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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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Abrams JA, Castro B, Gordhandas S, Grzegorczyk A, Maxwell M, Brawner B, Conserve DF, Ryan M. Conocimientos de la hipertensión: Health beliefs about hypertension in an under-resourced community in the Dominican Republic. PLoS One 2020; 15:e0235088. [PMID: 32574228 PMCID: PMC7310720 DOI: 10.1371/journal.pone.0235088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
Understanding health beliefs is important to facilitate health promotion and disease prevention as they influence health behaviors, outcomes, and disease management. Given the rise of hypertension-related diseases in the Dominican Republic, the purpose of our study was to identify hypertension-related health beliefs of Dominicans in order to inform the development of culturally appropriate interventions for hypertension prevention, care, and treatment. Semi-structured interviews were conducted with 20 Dominicans, 15 of whom were receiving treatment for hypertension. Operating within the interpretative paradigmatic framework, we conducted thematic analyses of interview data to identify hypertension-related health beliefs and practices. Iterative data analysis revealed the following themes: 1) Negative emotions are a primary cause of hypertension, 2) Medication is the best treatment but adherence is challenging, 3) Systemic barriers impede treatment access, 4) Hypertension negatively impacts mental and physical well-being, and 5) Lifestyle changes, relaxation, and social support help manage hypertension. Data gathered from member checking validated these findings. This study enhances understanding of the beliefs and experiences of Dominicans and emphasize the importance of implementing culturally competent health programming and care.
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Affiliation(s)
- Jasmine A. Abrams
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Bryan Castro
- Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Sushmita Gordhandas
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Anna Grzegorczyk
- California Pacific Medical Center, San Francisco, California, United States of America
| | - Morgan Maxwell
- Department of Population Health Sciences, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, United States of America
| | - Bridgette Brawner
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
| | - Donaldson F. Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, Columbia, South Carolina, United States of America
| | - Mark Ryan
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, United States of America
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Grant CL, Robinson T, Al Hinai A, Mack C, Guilfoyle R, Saleh A. Ethical considerations in global surgery: a scoping review. BMJ Glob Health 2020; 5:e002319. [PMID: 32399258 PMCID: PMC7204923 DOI: 10.1136/bmjgh-2020-002319] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/02/2020] [Accepted: 03/14/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction An unmet burden of surgical disease exists worldwide and is disproportionately shouldered by low-income and middle-income countries (LMICs). As the field of global surgery grows to meet this need, ethical considerations need to be addressed. Currently, there are no formal guidelines to help inform relevant stakeholders of the ethical challenges and considerations facing global surgical collaborations. The aim of this scoping review is to synthesise the existing literature on ethics in global surgery and identify gaps in the current knowledge. Methods A scoping review of relevant databases to identify the literature pertaining to ethics in global surgery was performed. Eligible articles addressed at least one ethical consideration in global surgery. A grounded theory approach to content analysis was used to identify themes in the included literature and guide the identification of gaps in existing literature. Results Four major ethical domains were identified in the literature: clinical care and delivery; education and exchange of trainees; research, monitoring and evaluation; and engagement in collaborations and partnerships. The majority of published literature related to issues of clinical care and delivery of the individual patient. Most of the published literature was published exclusively by authors in high-income countries (HICs) (80%), and the majority of articles were in the form of editorials or commentaries (69.1%). Only 12.7% of articles published were original research studies. Conclusion The literature on ethics in global surgery remains sparse, with most publications coming from HICs, and focusing on clinical care and short-term surgical missions. Given that LMICs are frequently the recipients of global surgical initiatives, the relative absence of literature from their perspective needs to be addressed. Furthermore, there is a need for more literature focusing on the ethics surrounding sustainable collaborations and partnerships.
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Affiliation(s)
| | - Tessa Robinson
- Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alreem Al Hinai
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Mack
- Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Department of Anesthesiology and Pain Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Regan Guilfoyle
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Office of Global Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Abdullah Saleh
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Office of Global Surgery, University of Alberta, Edmonton, Alberta, Canada
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Morgan J, Galvin S, Goldstein J, Fant C, Murphy R, Doobay-Persaud A. From Creation to Evaluation: A Comprehensive Global Health Scholars Program for Graduate Medical Education Trainees. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520951821. [PMID: 32913894 PMCID: PMC7444107 DOI: 10.1177/2382120520951821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/31/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Recently, participation in clinical global health rotations has significantly increased among graduate medical education (GME) trainees. Despite the many benefits these experiences provide, many ethical challenges exist. Well-intentioned partnerships and participants often encounter personal and professional dilemmas related to safety, social responsibility, and accountability. We designed a curriculum to provide trainees of all specialties with a comprehensive educational program aimed at delivering culturally mindful and ethically responsible clinical care in resource-constrained settings. METHODS The McGaw Global Health Clinical Scholars Program (GHCS) at Northwestern University offers a 2-year curriculum for selected GME trainees across specialties interested in global health. Each trainee must complete the following components: core lectures, peer journal club, specialty-specific lectures, a mentorship agreement, ethics and skill-based simulations, a global health field experience, a poster presentation, and a mentored scholarly project. RESULTS Since 2014, 84 trainees from 13 specialties have participated in the program with 50 current trainees and 39 graduates. Twenty-five trainees completed exit surveys, of which 95% would recommend this program to other trainees and 84% felt more prepared to deliver global health care. In addition, 78% reported career plans that included global health and/or work with underserved populations. Trainees described "acceptance of differences and respect for those differences" and "understanding sustainability" as learning points from the program. DISCUSSION Providing a comprehensive global health education program across specialties can be feasible and effective. GME trainees who participated in this program report feeling both more prepared for clinical experiences and more likely to serve the underserved anywhere.
