Impact of Global Health Research Training on Career Trajectories: The Fogarty International Clinical Research Scholars and Fellows Program

Characteristics and Experiences Associated with Interest in Global Surgery: What Brings US Medical Students to the Field?

INTRODUCTION

An estimated 5 billion people lack access to safe surgical care. Development and nurturing of medical student interest in global surgery can play a part in addressing this need. This study examines characteristics and experiences of medical students in the United States (US) associated with interest in global surgery.

METHODS

A cross-sectional survey study of US-based medical students was performed. Student leaders from the Global Surgery Student Alliance were recruited via email and distributed the online survey to peers at their institutions. Responses from students currently training outside of the US were excluded, as were surveys with <80% completion. Descriptive statistics and multivariate analysis were performed with p < 0.05 indicating significance in R (Vienna, Austria).

RESULTS

About 708 responses from students at 38 US medical schools were analyzed. 251 students (34.6%) identified as being interested in global surgery. After adjusting for covariates on multivariable regression, demographic factors significantly associated with interest in global surgery were Hispanic/Latino ethnicity (in comparison to Non-Hispanic White/Caucasian, OR = 1.30) and being born outside of the United States (OR = 1.21). Increased interest was also associated with previous clinical experiences in low or middle-income countries (OR = 1.19), public or global health experiences (OR = 1.18), and international service experiences (OR = 1.13).

CONCLUSIONS

While many factors may influence student interest in global surgery, previous global health experience and nonclinical global service work are important predictors regardless of background. Our results suggest that medical educators should look to both international clinical and nonclinical collaborations as a means to cultivate and nourish global surgery interest in medical students.

Perceived importance and interest in research by Chilean primary care providers

BACKGROUND

Primary care providers (PCPs) are relevant stakeholders for primary care research (PCR).

OBJECTIVE

We report the perceived importance and interest in PCR of a national sample of Chilean PCPs.

METHODS

We conducted a cross-sectional study targeting Chilean PCPs. An electronic survey assessing perceived relevance of PCR, research training and experience, training interests, and demographics was disseminated through emails and WhatsApp messages. Descriptive statistics were used to summarize data. Logistic regression models were used to estimate adjusted probabilities and 95% confidence intervals for high interest in PCR, high interest in using research methods, and high interest in receiving research training, and predictors of these outcomes.

RESULTS

A total of 387 providers completed the online survey. Only 26.4% of PCPs had research experience as a principal or co-investigator. However, most clinicians perceived PCR as very important (92.5%) and were interested in using research methods (90.7%) and receiving training (94.3%). There were no statistically significant differences in these perceptions between provider's discipline, role, sex, age, and geographical location after adjusting for covariates.

CONCLUSIONS

Despite few Chilean PCPs have research training, a large majority perceive it as important, are interested in using it in their practice and would like to receive training.

Health research mentorship in low- and middle-income countries: a scoping review

OBJECTIVE

The objective of this scoping review was to explore and synthesize the available literature on health research mentorship in low- and middle-income countries (LMICs).

INTRODUCTION

Research mentorship is broadly considered a useful strategy to improve research capacities and research outputs. Existing literature and guidance on research mentorship have focused on high-income countries and assumed resource-rich environments. Despite the successful endeavors to improve health research capacity in LMICs, the strategies that work best under different circumstances are poorly understood. There is a need to map and understand the evidence on health research mentorship in the context of LMICs.

INCLUSION CRITERIA

Sources that reported existing practices, barriers, and mitigation strategies related to health research mentorship in LMICs were included.

METHODS

We searched for published and unpublished studies and reports written in English, Spanish, or Portuguese. The search strategy was not limited by search dates and the last search was conducted on January 28, 2022. The databases searched included MEDLINE (PubMed), Embase, Web of Science Core Collection, CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis . We also searched for gray literature in a selection of websites and digital repositories. The JBI scoping review methodology was used.

