreased from 35.2% to 0% (p < 0.01). Conclusions Our group was able to successfully deliver lectures to a mixed audience of health workers in a region self-identified as struggling with mental health issues in Costa Rica. The surveys suggested learning occurred. A trend suggestive that the educational content improved the participants' confidence and knowledge components over time was noted. Future service trips may be able to build on this initial experience to improve on ways to raise capacity while delivering direct care to regions in need.
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Velin L, Van Daalen K, Guinto R, Herzig van Wees S, Saha S. Global health educational trips: ethical, equitable, environmental? BMJ Glob Health 2022; 7:bmjgh-2022-008497. [PMID: 35459690 PMCID: PMC9036353 DOI: 10.1136/bmjgh-2022-008497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/04/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Lotta Velin
- Centre for Teaching and Research in Disaster Medicine and Traumatology, Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Kim Van Daalen
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Renzo Guinto
- Planetary and Global Health Program, Saint Luke's College of Medicine William H Quasha Memorial, Quezon City, Philippines.,Sunway Centre for Planetary Health, Sunway University, Selangor, Malaysia
| | | | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
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Onyebeke W, Iroku-Malize T, McCullough LB, Grünebaum A, Chervenak FA. A professional virtues–based ethical framework for medical missions. AJOG GLOBAL REPORTS 2021; 1:100017. [PMID: 36277456 PMCID: PMC9564020 DOI: 10.1016/j.xagr.2021.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND More than 1.6 million physicians participate in medical missions each year. This effort is part of a long history of volunteerism and service to those in need in the form of medical missions to low-income countries. The Children's Health International Medical Project of Seattle has provided the following 7 guiding principles of sustainable short-term international medical missions: “mission, collaboration, education, service, teamwork, sustainability, and evaluation.” The role of professional virtues in grounding these principles and thus guiding medical missions is underappreciated. OBJECTIVE To provide a professional virtues–based ethical framework for medical missions, this article addressed the question, “How should physicians design and implement a medical mission in a professionally responsible way?” Reference is made to one of the authors’ experiences as a point of reference. STUDY DESIGN The authors addressed the questions on how to design and implement a medical mission based on 5 professional virtues: compassion, integrity, humility, self-effacement, and self-sacrifice. A concise, historically based explanation of each virtue was provided, and the implications of the aforementioned principles for medical missions were identified. RESULTS Compassion motivates the mission and its team members, whereas integrity, humility, self-effacement, and self-sacrifice guide team members as they act on the professional virtue of compassion. CONCLUSION These 5 professional virtues can be used to provide a practical framework for the professionally responsible design and implementation of medical missions.
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Tran Y, Jarrett J, Gardner S, Fernando J, Milliron M, Hong L. Long-Term Impact of Interprofessional Medical Mission Service Trips in Sierra Leone. Front Med (Lausanne) 2021; 8:742406. [PMID: 34646846 PMCID: PMC8502852 DOI: 10.3389/fmed.2021.742406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the impact of capacity-building short-term mission service trips to Sierra Leone on local health education and perspectives. Methods: This was a prospective, mixed-methods study. During three mission trips between June 2017 and December 2019, health professional students taught multiple locally selected patient care-related topics. Local staff completed knowledge questionnaires and were surveyed or interviewed on mission service impact along with the cultural competence of missionaries. Mission team members completed the Intercultural Effectiveness Scale (IES) and surveys to determine their cultural competence. Results: After initial education, 90% passed the knowledge questionnaire with at least a 50% and the correct response rate was 57.9 vs. 66.7% after 6 months and 2.5 years, respectively (p = 0.40). Local staff ranked education/training as most valuable (84%) and highly desired (53%). Mean IES score and survey responses of both missionaries and local staff rated mission team cultural competence as average. Conclusions: Education-focused mission trips in Sierra Leone seem to have long-lasting benefits and a positive impact on local staff, though improved intercultural competence is needed.
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Affiliation(s)
- Yen Tran
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, United States
| | - Jennie Jarrett
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Scott Gardner
- Department of Physician Assistants, Kettering College, Kettering, OH, United States
| | - James Fernando
- Adventist Health System Waterloo Hospital, Waterloo, Sierra Leone
| | - Mark Milliron
- Department of Physician Assistant Sciences, Loma Linda University, Loma Linda, CA, United States
| | - Lisa Hong
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, United States
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Beck NA, Roudnitsky E, Ritchie CA, Mitra SS, Afshar S. Assessment of global health programs at accredited dental schools in the United States. J Dent Educ 2021; 86:29-37. [PMID: 34383340 DOI: 10.1002/jdd.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/08/2021] [Accepted: 07/29/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Oral diseases pose a serious global health challenge. As such, dental education must integrate global health with emphasis on scalable and sustainable solutions. The aim of our study was to capture the scope of global health programs offered to dental students in the United States and identify ways in which dental schools may modify their curricula to improve global health knowledge and accessibility for students. MATERIALS AND METHODS For this cross-sectional, cohort study, the investigators sent a confidential and electronic survey to 213 faculty members at the 67 accredited dental schools in the United States. This voluntary survey was distributed in September and October of 2020 with answers being self-reported. RESULTS A total of 40 different schools are represented in this study, representing 59.7% of accredited dental schools in the United States. Using descriptive statistics, the results present existing global health opportunities, barriers preventing schools from expanding global health education, and necessary resources that schools without a program need to establish one. CONCLUSION Our results demonstrate promising findings, in relation to global health being a vital part of dental education. However, there is an urgent need for enhanced and more structured education in this space. As the global burden of oral disease contributes to the degree and severity of noncommunicable diseases worldwide, the development of a sustainable, preventive primary care approach must integrate oral health, making future dental professionals a crucial component of global health.