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Affiliation(s)
- Jennifer Morgan
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shannon Galvin
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Global Health Education, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Joshua Goldstein
- Graduate Medical Education, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | - Colleen Fant
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Pediatric Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Robert Murphy
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Ashti Doobay-Persaud
- Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Center for Global Health Education, Northwestern University Institute for Global Health, Chicago, IL, USA
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Doobay-Persaud A, Evert J, DeCamp M, Evans CT, Jacobsen KH, Sheneman NE, Goldstein JL, Nelson BD. Extent, nature and consequences of performing outside scope of training in global health. Global Health 2019; 15:60. [PMID: 31675976 PMCID: PMC6823963 DOI: 10.1186/s12992-019-0506-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/11/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Globalization has made it possible for global health professionals and trainees to participate in short-term training and professional experiences in a variety of clinical- and non-clinical activities across borders. Consequently, greater numbers of healthcare professionals and trainees from high-income countries (HICs) are working or volunteering abroad and participating in short-term experiences in low- and middle-income countries (LMICs). How effective these activities are in advancing global health and in addressing the crisis of human resources for health remains controversial. What is known, however, is that during these short-term experiences in global health (STEGH), health professionals and those in training often face substantive ethical challenges. A common dilemma described is that of acting outside of one's scope of training. However, the frequency, nature, circumstances, and consequences of performing outside scope of training (POST) have not been well-explored or quantified. METHODS The authors conducted an online survey of HIC health professionals and trainees working or volunteering in LMICs about their experiences with POST, within the last 5 years. RESULTS A total of 223 survey responses were included in the final analysis. Half (49%) of respondents reported having been asked to perform outside their scope of training; of these, 61% reported POST. Trainees were nearly twice as likely as licensed professionals to report POST. Common reasons cited for POST were a mismatch of skills with host expectations, suboptimal supervision at host sites, inadequate preparation to decline POST, a perceived lack of alternative options and emergency situations. Many of the respondents who reported POST expressed moral distress that persisted over time. CONCLUSIONS Given that POST is ethically problematic and legally impermissible, the high rates of being asked, and deciding to do so, were notable. Based on these findings, the authors suggest that additional efforts are needed to reduce the incidence of POST during STEGH, including pre-departure training to navigate dilemmas concerning POST, clear communication regarding expectations, and greater attention to the moral distress experienced by those contending with POST.
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Affiliation(s)
- Ashti Doobay-Persaud
- Division of Hospital Medicine, Departments of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University, 51 E Huron St, Chicago, IL, 60611, USA.
- Institute for Global Health, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1058, Chicago, IL, 60611, USA.
| | - Jessica Evert
- University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
- Child Family Health International, 400 29th St, Suite 508, Oakland, CA, 94609, USA
| | - Matthew DeCamp
- Center for Bioethics and Humanities and Division of General Internal Medicine, University of Colorado, 13080 E. 19th Avenue, Aurora, Colorado, 80045-2571, USA
| | - Charlesnika T Evans
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL, 60611, USA
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, 4400 University Dr, Fairfax, VA, 22030, USA
| | - Natalie E Sheneman
- Institute for Global Health, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1058, Chicago, IL, 60611, USA
| | - Joshua L Goldstein
- Departments of Neurology, Pediatrics, and Medical Education, Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave, Chicago, IL, 60611, USA
| | - Brett D Nelson
- Divisions of Global Health and Neonatology, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua St, Boston, MA, 02114, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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Hayward L, Fragala-Pinkham M, Schneider J, Coe M, Vargas C, Wassenar A, Emmons M, Lizzio C, Hayward J, Torres D. Examination of the short-term impact of a disability awareness training on attitudes toward people with disabilities: A community-based participatory evaluation approach. Physiother Theory Pract 2019; 37:257-270. [PMID: 31204874 DOI: 10.1080/09593985.2019.1630879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Worldwide over a billion people live with a disability including 400,000 people in Ecuador. People with disabilities (PWD) face barriers to full participation in society. Barriers are generated by negative attitudes created through socio-cultural experiences. Awareness about disability can be facilitated through disability awareness training (DAT). Studies examining outcomes on DAT exist in high-resourced countries but are nonexistent in Ecuador. Study purposes:1) create a DAT using community input and conduct the training; 2) examine the impact of the DAT on attitudes toward and awareness of PWD; and 3) explore community perceptions regarding the impact of the DAT on action. Methods: Community-based participatory evaluation was employed to design and assess the impact of a DAT with 60 community members from Latacunga, Ecuador. The DAT incorporated a multi-modal approach (interactive discussion, problem-solving, hands-on activities) and was informed by the theory of planned behavior. Data sources were the Multidimensional Attitudes Scale (MAS) (Spanish version) administered pre- and post-DAT and interviews conducted with nine DAT participants. Results: Mann Whitney U revealed significant changes in two of four MAS constructs: emotion p = .005 and cognition p = .003. Five themes emerged from the interviews: 1) view of disability; 2) contact; 3) attitude; 4) training impact; and 5) action. Conclusion: In the short-term DAT may increase awareness of and decrease negative attitudes associated with disability. Effective strategies highlighted for raising awareness and improving attitudes were contact with PWD and education. Education leads to more positive perceptions of the barriers PWD face and their ability to participate in society.
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Affiliation(s)
- Lorna Hayward
- Department of Physical Therapy Movement and Rehabilitative Sciences, Northeastern University , Boston, MA, USA
| | | | - Jennifer Schneider
- Department of International Volunteers, Hogar Para Sus Ninos , Latacunga, Ecuador
| | - Megan Coe
- Department of International Volunteers, Hogar Para Sus Ninos , Latacunga, Ecuador
| | - Carolina Vargas
- Department of Physical Therapy Movement and Rehabilitative Sciences, Northeastern University , Boston, MA, USA
| | - Amanda Wassenar
- Department of Physical Therapy Movement and Rehabilitative Sciences, Northeastern University , Boston, MA, USA
| | - Meghan Emmons
- Department of Physical Therapy Movement and Rehabilitative Sciences, Northeastern University , Boston, MA, USA
| | - Corinne Lizzio
- Department of Physical Therapy Movement and Rehabilitative Sciences, Northeastern University , Boston, MA, USA
| | - Julia Hayward
- Department of International Affairs, Northeastern University , Boston, MA, USA
| | - Daniela Torres
- Department of Biology, School of Arts and Sciences, Boston University , Boston, MA, USA
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Cheng MY, Rodriguez E. Short-Term Medical Relief Trips to Help Vulnerable Populations in Latin America. Bringing Clarity to the Scene. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050745. [PMID: 30832251 PMCID: PMC6427795 DOI: 10.3390/ijerph16050745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/05/2019] [Accepted: 02/16/2019] [Indexed: 11/16/2022]
Abstract
Non-profit organizations provide international medical relief trips to low/middle-income countries (LMIC) in order to provide healthcare to medically underserved areas. Short-term medical relief trips (STMRT) take a large amount of time and resources, and arouse concerns about their actual effectiveness. Here we develop a novel tool for consistently assessing how U.S. organizations provide primary care to Latin America through short-term medical relief trips. First, in Part 1, we create a “Best Practice” (BP) framework focused on the efficacy, sustainability, and long-term impact of the organizations based on a review of the last 27 years of available literature published in peer-reviewed journals. Second, in Part 2, out of 581 total medical relief organizations in the US, we identify the 19 organizations currently providing short-term primary care services to Spanish-speaking countries in Latin America. We use the BP framework to analyze the website content and secondary sources of these 19 organizations. We find that only three of the 19 organizations met 80% or more of the criteria defining BP according to the framework and four out of the 19 did not perform well in any of the framework’s three aspects of efficacy, sustainability, and long-term impact. Because there exists no current standardized way of assessing the methods implemented and services offered by STMRT, we provide suggestions about using this novel framework as a self-assessment tool for STMRT organizations.
