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Ukachukwu AEK, Ogundeji OD, Abu-Bonsrah N, Still MEH, Trillo-Ordonez Y, Oboh EN, Nischal SA, Deng DD, Ugorji C, Seas A, Badejo OA, Malomo TA, Nwaribe EE, Oyemolade TA, Okere OE, Oboh E, Waguia-Kouam R, Rahman R, Asemota I, Reddy R, von Isenburg M, Haglund MM, Fuller AT, Adeleye AO. The Scope, Trends, and Challenges of Neurosurgical Research in Nigeria: A Bibliometric Review. World Neurosurg 2024; 185:e86-e98. [PMID: 37931875 DOI: 10.1016/j.wneu.2023.10.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE This study investigates the scope, trends, and challenges of neurosurgical research in Nigeria since inception of the specialty in 1962. METHODS A bibliometric review of the neurosurgical literature from Nigeria was performed. Variables extracted included year and journal of publication, article topic, article type, research type, study design, article focus area, and limitations. Descriptive and quantitative analyses were performed for all variables. Trends of research publications were described in three periods: pioneering (1962-1981), recession (1982-2001), and resurgent (2002-2021). RESULTS Of the 1023 included articles, 10.0% were published in the pioneering period, 9.2% in the recession period, and 80.8% in the resurgent period. Papers were predominantly published in World Neurosurgery (4.5%) and Nigerian Journal of Clinical Practice (4.0%). A total of 79.9% of the 4618 authors were from Nigerian institutions; 86.3% of the articles covered clinical research and were mainly focused on service delivery and epidemiology (89.9%). The most prominent topics were traumatic brain injury (25.8%) and central nervous system malignancy (21.4%). Only 4.4% of the publications received funding, mostly from agencies in the United States (31.7%). Barriers to neurosurgical research included lack of clinical databases (18.0%), increasing burden of disease (12.5%), and diagnostic challenges (12.4%). CONCLUSIONS Neurosurgical research in Nigeria continues to grow due to increased training, workforce, and infrastructural improvements. Addressing the major challenges through establishment of research databases, development of evidence-based management guidelines, and increasing research training, funding and opportunities can increase research capacity in Nigeria.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA.
| | - Olaniyi D Ogundeji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ehita N Oboh
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Shiva A Nischal
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Di D Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Chiazam Ugorji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Andreas Seas
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Pratt School of Engineering, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Toluyemi A Malomo
- Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Ena Oboh
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | | | - Raphia Rahman
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Isaac Asemota
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ramya Reddy
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Megan von Isenburg
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Luthuli S, Daniel M, Corbin JH. Power imbalances and equity in the day-to-day functioning of a north plus multi-south higher education institutions partnership: a case study. Int J Equity Health 2024; 23:59. [PMID: 38491440 PMCID: PMC10943907 DOI: 10.1186/s12939-024-02139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Partnerships between Higher Education Institutions (HEIs) in the global north and south have commonly been used as a vehicle to drive global health research and initiatives. Among these initiatives, include health system strengthening, research capacity building, and human resource training in developing countries. However, the partnership functioning of many global north-south partnerships still carry legacies of colonialism through unrecognized behavior patterns, attitudes, and belief systems in how they function. Even with research literature calling for a shift from equality to equity in the functioning of these partnerships, many still struggle with issues of complex and unspoken power dynamics. To understand the successes and challenges of north-south partnerships, this paper explored partnership development and functioning of a northern and multi-southern HEIs partnership focused on nutrition education and research. METHODS A qualitative research approach was used; data were collected through in-depth interviews (IDIs) with questions developed from the Bergen Model of Collective Functioning (BMCF). Thirteen IDIs were conducted with partners from all institutions including stakeholders. FINDINGS The partnership was built on the foundation of experiences and lessons of a previous partnership. Partners used these experiences and lessons to devise strategies to improve partnership inputs, communication, leadership, roles and structures, and maintenance and communication tasks. However, these strategies had an impact on partnership functioning giving rise to issues of inequitable power dynamics. The northern partner had two roles: one as an equal partner and another as distributor of project funds; this caused a conflict in roles for this partner. The partners distinguished themselves according to partner resources - two partners were named implementing partners and two named supportive partners. Roles and partner resources were the greatest contributors to power imbalances and caused delays in project activities. CONCLUSION Using the BMCF to examine partnership dynamics illuminated that power imbalances caused a hierarchical stance in the partnership with northern partners having overall control and power of decision-making in the partnership. This could impact the effectiveness and sustainability of project in the southern institutions going forward.
