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Abdalla ME, Taha MH, Onchonga D, Magzoub ME, Au H, O'Donnell P, Neville S, Taylor D. Integrating the social determinants of health into curriculum: AMEE Guide No. 162. MEDICAL TEACHER 2024; 46:304-316. [PMID: 37677074 DOI: 10.1080/0142159x.2023.2254920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The World Health Organization (WHO) defines the Social Determinants of Health (SDOH) as the non-medical factors influencing health outcomes. SDOH is associated with conditions in which people are born, grow, work, and live. Medical schools and licensing bodies are increasingly recognizing the need for doctors and healthcare professionals to be aware of their patient's social context and how it impacts their states of health and disease. However, there is considerable variation in the approaches of different institutions and countries to incorporating SDOH into their curricula. In order to allow clinicians to adopt a holistic approach to patient health, equipping them with extensive knowledge of SDOH would give learners the confidence, skills, knowledge, and attitudes needed to effectively engage with patients and their families. This approach aids health professionals with knowledge of the influence of the social context and cultural factors that affect patients' behaviors in relation to health. Incorporating the SDOH in medical and health professional school curricula would contribute towards adequately preparing future healthcare practitioners to provide effective, comprehensive, and equitable care, especially to marginalized and underserved populations. The Guide will take an evidence-based approach grounded in the available contemporary literature and case studies. The focus will be on integrating SDOH into undergraduate and postgraduate medical curricula to promote an understanding of the social factors that influence patients' and communities' health. Ultimately, this guide seeks to contribute to the reduction of inequalities in health.
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Affiliation(s)
| | - Mohamed Hassan Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, UAE
| | - David Onchonga
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Hosanna Au
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Siobhán Neville
- School of Medicine, University of Limerick, Limerick, Ireland
| | - David Taylor
- Gulf Medical University, Al Jurf, Ajman, United Arab Emirates
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Howell BA, Kristal RB, Whitmire LR, Gentry M, Rabin TL, Rosenbaum J. A Systematic Review of Advocacy Curricula in Graduate Medical Education. J Gen Intern Med 2019; 34:2592-2601. [PMID: 31385216 PMCID: PMC6848624 DOI: 10.1007/s11606-019-05184-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Professionalism standards encourage physicians to participate in public advocacy on behalf of societal health and well-being. While the number of publications of advocacy curricula for GME-level trainees has increased, there has been no formal effort to catalog them. OBJECTIVE To systematically review the existing literature on curricula for teaching advocacy to GME-level trainees and synthesize the results to provide a resource for programs interested in developing advocacy curricula. METHODS A systematic literature review was conducted to identify articles published in English that describe advocacy curricula for graduate medical education trainees in the USA and Canada current to September 2017. Two reviewers independently screened titles, abstracts, and full texts to identify articles meeting our inclusion and exclusion criteria, with disagreements resolved by a third reviewer. We abstracted information and themes on curriculum development, implementation, and sustainability. Learning objectives, educational content, teaching methods, and evaluations for each curriculum were also extracted. RESULTS After reviewing 884 articles, we identified 38 articles meeting our inclusion and exclusion criteria. Curricula were offered across a variety of specialties, with 84% offered in primary care specialties. There was considerable heterogeneity in the educational content of included advocacy curriculum, ranging from community partnership to legislative advocacy. Common facilitators of curriculum implementation included the American Council for Graduate Medical Education requirements, institutional support, and preexisting faculty experience. Common barriers were competing curricular demands, time constraints, and turnover in volunteer faculty and community partners. Formal evaluation revealed that advocacy curricula were acceptable to trainees and improved knowledge, attitudes, and reported self-efficacy around advocacy. DISCUSSION Our systematic review of the medical education literature identified several advocacy curricula for graduate medical education trainees. These curricula provide templates for integrating advocacy education into GME-level training programs across specialties, but more work needs to be done to define standards and expectations around GME training for this professional activity.
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Affiliation(s)
- Benjamin A Howell
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, USA.
- VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Ross B Kristal
- Yale Primary Care Internal Medicine Residency Program, Yale New Haven Hospital, New Haven, CT, USA
| | - Lacey R Whitmire
- Yale Primary Care Internal Medicine Residency Program, Yale New Haven Hospital, New Haven, CT, USA
| | - Mark Gentry
- John Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, CT, USA
| | - Tracy L Rabin
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Julie Rosenbaum
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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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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Knox KE, Lehmann W, Vogelgesang J, Simpson D. Community Health, Advocacy, and Managing Populations (CHAMP) Longitudinal Residency Education and Evaluation. J Patient Cent Res Rev 2018; 5:45-54. [PMID: 31413996 DOI: 10.17294/2330-0698.1580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Longitudinal education initiatives designed to prepare residents to address health disparities and social determinants of health (SDH) are needed. This report addresses this gap by describing a family medicine residency's Community Health, Advocacy, and Managing Populations (CHAMP) curriculum and its evaluation by learners, faculty, and community partners. The CHAMP longitudinal curriculum is explicitly designed to prepare residents to address health disparities and SDH. We report early outcomes, including community partner feedback, of this innovative curriculum. Methods Data were obtained through standardized rotation evaluations, thematic analysis of structured group and individual interviews, and aggregated competency milestone data. Kirkpatrick's four-level model to evaluate effectiveness of training was used to frame design and analysis of learner, faculty, and community partner evaluations. Results Twenty residents have completed the year-one curriculum, 8 residents the year-two curriculum, and 8 residents the year-two and year-three elective. Community partners, residents, faculty, and leadership all were satisfied with the curriculum, particularly regarding relationship building and mentorship. Overall satisfaction with the rotation, quantitatively and qualitatively, was positive. Competency milestone ratings improved within each year of training: first-year residents by 0.6 (3.0 for 2015-2016 and 3.6 for 2016-2017) and second-year residents by 0.1 (5.2 vs 5.3). Conclusions The CHAMP curriculum uniquely a) spans all three years of residency; b) combines block mandatory rotations with a longitudinal elective experience; and c) integrates community health, advocacy, and managing populations to meet accreditation requirements and prepare residents to address health disparities and SDH.
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Affiliation(s)
- Kjersti E Knox
- Family Medicine, Aurora Health Care, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Will Lehmann
- Family Medicine, Aurora Health Care, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Deborah Simpson
- Family Medicine, Aurora Health Care, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Sharma M, Pinto AD, Kumagai AK. Teaching the Social Determinants of Health: A Path to Equity or a Road to Nowhere? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:25-30. [PMID: 28445214 DOI: 10.1097/acm.0000000000001689] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Medical schools are increasingly called to include social responsibility in their mandates. As such, they are focusing their attention on the social determinants of health (SDOH) as key drivers in the health of the patients and communities they serve. However, underlying this emphasis on the SDOH is the assumption that teaching medical students about the SDOH will lead future physicians to take action to help achieve health equity. There is little evidence to support this belief. In many ways, the current approach to the SDOH within medical education positions them as "facts to be known" rather than as "conditions to be challenged and changed." Educators talk about poverty but not oppression, race but not racism, sex but not sexism, and homosexuality but not homophobia. The current approach to the SDOH may constrain or even incapacitate the ability of medical education to achieve the very goals it lauds, and in fact perpetuate inequity. In this article, the authors explore how "critical consciousness" and a recentering of the SDOH around justice and inequity can be used to deepen collective understanding of power, privilege, and the inequities embedded in social relationships in order to foster an active commitment to social justice among medical trainees. Rather than calling for minor curricular modifications, the authors argue that major structural and cultural transformations within medical education need to occur to make educational institutions truly socially responsible.
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Affiliation(s)
- Malika Sharma
- M. Sharma is an infectious diseases physician and Canadian Institutes of Health Research (CIHR) Canadian HIV Trials Network (CTN)/Canadian Foundation for AIDS Research (CANFAR) postdoctoral fellow, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. A.D. Pinto is a family physician and public health specialist, Department of Family and Community Medicine, St. Michael's Hospital, assistant professor, Department of Family and Community Medicine, Faculty of Medicine and Dalla Lana School of Public Health, University of Toronto, clinician-scientist, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and director, The Upstream Lab, Toronto, Ontario, Canada. A.K. Kumagai is endocrinologist, professor, and vice chair of education, Department of Medicine, University of Toronto, and F.M. Hill Chair in Humanism Education, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Wroe EB. A Novel Scenario-Based Interview Tool to Evaluate Nontechnical Skills and Competencies in Global Health Delivery. J Grad Med Educ 2017; 9:467-472. [PMID: 28824760 PMCID: PMC5559242 DOI: 10.4300/jgme-d-16-00848.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/26/2017] [Accepted: 04/12/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite rapid growth in the number of physicians and academic institutions entering the field of global health, there are few tools that inform global health curricula and assess physician readiness for this field. OBJECTIVE To address this gap, we describe the development and pilot testing of a new tool to assess nontechnical competencies and values in global health. Competencies assessed include systems-based practice, interpersonal and cross-cultural communication, professionalism and self-care, patient care, mentoring, teaching, management, and personal motivation and experience. METHODS The Global Health Delivery Competency Assessment Tool presents 15 case vignettes and open-ended questions related to situations a global health practitioner might encounter, and grades the quality of responses on a 6-point ordinal scale. We interviewed 17 of 18 possible global health residents (94%), matched with 17 residents not training in global health, for a total of 34 interviews. A second reviewer independently scored recordings of 13 interviews for reliability. RESULTS Pilot testing indicated a high degree of discriminant validity, as measured by the instrument's ability to distinguish between residents who were and were not enrolled in a global health program (P < .001). It also demonstrated acceptable consistency, as assessed by interrater reliability (κ = 0.53), with a range of item-level agreement from 84%-96%. CONCLUSIONS The tool has potential applicability to a variety of academic and programmatic activities, including evaluation of candidates for global health positions and evaluating the success of training programs in equipping practitioners for entry into this field.
