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Frange A, Duffy S, Al-Rousan T, Evensen A, Nelson BD. Trainee Perspectives Regarding Advanced Clinical Global Health Fellowships in North America. Am J Trop Med Hyg 2021; 104:2286-2292. [PMID: 33872209 PMCID: PMC8176480 DOI: 10.4269/ajtmh.20-1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/10/2021] [Indexed: 11/07/2022] Open
Abstract
Postgraduate clinical global health (GH) training is a rapidly evolving field. To understand and improve training opportunities, we sought the perspectives of current and former trainees related to their advanced clinical training or global health fellowships and the anticipated impact on their careers. Clinical GH fellowships across North America were identified through websites and previous studies. An e-mail was sent to program directors to invite all current and former GH fellows to complete a web-based questionnaire. We contacted 100 GH fellowship programs. Fifty-two fellows from 10 different specialties completed the survey. The median fellowship length was 23.3 months, with an annual median of 4.8 months spent in low-income and middle-income countries, which was less than their reported ideal of 6 months. The majority reported satisfaction, the anticipation of career benefits, and that they would recommend fellowship training to others. Challenges included insufficient funding, mentorship, and formal curricula. Conducting research in high-income countries was a significant negative predictor of fellowship satisfaction. Most fellows (73.1%) were not at all or only a little concerned about the absence of fellowship accreditation, with only 17.3% desiring accreditation. Survey respondents were largely satisfied with their training and valued program flexibility and educational opportunities, including advanced tropical medicine certificates or diplomas. However, to improve fellowship training, improvements are needed in mentorship, standardized curricula, institutional support, and funding. For GH fellowship training to be effective and sustainable, institutions will need to balance the needs of fellows, training programs, and the communities (low-, middle-, and high-income countries) where the fellows serve.
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Affiliation(s)
- Adam Frange
- 1Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Sean Duffy
- 2Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tala Al-Rousan
- 3University of California San Diego Herbert Wertheim School of Public Health, La Jolla, California
| | - Ann Evensen
- 2Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Brett D Nelson
- 1Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- 4Divisions of Global Health and Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- 5Harvard Medical School, Boston, Massachusetts
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Al-Shakarchi N, Obolensky L, Walpole S, Hemingway H, Banerjee A. Global health competencies in UK postgraduate medical training: a scoping review and curricular content analysis. BMJ Open 2019; 9:e027577. [PMID: 31446406 PMCID: PMC6720244 DOI: 10.1136/bmjopen-2018-027577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess global health (GH) training in all postgraduate medical education in the UK. DESIGN Mixed methodology: scoping review and curricular content analysis using two GH competency frameworks. SETTING AND PARTICIPANTS A scoping review (until December 2017) was used to develop a framework of GH competencies for doctors. National postgraduate medical training curricula were analysed against this and a prior framework for GH competencies. The number of core competencies addressed and/or appearing in each programme was recorded. OUTCOMES The scoping review identified eight relevant publications. A 16-competency framework was developed and, with a prior 5-competency framework, used to analyse each of 71 postgraduate medical curricula. Curricula were examined by a team of researchers and relevant learning outcomes were coded as one of the 5 or 16 core competencies. The number of core competencies in each programme was recorded. RESULTS Using the 5-competency and 16-competency frameworks, 23 and 20, respectively, out of 71 programmes contained no global health competencies, most notably the Foundation Programme (equivalent to internship), a compulsory programme for UK medical graduates. Of a possible 16 competencies, the mean number across all 71 programmes was 1.73 (95% CI 1.42 to 2.04) and the highest number were in paediatrics and infectious diseases, each with five competencies. Of the 16 core competencies, global burden of disease and socioeconomic determinants of health were the two most cited with 47 and 35 citations, respectively. 8/16 competencies were not cited in any curriculum. CONCLUSIONS Equity of care and the challenges of practising in an increasingly globalised world necessitate GH competencies for all doctors. Across the whole of postgraduate training, the majority of UK doctors are receiving minimal or no training in GH. Our GH competency framework can be used to map and plan integration across postgraduate programmes.