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Affiliation(s)
- Silondile Luthuli
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Marguerite Daniel
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - J Hope Corbin
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
- Department of Health and Community Studies, Western Washington University, Bellingham, WA, USA
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Ragab L, Wassim M, Arfeen Z, Newman R, Rashid MA. Moving Together, Apart: Impacts of Travel Restrictions on a UK-Egypt Collaboration in Health Profession Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241253668. [PMID: 38736713 PMCID: PMC11084995 DOI: 10.1177/23821205241253668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
Objective University College London (UCL) and Newgiza University (NGU) have been in an academic collaboration since 2016 to establish undergraduate healthcare programmes in Egypt with an underlying ethos of capacity building and co-development. We explored impacts of pandemic-related travel restrictions on staff across both organisations. Methods We conducted 30 semi-structured interviews with academic and professional services staff from UCL and NGU schools of medicine, dentistry, and pharmacy. Data were jointly coded using reflexive thematic analysis and categorised according to the American Council on Education's Comprehensive Internationalisation Framework. Results Nine themes were identified, which related to each of the six components of the framework. In addition to mobility, participants' experiences also spread across the other five components (institutional commitment, leadership, curriculum, faculty support, and partnerships). Successful adaptations were made and staff felt able to 'keep the show on the road'. However, staff remained keen to keep in-person engagement a priority when possible, especially for quality management site visits. Conclusions Travel restrictions can have widespread impacts on all aspects of international collaborations. In this well-established relationship, there was sufficient resilience to withstand these impacts and, many positive unintended consequences emerged. A hybrid engagement model should be prioritised in future partnerships.
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Affiliation(s)
- Lamis Ragab
- School of Medicine, Newgiza University, Cairo, Egypt
| | - Monica Wassim
- School of Medicine, Newgiza University, Cairo, Egypt
| | - Zakia Arfeen
- Faculty of Medical Sciences, University College London, London, UK
| | - Rhiannon Newman
- Faculty of Medical Sciences, University College London, London, UK
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Wondimagegn D, Pain C, Seifu N, Cartmill C, Alemu AA, Whitehead CR. Reimagining global mental health in Africa. BMJ Glob Health 2023; 8:e013232. [PMID: 37666576 PMCID: PMC10481728 DOI: 10.1136/bmjgh-2023-013232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/20/2023] [Indexed: 09/06/2023] Open
Abstract
In 2001, the WHO launched The World Health Report most specifically addressing low-income and middle-income countries (LAMICs). It highlighted the importance of mental health (MH), identifying the severe public health impacts of mental ill health and made 10 recommendations. In 2022, the WHO launched another world MH report and reaffirmed the 10 recommendations, while concluding that 'business as usual for MH will simply not do' without higher infusions of money. This paper suggests the reason for so little change over the last 20 years is due to the importation and imposition of Western MH models and frameworks of training, service development and research on the assumption they are relevant and acceptable to Africans in LAMICs. This ignores the fact that most mental and physical primary care occurs within local non-Western traditions of healthcare that are dismissed and assumed irrelevant by Western frameworks. These trusted local institutions of healthcare that operate in homes and spiritual spaces are in tune with the lives and culture of local people. We propose that Western foundations of MH knowledge are not universal nor are their assumptions of society globally applicable. Real change in the MH of LAMICs requires reimagining. Local idioms of distress and healing, and explanatory models of suffering within particular populations, are needed to guide the development of training curricula, research and services. An integration of Western frameworks into these more successful approaches are more likely to contribute to the betterment of MH for peoples in LAMICs.
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Affiliation(s)
- Dawit Wondimagegn
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Clare Pain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nardos Seifu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Carrie Cartmill
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Cynthia Ruth Whitehead
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
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Rashid MA, Griffin A. Is West Really Best? The Discourse of Modernisation in Global Medical School Regulation Policy. TEACHING AND LEARNING IN MEDICINE 2023:1-12. [PMID: 37401838 DOI: 10.1080/10401334.2023.2230586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/21/2023] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
Phenomenon: In 2012, the World Federation for Medical Education (WFME) established a recognition programme to evaluate medical school regulatory agencies across the world, in response to a new U.S. accreditation policy. Given the predominantly Western origins and Eastern impacts of the WFME programme, this article deconstructs tensions in the programme using postcolonial theory. Approach: Critical discourse analysis examines the intersections of language, knowledge, and power relations to highlight what can or cannot be said about a topic. We employed it to delineate the dominant discourse underpinning the WFME recognition programme. We drew on the theoretical devices of Edward Said, whose work is foundational in postcolonial thinking but has not been widely used in medical education scholarship to date. An archive of literature about the WFME recognition programme dating back to 2003, when WFME first released global standards for medical education, was analyzed. Findings: In the globalization of medical school regulation, the discourse of modernization can be conceptualized as a means of holding knowledge and power in the West, and enacting this power on those in the East, playing on fears of marginalization in the event of non-engagement. The discourse allows these practices to be presented in an honorable and heroic way. Insights: By uncovering the representation of the WFME recognition programme as being modern and modernizing, this article explores how such conceptualisations can close off debate and scrutiny, and proposes further examination of this programme through a lens that recognizes the inherent inequities and geopolitical power differentials that it operates within.