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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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Evans FM, Mallepally NR, Dubowitz G, Vasilopoulos T, McClain CD, Enneking K. Factors influencing anesthesia residency selection: impact of global health opportunities. Can J Anaesth 2016; 63:674-81. [PMID: 27117988 DOI: 10.1007/s12630-016-0629-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/16/2015] [Accepted: 03/11/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE There is growing evidence to suggest that the current generation of medical students and young physicians is interested in global health. However, there are few data on the interest in global health by students pursuing a career in anesthesiology. The objective of this survey was to evaluate the importance of global health opportunities in regard to applicants' choice of anesthesiology residency programs. METHODS Anesthesiology residency program directors in the United States were invited to distribute an online survey to recently matched residents. To reduce study bias, the survey included a wide selection of reasons for program choices in addition to global health. Participants were asked to rate independently, on a scale of 1 to 10 (1 = least important, 10 = most important), the importance that each factor had on their selection of an anesthesiology residency program. RESULTS Of the 117 U.S. anesthesiology programs contacted, 87 (74%) distributed the survey. Completed surveys were obtained from 582 of 1,092 (53%) polled participants. All factors assessed were rated between 5 and 9 and the global health median [interquartile range] rating was 6 [3-7]. Nearly half of the survey respondents were interested in incorporating global health into future careers. More than three-quarters reported being interested in participating in, or reading about, global health activities during their residency. Responders with previous global health experience, or who were interested in an "in-country" experience, were more likely to choose programs that had global health opportunities available during residency. CONCLUSIONS Anesthesia residency program applicants are interested in global health. Having a global health opportunity was an important reason for choosing a residency program, comparable to some more traditional factors. Regardless of previous global health experience, the majority of future anesthesia residents are either planning or considering participation in global health activities during or after training.
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Affiliation(s)
- Faye M Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA, USA.
| | | | - Gerald Dubowitz
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | | | - Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA, USA
| | - Kayser Enneking
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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Bertelsen NS, DallaPiazza M, Hopkins MA, Ogedegbe G. Teaching global health with simulations and case discussions in a medical student selective. Global Health 2015; 11:28. [PMID: 26141160 PMCID: PMC4491235 DOI: 10.1186/s12992-015-0111-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 06/10/2015] [Indexed: 11/22/2022] Open
Abstract
Background Among US medical schools, demand for Global Health (GH) programs continues to grow. At the same time, cultural competency training has become a priority for medical students who will care for an increasingly diverse US patient population. We describe a pilot period for a new GH Selective designed to introduce medical students to global medicine and enhance culturally-sensitive communication skills. Methods As a 4-week clinical clerkship, the GH Selective was offered annually over a three-year period to a total of 33 students. Activities included clinical assignments, cultural competency and clinical skills simulations, patient case discussions in tropical medicine, journal clubs, and lectures. Faculty assessments of student performance and student evaluations of course content were focused on 6 course objectives, adapted from standardized GH objectives. Results For each offering of the GH Selective, at least 40 faculty members and fellows volunteered over 200 teaching hours from 11 medical school departments. Student feedback was consistently positive through competency-based curricular evaluations. As a result of its successes, the course is now offered on a biannual basis. Discussion Experiential, student-centered teaching employed in this course proved successful as an introduction to delivery of evidence-based and culturally sensitive GH. Special emphasis on working with standardized patients in interdisciplinary and cross-cultural simulations provided students with clinical skills applicable for care provided both locally and on international rotations. Conclusion With a special emphasis on cross-cultural sensitivity, this pilot elective trained future practitioners in fund of knowledge, clinical skills, and service delivery methods in GH. Electronic supplementary material The online version of this article (doi:10.1186/s12992-015-0111-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathan S Bertelsen
- Departments of Medicine and Population Health, New York University School of Medicine, Bellevue Hospital Center, 16N1, 462 First Ave, New York, NY, 10016, USA. .,Koç University School of Medicine, Rumeli Feneri Campus, Sariyer / Istanbul, Turkey.