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Affiliation(s)
| | - Lucy Obolensky
- Faculty of Medicine and Dentistry, Plymouth University Peninsula Medical School, Plymouth, UK
| | | | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
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Casanova Dias M, Abbara A, Gilbert R, van Schalkwyk MC, P Rees C, Ryland H, Leather AJ, Williams B, Crisp N. Equipping doctors for global health challenges. J R Soc Med 2017; 110:5-8. [PMID: 28106484 DOI: 10.1177/0141076816686349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Marisa Casanova Dias
- 1 MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK.,2 International Advisory Committee, Royal College of Psychiatrists, London E1 8BB, UK
| | - Aula Abbara
- 3 National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Rosie Gilbert
- 4 Moorfields Eye Hospital, UCL Institute of Ophthalmology, London EC1V 2PD, UK
| | | | - Claire P Rees
- 6 Junior International Committee, Royal College of General Practitioners, London NW1 2FB, UK
| | - Howard Ryland
- 7 Halswell Ward, Shaftesbury Clinic Forensic Unit, South West London and St. George's Mental Health NHS Trust, London SW17 7DJ, UK
| | - Andrew Jm Leather
- 8 King's Centre for Global Health and Health Partnerships, King's College London, London NW1 2FB, UK
| | - Bhanu Williams
- 9 Department of Paediatrics, London North West Healthcare NHS Trust, London HA1 3UJ, UK.,10 Royal College of Paediatrics and Child Health, London WC1X 8SH, UK
| | - Nigel Crisp
- 11 All Party Parliamentary Group on Global Health, House of Lords, London SW1A 0PW, UK
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Pope R, Shaker M, Ganesh P, Larkins-Pettigrew M, Pickett SD. Barriers to Global Health Training in Obstetrics and Gynecology. Ann Glob Health 2016; 82:625-629. [DOI: 10.1016/j.aogh.2016.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Walpole SC, Shortall C, van Schalkwyk MC, Merriel A, Ellis J, Obolensky L, Casanova Dias M, Watson J, Brown CS, Hall J, Pettigrew LM, Allen S. Time to go global: a consultation on global health competencies for postgraduate doctors. Int Health 2016; 8:317-23. [PMID: 27241136 PMCID: PMC5039817 DOI: 10.1093/inthealth/ihw019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/03/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Globalisation is having profound impacts on health and healthcare. We solicited the views of a wide range of stakeholders in order to develop core global health competencies for postgraduate doctors. METHODS Published literature and existing curricula informed writing of seven global health competencies for consultation. A modified policy Delphi involved an online survey and face-to-face and telephone interviews over three rounds. RESULTS Over 250 stakeholders participated, including doctors, other health professionals, policymakers and members of the public from all continents of the world. Participants indicated that global health competence is essential for postgraduate doctors and other health professionals. Concerns were expressed about overburdening curricula and identifying what is 'essential' for whom. Conflicting perspectives emerged about the importance and relevance of different global health topics. Five core competencies were developed: (1) diversity, human rights and ethics; (2) environmental, social and economic determinants of health; (3) global epidemiology; (4) global health governance; and (5) health systems and health professionals. CONCLUSIONS Global health can bring important perspectives to postgraduate curricula, enhancing the ability of doctors to provide quality care. These global health competencies require tailoring to meet different trainees' needs and facilitate their incorporation into curricula. Healthcare and global health are ever-changing; therefore, the competencies will need to be regularly reviewed and updated.