RESULTS

A total of 77 studies and reports were included in the review. The majority of the papers were from Africa (n=28). Others were from the Americas (n=7), South East Asia (n=4), East Mediterranean (n=2), and Western Pacific (n=2). The remaining studies were from LMICs that included at least 2 regional offices. Most of the mentorship projects (n=55) were initiated and funded by institutions from high-income countries. The first authors of 41 papers were primarily affiliated with LMICs. The findings were categorized under a description of research mentorship practices, barriers related to research mentorship, and suggested mitigation strategies. Deliverable-driven training using intensive hands-on mentorship and ongoing peer mentorship programs were some of the non-regular, non-institutionalized approaches used to improve research capacity for junior researchers in LMICs. None of the included papers focused on institutional components of research mentorship in LMICs. The barriers to research mentorship activities in LMICs included lack of clarity on mentorship, cultural variations, unbalanced power dynamics, socio-political influences, language barriers, lack of experienced mentors, and limited local funding. Institutionalizing research mentorship, adapting mentoring methodologies relying on local resources, and addressing and respecting diversity in mentorship programs were among the main strategies identified to effectively implement research mentorship in LMICs.

CONCLUSIONS

Research mentorship initiatives and practices are limited in LMICs. Few available practices have been introduced by researchers and research institutions from high-income countries and those that have are not yet institutionalized. The identified existing practices, barriers, and facilitators on health research mentorship could help the design, implementation, and evaluation of programs to institutionalize health research mentorship in LMICs.

REVIEW REGISTRATION

Open Science Framework osf.io/jqa9z/.

SUPPLEMENTAL DIGITAL CONTENT

A Spanish-language version of the abstract of this review is available as supplemental digital content: http://links.lww.com/SRX/A32.

Global Health Perspectives on Race in Research: Neocolonial Extraction and Local Marginalization

Best practices in global health training prioritize leadership and engagement from investigators from low- and middle-income countries (LMICs), along with conscientious community consultation and research that benefits local participants and autochthonous communities. However, well into the 20th century, international research and clinical care remain rife with paternalism, extractive practices, and racist ideation, with race presumed to explain vulnerability or protection from various diseases, despite scientific evidence for far more precise mechanisms for infectious disease. We highlight experiences in global research on health and illness among indigenous populations in LMICs, seeking to clarify what is both scientifically essential and ethically desirable in research with human subjects; we apply a critical view towards race and racism as historically distorting elements that must be acknowledged and overcome.

M. Johnson L, Du L, S. Dankishiya F, Byers MS, J. Ingles D, C. Heimburger D, H. Aliyu M. LMIC Research Centers' Experiences Hosting U.S. and LMIC Trainees: Evaluation of the Fogarty Global Health Fellows and Scholars Program, 2012 to 2020

In this mixed-methods study, we explore themes that emerged from a survey assessing the programmatic experiences of mentors and administrators at institutions in low- and middle-income countries (LMICs) hosting trainees supported by the Fogarty International Center's Global Health Program for Fellows and Scholars. A total of 89 of 170 potential respondents representing 31 countries completed the survey (response rate, 52.4%). There was agreement among respondents that their institutions received sufficient funds to support trainees and had the capacity to manage operational and financial aspects of the program. A majority also agreed that both LMIC and U.S. trainees were beneficial to the host institutions, and that trainee projects were relevant to the needs of the host country. Respondents felt that program benefits to LMIC trainees could be improved by increasing the research consumables budget, increasing the flexibility of program timelines, and increasing engagement between LMIC and U.S. trainees and institutions. Respondents indicated that both U.S. and LMIC trainees behaved professionally (including demonstrating respectful and ethical behavior) and took appropriate initiative to conduct their research projects. Findings from this study will help inform innovations to similar training initiatives that will enhance sustainability and improve program performance, and will be responsive to local needs.