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Affiliation(s)
- Melodyanne Y Cheng
- Departments of Comparative Medicine, Stanford University, Stanford, CA 94305, USA.
| | - Eunice Rodriguez
- Department of Pediatrics, Stanford University, Stanford, CA 94305, USA.
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A Review of Gynecologic Oncology in the Global Setting: Educating and Training the Next Generation of Women's Health Providers. Obstet Gynecol Surv 2019; 74:40-49. [PMID: 30648726 DOI: 10.1097/ogx.0000000000000630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Importance Women in low- and middle-income countries (LMICs) are responsible for the stability of their families. Child survival is directly linked to the health and well-being of their mother. Cancer is the leading cause of morbidity and mortality worldwide, and the incidence and mortality for women from cancer are projected to increase over the coming decades. Gynecologic cancer outcomes are improved when women are cared for by a gynecologic oncologist; however, there are limited specialized providers in LMICs. Increasing interest and involvement from specialists in the United States will improve partnerships abroad and the care of women worldwide. Objective To summarize the importance of global gynecologic oncology care and the current data for US trainees in obstetrics and gynecology to participate in clinical and capacity-building opportunities. Evidence Acquisition We performed a PubMed literature search for articles pertaining to the topic of global health education in obstetrics and gynecology and gynecologic oncology specifically. Results Many obstetric and gynecologic residency programs offer international opportunities, but these are less than those in other specialties and are more frequently focused in obstetrics. Many gynecologic oncology fellowship programs offer international experiences for fellows; however, the time and resources required are limited. Several US and international programs are ongoing to improve capacity building for gynecologic oncology in LMICs with local trainees. Conclusions and Relevance Training and care in gynecologic oncology care worldwide are improving through efforts at multiple levels. Continued efforts are needed to improve US trainee international education and experience.
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Eadsforth H. Professionalisation of International Medical Volunteer Work to Maintain Ethical Standards: A Qualitative Study Exploring the Experience of Volunteer Doctors in Relation to UK Policy. Med Sci (Basel) 2019; 7:medsci7010009. [PMID: 30646600 PMCID: PMC6359092 DOI: 10.3390/medsci7010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 11/18/2022] Open
Abstract
Doctors from the United Kingdom are increasingly involved in international medical volunteerism in low- and middle-income countries (LMICs). Although supported by government policy this practice lacks infrastructure and coordination. Volunteer activities can have positive impact but also risk causing harm. Without external governance the responsibility lies with volunteers and their organisations to self-evaluate their activities. This study aimed to explore influences affecting volunteer engagement with ethical standards and evaluative practice. Semi-structured interviews were conducted with seven doctors working in the Scottish National Health Service with volunteer experience in LMICs. Findings were analysed thematically to explore this issue in view of ongoing policy development. Although ethical standards were valued by participants they were unaware of relevant government policy. Influences on volunteer development are unstructured and vary in quality. Evaluation lacks structure and framing. Volunteer physicians face a number of barriers to engaging in critical evaluation of their activities in LMICs. Development and professionalization of medical volunteering in LMICs needs to address volunteer preparation and evaluative practice to maximise the benefits of volunteering, reduce the risk of harm and maximise learning and accountability. Further areas of research are suggested to inform professionalisation of this sector.
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Affiliation(s)
- Holly Eadsforth
- Department of Anaesthetics, Glasgow Royal Infirmary, Glasgow G4 0SF, UK.
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Arora G, Esmaili E, Pitt MB, Green A, Umphrey L, Butteris SM, St Clair NE, Batra M, O'Callahan C. Pediatricians and Global Health: Opportunities and Considerations for Meaningful Engagement. Pediatrics 2018; 142:peds.2017-2964. [PMID: 30054345 DOI: 10.1542/peds.2017-2964] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 11/24/2022] Open
Abstract
Pediatric practitioners whose expertise is primarily focused on the care of children within health settings in the United States are increasingly engaged in global child health (GCH). The wide spectrum of this involvement may include incorporating short-term or longer-term GCH commitments in clinical care, teaching and training, mentoring, collaborative research, health policy, and advocacy into a pediatric career. We provide an overview of routes of engagement, identify resources, and describe important considerations for and challenges to better equipping US pediatric practitioners to participate in meaningful GCH experiences. This article is part of a series on GCH describing critical issues relevant to caring for children from an international perspective.
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Affiliation(s)
- Gitanjli Arora
- Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California;
| | - Emily Esmaili
- Department of Pediatrics, Lincoln Community Health Center, Durham, North Carolina.,Center for Health Policy and Inequalities Research and Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | - Michael B Pitt
- Department of Pediatrics, University of Minnesota and University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Andrea Green
- Departments of Pediatrics and Pediatric Primary Care, University of Vermont Children's Hospital, Burlington, Vermont
| | - Lisa Umphrey
- Doctors Without Borders/Médecins Sans Frontiéres, Sydney, Australia
| | - Sabrina M Butteris
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nicole E St Clair
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maneesh Batra
- Department of Pediatrics, University of Washington, Seattle, Washington; and
| | - Cliff O'Callahan
- Department of Pediatrics, Middlesex Hospital and University of Connecticut, Middletown, Connecticut
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Batra M, Pitt MB, St Clair NE, Butteris SM. Global Health and Pediatric Education: Opportunities and Challenges. Adv Pediatr 2018; 65:71-87. [PMID: 30053931 DOI: 10.1016/j.yapd.2018.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Maneesh Batra
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, 4800 Sand Point Way Northeast, Mailstop OC.7.830, Seattle, WA 98105, USA.