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Affiliation(s)
- Mohammed Ahmed Rashid
- UCL Medical School, Faculty of Medical Sciences, University College London, London, UK
| | - Ann Griffin
- UCL Medical School, Faculty of Medical Sciences, University College London, London, UK
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Decolonizing Global Health Research: Perspectives from US and International Global Health Trainees. Ann Glob Health 2023; 89:9. [PMID: 36819967 PMCID: PMC9912860 DOI: 10.5334/aogh.3961] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/07/2023] [Indexed: 02/08/2023] Open
Abstract
Background "Decolonizing global health" (DGH) may help global health trainees understand and remediate the effects of historical colonialism on global health, but little is known regarding how trainees perceive DGH. Understanding their perspectives is critical for designing educational interventions tailored to their needs. Objectives To understand how trainees perceive DGH research and to determine if perspectives differ between trainees from high- (HICs) versus low- and middle-income countries (LMICs). Methods An online survey of all 2017-2022 pre-doctoral and post-doctoral trainees (n = 111) and mentors (n = 91) within a multi-university program that supports US and international investigators in one-year mentored global health research. The survey evaluated individuals' self-reported knowledge and attitudes toward DGH and their perceptions of historical colonialism's impact on eight aspects of global health. Findings The response rate to trainee surveys was 56%. Trainees from LMICs were less aware of the concept of DGH; 5/25 (20%) had never heard of DGH and 16/25 (64%) reported that they "know a little," whereas all HIC trainees had heard of DGH and 29/36 (81%) reported that they "know a little" (p = 0.019). For three aspects of global health (i.e., which research questions get asked; development of collaborative relationships; and data/statistical analyses), trainees from LMICs were more likely to report positive effects of colonialism. However, in open-ended responses, no thematic differences existed between how LMIC and HIC trainees defined DGH (i.e., actively eliminating power imbalances; prioritizing local needs; promoting local leadership; providing equitable opportunities; and ensuring programs are culturally appropriate). Conclusions Different perspectives surrounding what DGH means suggest a shared understanding may be needed and is arguably prerequisite to designing educational interventions to help global health trainees recognize, understand, and act in global health. Future research is needed to understand perspectives on decolonization across diverse contexts with attention to constructs such as race, ethnicity, and gender.
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Rashid MA. Hyperglobalist, sceptical, and transformationalist perspectives on globalization in medical education. MEDICAL TEACHER 2022; 44:1023-1031. [PMID: 35465822 DOI: 10.1080/0142159x.2022.2058384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Globalisation has been hotly debated in recent decades and has seemingly had a profound impact on medical education. This review synthesises the medical education literature using key perspectives from globalisation theory by Holton (Making globalisation). METHODS Holton (Making globalisation) recognised three key perspectives in globalisation theory-hyperglobalist, sceptical, and transformationalist. This article critically reviews the literature on globalisation in the field of medical education using this theoretical framework. RESULTS Hyperglobalist and sceptical perspectives dominated early periods of medical education literature on globalisation, projecting it either as a mainly positive or mainly negative force, respectively. Most forecasts grounded in these perspectives have not materialised in medical education policy and practice. Since 2010, the volume of scholarship about globalisation has increased and has been predominantly transformationalist in perspective, recognising a reality that has both positive and negative consequences. CONCLUSIONS The medical education literature has mirrored the broader social science literature, in moving over time from hyperglobalist and sceptical positions, towards a 'third wave' of globalisation thinking that is transformationalist. Medical education practitioners and policymakers should be mindful of these perspectives and trends as they navigate the opportunities and challenges presented by globalisation.
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Wondimagegn D, Ragab L, Yifter H, Wassim M, Rashid MA, Whitehead CR, Gill D, Soklaridis S. Breaking Borders: How Barriers to Global Mobility Hinder International Partnerships in Academic Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:37-40. [PMID: 34323859 PMCID: PMC8700298 DOI: 10.1097/acm.0000000000004257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This article describes the authors' personal experiences of collaborating across international borders in academic research. International collaboration in academic medicine is one of the most important ways by which research and innovation develop globally. However, the intersections among colonialism, academic medicine, and global health research have created a neocolonial narrative that perpetuates inequalities in global health partnerships. The authors critically examine the visa process as an example of a racist practice to show how the challenges of blocked mobility increase inequality and thwart research endeavors. Visas are used to limit mobility across certain borders, and this limitation hinders international collaborations in academic medicine. The authors discuss the concept of social closure and how limits to global mobility for scholars from low- and middle-income countries perpetuate a cycle of dependence on scholars who have virtually barrier-free global mobility-these scholars being mainly from high-income countries. Given the current sociopolitical milieu of increasing border controls and fears of illegal immigration, the authors' experiences expose what is at stake for academic medicine when the political sphere, focused on tightening border security, and the medical realm, striving to build international research collaborations, intersect. Creating more equitable global partnerships in research requires a shift from the current paradigm that dominates most international partnerships and causes injury to African scholars.