The Danish-American Research Exchange (DARE): a cross-sectional study of a binational research education program

BACKGROUND

Most medical educational programs emphasize clinical observation or clinical skill acquisition, fewer focus upon research. The Danish-American Research Exchange (DARE) program, sponsored by the Lundbeck Foundation, is unique in that the medical student initiates biomedical research collaboration between Danish and US medical institutions. To achieve this, Danish medical students (DARE students) conduct binational mentored research projects while based in the United States for 10 months. In addition, DARE students are introduced to interdisciplinary thinking about how to develop ultra-low-cost healthcare interventions through the '$10 Challenge'.

METHODS

We conducted a cross-sectional study of DARE alumni over five consecutive years (2015-2020, n = 24). Research metrics included completion of a research project, primary authorship, and co-authorship of publications. The number of publications, prior to and after the DARE program were enumerated. For the first four cohorts, graduation from medical school and acceptance or intention to enter a joint MD-PhD program also were assessed. Two focus groups were conducted using constructivist grounded theory. Discussions were transcribed, redacted, and coded using Dedoose software.

RESULTS

DARE Medical students were 31.2 years (range 24-35), the majority were women (67%;16/24). The majority (17/24;71%) completed a first author publication in a peer-reviewed journal with a median of 3.9 per DARE alumnus. DARE alumnus reported increased proficiency in biostatistics, epidemiology, coding and public speaking as well as stronger research qualities in creativity, critical thinking, comfort in approaching scientist in both the US and Denmark (p < 0.001 for all). Qualitative key themes included: increased confidence, a deepening of research inquiry and linkage to a research network.

CONCLUSIONS

Preliminarily, this study suggests that medical students can initiate binational collaboration in medicine. Benefits include research productivity, intention to pursue academic medical careers, as well as positive impacts on motivation. This medical student-initiated research model lays the groundwork for using this model across other country pairs to promote binational collaboration.

Factors associated with producing a scientific publication during medical training: evidence from a cross-sectional study of 40 medical schools in Latin America

Background: Scientific publication during medical training is key to promoting enduring cutting-edge knowledge. The promotion of science among medical students in Latin America is a multisectoral issue that is hampered by the lack of governmental knowledge to invest in national research, as well as by the lack of support from local universities. This study aims to determine the factors associated with the production of a scientific publication during medical training among Latin American medical students of local scientific societies.

Methods: This is a secondary data analysis of a cross-sectional study conducted in 2016 that assessed the use of information and communication technologies (ICTs) among medical students from 40 local scientific societies of medical students affiliated with FELSOCEM. Teams from each local scientific society surveyed self-reported scientific publications and explored their association with socioeconomic, academic, and research training conditions. We applied nested models to identify the covariates associated with self-reported scientific publication, obtaining a parsimonious mixed-effects multilevel model grouped by medical scientific society.

Results: Of 11,587 participants, the prevalence of scientific publications increased in 36% among medical students affiliated to a Scientific Society of Medical Students [parsimonious prevalence ratio (pPR)=1.36, 95%CI=1.16–1.59], 51% among medical students with advanced English proficiency [pPR=1.51, 95%CI=1.21 – 1.87], 85% among medical students who attended a scientific writing skills course [pPR=1.85, 95%CI=1.59–2.15], 81% among medical students who use Sci-Hub [pPR=1.81, 95%CI=1.50–2.20], and 108% among medical students who have access to a pirated academic account [pPR=2.08, 95%CI=1.83–2.36].