| | - Michael B Pitt
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Minnesota, 2450 Riverside Avenue, M657, Minneapolis, MN 55414, USA
| | - Nicole E St Clair
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Wisconsin School of Medicine and Public Health, H4/470 CSC, Box 4108, 600 Highland Avenue, Madison, WI 53792-4108, USA
| | - Sabrina M Butteris
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Wisconsin School of Medicine and Public Health, H4/470 CSC, Box 4108, 600 Highland Avenue, Madison, WI 53792-4108, USA
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Kaur G, Tabaie S, Brar J, Tangel V, Pryor KO. Global health education in United States anesthesiology residency programs: a survey of resident opportunities and program director attitudes. BMC MEDICAL EDUCATION 2017; 17:215. [PMID: 29145835 PMCID: PMC5689206 DOI: 10.1186/s12909-017-1056-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/02/2017] [Indexed: 05/07/2023]
Abstract
BACKGROUND Interest in global health during postgraduate residency training is increasing across medical specialties, and multiple disciplines have categorized global health training opportunities in their arena. No such cataloging exists for anesthesiology residency programs. The aim of this study was to assess and characterize global health opportunities and the attitudes of program directors (PDs) in U.S. anesthesiology residency programs towards this training. METHODS A cross-sectional 20-question survey on global health opportunities was distributed to 128 ACGME accredited anesthesiology residency program directors via email between October 2015 and January 2016. Descriptive statistics and exploratory inferential analyses were applied. Maximal nonresponse selection bias was estimated. RESULTS The overall response rate was 44%. Of those who responded, 61% reported that their residency program had a global health elective, with a maximal bias estimate of 6.5%. 45% of program directors with no global health elective reported wanting to offer one. 77% of electives have articulated educational goals, but there is substantial heterogeneity in curricula offered. Program director attitudes regarding the value of global health programs differed significantly between those with and without existing programs. CONCLUSIONS The proportion of U.S. anesthesiology residency programs offering global health electives is similar to that in other medical specialties. There is inconsistency in program structure, goals, curriculum, and funding. Attitudes of program directors differ between programs with and without electives, which may reflect bidirectional influence to be investigated further. Further studies are needed to codify curricula, assess effectiveness, and validate methodologies.
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Affiliation(s)
- Gunisha Kaur
- 525 East 68th Street Box 124, New York, NY 10065 USA
| | - Sheida Tabaie
- 525 East 68th Street Box 124, New York, NY 10065 USA
| | - Jasmit Brar
- 525 East 68th Street Box 124, New York, NY 10065 USA
| | | | - Kane O. Pryor
- 525 East 68th Street Box 124, New York, NY 10065 USA
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Khan R, Hodges B, Martimianakis MAT, Cole D. Twelve tips for undertaking reflexive global health experiences in medicine. MEDICAL TEACHER 2017; 39:1023-1028. [PMID: 28598707 DOI: 10.1080/0142159x.2017.1333589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND While interest and opportunities for global health experiences (GHE) continue to grow, the preparation of students and health professionals alike to engage in these GHEs remains limited. AIMS This article provides tips for reflexivity prior to undertaking a GHE and suggests ways to debrief the experience in order to ensure that trainees and professionals that engage in GHEs can both help their intended communities and also get the most out of the experience. METHODS The authors conducted a scoping review using Medline, PubMed and Google scholar using searching the terms: global health, global health experience, global health research, and international medical elective. We supplemented this search with our own experiences working with international partners. CONCLUSIONS GHEs should be undertaken with reflexivity prior to, during and subsequent to the experience in order to ensure that all collaborators in the partnership meet their intended goals.
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Affiliation(s)
- Rabia Khan
- a The Wilson Center, Faculty of Medicine, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - Brian Hodges
- a The Wilson Center, Faculty of Medicine, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | | | - Donald Cole
- a The Wilson Center, Faculty of Medicine, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
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Pitt MB, Slusher TM, Howard CR, Cole VB, Gladding SP. Pediatric Resident Academic Projects While on Global Health Electives: Ten Years of Experience at the University of Minnesota. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:998-1005. [PMID: 28489619 DOI: 10.1097/acm.0000000000001727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Many residency programs require residents to complete an academic project as part of a global health (GH) elective. However, there has been little description of the range of projects residents have pursued during GH electives or the extent to which these projects are consistent with proposed best practices. METHOD The authors conducted a document review of 67 written summaries or copies of presentations of academic projects (hereafter, summaries) completed by pediatric and medicine-pediatric residents at the University of Minnesota while on GH electives from 2005 to 2015. Two authors independently coded each summary for the type of project completed; when the project idea was generated; explicit mention of a mentor from the home institution, host institution, or both; whether a needs assessment was conducted; and whether there were plans for sustainability. RESULTS Most of the 67 projects were categorized into one of three project types: quality/process improvement (28 [42%]), education (18 [27%]), or clinical research (14 [21%]). Most summaries explicitly mentioned a mentor (45 [67%]), reported conducting a needs assessment (38 [57%]), and indicated sustainability plans (45 [67%]). Of the 42 summaries that indicated the timing of idea generation, 30 (71%) indicated the idea was developed after arriving at the host site. CONCLUSIONS Residents undertook a wide range of academic projects during GH electives, most commonly quality/process improvement and education projects. The projects were largely aligned with best practices, with most summaries indicating the resident worked with a mentor, conducted a needs assessment, and made plans for sustainability.
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Affiliation(s)
- Michael B Pitt
- M.B. Pitt is assistant professor, Department of Pediatrics, and director of global health education, Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota; ORCID: http://orcid.org/0000-0002-7123-2613. T.M. Slusher is professor, Department of Pediatrics, and codirector, Global Health Track, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota. C.R. Howard is associate professor, Department of Pediatrics, and director, Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota. V.B. Cole is coordinator, Global Health Track, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota. S.P. Gladding is assistant professor, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Hayward LM, Li L. Sustaining and improving an international service-learning partnership: Evaluation of an evidence-based service delivery model. Physiother Theory Pract 2017; 33:475-489. [DOI: 10.1080/09593985.2017.1318425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lorna M Hayward
- Physical Therapy Department, Northeastern University, Boston, MA, USA
| | - Li Li
- Department of Physical Therapy, Pain Relief Physical Therapy, Boston, MA, USA
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Development of an International Clinical Education Extracurricular Experience Through a Collaborative Partnership. Phys Ther 2017; 97:44-50. [PMID: 27609901 DOI: 10.2522/ptj.20160130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 08/29/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Participating in global health care through international clinical education may enhance the development of cultural competence and professionalism. Many logistical issues need to be resolved in the development of international clinical education experiences that meet program requirements. The purpose of this case report is to describe how a university developed such an experience for students by partnering with Amizade Global Service-Learning (Amizade), an organization that facilitates global learning experiences. CASE DESCRIPTION Medical, nursing, and pharmacy students were already participating in a 4-week international health-related service learning rotation through Amizade. The preexisting relationship and contractual agreement with the university provided the necessary legal framework. Amizade staff assisted in finding a physical therapist qualified and willing to host a student. The academic coordinator for clinical education at the university and Amizade liaisons determined living arrangements, schedule, clinical settings, and patient population. The selected student had expressed interest and had met all clinical education placement requirements. The academic coordinator for clinical education had ongoing electronic communications with all parties. OUTCOMES AND DISCUSSION The student demonstrated predicted attributes of cultural competence and professionalism; through the partnership with Amizade, the student was exposed to several unique interprofessional experiences. The steps used by the university faculty in developing this interprofessional, international clinical education experience through a collaborative partnership may provide guidance for other institutions.