| | - Michelle DallaPiazza
- Department of Medicine, Division of Infectious Diseases, New York University School of Medicine, New York, NY, USA
| | - Mary Ann Hopkins
- Department of Surgery, Director of Global Health Initiatives, New York University School of Medicine, New York, NY, USA
| | - Gbenga Ogedegbe
- Departments of Population Health and of Medicine, New York University School of Medicine, New York, NY, USA.,Global Institute of Public Health, New York University, New York, NY, USA
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Swain JD, Matousek AC, Scott JW, Cooper Z, Smink DS, Bolman RM, Finlayson SRG, Zinner MJ, Riviello R. Training surgical residents for a career in academic global surgery: a novel training model. JOURNAL OF SURGICAL EDUCATION 2015; 72:e104-e110. [PMID: 25911458 DOI: 10.1016/j.jsurg.2015.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/23/2014] [Accepted: 01/16/2015] [Indexed: 06/04/2023]
Abstract
Academic global surgery is a nascent field focused on improving surgical care in resource-poor settings through a broad-based scholarship agenda. Although there is increasing momentum to expand training opportunities in low-resource settings among academic surgical programs, most focus solely on establishing short-term elective rotations rather than fostering research or career development. Given the complex nature of surgical care delivery and programmatic capacity building in the resource-poor settings, many challenges remain before global surgery is accepted as an academic discipline and an established career path. Brigham and Women's Hospital has established a specialized global surgery track within the general surgery residency program to develop academic leaders in this growing area of need and opportunity. Here we describe our experience with the design and development of the program followed by practical applications and lessons learned from our early experiences.
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Affiliation(s)
- JaBaris D Swain
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexi C Matousek
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John W Scott
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas S Smink
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ralph Morton Bolman
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Michael J Zinner
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert Riviello
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Walker RJ, Campbell JA, Egede LE. Effective strategies for global health research, training and clinical care: a narrative review. Glob J Health Sci 2014; 7:119-39. [PMID: 25716404 PMCID: PMC4796426 DOI: 10.5539/gjhs.v7n2p119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/03/2014] [Indexed: 11/12/2022] Open
Abstract
The purpose of this narrative review was to synthesize the evidence on effective strategies for global health research, training and clinical care in order to identify common structures that have been used to guide program development. A Medline search from 2001 to 2011 produced 951 articles, which were reviewed and categorized. Thirty articles met criteria to be included in this review. Eleven articles discussed recommendations for research, 8 discussed training and 11 discussed clinical care. Global health program development should be completed within the framework of a larger institutional commitment or partnership. Support from leadership in the university or NGO, and an engaged local community are both integral to success and sustainability of efforts. It is also important for program development to engage local partners from the onset, jointly exploring issues and developing goals and objectives. Evaluation is a recommended way to determine if goals are being met, and should include considerations of sustainability, partnership building, and capacity. Global health research programs should consider details regarding the research process, context of research, partnerships, and community relationships. Training for global health should involve mentorship, pre-departure preparation of students, and elements developed to increase impact. Clinical care programs should focus on collaboration, sustainability, meeting local needs, and appropriate process considerations.
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Zhang PSL, Sim SC, Pong P, Islam N, Trinh-Shevrin C, Li S, Tsang T, Rey M. Evaluation of a Health Professionals' Training Program to Conduct Research in New York City's Asian American Community. AMERICAN JOURNAL OF HEALTH EDUCATION 2014; 15:97-104. [PMID: 24977241 DOI: 10.1080/19325037.2013.875964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Because health disparities among Asian Americans are understudied, a partnership program between the Charles B Wang Community Health Center and the Center for the Study of Asian American Health was created to increase awareness and interest in Asian American research. PURPOSE To evaluate the process, outcome, and impact of a health professionals' research training program. METHODS Mixed research methods were employed to collect data from online surveys administered to mentors and trainees of the program. RESULTS Although many trainees did not continue to pursue Asian American health disparities research, results indicate that the program has positive impacts on trainees in their preparedness to conduct CBPR, work within the Asian American community, and network with public health professionals and researchers. DISCUSSION This evaluation adds to the current literature of research training programs but more research on Asian American health disparities is needed. TRANSLATION TO HEALTH EDUCATION PRACTICE Although the program has helped raise awareness in Asian American health disparities research, more Asian American specific research training programs are needed to stimulate a true generation of researchers.