Conclusions: Producing a scientific publication among medical students is associated with being affiliated to a scientific society of medical students, English proficiency, training in scientific writing, use of Sci-Hub, and pirated academic accounts. The results will help clinical educators and medical programs improve resources for training students in high-quality research

Expanding Global Health Engagement through Fogarty Fellowship Programs

Training the next generation of global health researchers is vital for sustainable research partnerships and global health equity. The Fogarty International Center (National Institutes of Health) supports postdoctoral fellows and professional/graduate students in long-term, hands-on mentored research in low- and middle-income countries (LMICs). We surveyed 627 alumni (58% from the United States, 42% from LMICs) from three sequential Fogarty-sponsored global health research training programs (response rate: N = 257, 41%). Publications in the Index Medicus were used to ascertain scholarly output. Most alumni (63%) reported remaining engaged in LMICs and/or worked in academic/research careers (70%). Since completing their Fogarty fellowship, 144 alumni (56%) had received 438 new grants as principal investigator (PI), co-/multi-PI, or site PI. The 257 responding alumni had 5,318 publications during and since their Fogarty fellowships; 2,083 (39%) listed the Fogarty trainee as the first or senior author. These global health training programs highlight the value of LMIC research experience in nurturing the global health research workforce.

Assessing the Impact of the Pediatric Orthopaedic Society of North America (POSNA) Visiting Scholar Program

BACKGROUND

The primary objective of the Pediatric Orthopaedic Society of North America (POSNA)-Children's Orthopaedics in Underserved Regions (COUR) Visiting Scholar Program is to engage emerging leaders from low-income and middle-income countries (LMICs) in POSNA educational offerings. This study aims to outline the educational and leadership activities pursued by the alumni of the POSNA-COUR Visiting Scholars Program. We hypothesized that there may be a discrepancy between visiting scholar interest level and actual participation in key follow-up educational and leadership activities.

METHODS

A 32-question online survey developed by the POSNA-COUR committee was electronically delivered to the POSNA-COUR visiting scholarship recipients from 2007 to 2019. The survey inquired about scholars' educational background, clinical practice, and academic interests. Respondents also reported educational, research, and leadership activities that occurred following program participation.

RESULTS

Fifty-seven percent (44/77) of the previous scholars participated in the survey. Sixty-eight percent reported that >75% of their practice was comprised of pediatric patients. The COUR scholarship afforded 15 scholars the opportunity to attend their first educational conference in North America. The majority (86%) of respondents consulted POSNA members on care-related issues, 52% organized a POSNA member's visit to their country, and 13% have become members of POSNA. Scholars shared their knowledge with colleagues through lectures (73%), demonstration of surgical skills (63%), mentorship (59%), hosting local courses (43%), and research (14%). There was a significant discrepancy between interest and actual participation in research (98% vs. 16%, P<0.0001), hosting a regional course (98% vs. 43%, P<0.0001), and becoming a member of POSNA (96% vs. 13%, P<0.0001).

CONCLUSIONS

The POSNA-COUR Visiting Scholar Program is effective at providing beneficial educational opportunities to orthopaedic surgeons from LMICs. There is, however, a significant discrepancy between reported scholar interest and actual engagement in leadership endeavors including: research, organization of regional courses, and POSNA membership. The impact of the POSNA-COUR visiting scholar program can be enhanced through collaboration with scholarship alumni in these key areas.

LEVEL OF EVIDENCE

Level IV-case series.

Challenges and Strategies for Biomedical Researchers Returning to Low- and Middle-Income Countries after Training

The brain drain of professionals from low- and middle-income countries (LMICs) to developed countries is well documented and partially due to the challenges faced by biomedical researchers to establish themselves back at home, after training abroad. These challenges may result in the loss of highly trained individuals from LMICs and reduce the availability of local expertise to develop/inform best practices in health care and to direct locally relevant research. The path of training of LMIC researchers in high-income countries is well documented. However, strategies for a successful reintegration of biomedical researchers back to their home research institutions in LMICs are less clear. We report observations of workshops addressing repatriation needs of researchers returning to their home countries after training abroad during the American Society of Tropical Medicine and Hygiene (ASTMH) 2017 and 2018 annual meetings. Strategies proposed include maintaining connections with the home research institution, ideally through collaborations, planning 18 months ahead before returning with grants applications submitted, and engaging in networking throughout the training period. In addition to presenting our observations, we hope to build a network to facilitate this process, compile resources, and identify expertise within the ASTMH to develop robust strategies to allow young biomedical researchers to flourish in LMICs.