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Nouvet E, Chan E, Schwartz LJ. Looking good but doing harm? Perceptions of short-term medical missions in Nicaragua. Glob Public Health 2016; 13:456-472. [PMID: 27545146 DOI: 10.1080/17441692.2016.1220610] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this paper, we present findings from a qualitative study that gathered Nicaraguans' perceptions of short-term foreign medical missions, towards deepening the understanding of what Nicaraguans value or find limited in the work of such foreign missions operating in their country. Fifty-two interviews were conducted with patients, relatives of patients, Nicaraguan physicians and nurses who partnered with or observed missions at work, 'beneficiary' community leaders, and individuals who were unable or unwilling to access mission-provided healthcare. Factors underlying participants' positive and more critical accounts of foreign primary and surgical missions are described and analysed. Empirical investigation on how, whether or not, or on what bases short-term medical missions (STMs) have been perceived as beneficial, harmful, or otherwise by those on the receiving end of these efforts is limited. This study aims to contribute to the evidence base for reflecting on the ethical performance of trans-national STMs.
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Affiliation(s)
- Elysée Nouvet
- a Department of Clinical Epidemiology and Biostatistics , McMaster University , Hamilton , ON , Canada
| | - Elizabeth Chan
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Lisa J Schwartz
- a Department of Clinical Epidemiology and Biostatistics , McMaster University , Hamilton , ON , Canada
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Lukolyo H, Rees CA, Keating EM, Swamy P, Schutze GE, Marton S, Turner TL. Perceptions and Expectations of Host Country Preceptors of Short-Term Learners at Four Clinical Sites in Sub-Saharan Africa. Acad Pediatr 2016; 16:387-93. [PMID: 26581780 DOI: 10.1016/j.acap.2015.11.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The demand for global health electives among medical students and residents has grown substantially, yet perspectives of international hosts are not well documented. This study aimed to assess how host country supervising clinical preceptors perceive learners on short-term global health electives of up to 6 weeks. METHODS This study used a cross-sectional survey design and assessed international clinical preceptors' perceptions of short-term learners' (STLs) professional behaviors, medical knowledge, competency in systems-based care, as well as the benefits and burdens of hosting STLs. Surveys were sent to all clinical preceptors (n = 47) at 4 clinical sites in sub-Saharan Africa in 2015. RESULTS Thirty-two preceptors (68%) responded to the survey. Most respondents (97%) were satisfied in their role hosting STLs and reported that STLs enhanced patient care and the professional image of the clinical site. Nearly half of respondents (45%) reported decreased self-perceived efficiency in clinical care tasks. Qualitative data identified concerns related to STLs' professionalism and teamwork. Respondents also identified knowledge gaps in understanding differences in health systems and epidemiology in host country settings. Respondents preferred that rotations last at least 4 weeks and that STLs complete predeparture training. CONCLUSIONS STLs were largely positively regarded by international host clinical preceptors. To improve mutuality of benefits, sending institutions should ensure learners understand host country expectations of professionalism and that learners are well prepared for medical, ethical, and cultural challenges through participation in predeparture curricula that prepare them clinically and emotionally for these international experiences. Rotations of at least 4 weeks may enhance benefits to learners and hosts.
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Affiliation(s)
- Heather Lukolyo
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
| | - Chris A Rees
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | | | - Padma Swamy
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Gordon E Schutze
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Stephanie Marton
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Teri L Turner
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
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Pitt MB, Gladding SP, Majinge CR, Butteris SM. Making Global Health Rotations a Two-Way Street: A Model for Hosting International Residents. Glob Pediatr Health 2016; 3:2333794X16630671. [PMID: 27336002 PMCID: PMC4905152 DOI: 10.1177/2333794x16630671] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/06/2016] [Accepted: 01/12/2016] [Indexed: 11/17/2022] Open
Abstract
As US residency programs are increasingly offering global health electives for their trainees, there is a growing call for these opportunities to include bidirectional exchanges—where residents from both the US and international partner institutions rotate at the other’s site. Curricular, logistical, and funding challenges of hosting residents from an international site may be barriers to developing these programs. In this report, the authors describe an 8-year experience of a US institution hosting residents from a resource-limited international partner and provide a framework for others institutions to develop bidirectional exchanges. They also report the visiting international residents’ perceptions of the impact of the exchange on their clinical practice, teaching, career paths, and their home institution.
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Affiliation(s)
| | | | - Charles R Majinge
- Dodoma Christian Medical Centre Trust, Dodoma, United Republic of Tanzania
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Abstract
Responding to disparities in health, thousands of health care providers volunteer annually for short-term medical service trips (MSTs) to serve communities in need as a result of environmental, geographic, historical, or sociopolitical factors. Although well intentioned, short-term MSTs have the potential to benefit and harm those involved, including participants and communities being served. The contexts, resource and time limitations, and language and cultural barriers present ethical challenges. There have been increasing requests for standardized global guidelines, transparency, and open review of MSTs and their outcomes. Principles of mission, partnership, preparation, reflection, support, sustainability, and evaluation inform and equip those engaging in medical volunteerism.
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Affiliation(s)
- Geren S Stone
- Department of Medicine, MGH Center for Global Health, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Kristian R Olson
- Department of Medicine, MGH Center for Global Health, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Weng YH, Chiou HY, Tu CC, Liao ST, Bhembe PT, Yang CY, Chiu YW. Survey of patient perceptions towards short-term mobile medical aid for those living in a medically underserved area of Swaziland. BMC Health Serv Res 2015; 15:524. [PMID: 26613782 PMCID: PMC4661953 DOI: 10.1186/s12913-015-1186-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 11/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background An increasing number of short-term medical missions (STMMs) are being dispatched to provide humanitarian healthcare; however, extensive investigations on how recipient patients perceive STMMs are lacking. The current study evaluated the perceptions of patients toward medical services provided by a Taiwanese STMM in a resource-poor area of Swaziland. Methods A structured questionnaire survey was completed by patients who had received medical services from the medical mission of Taipei Medical University in Swaziland in July 2014. Results In total, 349 questionnaires were valid for the analysis. More respondents were female than male (69.6 % vs 30.4 %). The most common chief complaint was musculoskeletal problems (45.8 %), followed by respiratory symptoms (35.0 %). Most of the patients stated that their overall experience with the medical services was excellent (91.4 %). Universal patients would like to see the service provided in the future (99.7 %). Nearly 90 % of the patients were aware of how to take care of the medical problem they were diagnosed with. A majority of the patients comprehended what their medical providers said. Only a few patients did not understand what physicians said (5.2 %). Conclusion Medical services provided by the STMM were helpful in resolving patients’ problems. The data have crucial implications for evaluating overseas mobile medical aid from the viewpoint of patients. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1186-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yi-Hao Weng
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan. .,Health Policy and Care Research Center, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
| | - Chi-Cheng Tu
- Taiwan Medical Mission, Taipei Medical University, Taipei, Taiwan.
| | - Say-Tsung Liao
- Taiwan Medical Mission, Taipei Medical University, Taipei, Taiwan.
| | - Patience Thulile Bhembe
- Southern Africa Nazarene University, Manzini, Swaziland. .,Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan.
| | - Chun-Yuh Yang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Ya-Wen Chiu
- Health Policy and Care Research Center, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan. .,Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan.
