Beyond Visas and Vaccines: Preparing Students for Domestic and Global Health Engagement

Global emergency medicine: four part series : Paper 4: Global EM education and professionalization

In 2018, the Canadian Association of Emergency Physicians (CAEP) academic symposium included developing recommendations on supporting global emergency medicine (EM) in Canadian departments and divisions. Members of CAEP's Global EM committee created a four-part series to be published in CJEM that would build upon the symposium recommendations. The objective is to offer practical tools to EM physicians interested in becoming involved in Global EM, as well as provide departments with successful Canadian case examples that foster, facilitate, and grow Global EM efforts. This submission is the fourth paper of the series which focuses on education and continuing professional development for Global EM. It includes resources for resident global EM electives, fellowship training and ongoing or additional CPD training for practicing EM physicians. It also highlights the importance of pre-departure training and other required elements of engaging responsibly in Global EM work.

Global competency impact of sustained remote international engagement for students

BACKGROUND

To provide just equity in academic exchange, as well as to reduce prohibitive travel cost and address environmental concerns, the past paradigm of international student exchange has fundamentally shifted from one directional travel to mutually beneficial bidirectional remote communication between students all over the globe. Current analysis aims to quantify cultural competency and evaluate academic outcomes.

METHODS

Sixty students half from the US and half from Rwanda grouped in teams of 4 engaged in a nine-month project-focused relationship. Cultural competency was evaluated prior to project initiation and six months after completion of the project. Student perspective of project development was analyzed weekly and final academic outcome was evaluated.

RESULTS

Change in cultural competency was not significant; however, students did identify satisfaction in team interaction and academic outcomes were achieved.

CONCLUSION

A single remote exchange between students in two countries may not be transformative but it can provide cultural enrichment and successful academic project outcome and may serve to enhance cultural curiosity.

Pre-departure and Post-elective Requirements for Global Health Electives: Survey of Canadian Royal College Emergency Medicine Programs

Objectives: Global Health (GH) electives offer unique learning opportunities; however, risks to trainees and host populations should be minimized through pre-departure training and post-elective debriefing. In a 2016 study, only three Canadian residency programs mandated such training, although specific data on Emergency Medicine (EM) programs is lacking. This study aimed to identify GH elective requirements and perceived training gaps among EM programs.

Methods: We conducted two email surveys (one each for EM program directors [PDs] and residents) regarding training requirements and perceived gaps for GH electives. We also contacted university postgraduate medical education (PGME) and GH offices, via their online publicized emails, to assess university-wide requirements and resources.

Results: Nine PDs responded, with 78% reporting having residents participate in GH electives. Many PDs (67%) believed residents were moderately prepared for GH electives, while 33% felt they were unprepared to some degree. Forty seven out of an estimated 380 EM residents responded with 35% having completed a GH elective during residency. Of those, only one (6%) reported feeling very prepared, and 43% believed there was a need to improve trainings. Uncertainty around training requirements was reported, and residents identified challenges faced on electives, as well as priority topics for training. Responses from PGME and GH offices indicated that pre-departure training and post-elective debriefing were required or available at more universities than was indicated by the PD and resident respondents. However university requirements varied widely, with some exclusively requiring basic travel information and Health and Safety checklists or modules. The disparate responses indicate that residents and PDs may either be unaware of university requirements or not utilize available training resources for GH electives.

Conclusions: Although Canadian EM residents participate in GH electives, the majority of training programs do not require pre-departure training or post-elective debriefing. PDs and residents report varying levels of preparedness, and residents acknowledge a variety of challenges during GH electives. This information can be used to inform pre-departure training and post-elective debriefing and encourage EM residents to access available university-wide training.

Impact of Global Health Electives on US Medical Residents: A Systematic Review

BACKGROUND

The prevalence of global health in graduate medical education in the United States (US) has soared over the past two decades. The majority of US internal medicine and pediatric residency programs now offer global health electives abroad. Despite the prevalence of global health electives among US graduate medical programs today, challenges exist that may impact the experience for visiting trainees and/or host institutions. Previous reviews have predominately focused on experiences of undergraduate medical students and have primarily described positive outcomes.

OBJECTIVES

The aim of this study was to summarize the overall impact of global health electives on US internal medicine, medicine-pediatric, and pediatric residents, paying specific attention to any negative themes reported in the literature.

