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Wells T, Parameshwar P, Marais H, Hoffman R, Arora G. Using Prompted Reflective Writing to Demonstrate Learning of Physician Competencies during Global Clinical Rotations. Am J Trop Med Hyg 2022; 106:tpmd210485. [PMID: 35292590 PMCID: PMC9128709 DOI: 10.4269/ajtmh.21-0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 01/05/2022] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Traci Wells
- David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Hendrik Marais
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Risa Hoffman
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Gitanjli Arora
- Keck School of Medicine, University of Southern California, Los Angeles, California
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2
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Standish K, McDaniel K, Ahmed S, Allen NH, Sircar S, Mira M, Khoshnood K. U.S. trainees' experiences of ethical challenges during research in low- and middle-income countries: A mixed methods study. Glob Public Health 2021; 17:1433-1449. [PMID: 34061716 DOI: 10.1080/17441692.2021.1933124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
High-income country (HIC) trainees are participating in research in low- and middle-income countries (LMIC) in increasing numbers, yet the ethical challenges they face have not been well described. We conducted a mixed methods study of U.S. graduate and undergraduate students who conducted research in LMIC, including an online survey and semi-structured interviews. Among 123 online survey respondents, 31% reported ethical challenges and nearly two-thirds of respondents did not feel well prepared to deal with ethical challenges. Qualitative analysis of the 17 semi-structure interviews and narrative survey responses revealed many themes of 'ethics in practice': challenges in setting research priorities, navigating relationships with host country partners, scope of research practice, and human subject protections. Respondents reported that pre-departure trainings were not reflective of ethical frameworks or research contexts in LMIC, and few described seeking host mentor help in addressing ethical challenges. These results suggest a need for improvements in training, oversight and mentorship of trainee researchers, and to further engage both HIC and LMIC institutions, educators and researchers in addressing ethical issues.
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Affiliation(s)
| | | | - Shirin Ahmed
- Yale Institute for Global Health, Yale University, New Haven, CT, USA
| | - Nikole H Allen
- Yale Institute for Global Health, Yale University, New Haven, CT, USA
| | | | - Meredith Mira
- Yale's Office of Career Strategy, New Haven, CT, USA
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3
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Lu PM, Mansour R, Qiu MK, Biraro IA, Rabin TL. Low- and Middle-Income Country Host Perceptions of Short-Term Experiences in Global Health: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:460-469. [PMID: 33298696 DOI: 10.1097/acm.0000000000003867] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Stakeholders have expressed concerns regarding the impact of visiting trainees and physicians from high-income countries (HICs) providing education and/or short-term clinical care in low- and middle-income countries (LMICs). This systematic review aimed to summarize LMIC host perceptions of visiting trainees and physicians from HICs during short-term experiences in global health (STEGH). METHOD In September 2018 then again in August 2020, the authors searched 7 databases (PubMed, Embase, Scopus, Web of Science, ERIC, Cochrane Library, Global Index Medicus) for peer-reviewed studies that described LMIC host perceptions of STEGH. They extracted information pertaining to study design, participant demographics, participant perceptions, representation of LMICs and HICs, and HIC visitors' roles and used thematic synthesis to code the text, develop descriptive themes, and generate analytical themes. RESULTS Of the 4,020 studies identified, 17 met the inclusion criteria. In total, the studies included 448 participants, of which 395 (88%) represented LMICs. The authors identified and organized 42 codes under 8 descriptive themes. They further organized these descriptive themes into 4 analytical themes related to STEGH: (1) sociocultural and contextual differences, (2) institutional and programmatic components, (3) impact on host institutions and individuals, and (4) visitor characteristics and conduct. CONCLUSIONS STEGH can have both beneficial and detrimental effects on LMIC host institutions and individuals. The authors translated these findings into a set of evidence-based best practices for STEGH that provide specific guidance for LMIC and HIC stakeholders. Moving forward, LMIC and HIC institutions must work together to focus on the quality of their relationships and create conditions in which all stakeholders feel empowered to openly communicate to ensure equity and mutual benefit for all parties.
