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Hunchak C, Battison AW, Oyedokun T, Stempien J, Landes M, Khatib N, Desouza K, Pritchard J, Erak M, Chun S, Bartels S, Sithamparapillai A, Johnson K, Eggink K, Collier A. Supporting global emergency medicine practice for Canadian physicians: models to foster academic productivity and build collaborative communities of practice. CAN J EMERG MED 2024:10.1007/s43678-024-00747-8. [PMID: 39198328 DOI: 10.1007/s43678-024-00747-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/01/2024] [Indexed: 09/01/2024]
Affiliation(s)
- Cheryl Hunchak
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Andrew W Battison
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Taofiq Oyedokun
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - James Stempien
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Megan Landes
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nour Khatib
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kimberly Desouza
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine and Trauma Care, Aalborg University Hospital, Aalborg, Denmark
| | - Jodie Pritchard
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Marko Erak
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Shannon Chun
- Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Susan Bartels
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
- Departments of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Arjun Sithamparapillai
- Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kirsten Johnson
- Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelly Eggink
- Department of Emergency Medicine, North Island Hospital - Comox Valley, Island Health Authority, Courtenay, BC, Canada
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Heller DJ, Hudspeth JC, Kishore SP, Mercer T, Schwartz JI, Rabin TL. Bringing Generalists to Global Health: a Missed Opportunity and Call to Action. J Gen Intern Med 2024; 39:1901-1904. [PMID: 38135777 PMCID: PMC11282038 DOI: 10.1007/s11606-023-08573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
The credo of the generalist physician has always been the promotion of health for all, in every aspect: not just multiple vulnerable organ systems, but multiple social, cultural, and political factors that contribute to poor health and exacerbate health inequity. In recent years, the field of global health has also adopted this same mission: working across both national and clinical specialty borders to improve health for all and end health disparities worldwide. Yet within the Society for General Internal Medicine, and among American generalists, engagement in global health, both within and outside the USA, remains uncommon. We see this gap as an opportunity, because in fact generalists in America already have the skills and experience that global health badly needs. SGIM could promote generalists to global health's vanguard, with three core steps. First, we generalists must continue to integrate health for the vulnerable into our domestic work, generating care models applicable in low-resource settings around the globe. Conversely, we must also engage with and implement international ideas and solutions for universal access to primary care for vulnerable patients in the USA. And lastly, we must build platforms to connect ourselves with colleagues worldwide to exchange these learnings.
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Affiliation(s)
- David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - James C Hudspeth
- Department of Medicine, Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sandeep P Kishore
- Division of Hospital Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Tim Mercer
- Division of Global Health, Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Jeremy I Schwartz
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Tracy L Rabin
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Matias WR, Cuneo CN, Richterman A, Beckett AG, Farrar AE, Rhatigan JJ, Palazuelos D. Characteristics of Global Health Careers among Graduates of a Global Health Equity Residency Training Program in the United States. Ann Glob Health 2023; 89:44. [PMID: 37362826 PMCID: PMC10289043 DOI: 10.5334/aogh.4074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Background The number of global health (GH) physician training programs in the United States has increased in the past decade. Few studies have explored the demographics of individuals in these programs, the impact of global health training on career development, and specific factors associated with whether graduates achieve a career in global health. Objectives We aimed to describe characteristics of program graduates and quantify which previously identified factors were associated with achieving a self-defined career in GH among a cohort of graduates from one GH post-graduate training program in a highly resourced academic medical center in the United States between 2003 and 2018. Methods We conducted a cross-sectional survey and analyzed differences between participants who self-identified as having a career in GH compared to those who did not. Findings Among 59 individuals invited to participate, 53 (89.9%) responded to the survey. Having a GH mentor was associated with having a career in GH (OR 10.3; p = 0.004). Those who had a GH career were more likely to have a clearly-defined career path (p = 0.03), have institutional support in their current job (p = 0.00006), be able to manage the split between their GH and non-GH work (p = 0.0001), find funding to achieve their objectives in GH (p = 0.01), invest in their personal and family life (p = 0.05), and split work abroad and domestically with few challenges (p = 0.01). Conclusions We present sociodemographic and career characteristics for graduates from a GH training program in a highly resourced academic medical center in the United States. Mentorship, institutional support, funding, ability to balance GH with non-GH work, and time spent domestically or abroad are key factors associated with successful careers in GH. If institutional funding is allocated to strengthen these aspects of GH training, we anticipate more sustained GH career development.