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Affiliation(s)
- Dawit Wondimagegn
- D. Wondimagegn is associate professor and chief executive director, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lamis Ragab
- L. Ragab is professor of pediatrics and pediatric hematology, Faculty of Medicine, Cairo University, and vice president for life and health sciences, Newgiza University, Cairo, Egypt
| | - Helen Yifter
- H. Yifter is assistant professor of medicine, Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Monica Wassim
- M. Wassim is a teaching assistant, Faculty of Medicine, Newgiza University, Cairo, Egypt
| | - Mohammed A. Rashid
- M.A. Rashid is clinical associate professor, University College London Medical School, London, United Kingdom; ORCID: https://orcid.org/0000-0002-8443-1240
| | - Cynthia R. Whitehead
- C.R. Whitehead is professor, Department of Family and Community Medicine, Women’s College Hospital, and director, Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-0134-9074
| | - Deborah Gill
- D. Gill is professor of medical education and director, University College London Medical School, London, United Kingdom; ORCID: https://orcid.org/0000-0002-5731-6036
| | - Sophie Soklaridis
- S. Soklaridis is associate professor, Department of Psychiatry and Department of Family and Community Medicine, University of Toronto, and senior scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-5119-8473
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Naidu T. Modern Medicine Is a Colonial Artifact: Introducing Decoloniality to Medical Education Research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S9-S12. [PMID: 34380933 DOI: 10.1097/acm.0000000000004339] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Modern medicine is an artifact of colonialism because the science that underpins modern medicine emerged from Western knowledge structures based on a history of colonialism. The author suggests the colonial roots of Western-based modern medicine must be reexamined. While there are various critical theories that may be applied in this reexamination, most do not adequately account for intersectional, intergenerational, and sociohistorical inequities encountered in the multiplicity of global contexts in practice teaching and research within medicine. The author presents decoloniality as a theoretical perspective from which to interrogate sociohistorical, geopolitical, and economic perspectives on gender, race, and heteropaternalistic influences in medicine emanating from a basis in colonially developed systems of knowledge production. The author offers definitions of relevant theoretical terms and suggests that decolonial praxis begins with an initial realization or awareness of one's position within the colonial matrix of power followed by the reflecting or deliberation, or a grappling with real-life struggles that are encountered in confronting the oppressive operations of the colonial matrix of power. Decolonial praxis involves action through challenging mainstream foundational theories-the questions they generate, the research methods they support, and the writing styles they employ. In medical education, this may involve changing powerful actors, such as medical journal editors and researchers, with historical privilege; shifting the balance of power in research spaces; and dismantling physical and intellectual structures and institutions established on colonial epistemologies.
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Affiliation(s)
- Thirusha Naidu
- T. Naidu is head of clinical psychology, King Dinuzulu Hospital Complex, and a lecturer, Department of Behavioural Medicine, University of KwaZulu-Natal, Durban, South Africa
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Rodin D, Dare AJ, Booker R, Booth C, Bryant H, Ginsburg O, Giuliani M, Gospodarowicz M, Gupta S, Hammad N, Rosberger Z, Sutcliffe S, Earle CC. Transforming Canada's role in global cancer control. Lancet Oncol 2021; 22:e400-e409. [PMID: 34478676 DOI: 10.1016/s1470-2045(21)00374-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Abstract
Cancer has not been an explicit priority of Canada's international health and development agenda, but it is key to realising the country's Sustainable Development Goal commitments. Multiple converging political, health, and social forces could now drive support for a more integrated Canadian approach to global cancer control. Success will depend on the extent to which Canadian leaders and institutions can build consensus as a community and agree to work together. Collaboration should include agreement on the framing and prioritisation of the core issues, building a broad coalition base, aligning with priorities of international partners, and on a governance structure that reflects the principles of equity, diversity, and inclusion. This Series paper will discuss global cancer control within Canada's global health agenda, how Canada can address its history of colonisation and present-day disparities in its global work, and the challenges and opportunities of creating a Canadian global cancer control network.