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Holm M, Burkhartzmeyer H. Implementation of a phased medical educational approach in a developing country. Glob Health Action 2015; 8:29882. [PMID: 26562146 PMCID: PMC4643178 DOI: 10.3402/gha.v8.29882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 11/20/2022] Open
Abstract
Objective Healthcare provider education can serve as one method for improving healthcare in developing countries. Working with providers at St Luke Hospital in Haiti, we developed a phased educational approach through partnership development, face-to-face teaching, and virtual educational tools. Design Our novel approach included three phases: direct patient care, targeted education, and utilization of the train-the-trainer model. Our end goal was an educational system that could be utilized by the local medical staff to continually improve their medical knowledge, even after our educational project was completed. We implemented pre- and post-lecture evaluations during our teaching phase to determine whether the education provided was effective and beneficial. Additionally, we provided medical lectures on a shared file internet platform, Box.com, during the train-the-trainer phase to allow healthcare providers in Haiti to access the educational content electronically. Results In total, 47 lectures were given to 150 medical providers, including nurses, physicians, and pharmacists. Pre- and post-lecture evaluations were administered. The mean was 30.63 (14.40) for pre-lecture evaluations and 93.36 (9.80) for post-lecture evaluations indicating improvement out of a total of 100 possible points. Our collaborative Box.com account contains 214 medical education lectures available for viewing as a constant resource to St Luke Hospital staff. Thus far, 20 of the 43 (47%) Haitian medical providers have viewed lectures, with an average of 5.6 lectures viewed per person. Qualitative data suggest that these methods improved communication between healthcare staff, promoted better ways of triaging patients, and improved job satisfaction. Conclusions A phased educational approach can improve healthcare workers’ knowledge through partnership in a developing country. Educating local providers is one way of ensuring that in-country healthcare staff will improve their medical knowledge and expertise.
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Development Strategy of Health Tourism in Iran. INTERNATIONAL JOURNAL OF TRAVEL MEDICINE AND GLOBAL HEALTH 2015. [DOI: 10.20286/ijtmgh-0304143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Boost or burden? Issues posed by short placements in resource-poor settings. Br J Gen Pract 2015; 64:272-3. [PMID: 24868043 DOI: 10.3399/bjgp14x679945] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Rominski SD, Yakubu J, Oteng RA, Peterson M, Tagoe N, Bell SA. The role of short-term volunteers in a global health capacity building effort: the Project HOPE-GEMC experience. Int J Emerg Med 2015; 8:23. [PMID: 26207148 PMCID: PMC4508279 DOI: 10.1186/s12245-015-0071-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 07/07/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Increasingly, medical students and practicing clinicians are showing interest in traveling to low-income settings to conduct research and engage in clinical rotations. While global health activities have the potential to benefit both the individual and the host, there can be challenges. We describe one way to harmonize the desire of volunteers to have a meaningful impact on the health care delivery system in a developing country with the needs of that country. METHODS The Project Health Opportunities for People Everywhere (HOPE)-Ghana Emergency Medicine Collaborative (GEMC) Partnership has successfully integrated short-term volunteer physicians and nurses to facilitate the training of emergency medicine (EM) residents and specialist nurses in Kumasi, Ghana. RESULTS Since the launching of this partnership in 2011, eight physicians and 10 nurses have rotated at Komfo Anokye Teaching Hospital (KATH). The impact of these volunteers goes beyond the clinical service and supervision they provide while on the ground. They act as mentors to the trainees and assist the program leadership with teaching and assessments. CONCLUSIONS Although generally smooth, there have been challenges, all of which have been met and are being resolved. This partnership is an example of how collaborations can harness the expertise and energy of short-term volunteers to achieve the goals of capacity building and self-sustainability.
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Affiliation(s)
- Sarah D Rominski
- />Global REACH, University of Michigan Medical School, 1111 East Catherine St. 236 Victor Vaughan, Ann Arbor, MI 48109 USA
| | - Jamila Yakubu
- />Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Dr. TC-B1 354, Ann Arbor, MI 48109 USA
| | - Rockefeller A Oteng
- />Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Dr. TC-B1 354, Ann Arbor, MI 48109 USA
| | - Matt Peterson
- />Project HOPE, 255 Carter Hall Lane, Millwood, VA 22646 USA
| | - Nadia Tagoe
- />Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sue Anne Bell
- />School of Nursing, University of Michigan, 400 North Ingalls St., Ann Arbor, MI 48109 USA
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Ahluwalia P, Cameron D, Cockburn L, Ellwood L, Mori B, Nixon SA. Analyzing international clinical education practices for Canadian rehabilitation students. BMC MEDICAL EDUCATION 2014; 14:187. [PMID: 25199819 PMCID: PMC4167514 DOI: 10.1186/1472-6920-14-187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 09/05/2014] [Indexed: 05/30/2023]
Abstract
BACKGROUND Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training ("WEIGHT Guidelines") were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master's-level rehabilitation students at a Canadian university. METHODS In-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research. RESULTS Five themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about "costs", (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing. CONCLUSIONS International clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian "sending institution", including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the "receiving organizations" based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.
