A global health capstone: an innovative educational approach in a competency-based curriculum for medical students

Integrating Public Health Into Undergraduate Medicine in North America: A Systematic Review

The coronavirus disease 2019 (COVID-19) pandemic has served as a stark reminder of the importance of foundational public health training for all physicians. However, the most effective way to incorporate these concepts into undergraduate medical education remains unclear. Here, we characterize the literature regarding the effectiveness of public health integration into undergraduate medical education in North America. We systematically searched MEDLINE, Embase, Cochrane Central, and Education Resources Information Center (ERIC) in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines for North American peer-reviewed literature, published from 01/01/2000 to 30/08/2021, that described outcomes of integrating public health training within an undergraduate medical curriculum. Results were qualitatively synthesized into key themes. A total of 38 studies, involving interventions across 43 medical schools, were included. Studies reported on a combination of public (n=13), global (n=9), population (n=9), community (n=6), and epidemiological (n=1) health interventions, and either implemented one-off workshops, electives, or international experiences (n=19); a longitudinal theme or long-term enrichment pathway (n=14); or a case-based learning curriculum (n=8). The majority (81.5%, 31/38) of integrations were self-described as successful and, of studies reporting on feasibility, most (94.1%, 16/17) were indicated as feasible. The definition of what constituted such success, however, was unclear. Innovative examples included the use of simulation workshops and mobile-optimized media content. Key challenges were noted, however, in securing adequate funding and buy-in from administrative leadership. Robust community partnerships and iterative cycles of implementation of the intervention were critical factors to success. In summary, foundational public health components can be effectively integrated into medical school curricula and would benefit from adequate resourcing, innovation, community partnerships, and continuous improvement.

From the Global North to the Global South: preparing students for away rotations

Makerere University College of Health Sciences, Kampala, Uganda, has established partnerships with several other institutions worldwide, including the University of Brescia and "Magna Græcia" University, which have agreed to collaborate for the primary purpose of student exchange. Our aim is to comment on students' preparation for away rotations based on the authors' own experiences and opinions alongside a review of selected papers on the preparation of students for global health and ethical collaboration. Medical electives represent a unique opportunity for all medical students, not merely for those who will work in resource-limited settings due to increasing globalization. The emergence of ethical international collaborations is of paramount importance to stimulate these projects and ensure that they are implemented safely and with adequate preparation even and especially during the COVID-19 pandemic.

Using Prompted Reflective Writing to Demonstrate Learning of Physician Competencies during Global Clinical Rotations

Global health education programs have grown in number and rigor with the development of learning objectives, competency frameworks, and assessment tools. This study aimed to assess whether prompted reflective writing could demonstrate medical student learning of physician competencies during global clinical rotations. From 2014 to 2018, 135 medical students who participated in global health clinical rotations responded to four reflective writing prompts. We conducted qualitative content analysis of 487 individual responses using grounded theory and an iterative process to identify themes associated with the eight American Association of Medical College physician competency domains. In response to prompted reflective writing assignments, students demonstrated learning related to all eight competencies. They reflected on systems-based practice while also sharing their growth in knowledge and skills related to personal and professional development, knowledge for practice, interprofessional collaboration, and patient care. In demonstrating practice-based learning and improvement, students additionally reflected on how the experiences during their global clinical rotations might influence their future careers as physicians. Our findings suggest that prompted reflective writing during global clinical rotations allows medical students to demonstrate learning in the competency domains expected of all physician trainees and to reflect on the application of this learning to current and future patient care. In reading students' writings, we found that prompted reflective writing during global clinical rotations offers an opportunity for students to illustrate the knowledge and skills they have acquired as physicians in training.