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Affiliation(s)
- Paul M Lu
- P.M. Lu is assistant professor, Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-7519-9689
| | - Rania Mansour
- R. Mansour is a first-year medical student, St. George's, University of London, London, United Kingdom; ORCID: http://orcid.org/0000-0002-2822-5645
| | - Maylene K Qiu
- M.K. Qiu is systematic review coordinator, Biomedical Library, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-6912-3733
| | - Irene A Biraro
- I.A. Biraro is senior lecturer, Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; ORCID: http://orcid.org/0000-0002-8303-6046
| | - Tracy L Rabin
- T.L. Rabin is associate professor of medicine and director, Office of Global Health, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut; ORCID: http://orcid.org/0000-0002-4829-9051
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Schmid A, DeGrazia M, Mott S, Schuler E, Schenkel SR, Niescierenko M, Hickey PA. Pediatric nurses' perceptions of preparedness for global health fieldwork. J SPEC PEDIATR NURS 2020; 25:e12304. [PMID: 32692485 DOI: 10.1111/jspn.12304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/08/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this qualitative descriptive research study was to understand the current state, perceived content, and experiential needs of pediatric nurses preparing for global health (GH) fieldwork experience. This study aimed to inform stakeholders about the standard and unique preparation needs of pediatric GH nurses. STUDY DESIGN AND METHODS One group and five individual interviews were held with nurses from a large pediatric quaternary care facility in the Northeast United States. Data from the interviews were transcribed verbatim, eliminating personal data. Only deidentified transcripts were used for data analysis. Members of the study team used content analysis to systematically code and analyze the data. RESULTS Qualitative content analysis revealed five categories: (1) identifying clear objectives, (2) understanding the practice environment, (3) self-assessment of clinical skills, cultural competencies, and adaptability, (4) safety and logistics planning, and (5) psychological self-care and reentry anticipatory guidance. CONCLUSIONS Findings can provide a basis for program planning to prepare pediatric nurses for GH fieldwork. Program planning must account for the unique features of the site and situation. Organizational and personal preparation can influence the perceived success of the GH experience.
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Affiliation(s)
- Alexis Schmid
- Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Global Health Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Northeastern University, Boston, Massachusetts, USA
| | - Michele DeGrazia
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Sandra Mott
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ethan Schuler
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sara R Schenkel
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michelle Niescierenko
- Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Global Health Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia A Hickey
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Background: The interest in Global Health (GH) as an academic discipline has increased in the last decade. This article reports the findings of a scoping review of studies about Global Health education in the Americas. Objective: To analyse educational programs on global health in the Americas. Method: Five electronic databases were used in a scoping review: PubMed, Scopus, Web of Knowledge, CINAHL, and Lilacs. Data collection happened in November 2017–March 2018. The following stages were rigorously observed: identification, selection, charting, and summarizing the studies that were included. To process the data, we used IRaMuTeQ software. Findings: Forty-six studies were identified and organized in categories: 1) diversity of the topics addressed in GH; 2) models of teaching; 3) emotional, cultural, and collaborative aspects in teaching GH; 4) student preparation for GH experiences; and 5) structures required for a GH course. Conclusions: The existing global health curriculum in the Americas is diffuse and limited, with a greater focus on clinical aspects. Thus, a minimum curriculum for students from different areas is needed. Results evidenced that the teaching of global health in the Americas is still incipient, although it is promising. The lack of a common curriculum for the courses in the region makes it difficult to train sensitive and capable professionals to achieve the 2030 Sustainable Development Goals.
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Kalbarczyk A, Nagourney E, Martin NA, Chen V, Hansoti B. Are you ready? A systematic review of pre-departure resources for global health electives. BMC MEDICAL EDUCATION 2019; 19:166. [PMID: 31118015 PMCID: PMC6532266 DOI: 10.1186/s12909-019-1586-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 04/30/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND There has been an exponential increase in the offering of short-term international field experiences in recent years in response to student demands for global health opportunities. Pre-departure preparation is an essential component to equip trainees with the adequate safety, wellness, and cultural competence needed to engage in a meaningful and mutually beneficial elective. This review seeks to quantify the plethora of pre-departure preparation training available to public health, clinical, and undergraduate trainees across the continuum of education for short-term experiences in low-and middle-income countries (LMICs). METHODS We performed a systematic review of Pubmed, Embase, Web of Science, Scopus, and Ovid Global Health in February, 2018. A three-concept search was employed and included "global or international health"; "education or preparation of personnel/students"; and "field programs or travel." The study teamed used PRISMA reporting guidelines to conduct title and full-text reviews and conduct data extraction and analysis. RESULTS The search returned 2506 unique articles. Of these, 55 met inclusion criteria and were included in the final review. Ninety one percent (91%) of articles focused on pre-departure trainings for medical students and residents. Nine thematic domains for short-term international field experiences emerged; culture, safety, and project-specific knowledge were the most frequently covered domains while mentorship, professionalism, and emotional wellness and culture shock were least common. Approximately half (53.3%) of studies specifically evaluated the pre-departure component of the international experience using a survey or evaluation form. Recommendations emerged from these evaluations including early engagement with international partners, inclusion of self-reflection exercises and site-specific content, and utilization of interactive approaches in learning. Some institutions face barriers to conducting pre-departure preparation such as lack of dedicated faculty, finances, and institutional support. CONCLUSIONS Interest in pre-departure training for international experiences is growing but few programs conduct and publish evaluations of these trainings. Pre-departure trainings should be developed in partnership with receiving institutions and faculty and incorporate critical self- reflection throughout the experience. In addition to the experience itself, institutions need to evaluate these curricula to better understand how they influence trainees' capacity to effectively engage in LMIC settings.