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Affiliation(s)
| | - Shao-Chee Sim
- Charles B Wang Community Health Center, New York City
| | - Perry Pong
- Charles B Wang Community Health Center, New York City
| | - Nadia Islam
- Center for Study of Asian American Health, New York City
| | | | - Shijian Li
- Center for Study of Asian American Health, New York City
| | - Thomas Tsang
- Charles B Wang Community Health Center, New York City
| | - Mariano Rey
- Center for Study of Asian American Health, New York City
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Toumi R. Globalization and health care: global justice and the role of physicians. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:71-80. [PMID: 23749250 DOI: 10.1007/s11019-013-9494-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In today's globalized world, nations cannot be totally isolated from or indifferent to their neighbors, especially in regards to medicine and health. While globalization has brought prosperity to millions, disparities among nations and nationals are growing raising once again the question of justice. Similarly, while medicine has developed dramatically over the past few decades, health disparities at the global level are staggering. Seemingly, what our humanity could achieve in matters of scientific development is not justly distributed to benefit everyone. In this paper, it will be argued that a global theoretical agreement on principles of justice may prove unattainable; however, a grass-roots change is warranted to change the current situation. The UNESCO Declaration on Bioethics and Human Rights will be considered as a starting point to achieve this change through extracting the main values embedded in its principles. These values, namely, respecting human dignity and tending to human vulnerability with a hospitable attitude, should then be revived in medical practice. Medical education will be one possible venue to achieve that, especially through role models. Future physicians will then become the fervent advocates for a global and just distribution of health care.
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Affiliation(s)
- Rabee Toumi
- Duquesne University, 300 Fisher Hall, 600 Forbes Ave., Pittsburgh, PA, 15282, USA,
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Yassi A, Breilh J, Dharamsi S, Lockhart K, Spiegel JM. The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm. JOURNAL OF ACADEMIC ETHICS 2013. [DOI: 10.1007/s10805-013-9182-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wallace EA, Miller-Cribbs JE, Duffy FD. An experiential community orientation to improve knowledge and assess resident attitudes toward poor patients. J Grad Med Educ 2013; 5:119-24. [PMID: 24404238 PMCID: PMC3613295 DOI: 10.4300/jgme-d-12-00015.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 05/12/2012] [Accepted: 06/25/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Future physicians may not be prepared for the challenges of caring for the growing population of poor patients in this country. Given the potential for a socioeconomic "gulf" between physicians and patients and the lack of curricula that address the specific needs of poor patients, resident knowledge about caring for this underserved population is low. INTERVENTION We created a 2-day Resident Academy orientation, before the start of residency training, to improve community knowledge and address resident attitudes toward poor patients through team-based experiential activities. We collected demographic and satisfaction data through anonymous presurvey and postsurvey t tests, and descriptive analysis of the quantitative data were conducted. Qualitative comments from open-ended questions were reviewed, coded, and divided into themes. We also offer information on the cost and replicability of the Academy. RESULTS Residents rated most components of the Academy as "very good" or "excellent." Satisfaction scores were higher among residents in primary care training programs than among residents in nonprimary care programs for most Academy elements. Qualitative data demonstrated an overall positive effect on resident knowledge and attitudes about community resource availability for underserved patients, and the challenges of poor patients to access high-quality health care. CONCLUSIONS The Resident Academy orientation improved knowledge and attitudes of new residents before the start of residency, and residents were satisfied with the experience. The commitment of institutional leaders is essential for success.
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Mitchell JA. Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum. JOURNAL OF TEACHING IN SOCIAL WORK 2012; 32:471-486. [PMID: 31289423 PMCID: PMC6615890 DOI: 10.1080/08841233.2012.725458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training vary widely. The additional training provided at places of employment and through continuing education after the master's degree is often inadequate for competently addressing the issues clinicians face in practice.