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Affiliation(s)
- Wilfredo R. Matias
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, US
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
- Center for Global Health, Massachusetts General Hospital, Boston, MA, US
| | - C. Nicholas Cuneo
- Center for Community and Global Health, Johns Hopkins University School of Medicine, Baltimore, MD, US
- HEAL Refugee Health and Asylum Collaborative, Baltimore, MD, USA
- Division of Pediatric Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Division of Hospital Medicine, Johns Hopkins Hospital, Baltimore, MD, US
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Aaron Richterman
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Anne G. Beckett
- Department of Internal Medicine, Boston Medical Center, Boston, MA, US
- Department of Pediatrics, Boston Medical Center, Boston, MA, US
| | - Alison E. Farrar
- Harvard Medical School, Boston, MA, US
- Department of Physics, University of Oxford, Oxford, UK
| | - Joseph J. Rhatigan
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, US
| | - Daniel Palazuelos
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, US
- Partners In Health, Boston, MA, US
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Quaglio G, Nsubuga JB, Maziku D, Tsegaye A, Parise N, Cavagna C, Lochoro P, Strepparava MG, Dalt LD, Okori S, Gatta A, Kamunga AM, Putoto G. International medical electives in Sub-Saharan Africa: experiences from a 19-year NGO-driven initiative. BMC MEDICAL EDUCATION 2023; 23:184. [PMID: 36973742 PMCID: PMC10041499 DOI: 10.1186/s12909-023-04154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Mainstream medical education remains largely focused on national health issues. Therefore, in order to expose medical students to international health issues, it is beneficial to facilitate international medical electives. METHODS This article describes the Junior Project Officer (JPO) program, a medical experience based on clinical electives in Sub-Saharan Africa, supported by a Non-Governmental Organisation (NGO). Residents spend 6 months as part of a multidisciplinary medical team in Africa. A post-elective online survey was administered to all who participated in the program in the period 2002-2020. The questionnaire comprised three domains: (i) general and pre-departure information; (ii) the experience; (iii) the post-experience. RESULTS Questionnaires were received from 157/241 subjects, a response rate of 65%. The most common specialties were pediatrics, public health, and internal medicine. Of all, 87% carried out clinical activities; 45% also worked in the management of health services, and 60% carried out research activities. About 64% reported difficulties linked to a lack of equipment, different ways of working (57%), and exposure to situations for which they did not feel technically prepared (56%). In 25% of cases, residents reported that their school's attitude to their doing the elective was not positive: upon their return, over 50% felt that their experience was not sufficiently valued by their institution. Respondents considered the experience important for professional and personal growth (93% and 80% respectively ). Forty-two participants (27%) reported that the experience had a significant impact on their future career choices. CONCLUSION Despite the difficulties encountered, a well-structured experience in international health can have a positive impact on residents, professionally and personally. Key factors behind the positive outcomes are the substantial length (6 months) of the experience, and the long term working relationships between the sending and receiving institutions. The schools in Italy that provide the students for the electives need to see more evidence that international electives are worth the investment.
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Affiliation(s)
- Gianluca Quaglio
- Medical Preparedness and Crisis Management Unit (MPCMU), Directorate-General for Personnel, European Parliament, Rue Wiertz, 60, B-1047, Brussels, Belgium.