Measuring Success in Global Health Training: Data From 14 Years of a Postdoctoral Fellowship in Infectious Diseases and Tropical Medicine

Background.

In modern academic medicine, especially in the fields of infectious diseases and global health, aspiring physician-scientists often wait years before achieving independence as basic, translational, and clinical investigators. This study employed mixed methods to evaluate the success of the Burroughs Wellcome Fund/American Society for Tropical Medicine and Hygiene (BWF/ASTMH) global health postdoctoral fellowship in promoting scientific independence.

Methods.

We examined quantitative data obtained from the National Institutes of Health (NIH) and qualitative data provided by the ASTMH and program participants to assess BWF/ASTMH trainees' success in earning NIH grants, publishing manuscripts, and gaining faculty positions. We also calculated the return on investment (ROI) associated with the training program by dividing direct costs of NIH research grants awarded to trainees by the direct costs invested by the BWF/ASTMH fellowship.

Results.

Forty-one trainees received fellowships between 2001 and 2015. Within 3 years of completing their fellowships, 21 of 35 (60%) had received career development awards, and within 5 years, 12 of 26 (46%) had received independent research awards. Overall, 22 of 35 (63%) received 1 or more research awards. BWF/ASTMH recipients with at least 3 years of follow-up data had coauthored a mean of 36 publications (range, 2-151) and 29 of 35 (82%) held academic positions. The return on investment was 11.9 overall and 31.8 for fellowships awarded between 2001 and 2004.

Conclusions.

Between 2001 and 2015, the BWF/ASTMH postdoctoral training program successfully facilitated progress to scientific independence. This program model underscores the importance of custom-designed postdoctoral training as a bridge to NIH awards and professional autonomy.

Global Health Career Interest among Medical and Nursing Students: Survey and Analysis

BACKGROUND

Global health experiences undertaken in international settings (GHEs) are becoming an increasingly prevalent aspect of health professions education and, as such, merit comprehensive analysis of the impact they have on students and host communities.

OBJECTIVE

To assess the associations between demographic/experiential factors and the interest of health professions students in careers involving global health.

METHODS

A cross-sectional survey was administered online to a convenience sample of medical and nursing students at Johns Hopkins University. Questions addressed level of interest in a global health career, prior GHEs, and demographic information. Items were either Likert scale or multiple choice. Various regression analyses were performed.

FINDINGS

Of 510 respondents, 312 (61.2%) expressed interest in a global health career and 285 (55.9%) had prior GHEs. Multivariate logistic regression found female sex, age ≥27 years, household income <$100,000/y, and a prior research-related GHE independently associated with higher interest in global health careers. On subset analysis of participants with one or more prior GHEs: age ≥27 years, household income <$100,000/y, a prior research-related GHE, and having multiple GHEs were each independently associated with increased interest in a global health career.

CONCLUSIONS

Simply participating in a global health experience abroad is not significantly associated with interest in a global health career. However, sex, age, household income, and research-related GHEs are significantly associated with global health career interest. These findings may inform the development of global health programs at medical and nursing schools and can guide efforts to increase the number of health care professionals entering global health careers.

The Benjamin H. Kean Travel Fellowship in Tropical Medicine: Assessment of Impact at 15 Years