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Nelson BD, Kasper J, Hibberd PL, Thea DM, Herlihy JM. Developing a Career in Global Health: Considerations for Physicians-in-Training and Academic Mentors. J Grad Med Educ 2012; 4:301-6. [PMID: 23997872 PMCID: PMC3444181 DOI: 10.4300/jgme-d-11-00299.1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Global health is an expansive field, and global health careers are as diverse as the practice of medicine, with new paths being forged every year. Interest in global health among medical students, residents, and fellows has never been higher. As a result, a greater number of these physicians-in-training are participating in global health electives during their training. However, there is a gap between the level of trainee interest and the breadth and depth of educational opportunities that prepare them for a career in global health. OBJECTIVE Global health experiences can complement and enhance each step of traditional physician training, from medical school through residency and fellowship. Global health experiences can expose trainees to patients with diverse pathologies, improve physical exam skills by decreasing reliance on laboratory tests and imaging, enhance awareness of costs and resource allocation in resource-poor settings, and foster cultural sensitivity. The aim of this article is to describe issues faced by physicians-in-training and the faculty who mentor them as trainees pursue careers in global health. METHODS We conducted a narrative review that addresses opportunities and challenges, competing demands on learners' educational schedules, and the need for professional development for faculty mentors. CONCLUSIONS A widening gap between trainee interest and the available educational opportunities in global health may result in many medical students and residents participating in global health experiences without adequate preparation and mentorship. Without this essential support, global health training experiences may have detrimental consequences on both trainees and the communities hosting them. We discuss considerations at each training level, options for additional training, current career models in global health, and challenges and potential solutions during training and early career development.
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McCunn M, Speck RM, Chung I, Atkins JH, Raiten JM, Fleisher LA. Global health outreach during anesthesiology residency in the United States: a survey of interest, barriers to participation, and proposed solutions. J Clin Anesth 2012; 24:38-43. [PMID: 22284317 DOI: 10.1016/j.jclinane.2011.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 06/06/2011] [Accepted: 06/07/2011] [Indexed: 10/14/2022]
Abstract
STUDY OBJECTIVE To assess the interest in and barriers to pursuing global health outreach (GHO) experiences for anesthesiology residents in the United States. DESIGN Survey instrument. SETTING Academic department of anesthesiology. SUBJECTS Anesthesiology residents who were members of the American Society of Anesthesiologists (ASA). MEASUREMENTS An online survey was administered to residents in anesthesiology via the ASA membership database. Descriptive statistics, including means, frequencies, and percentages were calculated. MAIN RESULTS 91% of participants indicated an interest in GHO, of whom fewer than half (44%) had done a GHO medical mission. Seventy-nine percent reported that GHO affected their current practice or education; 33% commented they were now less wasteful with supplies and resources. Permission from work or obtaining work coverage were the primary barriers for both those with and without previous GHO participation. Of all respondents, 78% agreed that the availability of a GHO residency track would influence their ranking of that program for training, and 71% would pursue a GHO fellowship if available. CONCLUSIONS Anesthesiology residents have an interest in residency and fellowship GHO programs. Formalization of GHO programs during training may reduce work-related barriers associated with GHO participation and broaden academic program recruitment.
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Affiliation(s)
- Maureen McCunn
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA 19104-6112, USA.
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Abstract
This study seeks to assess the educational value of an international psychiatry elective using a cross section of psychiatric residents. In 2010, a 10-item semi-structured questionnaire was administered to Mount Sinai psychiatric residents who have participated in the Global Health Residency Track of the Mount Sinai School of Medicine. Authors reviewed the qualitative data and arrived at a consensus regarding trends and deviations regarding residents' experiences of their international field work. Six residents participated in this study. Common themes included exposure to sicker, treatment-naïve patients in resource scarce conditions, enhancement of cross-cultural communications skills, renewed appreciation for psychiatry, empowerment as teachers, and greater awareness of health-care systems. Knowing that an international elective existed would be a significant factor in their choice of residency. Respondents had concerns for the sustainability. Participants felt that the elective was a place to consolidate skills already learned during residency and resulted in increased professional confidence although it did not necessarily alter career paths. International electives can enrich psychiatric residency training in terms of understanding of mental health care systems, cross cultural psychiatry, sharpening diagnostic skills, building professional confidence and communication skills, and reaffirming motivation to practice psychiatry.
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Affiliation(s)
- Michele Wang
- Columbia Presbyterian Medical Center, New York, NY, USA.