- Operational Research Unit, Doctors with Africa Cuamm, Padova, Italy.
| | | | - Donald Maziku
- Tosamaganga Hospital, Iringa, United Republic of Tanzania
| | | | - Nicoletta Parise
- Department of Statistical Sciences, Padova University, Padova, Italy
| | - Chiara Cavagna
- Operational Research Unit, Doctors with Africa Cuamm, Padova, Italy
| | | | - Maria Grazia Strepparava
- Clinical Psychology Unit, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Liviana Da Dalt
- Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | - Alessandra Gatta
- Operational Research Unit, Doctors with Africa Cuamm, Padova, Italy
| | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa Cuamm, Padova, Italy
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Sayeed S, Taylor L. Institutionalising global health: a call for ethical reflection. BMJ Glob Health 2020; 5:bmjgh-2020-003353. [PMID: 32943431 PMCID: PMC7500186 DOI: 10.1136/bmjgh-2020-003353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
We describe a global health course and pedagogy that highlights the moral ambiguity and many ethical compromises that have emerged as the discipline has increasingly become institutionalised. We encourage students to reflect on how the oft-declared aspiration for global health equity still remains seriously contested as a normative and political matter, especially in settings like the USA. We further encourage students to reflect on how authentic concern for social justice, health equity and human rights are consistently undermined by unconscious and/or intentional fealty to standard operating procedures within hierarchical structures and systems. Lastly, we encourage students to openly question and critique the dominant socioeconomic and institutional paradigms that influence practitioner ways of thinking about global health. Our aim is to provide a learning space for students to at least imagine, if not demand, more daring modes of engagement. We also encourage our colleagues in the global health education community to be forthright that the process of institutionalising global health reliably favours our own interests more than those we claim to be most concerned about. If the ideal of global health is to build a bridge to human solidarity, we see substantial risk that current popularised approaches might never yield a structural tipping point.
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Affiliation(s)
- Sadath Sayeed
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Taylor
- Population Health, NYU Grossman School of Medicine, New York, New York, USA
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6
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Elmore SNC, Royce TJ, Oladeru OT, Freese CM, Wakefield DV, Vapiwala N, Zietman AL. Global Health Perspectives Among Radiation Oncology Residency Program Directors: A Knowledge, Attitudes, and Practices Survey. Int J Radiat Oncol Biol Phys 2020; 107:419-425. [PMID: 32126266 DOI: 10.1016/j.ijrobp.2020.02.467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Interest in global health has risen among medical students applying to and residents training in radiation oncology, often outpacing available educational offerings. The Association of Residents in Radiation Oncology Global Health Subcommittee sought to determine the perceptions of program directors (PDs) in radiation oncology and their current or planned global health curricular opportunities. METHODS AND MATERIALS A standardized, Knowledge-Attitudes-Practices survey composed of 32 binary items was sent to PDs for all Accreditation Council for Graduate Medical Education-accredited radiation oncology programs. RESULTS The program response rate was 60% (55 of 91). Responding programs were distributed evenly geographically and included a range of training program sizes. Most PDs (77%) knew that most nations did not meet standard minimum benchmarks for radiation therapy access. Although 89% would support residents in pursuing global health rotations, only 22% would support departmental funding of such rotations. Furthermore, 94% believed that global health was a field worthy of an academic career, but only 39% believed that it had appropriate rigor. Only 8% of programs had dedicated global health rotations. CONCLUSIONS Radiation oncology PDs largely expressed favorable views of global health as a pursuit and affirmed a high degree of resident and medical student interest. However, faculty commitment and program offerings currently lag behind the interest level. In particular, a substantial number of PDs do not perceive global health to be a rigorous academic endeavor. Future progress in academic global health in radiation oncology will require strategies to systematically support pathways for the development of experience and scholarship both within and beyond residency.