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Affiliation(s)
- Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
| | - Anna J Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada
| | - Reanne Booker
- Palliative and End-of-Life Care Services-Calgary Zone, Calgary, AB, Canada
| | | | - Heather Bryant
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Ophira Ginsburg
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Population Health and Perlmutter Cancer Centre, NYU Grossman School of Medicine, New York, NY, USA
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Mary Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Sumit Gupta
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | | | - Craig C Earle
- Canadian Partnership Against Cancer, Toronto, ON, Canada
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Vulpe H, Vanderpuyne V, Yarney J, Tosoni S, Ringash J, Kassam Z, Wong RKS. Design and Implementation of a Distant-Learning Clinical Research Mentorship Program: The Accra-Toronto Collaboration. JCO Glob Oncol 2021; 6:919-928. [PMID: 32603189 PMCID: PMC7328115 DOI: 10.1200/jgo.19.00240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE For many oncology training programs in low- and middle-income countries, dedicated time for research education and mentorship of trainees is limited. Here, we report a 1-year-long collaboration between a cancer center in Canada and one in Ghana with the aim of imparting clinical research skills and mentoring the research of radiation oncology residents. METHODS On the basis of a needs assessment conducted in Ghana, we designed a curriculum consisting of 13 weekly seminars delivered via videoconference, followed by a 1-year-long mentorship program to support research projects. The primary outcome was the feasibility of the program from seminars to manuscript preparation. We used multiple secondary outcomes to capture the learning experience with study-specific questionnaires. We evaluated critical thinking ability using the Berlin questionnaire. Funding was made available for research and travel to international conferences. RESULTS Five Ghanaian trainees submitted research proposals. Nine Canadian faculty members delivered the seminars and two served as methodology mentors, and two Ghanaian faculty acted as local supervisors. Feedback questionnaires from all participants showed that they agreed strongly that they would recommend the sessions to another resident (75%), that the objectives were clear (71%), and that the topics were useful for their training (73%). At the end of the program, two Ghanaian trainees finalized their manuscripts and one was published. CONCLUSION Here, we report on the implementation of a mentorship program focused on research methods and evidence-based medicine in sub-Saharan Africa. The program was successful in the drafting and publication of abstracts and manuscripts by local trainees.
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Affiliation(s)
- Horia Vulpe
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Columbia University, Department of Radiation Oncology, New York, NY.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | | | - Joel Yarney
- National Center for Radiotherapy, Accra, Ghana
| | - Sarah Tosoni
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jolie Ringash
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Columbia University, Department of Radiation Oncology, New York, NY
| | - Zahra Kassam
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Stronach Regional Cancer Center, Newmarket, Ontario
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Haruna-Cooper L, Nicholson JG, Rashid MA. Racial equity in medical education: Implications for international collaboration. CLINICAL TEACHER 2021; 18:500-501. [PMID: 34132484 DOI: 10.1111/tct.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
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Naidu T. Southern exposure: levelling the Northern tilt in global medical and medical humanities education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:739-752. [PMID: 32500281 DOI: 10.1007/s10459-020-09976-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/20/2020] [Indexed: 05/16/2023]
Abstract
Global medical education is dominated by a Northern tilt. Global universities' faculty and students dominate research, scholarship and teaching about what is termed global education. This tilt has been fixed in global biomedical education with some acknowledgement from the Global South of the comparative benefits of global exchange. Student exchange is predominantly North to South. Students from the Global South are less likely to visit the North on global medical education visits. Global indigenous and traditional ways of knowing rooted may be suppressed, hidden or misappropriated and repackaged for consumption in the Global South with Global North ways of knowing as a reference point. A global history of colonization has shaped this trend influencing postcolonial theorists and decolonial activists to question the legitimacy and depose the influence of dominant Global North ideas. This is evident in how communication skills, reflective practice and narratives are presented and taught. Global North students must be introduced to Global South ways of knowing before visiting the Global South from a position of critical consciousness. Emancipatory education is best led by transformative Global North-South dialogue.
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Affiliation(s)
- Thirusha Naidu
- Department of Behavioural Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, P/Bag X7, Congella, 4013, South Africa.