The Benjamin H. Kean Fellowship in Tropical Medicine is an American Society of Tropical Medicine and Hygiene initiative that provides medical students with funding for international clinical or research experiences lasting at least 1 month. Of the 175 Kean fellows from 1998 to 2013, 140 had current available e-mails, and 70 of the 140 (50%) responded to a survey about their fellowship experience. Alumni indicated that the Kean Fellowship had a high impact on their career plans with regard to preparation for (N = 65, 94.2%) and inspiration to pursue (N = 59, 88.1%) a career in tropical medicine and global health. Continued involvement in tropical medicine and global health was common: 52 alumni (74.3%) were currently working in tropical medicine or global health, 49 (71.0%) had done so in the interim between the Kean fellowship and their current position; and 17 of 19 Kean fellows (89.4%) who had completed all medical training and were now in professional practice continued to work in tropical medicine and global health. Alumni had been highly productive academically, publishing a total of 831 PubMed-indexed manuscripts, almost all on tropical medicine or global health topics, in the period between their fellowship year and 2013. Alumni reported strengths of the fellowship including funding, networking, and flexibility, and suggested that more networking and career mentoring would enhance the program. The Benjamin H. Kean fellowship program has been highly successful at inspiring and fostering ongoing work by trainees in tropical medicine and global health.

HIV Strategic Information in Non-European Union Countries in the World Health Organization European Region: Capacity Development Needs

BACKGROUND

Capacity building of the national HIV strategic information system is a core component of the response to the HIV epidemic as it enables understanding of the evolving nature of the epidemic, which is critical for program planning and identification of the gaps and deficiencies in HIV programs.

OBJECTIVE

The study aims to describe the results of the assessment of the needs for further development of capacities in HIV strategic information systems in the non-European Union (EU) countries in the World Health Organization European Region (EUR).

METHODS

Self-administered questionnaires were distributed to national AIDS programs. The first questionnaire was sent to all countries (N=18) to find out, among other issues, the priority level for strengthening a range of HIV surveillance areas and their key gaps and weaknesses. The second questionnaire was sent to 15 countries to more specifically determine capacities for the analysis of the HIV care cascade.

RESULTS

Responses to the first questionnaire were received from 10 countries, whereas 13 countries responded to the second questionnaire. Areas that were most frequently marked as being of high to moderate priority for strengthening were national electronic patient monitoring systems, evaluation of HIV interventions and impact analysis, implementation science, and data analysis. Key weaknesseses were lack of electronic reporting of HIV cases, problems with timeliness and completeness of reporting in HIV cases, under-estimates of the reported number of HIV-related deaths, and limited CD4 count testing at the time of HIV diagnosis. Migrant populations, internally displaced persons, and refugees were most commonly mentioned as groups not covered by surveillance, followed by clients of sex workers and men who have sex with men. The majority of countries reported that they were able to provide the number of people diagnosed with HIV who know their HIV status, which is important for the analysis of cross-sectional and longitudinal HIV care cascades. Ability to report on some of the key impact indicators of HIV programs-viral load suppression and mortality-should be considerably strengthened.

CONCLUSIONS

The assessment found a substantial need to invest in surveillance capacities, which is a cornerstone in the development of an evidence-informed response to HIV epidemics.

Impact of Global Health Research Training on Scholarly Productivity: The Fogarty International Clinical Research Scholars and Fellows Program

In the Fogarty International Clinical Research Scholars and Fellows (FICRS-F) Program, 536 U.S. and international doctoral and postdoctoral health profession students and trainees completed 1-year research training at research centers in low- and middle-income countries. To evaluate the Program's impact, we analyzed data gathered prospectively during the Program, from PubMed, and from a representative survey of alumni. Of 100 randomly selected respondents, 94 returned the survey. Reflecting the sources of funding, human immunodeficiency virus/acquired immunodeficiency syndrome was the focus of 47% of the projects, but research in noncommunicable diseases (NCDs) and dual infection/NCD-related topics increased over time. Among the first 1,617 alumni publications, output was associated positively with being an international versus U.S. trainee, a postdoctoral Fellow versus predoctoral Scholar, and accumulation of more years post-training (all P < 0.001). Fellows were first author on a higher proportion of their articles than were Scholars (P < 0.001), and U.S. trainees were more often first author than international trainees (P = 0.04). Survey respondents had submitted 117 grant applications, and 79 (67.5%) had been funded. The FICRS-F Program yielded substantial research productivity in the early post-training years. Research outputs and impact will increase over time as alumni careers mature and they gain research independence and assume leadership positions.