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Affiliation(s)
- Shekinah N C Elmore
- Harvard Radiation Oncology Program, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Trevor J Royce
- Harvard Radiation Oncology Program, Boston, Massachusetts; Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Oluwadamilola T Oladeru
- Harvard Radiation Oncology Program, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Chris M Freese
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Daniel V Wakefield
- University of Tennessee Health Science Center, Memphis, Tennessee; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony L Zietman
- Harvard Radiation Oncology Program, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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7
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Balogun OD, Choi AMK, Formenti SC. Shaping the Path for a Global Oncology Academic Career. JAMA Oncol 2020; 5:931-932. [PMID: 31046103 DOI: 10.1001/jamaoncol.2019.0555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Onyinye D Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York
| | - Augustine M K Choi
- New York Presbyterian Hospital, New York.,Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York
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Ventres WB, Wilson BK. Rethinking Goals: Transforming Short-Term Global Health Experiences Into Engagements. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:32-36. [PMID: 31219810 DOI: 10.1097/acm.0000000000002841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The authors challenge the conventional wisdom guiding what participants in short-term experiences in global health (STEGHs) should be learning. Medical students and residents from the United States have been told to focus on standardized competencies and ethical principles, in addition to the biomedical knowledge, skills, and attitudes highlighted by working internationally. The authors suggest that although these training goals are important, they may divert learners from developing their professional identities in ways that contribute to the health of all persons, especially those who are economically poor and socially marginalized. The authors postulate that such a professional transformation will occur only if STEGH participants attend to 5 key learning goals: develop contextual inquisitiveness, grow in insightful understanding, nurture global humility, cultivate structural awareness, and critically engage in the pursuit of creating equitable and just societies. Further, the authors argue that only by attending to these goals will any genuine change in the root causes of inequities in health outcomes occur. The authors review these goals and encourage their use for professional and pedagogical purposes over the duration of any STEGH-before departure, while in host communities, and upon return home.
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Affiliation(s)
- William B Ventres
- W.B. Ventres is Ben Saltzman, MD, Distinguished Chair in Rural Family Medicine, Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; ORCID: https://orcid.org/0000-0003-3573-2845. B.K. Wilson is a PhD graduate, Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, Texas; ORCID: https://orcid.org/0000-0002-6271-2885
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Abudu RM, Cira MK, Pyle DH, Duncan K. Landscape of Global Oncology Research and Training at National Cancer Institute-Designated Cancer Centers: Results of the 2018 to 2019 Global Oncology Survey. J Glob Oncol 2019; 5:1-8. [PMID: 31756139 PMCID: PMC6882505 DOI: 10.1200/jgo.19.00308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The National Cancer Institute (NCI)-Designated Cancer Centers (NDCCs) are active in global oncology research and training, leading collaborations to support global cancer control. To better understand global oncology activities led by NDCCs, the NCI Center for Global Health collaborated with ASCO to conduct the 2018/2019 NCI/ASCO Global Oncology Survey of NDCCs. METHODS Seventy NDCCs received a two-part survey that focused on global oncology programs at NDCCs and non-National Institutes of Health (NIH)-funded global oncology projects with an international collaborator led by the NDCCs. Sixty-seven NDCCs responded to the survey. Data were coded and analyzed by NCI-Center for Global Health staff. RESULTS Thirty-three NDCCs (47%) reported having a global oncology program, and 61 (87%) reported a collective total of 613 non-NIH-funded global oncology projects. Of the NDCCs with global oncology programs, 17 reported that trainees completed rotations outside the United States and the same number enrolled trainees from low- and middle-income countries (LMIC). Primary focus areas of non-NIH-funded projects were research (469 [76.5%]) and capacity building or training (197 [32.1%]). Projects included collaborators from 110 countries; 68 of these were LMIC. CONCLUSION This survey shows that there is a substantial amount of global oncology research and training conducted by NDCCs and that much of this is happening in LMIC. Trends in these data reflect those in recent literature: The field of global oncology is growing, advancing scientific knowledge, contributing to building research and training capacity in LMIC, and becoming a recognized career path. Results of the 2018 Global Oncology Survey can be used to foster opportunities for NDCCs to work collaboratively on activities and to share their findings with relevant stakeholders in their LMIC collaborator countries.