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Wieland ML, Beckman TJ, Cha SS, Beebe TJ, McDonald FS. Residents' attitudes and behaviors regarding care for underserved patients: a multi-institutional survey. J Grad Med Educ 2011; 3:337-44. [PMID: 22942959 PMCID: PMC3179238 DOI: 10.4300/jgme-03-03-41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 11/02/2010] [Accepted: 11/10/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident physicians often encounter underprivileged patients before other providers, yet little is known about residents' attitudes and behaviors regarding these patients. OBJECTIVE To measure US resident physician attitudes regarding topics relevant to medically underserved patients, their behaviors (volunteerism) with underserved patients, and the association between attitudes and behaviors. METHODS In 2007 and 2008, 956 surveys on resident attitudes and behaviors about underserved patients were distributed to 18 residency programs in the United States. Survey content was based on existing literature and an expert needs assessment. The attitude assessment had 15 items with 3-point scales (range 0-1). The behavior assessment evaluated volunteering for underserved patients in the past, present, and future. RESULTS A total of 498 surveys (response rate = 52%) were completed. Attitudes regarding underserved patients were generally positive and more favorable for women than men (overall attitude score 0.83 versus 0.74; P = < .001). Rates of volunteering for underserved patients were high in medical school (N = 375, 76%) and anticipated future practice (N = 409, 84%), yet low during residency (N = 95, 19%). Respondents who volunteered regularly had more favorable attitudes than those who did not volunteer (overall average attitude score of 0.81 versus 0.73; P = <.001). Relationships between hours volunteered per-week and favorable attitudes about topics related to the underserved were significant across all 15 items in medical school and anticipated future practice (P value range of .035 to <.0001). CONCLUSIONS This survey revealed that US residents' attitudes towards topics regarding medically underserved populations are generally favorable. Rates of volunteerism for underserved patients were higher in medical school than during residency, and resident's anticipated rates of volunteerism in future practice volunteerism were approximately the same as rates of volunteerism in medical school. Resident attitudes are strongly correlated with volunteerism.
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Affiliation(s)
- Mark L Wieland
- Corresponding author: Mark L. Wieland, MD, MPH, 200 First Street SW, Rochester, MN 55904, 507-255-8715, 507-255-9189,
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Castillo J, Goldenhar LM, Baker RC, Kahn RS, DeWitt TG. Reflective practice and competencies in global health training: lesson for serving diverse patient populations. J Grad Med Educ 2010; 2:449-55. [PMID: 21976097 PMCID: PMC2951788 DOI: 10.4300/jgme-d-10-00081.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 06/02/2010] [Accepted: 06/15/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident interest in global health care training is growing and has been shown to have a positive effect on participants' clinical skills and cultural competency. In addition, it is associated with career choices in primary care, public health, and in the service of underserved populations. The purpose of this study was to explore, through reflective practice, how participation in a formal global health training program influences pediatric residents' perspectives when caring for diverse patient populations. METHODS Thirteen pediatric and combined-program residents enrolled in a year-long Global Health Scholars Program at Cincinnati Children's Hospital Medical Center during the 2007-2008 academic year. Educational interventions included a written curriculum, a lecture series, one-on-one mentoring sessions, an experience abroad, and reflective journaling assignments. The American Society for Tropical Medicine and Hygiene global health competencies were used as an a priori coding framework to qualitatively analyze the reflective journal entries of the residents. RESULTS Four themes emerged from the coded journal passages from all 13 residents: (1) the burden of global disease, as a heightened awareness of the diseases that affect humans worldwide; (2) immigrant/underserved health, reflected in a desire to apply lessons learned abroad at home to provide more culturally effective care to immigrant patients in the United States; (3) parenting, or observed parental, longing to assure that their children receive health care; and (4) humanitarianism, expressed as the desire to volunteer in future humanitarian health efforts in the United States and abroad. CONCLUSIONS Our findings suggest that participating in a global health training program helped residents begin to acquire competence in the American Society for Tropical Medicine and Hygiene competency domains. Such training also may strengthen residents' acquisition of professional skills, including the Accreditation Council for Graduate Medical Education competencies.