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Affiliation(s)
- Sarah C Walpole
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Hull York Medical School, York, UK
| | - Clare Shortall
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Doctors of the World, London, UK
| | - May Ci van Schalkwyk
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Royal Free Hospital, London, UK
| | - Abi Merriel
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Jayne Ellis
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Malawi Liverpool Wellcome Trust, Malawi
| | - Lucy Obolensky
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Global and Remote Healthcare, Plymouth University, Plymouth, UK
| | - Marisa Casanova Dias
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Camden & Islington NHS Foundation Trust, London, UK
| | - Jessica Watson
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Colin S Brown
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Hospital for Tropical Diseases, University College London Hospitals, London, UK
| | - Jennifer Hall
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Institute for Global Health, University College London, London, UK
| | - Luisa M Pettigrew
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Allen
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Weigel R, Robinson D, Stewart M, Assinder S. Entry characteristics and performance in a Masters module in Tropical Medicine: a 5-year analysis. Trop Med Int Health 2016; 21:792-8. [PMID: 27098188 DOI: 10.1111/tmi.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Postgraduate courses can contribute to better-qualified personnel in resource-limited settings. We aimed to identify how entry characteristics of applicants predict performance in order to provide support measures early. METHODS We describe demographic data and end-of-module examination marks of medical doctors who enrolled in a first semester module of two one-year MSc programmes between 2010 and 2014. We used t-tests and one-way anova to compare, and post hoc tests to locate differences of mean marks between categories of entry characteristics in univariate analysis. After exclusion of collinear variables, multiple regression examined the effect of several characteristics in multivariable analysis. RESULTS Eighty-nine students (47% male) with a mean age of 32 (SD 6.4) years who received their medical degree in the UK (19%), other European (22%), African (35%) or other countries (24%) attended the 3-months module. Their mean mark was 69.1% (SD 10.9). Medical graduates from UK universities achieved significantly higher mean marks than graduates from other countries. Students' age was significantly negatively correlated with the module mark. In multiple linear regression, place of medical degree (β = -0.44, P < 0.001) and time since graduation (β = -0.28, P = 0.007) were strongest predictors of performance, explaining 32% of the variation of mean marks. CONCLUSION Students' performance substantially differs based on their entry criteria in this 1st semester module. Non-UK graduates and mature students might benefit from early support.
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Affiliation(s)
- R Weigel
- Department of Education and Training, Liverpool School of Tropical Medicine, Liverpool, UK
| | - D Robinson
- Department of Education and Training, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Stewart
- Department of Education and Training, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Assinder
- Department of Education and Training, Liverpool School of Tropical Medicine, Liverpool, UK
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Harmer A, Lee K, Petty N. Global health education in the United Kingdom: a review of university undergraduate and postgraduate programmes and courses. Public Health 2015; 129:797-809. [PMID: 25749672 DOI: 10.1016/j.puhe.2014.12.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 10/17/2014] [Accepted: 12/01/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study reviews the current state of global health education (GHE) in the United Kingdom (UK) through the collation and synthesis of data on undergraduate and postgraduate global health degree programmes. It examines both the curriculum provided and profile of the student currently studying global health in the UK. STUDY DESIGN Descriptive, case study design. METHODS A systematic review of the literature identified a set of global health 'core competencies' that students could acquire through their chosen programme of study. Those competencies were synthesized and then compared to core and elective courses currently offered by global health degree programmes at UK universities. A questionnaire was designed and sent electronically to all global health Programme Directors requesting generic information regarding the profile of their global health students. RESULTS Fifteen universities in the UK, based in England and Scotland, offered twenty-five postgraduate and six undergraduate global health degree programmes in 2012-13. Two Universities were developing a full, three-year, undergraduate degree programme in global health. Sixteen core competencies for a medical and non-medical student constituency were identified. Of these, just three 'core competencies' - epidemiology of tropical diseases, health systems (including health system management), and health care services - corresponded directly to core and elective courses offered by >50% of UK universities. The five most frequently offered subjects were: health systems (including health system management), research methods, public health (including specialisations in prevention, treatment and care), epidemiology, and health economics. CONCLUSIONS GHE in UK universities has seen comparable growth to North American institutions, becoming Europe's regional hub for undergraduate and postgraduate courses and programmes. As with the US and Canadian experience, GHE at the undergraduate level is offered primarily to medical students through intercalated degree programmes. At the postgraduate level, there is more innovation in content and mode of delivery, with a small number of UK universities providing students from a diversity of backgrounds the opportunity to study global health from multidisciplinary perspectives. Distance learning is also seeking to make the delivery of GHE truly global, with a growing number of universities recognizing its potential to further innovate in global health pedagogy. While demand for GHE is predicted to remain robust, to ensure the needs of students and practitioners are met, more critical reflection on global health curricula, the desired profile of graduates, and equity of access is required.
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Affiliation(s)
- Andrew Harmer
- Global Public Health Unit, Social Policy, University of Edinburgh, Edinburgh, UK.
| | - Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Nico Petty
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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9
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Affiliation(s)
- Elizabeth Molyneux
- Department of Paediatric and Child Health, College of Medicine, , Blantyre, Malawi
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