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Wong RKS, Vanderpuye V, Yarne J, Ndlovu N, Lasebikan N, Szumacher E, Kassam Z. Clinical research mentorship programme (CRMP) for radiation oncology residents in Africa-building capacity through mentoring. Ecancermedicalscience 2021; 15:1210. [PMID: 33912235 PMCID: PMC8057773 DOI: 10.3332/ecancer.2021.1210] [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: 06/17/2020] [Indexed: 11/19/2022] Open
Abstract
Research skills are mandatory for all oncology residency training programmes. Creating the environment to foster skills and passion can be a challenge in all settings, and a unique challenge in low and middle income countries (LMICs). Tremendous clinical workload places exceptional demand on clinician teachers, research infrastructure and access to research collaborators with diverse methodological skill sets can be limited. International collaborations, and in particular relationship partnerships (Whitehead et al ((2018) Acad Med 93 1760-1763)) can be a useful approach to bridge resource gaps and enrich the support available to trainees (Research EoH ((2014) TDR/ESSENCE/2.14)). The Clinical Research Mentorship Programme (CRMP) is a collaborative initiative created by the University of Toronto Department of Radiation Oncology, Princess Margaret Cancer Centre, delivered in collaboration with LMIC radiation oncology residency programmes with the primary goal of enriching the research experience of LMIC oncology trainees. It was inspired by observing a need, an enthusiasm to collaborate and some seed funding that supported the idea. At the heart of the programme is a formalised relationship, a triad, between a LMIC oncology trainee, their local supervisor and a mentor from Toronto. Within the collaborative environment created between the LMIC and high income country (HIC) institutions, enabled by remote learning technologies, a 12-week research methods seminar kick starts a year-long mentorship for the trainee on their research question. The goal is to enrich the quality of the research experience for the trainee, resulting in dissemination of research findings in international conferences and publications. A standard evaluation package is used (Vuple et al ((2021) 6 919-928)). In this paper, through a description of our collaboration, we will highlight how a distant mentorship programme was used to enhance clinical research mentorship skills for radiation oncology trainees in Africa. We hope the format we have chosen will continue to demonstrate effectiveness for our trainees, sustainability for our faculty and institutions and will serve as one mechanism to build radiation capacity for LMIC through collaboration, mentorship and research.
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Affiliation(s)
- Rebecca KS Wong
- Princess Margaret Cancer Center, University Health Network; Department of Radiation Oncology, University of Toronto, Toronto M5G 2M9, Ontario, Canada
| | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, PO Box KB369, Accra, Ghana
| | - Joel Yarne
- National Center for Radiotherapy Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, PO Box KB369, Accra, Ghana
| | - Ntokozo Ndlovu
- Parirenyatwa Radiotherapy Centre, Department of of Oncology, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | | | - Ewa Szumacher
- Odette Cancer Center, Sunnybrook Health Sciences Center; Department of Radiation Oncology, University of Toronto, Toronto M4N 3M5, Ontario, Canada
| | - Zahra Kassam
- Stronach Regional Cancer Center; Department of Radiation Oncology, University of Toronto, Toronto L3Y 2P9, Ontario, Canada
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Eichbaum QG, Adams LV, Evert J, Ho MJ, Semali IA, van Schalkwyk SC. Decolonizing Global Health Education: Rethinking Institutional Partnerships and Approaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:329-335. [PMID: 32349015 DOI: 10.1097/acm.0000000000003473] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Global health often entails partnerships between institutions in low- and middle-income countries (LMICs) that were previously colonized and high-income countries (HICs) that were colonizers. Little attention has been paid to the legacy of former colonial relationships and the influence they have on global health initiatives. There have been recent calls for the decolonization of global health education and the reexamination of assumptions and practices under pinning global health partnerships. Medicine's role in colonialism cannot be ignored and requires critical review. There is a growing awareness of how knowledge generated in HICs defines practices and informs thinking to the detriment of knowledge systems in LMICs. Additionally, research partnerships often benefit the better-resourced partner. In this article, the authors offer a brief analysis of the intersections between colonialism, medicine, and global health education and explore the lingering impact of colonialist legacies on current global health programs and partnerships. They describe how "decolonized" perspectives have not gained sufficient traction and how inequitable power dynamics and neocolonialist assumptions continue to dominate. They discuss 5 approaches, and highlight resources, that challenge colonial paradigms in the global health arena. Furthermore, they argue for the inclusion of more transfor mative learning approaches to promote change in attitudes and practice. They call for critical reflection and concomitant action to shift colonial paradigms toward more equitable partnerships in global education.
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Affiliation(s)
- Quentin G Eichbaum
- Q.G. Eichbaum is professor of pathology, microbiology and immunology, and director, Vanderbilt Pathology Program in Global Health, Vanderbilt University Medical Center, as well as professor of medical education and administration, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lisa V Adams
- L.V. Adams is associate dean for global health, associate professor of medicine and epidemiology, and director, Center for Global Health Equity, Geisel School of Medicine at Dartmouth and Dartmouth College, Hanover, New Hampshire; ORCID: http://orcid.org/0000-0002-1303-2154
| | - Jessica Evert
- J. Evert is assistant clinical professor, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, and executive director, Child Family Health International, Oakland, California; ORCID: http://orcid.org/0000-0002-3669-7693
| | - Ming-Jung Ho
- M.-J. Ho is professor, Department of Family Medicine, Georgetown University School of Medicine, associate director, Center for Innovation and Leadership in Education, Georgetown University Medical Center, and director of education research, MedStar Health, Washington, DC
| | - Innocent A Semali
- I.A. Semali is senior lecturer, Epidemiology, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Susan C van Schalkwyk
- S.C. van Schalkwyk is professor, Health Professions Education, and director, Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; ORCID: http://orcid.org/0000-0003-1596-6791
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Wondimagegn D, Soklaridis S, Yifter H, Cartmill C, Yeshak MY, Whitehead C. Passing the microphone: broadening perspectives by amplifying underrepresented voices. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:1139-1147. [PMID: 33175325 PMCID: PMC7656220 DOI: 10.1007/s10459-020-10012-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/30/2020] [Indexed: 05/17/2023]
Affiliation(s)
- Dawit Wondimagegn
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Sophie Soklaridis
- The Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street 1ES-559, Toronto, ON, M5G 2C4, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
- Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Helen Yifter
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Carrie Cartmill
- The Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street 1ES-559, Toronto, ON, M5G 2C4, Canada
| | - Mariamawit Yonathan Yeshak
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Cynthia Whitehead
- The Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street 1ES-559, Toronto, ON, M5G 2C4, Canada.