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Affiliation(s)
- Jonathan Castillo
- Corresponding author: Jonathan Castillo, MD, MPH, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, ML 7035, Cincinnati, OH 45229-3039, 513.636.4185,
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Wieland ML, Beckman TJ, Cha SS, Beebe TJ, McDonald FS. Resident physicians' knowledge of underserved patients: a multi-institutional survey. Mayo Clin Proc 2010; 85:728-33. [PMID: 20675511 PMCID: PMC2912734 DOI: 10.4065/mcp.2009.0703] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To measure actual and perceived resident physician knowledge of underserved patient populations. PARTICIPANTS AND METHODS Using the existing literature on vulnerable patient populations and interviews with experts in the field, we designed a cross-sectional, multi-institutional survey to assess actual and perceived resident knowledge of topics related to underserved populations. The survey of actual knowledge consisted of 30 multiple-choice questions, and the survey of perceived knowledge consisted of 15 items based on 3-point Likert scales of confidence. RESULTS A total of 498 surveys were completed at 18 residency programs representing 7 different specialties at 10 US institutions. Assessment of perceived knowledge demonstrated that residents were very confident only 14.0% of the time, somewhat confident 66.4% of the time, and not at all confident 19.6% of the time. Assessment of actual knowledge revealed that the average percent correct across all 30 questions was 38%. Women scored better than men (average score, 40.6% vs 36.0%; P=.01), and African Americans scored higher than members of other racial or ethnic groups (average score, 43.5% vs 38.0%; P=.04). Associations between residents' perceived and actual knowledge were generally high. CONCLUSION For the US residents surveyed, the actual and perceived knowledge about most topics relating to underserved populations was low, whereas associations between actual and perceived knowledge were high. These findings suggest the need to improve resident education regarding underserved patient populations.
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Affiliation(s)
- Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Twagirumugabe T, Carli F. Rwandan Anesthesia Residency Program: A Model of North-South Educational Partnership. Int Anesthesiol Clin 2010; 48:71-8. [DOI: 10.1097/aia.0b013e3181dd4f65] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Teaching health policy to residents--three-year experience with a multi-specialty curriculum. J Gen Intern Med 2009; 24:1322-6. [PMID: 19862580 PMCID: PMC2787946 DOI: 10.1007/s11606-009-1143-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 07/31/2009] [Accepted: 09/29/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Most residents have limited education or exposure to health policy during residency. AIMS We developed a course to (1) educate residents on health policy topics applicable to daily physician practice; (2) expose residents to health policy careers through visits with policy makers and analysts; (3) promote personal engagement in health policy. SETTING Residents registered for a 3-week elective offered twice annually through the George Washington University Department of Health Policy. PROGRAM DESCRIPTION The course format includes: daily required readings and small-group seminars with policy experts, interactive on-site visits with policy makers, and final team presentations to senior faculty on topical health policy issues. PROGRAM EVALUATION One hundred thirty residents from 14 specialties have completed the course to date. Seventy completed our post-course survey. Most participants [59 (84%)] felt the course was very or extremely helpful. Participant self-ratings increased from pre- to post-course in overall knowledge of health policy [2 (3%) good or excellent before, 58 (83%) after], likelihood of teaching policy concepts to peers [20 (25%) vs. 62 (86%)], and likelihood of pursuing further health policy training [28 (37%) vs. 56 (82%)]. CONCLUSIONS This 3-week elective in health policy improves self-reported knowledge and interest in health policy research, advocacy, and teaching.
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Philpott J, Batty H. Learning best together: social constructivism and global partnerships in medical education. MEDICAL EDUCATION 2009; 43:923-924. [PMID: 19709017 DOI: 10.1111/j.1365-2923.2009.03436.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Affiliation(s)
- Paul E Farmer
- Program in Infectious Disease and Social Change, Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, USA.
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Ivers LC, Garfein ES, Augustin J, Raymonville M, Yang AT, Sugarbaker DS, Farmer PE. Increasing access to surgical services for the poor in rural Haiti: surgery as a public good for public health. World J Surg 2008; 32:537-42. [PMID: 18320267 PMCID: PMC2267856 DOI: 10.1007/s00268-008-9527-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although surgical care has not been seen as a priority in the international public health community, surgical disease constitutes a significant portion of the global burden of disease and must urgently be addressed. The experience of the nongovernmental organizations Partners In Health (PIH) and Zanmi Lasante (ZL) in Haiti demonstrates the potential for success of a surgical program in a rural, resource-poor area when services are provided through the public sector, integrated with primary health care services, and provided free of charge to patients who cannot pay. Providing surgical care in resource-constrained settings is an issue of global health equity and must be featured in national and international discussions on the improvement of global health. There are numerous training, funding, and programmatic considerations, several of which are raised by considering the data from Haiti presented here.
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Affiliation(s)
- Louise C Ivers
- Division of Social Medicine and Health Inequalities, Department of Medicine, Brigham and Women's Hospital, 641 Huntington Avenue, Boston, MA 02115, USA
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