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Affiliation(s)
- Rachel M. Abudu
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Mishka K. Cira
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Kalina Duncan
- National Cancer Institute Center for Global Health, Rockville, MD
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Onyia CU, Ojo OA. Letter to the Editor. Barriers to global surgery academic collaborations. J Neurosurg 2019; 130:1402-1403. [PMID: 30095332 DOI: 10.3171/2018.5.jns181337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fallah PN, Bernstein M. Barriers to participation in global surgery academic collaborations, and possible solutions: a qualitative study. J Neurosurg 2019; 130:1157-1165. [PMID: 29624152 DOI: 10.3171/2017.10.jns17435] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 10/18/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE There is a global lack of access to surgical care, and this issue disproportionately affects those in low- and middle-income countries. Global surgery academic collaborations (GSACs) between surgeons in high-income countries and those in low- and middle-income countries are one possible sustainable way to address the global surgical need. The objective of this study was to examine the barriers to participation in GSACs and to suggest ways to increase involvement. METHODS A convenience sample of 86 surgeons, anesthesiologists, other physicians, residents, fellows, and nurses from the US, Canada, and Norway was used. Participants were all health care providers from multiple specialties and multiple academic centers with varied involvement in GSACs. More than half of the participants were neurosurgeons. Participants were interviewed in person or over Skype in Toronto over the course of 2 months by using a predetermined set of open-ended questions. Thematic content analysis was used to evaluate the participants' responses. RESULTS Based on the data, 3 main themes arose that pointed to individual, community, and system barriers for involvement in GSACs. Individual barriers included loss of income, family commitments, young career, responsibility to local patients, skepticism of global surgery efforts, ethical concerns, and safety concerns. Community barriers included insufficient mentorship and lack of support from colleagues. System barriers included lack of time, minimal academic recognition, insufficient awareness, insufficient administrative support and organization, and low political and funding support. CONCLUSIONS Steps can be taken to address some of these barriers and to increase the involvement of surgeons from high-income countries in GSACs. This could lead to a necessary scale-up of global surgery efforts that may help increase worldwide access to surgical care.
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Affiliation(s)
| | - Mark Bernstein
- 2Division of Neurosurgery, Department of Surgery, University of Toronto; and
- 3Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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12
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Palazuelos D. Training Toward a Movement: Career Development Insights From the First 7 Years of a Global Health Equity Residency. J Grad Med Educ 2018; 10:509-516. [PMID: 30386475 PMCID: PMC6194880 DOI: 10.4300/jgme-d-18-00213.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/12/2018] [Accepted: 07/05/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine at Brigham and Women's Hospital provides global health training during residency, but little is known about its effect on participants' selection of a global health career. OBJECTIVE We assessed the perceptions of residency graduates from the first 7 classes to better understand the outcomes of this education program, and the challenges faced by participants. METHODS We interviewed 27 of 31 physicians (87%) who graduated from the program between 2003 and 2013 using a convergent mixed-methods design and a structured interview tool that included both open-ended and forced-choice questions. We independently coded and analyzed qualitative data using a case study design, and then wove together the qualitative and quantitative data at the interpretation phase using a parallel convergent mixed-methods design. RESULTS Entering a career focused on social justice was cited as the most common motivator for selecting to train in global health. Most respondents (83%, 20 of 24) reported they were able to achieve this goal despite structural barriers, such as lower salaries compared with peers, a lack of mentors in the field, poorly structured and undersupported career pathways at their institutions, and unique work-life challenges. CONCLUSIONS A majority of graduates from 1 dedicated residency program in global health and internal medicine reported they were able to continue to engage in global health activities after graduation and, despite identified challenges, reported that they planned long-term careers in global health.
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Citrin D, Mehanni S, Acharya B, Wong L, Nirola I, Sherchan R, Gauchan B, Karki KB, Singh DR, Shamasunder S, Le P, Schwarz D, Schwarz R, Dangal B, Dhungana SK, Maru S, Mahar R, Thapa P, Raut A, Adhikari M, Basnett I, Kaluanee SP, Deukmedjian G, Halliday S, Maru D. Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal. Glob Health Action 2018; 10:1367161. [PMID: 28914185 PMCID: PMC5645653 DOI: 10.1080/16549716.2017.1367161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe. Objectives: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings. Methods: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework. Results: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships. Conclusions: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians.