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Affiliation(s)
| | - Debra Cameron
- 160-500 University Avenue, Toronto, ON M5G 1 V7 Canada
| | - Lynn Cockburn
- 160-500 University Avenue, Toronto, ON M5G 1 V7 Canada
| | - Lynn Ellwood
- 160-500 University Avenue, Toronto, ON M5G 1 V7 Canada
| | - Brenda Mori
- 160-500 University Avenue, Toronto, ON M5G 1 V7 Canada
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Health Care Voluntourism: Addressing Ethical Concerns of Undergraduate Student Participation in Global Health Volunteer Work. HEC Forum 2014; 26:285-97. [DOI: 10.1007/s10730-014-9243-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saffran L. In reply to Ventres. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:529. [PMID: 24667466 PMCID: PMC4885547 DOI: 10.1097/acm.0000000000000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Lise Saffran
- Interim director, University of Missouri Master of Public Health Program, Columbia, Missouri;
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Havryliuk T, Bentley S, Hahn S. Global health education in emergency medicine residency programs. J Emerg Med 2014; 46:847-52. [PMID: 24613226 DOI: 10.1016/j.jemermed.2013.11.101] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/21/2013] [Accepted: 11/17/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Interest in global health and international electives is growing among Emergency Medicine (EM) residents in the United States (US). The majority of EM residency programs offer opportunities for international electives. The degree of participation among residents and type of support provided by the residency program, however, remains unclear. STUDY OBJECTIVES To explore the current state of global health education among EM residents who participate in international electives. METHODS A 12-question survey was e-mailed to the program directors of the 192 EM residency programs in the US. The survey included questions about the number of residents participating in international electives and the types of preparation, project requirements, supervision, and feedback participating residents receive. RESULTS The response rate was 53% with 102 responses. Seventy-five of 102 (74%) programs reported that at least one resident participated in an international elective in the 2010-2011 academic year. Forty-three programs (42%) report no available funding to support any resident on an international elective. Residents receive no preparation for international work in 41 programs (40%). Only 25 programs (26%) required their residents to conduct a project while abroad. Forty-nine programs (48%) reported no formal debriefing session, and no formal feedback was collected from returning residents in 57 of 102 (59%) programs. CONCLUSION The majority of EM residencies have residents participating in international electives. However, the programs report variable preparation, requirements, and resident supervision. These results suggest a need for an expanded and more structured approach to international electives undertaken by EM residents.
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Affiliation(s)
| | - Suzanne Bentley
- Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sigrid Hahn
- Icahn School of Medicine at Mount Sinai, New York, New York
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Hansoti B, Weiner SG, Martin IB, Dunlop S, Hayward AS, Tupesis JP, Becker TK, Douglass K. Society for Academic Emergency Medicine's Global Emergency Medicine Academy: global health elective code of conduct. Acad Emerg Med 2013; 20:1319-20. [PMID: 24341588 DOI: 10.1111/acem.12264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 08/31/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Bhakti Hansoti
- Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Scott G. Weiner
- The Department of Emergency Medicine; Tufts Medical Center and Tufts University School of Medicine; Boston MA
| | - Ian B.K. Martin
- The Department of Emergency Medicine; University of North Carolina School of Medicine; Chapel Hill NC
- The Department of Internal Medicine; University of North Carolina School of Medicine; Chapel Hill NC
| | - Stephen Dunlop
- The Department of Emergency Medicine; Hennepin County Medical Center; University of Minnesota; Minneapolis MN
| | - Alison S. Hayward
- The Department of Emergency Medicine; Yale School of Medicine; New Haven CT
| | - Janis P. Tupesis
- The Division of Emergency Medicine; University of Wisconsin School of Medicine and Public Health; Madison WI
| | - Torben K. Becker
- The Department of Emergency Medicine; University of Michigan; Ann Arbor MI
| | - Katherine Douglass
- The Department of Emergency Medicine; The George Washington University; Washington DC
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Asgary R, Junck E. New trends of short-term humanitarian medical volunteerism: professional and ethical considerations. JOURNAL OF MEDICAL ETHICS 2013; 39:625-31. [PMID: 23236086 DOI: 10.1136/medethics-2011-100488] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Short-term humanitarian medical volunteerism has grown significantly among both clinicians and trainees over the past several years. Increasingly, both volunteers and their respective institutions have faced important challenges in regard to medical ethics and professional codes that should not be overlooked. We explore these potential concerns and their risk factors in three categories: ethical responsibilities in patient care, professional responsibility to communities and populations, and institutional responsibilities towards trainees. We discuss factors increasing the risk of harm to patients and communities, including inadequate preparation, the use of advanced technology and the translation of Western medicine, issues with clinical epidemiology and test utility, difficulties with the principles of justice and clinical justice, the lack of population-based medicine, sociopolitical effects of foreign aid, volunteer stress management, and need for sufficient trainee supervision. We review existing resources and offer suggestions for future skill-based training, organisational responsibilities, and ethical preparation.
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Affiliation(s)
- Ramin Asgary
- Department of Medicine, New York University School of Medicine, , New York, New York, USA
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Hambrecht A, Duenas MJ, Hahn EJ, Aryan HE, Hughes SA, Waters D, Levy ML, Jandial R. Strategic design for pediatric neurosurgery missions across the Western Hemisphere. Surg Neurol Int 2013; 4:62. [PMID: 23772332 PMCID: PMC3681000 DOI: 10.4103/2152-7806.111092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/14/2013] [Indexed: 11/21/2022] Open
Abstract
Background: With growing interest in global health, surgeons have created outreach missions to improve health care disparities in less developed countries. These efforts are mainly episodic with visiting surgeons performing the operations and minimal investment in local surgeon education. To create real and durable advancement in surgical services in disciplines that require urgent patient care, such as pediatric neurosurgery, improving the surgical armamentarium of the local surgeons must be the priority. Methods: We propose a strategic design for extending surgical education missions throughout the Western Hemisphere in order to transfer modern surgical skills to local neurosurgeons. A selection criteria and structure for targeted missions is a derivative of logistical and pedagogical lessons ascertained from previous missions by our teams in Peru and Ukraine. Results: Outreach programs should be applied to hospitals in capital cities to serve as a central referral center for maximal impact with fiscal efficiency. The host country should fulfill several criteria, including demonstration of geopolitical stability in combination with lack of modern neurosurgical care and equipment. The mission strategy is outlined as three to four 1-week visits with an initial site evaluation to establish a relationship with the hospital administration and host surgeons. Each visit should be characterized by collaboration between visiting and host surgeons on increasingly complex cases, with progressive transfer of skills over time. Conclusion: A strategic approach for surgical outreach missions should be built on collaboration and camaraderie between visiting and local neurosurgeons, with the mutual objective of cost-effective targeted renovation of their surgical equipment and skill repertoire.
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Affiliation(s)
- Amanda Hambrecht
- NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
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Chiu YW, Weng YH, Chen CF, Yang CY, Chiou HY, Lee ML. A comparative study of Taiwan's short-term medical missions to the South Pacific and Central America. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2012; 12:37. [PMID: 23270459 PMCID: PMC3546052 DOI: 10.1186/1472-698x-12-37] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/18/2012] [Indexed: 11/16/2022]
Abstract
Background Taiwan has been dispatching an increasing number of short-term medical missions (STMMs) to its allied nations to provide humanitarian health care; however, overall evaluations to help policy makers strengthen the impact of such missions are lacking. Our primary objective is to identify useful strategies by comparing STMMs to the South Pacific and Central America. Methods The data for the evaluation come from two main sources: the official reports of 46 missions to 11 countries in Central America and 25 missions to 8 countries in the South Pacific, and questionnaires completed by health professionals who had participated in the above missions. In Central America, STMMs were staffed by volunteer health professionals from multiple institutions. In the South Pacific, STMMs were staffed by volunteer health professionals from single institutions. Results In comparison to STMMs to Central America, STMMs to the South Pacific accomplished more educational training for local health providers, including providing heath-care knowledge and skills (p<0.05), and training in equipment administration (p<0.001) and drug administration (p<0.005). In addition, language constraints were more common among missions to Central America (p<0.001). There was no significant difference in the performance of clinical service between the two regions. Conclusions Health-care services provided by personnel from multiple institutions are as efficient as those from single institutions. Proficiency in the native language and provision of education for local health-care workers are essential for conducting a successful STMM. Our data provide implications for integrating evidence into the deployment of STMMs.