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
- Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
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Giuliani M, Frambach J, Broadhurst M, Papadakos J, Fazelad R, Driessen E, Martimianakis MAT. A critical review of representation in the development of global oncology curricula and the influence of neocolonialism. BMC MEDICAL EDUCATION 2020; 20:93. [PMID: 32228538 PMCID: PMC7106787 DOI: 10.1186/s12909-020-1989-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/28/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Global curricular homogenization is purported to have a multitude of benefits. However, homogenization, as typically practiced has been found to promote largely Western ideals. The purpose of this study was to explore the issue of representation in the development of global oncology curricula. METHODS This systematic review of global oncology curricula involved a comprehensive search strategy of eight databases from inception to December 2018. Where available, both controlled vocabulary terms and text words were used. Two investigators independently reviewed the publications for eligibility. Full global/core oncology curricular documents were included. Data analysis included exploration of representation across a number of axes of power including sex and geographic sector, consistent with a neocolonial approach. RESULTS 32,835 documents were identified in the search and 17 remained following application of the inclusion/exclusion criteria. Eleven of 17 papers were published from 2010 to 2018 and 13 curricula originated from Europe. The 17 curricula had 300 authors; 207 were male and most were from Europe (n = 190; 64%) or North America (n = 73; 24%). The most common curricular purposes were promoting quality patient care (n = 11), harmonization of training standards (n = 10), and facilitating physician mobility (n = 3). The methods for creation of these curricula were most commonly a committee or task force (n = 10). Over time there was an increase in the proportion of female authors and the number of countries represented in the authorship. CONCLUSION Existing global oncology curricula are heavily influenced by Western male authors and as a result may not incorporate relevant socio-cultural perspectives impacting care in diverse geographic settings.
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Affiliation(s)
- Meredith Giuliani
- Radiation Medicine Program, Princess Margret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, 610 University Ave, Toronto, ON M5G2M9 Canada
| | - Janneke Frambach
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | | | - Janet Papadakos
- Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rouhi Fazelad
- Information Sciences, Princess Margret Cancer Centre, Toronto, Canada
| | - Erik Driessen
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Frambach JM, Talaat W, Wasenitz S, Martimianakis MAT. The case for plural PBL: an analysis of dominant and marginalized perspectives in the globalization of problem-based learning. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:931-942. [PMID: 31624967 PMCID: PMC6908557 DOI: 10.1007/s10459-019-09930-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/07/2019] [Indexed: 06/10/2023]
Abstract
The globalization of problem-based learning (PBL) in health professions education has been both celebrated and criticized. Using a critical narrative review approach, underpinned by our archive of global PBL literature and a targeted literature search, we analyze these dominant global discourses of PBL in health professions education. More precisely, we explore what is missed when the globalization of PBL is theorized either as a positive consequence of standardization, or a problematic spread of Western educational ideals and values around the world. We make visible how two dominant global discourses, a universalist and culturalist discourse, have emerged in the global proliferation of PBL. We also discuss the limitations of the two discourses by demonstrating how they either ignore contextual and cultural diversity or see it as problematic. We then turn to a perspective that has been marginalized in the PBL literature that emphasizes the global origins of PBL, transcending the dichotomy between West and non-West. We make a case for relating to PBL as a plural construct in order to learn from the cultural and situational nuances of educational activities labeled PBL around the world. We argue that PBL as a singular and universal concept has no global future, yet versions of PBL may continue to thrive locally. Finally, we propose avenues for future research that may help elucidate the global and local values that underpin our curricula, as well as the socio-political factors that perpetuate neo-colonialist views and practices in the uptake and implementation of PBL approaches across the globe.