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Affiliation(s)
- David Citrin
- a Possible , Kathmandu , Nepal.,b Department of Anthropology , University of Washington , Seattle , WA , USA.,c Department of Global Health , University of Washington , Seattle , WA , USA.,d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA
| | - Stephen Mehanni
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,g Gallup Indian Medical Center , Gallup , NM , USA
| | - Bibhav Acharya
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,h Department of Psychiatry , University of California, San Francisco , San Francisco , CA , USA.,i Shared Minds , Boston , MA , USA
| | - Lena Wong
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,j Tuba City Regional Health Care , Tuba City , AZ , USA
| | - Isha Nirola
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Rekha Sherchan
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Bikash Gauchan
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Khem Bahadur Karki
- k Nepal Health Research Council , Ministry of Health , Kathmandu , Nepal
| | - Dipendra Raman Singh
- l Public Health Monitoring & Evaluation Division , Ministry of Health , Kathmandu , Nepal
| | - Sriram Shamasunder
- e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Phuoc Le
- e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Dan Schwarz
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA
| | - Ryan Schwarz
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,o Department of Medicine, Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.,p Department of Medicine , Harvard Medical School , Boston , MA , USA
| | | | | | - Sheela Maru
- a Possible , Kathmandu , Nepal.,q Department of Obstetrics and Gynecology , Boston Medical Center , Boston , MA , USA.,r Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , MA , USA.,s Department Medicine, Division of Women's Health , Brigham and Women's Hospital , Boston , MA , USA
| | | | | | | | - Mukesh Adhikari
- t District Health Office, Department of Health Services , Ministry of Health , Mangalsen , Achham , Nepal
| | | | - Shankar Prasad Kaluanee
- a Possible , Kathmandu , Nepal.,u School of Leadership and Development , Eastern University , St. Davids , PA , USA
| | - Grace Deukmedjian
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,v Tséhootsooí Medical Center , Fort Defiance , AZ , USA
| | - Scott Halliday
- a Possible , Kathmandu , Nepal.,d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA
| | - Duncan Maru
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA.,p Department of Medicine , Harvard Medical School , Boston , MA , USA.,w Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA
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14
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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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15
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Mehta A, Xu T, Murray M, Casey KM. Medical Student Perceptions of Global Surgery at an Academic Institution: Identifying Gaps in Global Health Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1749-1756. [PMID: 28767491 DOI: 10.1097/acm.0000000000001832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Robust global health demands access to safe, affordable, timely surgical care for all. The long-term success of global surgery requires medical students to understand and engage with this emerging field. The authors characterized medical students' perceptions of surgical care relative to other fields within global health. METHOD An optional, anonymous survey was given to all Johns Hopkins medical students from February to March 2016 to assess perceptions of surgical care and its role in global health. RESULTS Of 480 students, 365 (76%) completed the survey, with 150 (41%) reporting global health interests. One-third (34%) of responding students felt that surgical care is one of two fields with the greatest potential global health impact in the future, second to infectious disease (49%). A minority (28%) correctly identified that trauma results in more deaths worldwide than obstetric complications or HIV/AIDS, tuberculosis, and malaria combined. Relative to other examined fields, students perceived surgical care as the least preventive and cost-effective, and few students (3%) considered adequate surgical care the best indicator of a robust health care system. Students believed that practicing in a surgical field was least amenable to pursuing a global health career, citing several barriers. CONCLUSIONS Medical students have several perceptions of global surgery that contradict current evidence and literature, which may have implications for their career choices. Opportunities to improve students' global health knowledge and awareness of global surgery career paths include updating curricula, fostering meaningful international academic opportunities, and creating centers of global surgery and global health consortia.