METHODS

An Ovid MEDLINE and Ovid EMBASE literature search was conducted to identify studies that evaluated the effects of global health electives on US internal medicine, medicine-pediatric, and pediatric residents.

FINDINGS

Ten studies were included. Four positive themes emerged: (1) improvement of medical knowledge, physical examination, and procedural skills, (2) improvement in resourcefulness and cost-effectiveness, (3) improvement in cultural and interpersonal competence, and (4) professional and career development. Two negative themes were identified: (1) health risks and (2) safety risks.

CONCLUSIONS

Global health electives provide a number of perceived benefits for US medical trainees; however, we importantly highlight health and safety concerns described while abroad. Global health educators should recognize the host of unique challenges experienced during a global health elective and investigate how to best mitigate these concerns. Incorporation of mandatory pre-, intra-, and post-elective training programs and establishment of universally adopted global health best practice guidelines may serve to address some the challenges visiting trainees encounter while abroad.

Impact of Global Health Electives on US Medical Residents: A Systematic Review

Background:

The prevalence of global health in graduate medical education in the United States (US) has soared over the past two decades. The majority of US internal medicine and pediatric residency programs now offer global health electives abroad. Despite the prevalence of global health electives among US graduate medical programs today, challenges exist that may impact the experience for visiting trainees and/or host institutions. Previous reviews have predominately focused on experiences of undergraduate medical students and have primarily described positive outcomes.

Objectives:

The aim of this study was to summarize the overall impact of global health electives on US internal medicine, medicine-pediatric, and pediatric residents, paying specific attention to any negative themes reported in the literature.

Methods:

An Ovid MEDLINE and Ovid EMBASE literature search was conducted to identify studies that evaluated the effects of global health electives on US internal medicine, medicine-pediatric, and pediatric residents.

Findings:

Ten studies were included. Four positive themes emerged: (1) improvement of medical knowledge, physical examination, and procedural skills, (2) improvement in resourcefulness and cost-effectiveness, (3) improvement in cultural and interpersonal competence, and (4) professional and career development. Two negative themes were identified: (1) health risks and (2) safety risks.

Conclusions:

Global health electives provide a number of perceived benefits for US medical trainees; however, we importantly highlight health and safety concerns described while abroad. Global health educators should recognize the host of unique challenges experienced during a global health elective and investigate how to best mitigate these concerns. Incorporation of mandatory pre-, intra-, and post-elective training programs and establishment of universally adopted global health best practice guidelines may serve to address some the challenges visiting trainees encounter while abroad.

A Review of Learner Exchange Program in the Dental Fraternity: A Paradigm Shift for the Excellence

Dentistry is an art and science which mainly depends on the subject knowledge, instruments, materials, technology, and skills of the operator. Sharing the knowledge and available infrastructure and technology are the best solutions to enhance the skills and improve the work pattern of the present dentist. This could be easily achieved through the introduction of learner exchange program for students as well as faculty. The exchange program has multiple advantages being beneficial for the budding dentist and the faculty, which ultimately improves the interstate relationship and help the community in health care sectors.

A National Survey of U.S. Dental Students' Experiences with International Service Trips

Globalization, along with the increasing prevalence of non-communicable diseases, their risk factors, and poor oral health, demands global approaches to oral health care. Trained health care workers' providing volunteer services abroad is one model used for improving access to dental services for some communities. Currently, little is known about U.S. dental student involvement in international clinical service volunteerism. The aim of this exploratory study was to capture national survey data from predoctoral dental students about their interest in and experience with global health service trips. The survey sought to assess students' past experiences and current and future interest in programs providing dental and/or medical services in order to lay the foundation for further research. A 12-question web-based survey was distributed in May 2017 to 22,930 students enrolled in U.S. dental schools. A total of 1,555 students responded, for a response rate of 7%. Respondents were evenly distributed across the four academic years. Approximately 22% (n=342) of the respondents had already participated in a service trip experience, 83% reported interest in a service trip while in school, and 92% were interested after graduation. Reported motivations for international trips included the desire to care for the underserved and to obtain a more global view of health and disease. Concerns were expressed regarding costs and time constraints. This study provided preliminary, exploratory data on dental student engagement with international service trips. Both interest and participation in international service trips among responding students were high, reflecting current trends in both dentistry and medicine. Dental education may have an opportunity to guide student engagement in more sustainable and ethical volunteering in the U.S. and abroad.