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Affiliation(s)
- Nicole A Beck
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Emily Roudnitsky
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Collin A Ritchie
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shivani S Mitra
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Salim Afshar
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW Health inequities continue to exist globally especially when it comes to surgical and anesthesia services. Due to the lack of physician anesthesiologists in low- and middle-income countries, there has been an increase in the number of medical mission trips. Although these volunteers are attempting to fulfill a need they must be mindful and remember to adhere to ethical principles as they work collaboratively with host institutions. We will review the ethical dilemmas inherent in anesthesia mission trips. RECENT FINDINGS Physician volunteers for medical missions may cause significant harm to patients and host communities if they do not work in tandem with host institutions. SUMMARY Medical missions fulfill acute medical needs and have the opportunity to make a positive contribution to host communities by fulfilling local needs and supporting educational efforts for local providers.
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Chang AY, Laker-Oketta M, Coates SJ. Prioritizing equity and inclusion in global health dermatology. Int J Womens Dermatol 2021; 7:154-157. [PMID: 33937482 PMCID: PMC8072506 DOI: 10.1016/j.ijwd.2020.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Aileen Y. Chang
- Department of Dermatology, University of California, San Francisco, CA, United States
- Corresponding author.
| | - Miriam Laker-Oketta
- Infectious Diseases Institute, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah J. Coates
- Department of Dermatology, University of California, San Francisco, CA, United States
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Lukas S, Crowe SJ, Law M, Kahaleh A, Addo-Atuah J, Nonyel NP, Ombengi D, Singhal M, Sultan D, Tamukong R. An Ethics-based Approach to Global Health Research Part 2: Strategies for Overcoming Logistic and Implementation Challenges. Res Social Adm Pharm 2020; 16:1580-1587. [PMID: 32811755 DOI: 10.1016/j.sapharm.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 01/31/2023]
Abstract
With the growth of global pharmacy partnerships and collaborative research, particularly between high-income countries and low- or middle-income countries, it is necessary to establish best practices for fair and ethical collaboration and research. There is a gap in the pharmacy literature in this regard. Through this commentary, authors will present a pathway for future global health researchers including generating ideas based on mutual needs of the partnership and the community; exploring the importance of regulations including the need to conduct research and partnership projects within the confines of each participant's professional scope of practice, expertise, and licensure; describing the need to develop agreements and the components that should be included in such an agreement; discussing ethical guidelines for research planning, obtaining ethical approval, and planning for adverse events; and illustrating ethical considerations for research implementation with considerations around consent, data collection, linking patients to care after the completion of the study, and dissemination. Global examples, with a pharmacy-specific approach where applicable, within each section highlight the importance of discussion and action around ethics and equity when pursuing collaborative research, recognizing that many of these situations involve difficult decisions.
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Affiliation(s)
- Stephanie Lukas
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO, 63110, USA.
| | - Susie J Crowe
- Bill Gatton College of Pharmacy, Maple Avenue, Bldg. 7. Mountain Home, TN, USA.
| | - Miranda Law
- Howard University College of Pharmacy, 2300 4th St NW, Washington, DC, 20059, USA.
| | - Abby Kahaleh
- Roosevelt University College of Pharmacy, 1400 N Roosevelt Blvd Schaumburg, IL, 60173, USA.
| | - Joyce Addo-Atuah
- Touro College of Pharmacy, 230 W 125th Street, Room 429, New York, NY, 10027, USA.
| | - Nkem P Nonyel
- University of Maryland Eastern Shore, School of Pharmacy and Health Professions, 1 College Backbone Road, Princess Anne, MD, 21853, USA.
| | - David Ombengi
- Medical College of Wisconsin School of Pharmacy and Department of Family Medicine, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Mudit Singhal
- D'Youville School of Pharmacy, 320 Porter Avenue, Buffalo, NY, 14201, USA.
| | - Dawood Sultan
- Mercer University College of Health Professions, 3001 Mercer University Drive, Atlanta, GA, 30341-4155, USA.
| | - Robert Tamukong
- Mbarara University of Science &Technology, P.O.Box 1410, Mbarara, Uganda.
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