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Affiliation(s)
- Ambar Mehta
- A. Mehta is a fourth-year medical student, Johns Hopkins School of Medicine, Baltimore, Maryland. T. Xu is a recent graduate, Johns Hopkins School of Medicine, Baltimore, Maryland. M. Murray is a fourth-year medical student, Johns Hopkins School of Medicine, Baltimore, Maryland. K.M. Casey is president-elect, Alliance for Surgery and Anesthesia Presence, Newport, Rhode Island
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16
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Creating Flexible and Sustainable Work Models for Academic Obstetrician–Gynecologists Engaged in Global Health Work. Obstet Gynecol 2017; 130:843-851. [DOI: 10.1097/aog.0000000000002240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Cox JT, Kironji AG, Edwardson J, Moran D, Aluri J, Carroll B, Warren N, Chen CCG. Global Health Career Interest among Medical and Nursing Students: Survey and Analysis. Ann Glob Health 2017; 83:588-595. [PMID: 29221533 DOI: 10.1016/j.aogh.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Global health experiences undertaken in international settings (GHEs) are becoming an increasingly prevalent aspect of health professions education and, as such, merit comprehensive analysis of the impact they have on students and host communities. OBJECTIVE To assess the associations between demographic/experiential factors and the interest of health professions students in careers involving global health. METHODS A cross-sectional survey was administered online to a convenience sample of medical and nursing students at Johns Hopkins University. Questions addressed level of interest in a global health career, prior GHEs, and demographic information. Items were either Likert scale or multiple choice. Various regression analyses were performed. FINDINGS Of 510 respondents, 312 (61.2%) expressed interest in a global health career and 285 (55.9%) had prior GHEs. Multivariate logistic regression found female sex, age ≥27 years, household income <$100,000/y, and a prior research-related GHE independently associated with higher interest in global health careers. On subset analysis of participants with one or more prior GHEs: age ≥27 years, household income <$100,000/y, a prior research-related GHE, and having multiple GHEs were each independently associated with increased interest in a global health career. CONCLUSIONS Simply participating in a global health experience abroad is not significantly associated with interest in a global health career. However, sex, age, household income, and research-related GHEs are significantly associated with global health career interest. These findings may inform the development of global health programs at medical and nursing schools and can guide efforts to increase the number of health care professionals entering global health careers.
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Affiliation(s)
- Jacob T Cox
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jill Edwardson
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD
| | - Dane Moran
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - James Aluri
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryn Carroll
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Nicole Warren
- Johns Hopkins University School of Nursing, Baltimore, MD
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18
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Peluso MJ, van Schalkwyk S, Kellett A, Brewer TF, Clarfield AM, Davies D, Garg B, Greensweig T, Hafler J, Hou J, Maley M, Mayanja-Kizza H, Pemba S, Jenny Samaan J, Schoenbaum S, Sethia B, Uribe JP, Margolis CZ, Rohrbaugh RM. Reframing undergraduate medical education in global health: Rationale and key principles from the Bellagio Global Health Education Initiative. MEDICAL TEACHER 2017; 39:639-645. [PMID: 28362131 DOI: 10.1080/0142159x.2017.1301654] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Global health education (GHE) continues to be a growing initiative in many medical schools across the world. This focus is no longer limited to participants from high-income countries and has expanded to institutions and students from low- and middle-income settings. With this shift has come a need to develop meaningful curricula through engagement between educators and learners who represent the sending institutions and the diverse settings in which GHE takes place. The Bellagio Global Health Education Initiative (BGHEI) was founded to create a space for such debate and discussion and to generate guidelines towards a universal curriculum for global health. In this article, we describe the development and process of our work and outline six overarching principles that ought to be considered when adopting an inclusive approach to GHE curriculum development.