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Affiliation(s)
- Ya-Wen Chiu
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
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Chiu YW, Weng YH, Chen CF, Yang CY, Lee ML. Perceptions and efficiency of short-term medical aid missions among key groups of health professionals. Eval Health Prof 2012; 37:379-93. [PMID: 23053403 DOI: 10.1177/0163278712461503] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated the perceptions of short-term assignments of medical services among participating health care professionals dispatched from Taiwan to underdeveloped areas. Structured questionnaires were mailed to four groups of professionals (physicians, pharmacists, nurses, and public health personnel) who had participated in any of 88 medical missions dispatched to 24 allied nations. A total of 278 returns were valid for analysis. Among them, 222 respondents reported that they had participated in just one overseas medical mission (79.9%). The majority of physicians, pharmacists, and nurses listed humanitarianism as their foremost incentive for participation. In contrast, public health personnel most frequently reported that they had been assigned to the mission abroad. Pharmacists, nurses, and public health personnel most commonly stated that their top goal was health care; but physicians said that aiding Taiwan's diplomatic relations was their main motive. While all groups generally recognized language proficiency and cultural awareness as important for conducting successful short-term medical aid missions (STMMs), many members of groups did not rate their own capabilities in those area as sufficient, especially pharmacists (p < .001). Orientation for participants and training for local health workers were seen as relatively insufficient. In conclusion, there are considerable differences in the thoughts about STMMs across four key groups of heath personnel. The findings can help inform efforts to integrate evidence into the deployment of STMMs.
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Affiliation(s)
- Ya-Wen Chiu
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hao Weng
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chih-Fu Chen
- Humanitarian Assistance Department, International Cooperation and Development Fund, Taipei, Taiwan
| | - Chun-Yuh Yang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
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Levy ML, Duenas VJ, Hambrecht AC, Hahn EJ, Aryan HE, Jandial R. Pediatric neurosurgery outreach: sustainability appraisal of a targeted teaching model in Kiev, Ukraine. JOURNAL OF SURGICAL EDUCATION 2012; 69:611-616. [PMID: 22910158 DOI: 10.1016/j.jsurg.2012.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/09/2012] [Accepted: 05/25/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE This study evaluates the efficacy of operative skill transfer in the context of targeted pediatric outreach missions completed in Kiev, Ukraine. In addition the ability to create sustainable surgical care improvement is investigated as an efficient method to improve global surgical care. METHODS Three 1-week targeted neurosurgical missions were performed (2005-2007) to teach neuroendoscopy, which included donation of the necessary surgical equipment, so the host team can deliver newly acquired surgical skills to their citizens after the visiting mission team departs. The neuroendoscopy data for the 4 years after the final mission in 2007 was obtained. RESULTS After performing pediatric neurosurgery missions in 2005-2007, with a focus on teaching neuroendoscopy, the host team demonstrated the sustainability of our educational efforts in the subsequent 4 years by performing cases independently for their citizens. Since the last targeted mission of 2007, neuroendoscopic procedures have continued to be performed by the trained host surgeons. In 2008, 33 cases were performed. In 2009 and 2010, 29 and 22 cases were completed, respectively. In 2011, local neurosurgeons accomplished 27 cases. To date, a total of 111 operations have been performed over the past 4 years independent of any visiting team, illustrating the sustainability of educational efforts of the missions in 2005-2007. CONCLUSIONS Effective operative skill transfer to host neurosurgeons can be accomplished with limited international team visits using a targeted approach that minimizes expenditures on personnel and capital. With the priority being teaching of an operative technique, as opposed to perennially performing operations by a visiting mission team, sustainable surgical care was achieved and perpetuated after missions officially concluded.
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Affiliation(s)
- Michael L Levy
- Division of Neurosurgery, City of Hope National Medical Center, Duarte, CA 91010, USA
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Crump JA, Sugarman J. Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg 2010; 83:1178-82. [PMID: 21118918 PMCID: PMC2990028 DOI: 10.4269/ajtmh.2010.10-0527] [Citation(s) in RCA: 329] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Academic global health programs are growing rapidly in scale and number. Students of many disciplines increasingly desire global health content in their curricula. Global health curricula often include field experiences that involve crossing international and socio-cultural borders. Although global health training experiences offer potential benefits to trainees and to sending institutions, these experiences are sometimes problematic and raise ethical challenges. The Working Group on Ethics Guidelines for Global Health Training (WEIGHT) developed a set of guidelines for institutions, trainees, and sponsors of field-based global health training on ethics and best practices in this setting. Because only limited data have been collected within the context of existing global health training, the guidelines were informed by the published literature and the experience of WEIGHT members. The Working Group on Ethics Guidelines for Global Health Training encourages efforts to develop and implement a means of assessing the potential benefits and harms of global health training programs.
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Affiliation(s)
- John A. Crump
- *Address correspondence to John A. Crump, Division of Infectious Diseases and International Health, Box 102359, Duke University Medical Center, Durham, NC 27710, E-mail: ; and Jeremy Sugarman, Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Hampton House 351, 624 North Broadway, Baltimore, MD 21205, E-mail:
| | - Jeremy Sugarman
- *Address correspondence to John A. Crump, Division of Infectious Diseases and International Health, Box 102359, Duke University Medical Center, Durham, NC 27710, E-mail: ; and Jeremy Sugarman, Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Hampton House 351, 624 North Broadway, Baltimore, MD 21205, E-mail:
| | - the Working Group on Ethics Guidelines for Global Health Training (WEIGHT)
- †Working Group on Ethics Guidelines for Global Health Training (WEIGHT) members include: Michele Barry, Anant Bhan, Pierce Gardner, Jeffrey P. Koplan, Ahaz T. Kulanga, Silvia M. Montano, Elizabeth Myers, Kirsten Patrick, John D. Porter, Alan C. Regenberg, Kiat Ruxrungtham, Nelson K. Sewankambo, and John F. Shao
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