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Affiliation(s)
- Janneke M Frambach
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Wagdy Talaat
- Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Stella Wasenitz
- Department of Arts and Humanities, Teachers College, Columbia University, New York City, USA
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19
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Molina RL, Kasper J. The power of language-concordant care: a call to action for medical schools. BMC MEDICAL EDUCATION 2019; 19:378. [PMID: 31690300 PMCID: PMC6833293 DOI: 10.1186/s12909-019-1807-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/12/2019] [Indexed: 05/23/2023]
Abstract
We live in a world of incredible linguistic diversity; nearly 7000 languages are spoken globally and at least 350 are spoken in the United States. Language-concordant care enhances trust between patients and physicians, optimizes health outcomes, and advances health equity for diverse populations. However, historical and contemporary trauma have impaired trust between communities of color, including immigrants with limited English proficiency, and physicians in the U.S. Threats to informed consent among patients with limited English proficiency persist today. Language concordance has been shown to improve care and serves as a window to broader social determinants of health that disproportionately yield worse health outcomes among patients with limited English proficiency. Language concordance is also relevant for medical students engaged in health care around the world. Global health experiences among medical and dental students have quadrupled in the last 30 years. Yet, language proficiency and skills to address cultural aspects of clinical care, research and education are lacking in pre-departure trainings. We call on medical schools to increase opportunities for medical language courses and integrate them into the curriculum with evidence-based teaching strategies, content about health equity, and standardized language assessments. The languages offered should reflect the needs of the patient population both where the medical school is located and where the school is engaged globally. Key content areas should include how to conduct a history and physical exam; relevant health inequities that commonly affect patients who speak different languages; cultural sensitivity and humility, particularly around beliefs and practices that affect health and wellbeing; and how to work in language-discordant encounters with interpreters and other modalities. Rigorous language assessment is necessary to ensure equity in communication before allowing students or physicians to use their language skills in clinical encounters. Lastly, global health activities in medical schools should assess for language needs and competency prior to departure. By professionalizing language competency in medical schools, we can improve patients' trust in individual physicians and the profession as a whole; improve patient safety and health outcomes; and advance health equity for those we care for and collaborate with in the U.S. and around the world.
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Affiliation(s)
- Rose L. Molina
- Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215 USA
- Scholars in Medicine Office, Harvard Medical School, Boston, 02115 MA USA
| | - Jennifer Kasper
- Scholars in Medicine Office, Harvard Medical School, Boston, 02115 MA USA
- Pediatrics and Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115 USA
- Department of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115 USA
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20
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van der Aa JE, Scheele F, Goverde AJ, Teunissen PW. A qualitative study on harmonization of postgraduate medical education in Europe: negotiating flexibility is key. PERSPECTIVES ON MEDICAL EDUCATION 2019; 8:216-222. [PMID: 31297707 PMCID: PMC6684500 DOI: 10.1007/s40037-019-0523-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION International harmonization of postgraduate medical education is gaining importance in the globalization of medical education. Harmonization is regarded as the establishment of common standards in education, while maintaining regional or local freedom to adapt training to contexts. During the development of a harmonized curriculum, tensions between standardization and contextualization may surface. To allow future harmonization projects to recognize these tensions and deal with them in a timely manner, this study aims to gain insight into tensions that may arise when developing a harmonized curriculum for postgraduate medical education in Obstetrics and Gynaecology in Europe. METHODS Focus groups were held with international curriculum developers to discuss challenges that resulted from tensions between standardization and contextualization when developing a harmonized European curriculum for postgraduate medical education in Obstetrics and Gynaecology. Data were analyzed through conventional content analysis, using the principles of template analysis. RESULTS AND DISCUSSION Tensions between standardization and contextualization in the development of a harmonized curriculum were apparent in two domains: 1) Varying ideas about what the harmonized curriculum means for the current curriculum and 2) Inconsistencies between educational principles and the reality of training. Additionally, we identified ways of dealing with these tensions, which were characterized as 'negotiating flexibility'. Tensions between standardization and contextualization surfaced in the development phase of harmonizing a curriculum, partly because it was anticipated that there would be problems when implementing the curriculum.
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Affiliation(s)
- Jessica E van der Aa
- Department of Research and Education, OLVG Hospital, Amsterdam, The Netherlands.
- Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands.
| | - Fedde Scheele
- Department of Research and Education, OLVG Hospital, Amsterdam, The Netherlands
- Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands
- European Board & College of Obstetrics and Gynaecology, Brussels, Belgium
- Department of Obstetrics and Gynecology, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| | - Angelique J Goverde
- European Board & College of Obstetrics and Gynaecology, Brussels, Belgium
- Department of Reproductive Medicine and Gynaecology, University Medical Centre, Utrecht, The Netherlands
| | - Pim W Teunissen
- Department of Obstetrics and Gynecology, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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