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Affiliation(s)
- Michael J Peluso
- a Harvard Medical School , Brigham and Women's Hospital , Boston , MA , USA
| | - Susan van Schalkwyk
- b Stellenbosch University, Centre for Health Professions Education , Tygerberg , South Africa
| | - Anne Kellett
- c Yale University School of Medicine, Office of International Medical Student Education , New Haven , CT , USA
| | | | - A Mark Clarfield
- e Medical School for International Health, Ben Gurion University of the Negev , Beer-Sheva , Israel
| | - David Davies
- f Warwick Medical School, University of Warwick , Coventry , United Kingdom
| | - Bishan Garg
- g Dr Sushila Nayar School of Public Health , Sewagram , India
| | | | - Janet Hafler
- c Yale University School of Medicine, Office of International Medical Student Education , New Haven , CT , USA
| | | | - Moira Maley
- j The University of Western Australia, The Rural Clinical School of Western Australia , Crawley , Australia
| | | | - Senga Pemba
- l St Francis University College of Health , Ifakara , Tanzania
| | - Janette Jenny Samaan
- m Global Health Learning Opportunities , Association of American Medical Colleges , Washington , DC , USA
| | | | | | | | - Carmi Z Margolis
- e Medical School for International Health, Ben Gurion University of the Negev , Beer-Sheva , Israel
- q Prywes Center for Medical Education, Ben Gurion University Faculty of Health Sciences , Beer-Sheva , Israel
| | - Robert M Rohrbaugh
- c Yale University School of Medicine, Office of International Medical Student Education , New Haven , CT , USA
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19
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Rodin D, Yap ML, Grover S, Longo JM, Balogun O, Turner S, Eriksen JG, Coleman CN, Giuliani M. Global Health in Radiation Oncology: The Emergence of a New Career Pathway. Semin Radiat Oncol 2017; 27:118-123. [DOI: 10.1016/j.semradonc.2016.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Adams LV, Wagner CM, Nutt CT, Binagwaho A. The future of global health education: training for equity in global health. BMC MEDICAL EDUCATION 2016; 16:296. [PMID: 27871276 PMCID: PMC5117699 DOI: 10.1186/s12909-016-0820-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 11/09/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Among academic institutions in the United States, interest in global health has grown substantially: by the number of students seeking global health opportunities at all stages of training, and by the increase in institutional partnerships and newly established centers, institutes, and initiatives to house global health programs at undergraduate, public health and medical schools. Witnessing this remarkable growth should compel health educators to question whether the training and guidance that we provide to students today is appropriate, and whether it will be applicable in the next decade and beyond. Given that "global health" did not exist as an academic discipline in the United States 20 years ago, what can we expect it will look like 20 years from now and how can we prepare for that future? DISCUSSION Most clinicians and trainees today recognize the importance of true partnership and capacity building in both directions for successful international collaborations. The challenge is in the execution of these practices. There are projects around the world where this is occurring and equitable partnerships have been established. Based on our experience and observations of the current landscape of academic global health, we share a perspective on principles of engagement, highlighting instances where partnerships have thrived, and examples of where we, as a global community, have fallen short. CONCLUSIONS As the world moves beyond the charity model of global health (and its colonial roots), it is evident that the issue underlying ethical global health practice is partnership and the pursuit of health equity. Thus, achieving equity in global health education and practice ought to be central to our mission as educators and advisors when preparing trainees for careers in this field. Seeking to eliminate health inequities wherever they are ingrained will reveal the injustices around the globe and in our own cities and towns.
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Affiliation(s)
- Lisa V. Adams
- Center for Health Equity, Dartmouth’s Geisel School of Medicine, 1 Rope Ferry Road, Room 219, Hanover, NH 03755 USA
| | - Claire M. Wagner
- Union for International Cancer Control, 62 Route de Frontenex, 1207 Geneva, Switzerland
| | - Cameron T. Nutt
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115 USA
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Loh LC. "Taxes," "Antes," and "Bonuses": More on the Realities of Global Health Careers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:161-162. [PMID: 26813645 DOI: 10.1097/acm.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Lawrence C Loh
- Adjunct professor, Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, and director of programs, The 53rd Week Ltd., Brooklyn, New York;
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22
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Lukolyo H, Haq C. "Taxes," "Antes," and "Bonuses": More on the Realities of Global Health Careers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:162. [PMID: 26813646 DOI: 10.1097/acm.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Heather Lukolyo
- Third-year resident in pediatrics and child global health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; . Professor, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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