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Affiliation(s)
- Anna Kalbarczyk
- Johns Hopkins Center for Global Health, Baltimore, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Emily Nagourney
- Johns Hopkins Center for Global Health, Baltimore, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nina A. Martin
- Johns Hopkins Center for Global Health, Baltimore, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Victoria Chen
- Johns Hopkins Center for Global Health, Baltimore, USA
| | - Bhakti Hansoti
- Johns Hopkins Center for Global Health, Baltimore, USA
- Johns Hopkins School of Medicine, Baltimore, USA
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7
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Kironji AG, Cox JT, Edwardson J, Moran D, Aluri J, Carroll B, Chen CCG. Pre-departure Training for Healthcare Students Going Abroad: Impact on Preparedness. Ann Glob Health 2018. [PMID: 30779518 PMCID: PMC6748281 DOI: 10.29024/aogh.2378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Many medical and nursing schools offer opportunities for students to participate in global health experiences abroad, but little is known about the efficacy of pre-departure training in preparing students for these experiences. Objectives: The primary aim was to identify characteristics of pre-departure training associated with participants’ reporting a high level of preparedness for their global health experiences. Secondary objectives included identifying students’ preferred subjects of study and teaching modalities for pre-departure training. Methods: A questionnaire was distributed to all medical and nursing students at our institution from 2013 to 2015. Questions addressed prior global health experiences and pre-departure training, preferences for pre-departure training, and demographic information. Findings: Of 517 respondents, 55% reported having a prior global health experience abroad, 77% of whom felt prepared for their experience. Fifty-three percent received pre-departure training. Simply receiving pre-departure training was not associated with perceived preparedness, but pre-departure training in the following learning domains was: travel safety, personal health, clinical skills, cultural awareness, and leadership. Perceiving pre-departure training as useful was also independently associated with self-reported preparedness. Students’ preferred instruction methods included discussion, lecture, and simulation, and their most desired subjects of study were travel safety (81%), cultural skills (87%), and personal health (82%). Conclusions: Incorporating travel safety, personal health, clinical skills, cultural awareness, and/or leadership into pre-departure training may increase students’ preparedness for global health experiences. Student perceptions of the usefulness of pre-departure training is also associated with self-reported preparedness, suggesting a possible “buy-in” effect.
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Affiliation(s)
| | - Jacob T Cox
- Johns Hopkins School of Medicine, Baltimore, MD, US
| | - Jill Edwardson
- Department of Gynecology and Obstetrics, John Hopkins School of Medicine, Baltimore, MD, US
| | - Dane Moran
- John Hopkins School of Medicine, Baltimore, MD, US
| | - James Aluri
- John Hopkins School of Medicine, Baltimore, MD, US
| | - Bryn Carroll
- John Hopkins School of Medicine, Baltimore, MD, US
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, US
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Lu PM, Park EE, Rabin TL, Schwartz JI, Shearer LS, Siegler EL, Peck RN. Impact of Global Health Electives on US Medical Residents: A Systematic Review. Ann Glob Health 2018; 84:692-703. [PMID: 30779519 DOI: 10.9204/aogh.2379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The prevalence of global health in graduate medical education in the United States (US) has soared over the past two decades. The majority of US internal medicine and pediatric residency programs now offer global health electives abroad. Despite the prevalence of global health electives among US graduate medical programs today, challenges exist that may impact the experience for visiting trainees and/or host institutions. Previous reviews have predominately focused on experiences of undergraduate medical students and have primarily described positive outcomes. OBJECTIVES The aim of this study was to summarize the overall impact of global health electives on US internal medicine, medicine-pediatric, and pediatric residents, paying specific attention to any negative themes reported in the literature. METHODS An Ovid MEDLINE and Ovid EMBASE literature search was conducted to identify studies that evaluated the effects of global health electives on US internal medicine, medicine-pediatric, and pediatric residents. FINDINGS Ten studies were included. Four positive themes emerged: (1) improvement of medical knowledge, physical examination, and procedural skills, (2) improvement in resourcefulness and cost-effectiveness, (3) improvement in cultural and interpersonal competence, and (4) professional and career development. Two negative themes were identified: (1) health risks and (2) safety risks. CONCLUSIONS Global health electives provide a number of perceived benefits for US medical trainees; however, we importantly highlight health and safety concerns described while abroad. Global health educators should recognize the host of unique challenges experienced during a global health elective and investigate how to best mitigate these concerns. Incorporation of mandatory pre-, intra-, and post-elective training programs and establishment of universally adopted global health best practice guidelines may serve to address some the challenges visiting trainees encounter while abroad.
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Affiliation(s)
- Paul M Lu
- Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, US
| | - Elizabeth E Park
- Department of Medicine, Weill Cornell Medical College, New York, NY, US
| | - Tracy L Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
| | - Jeremy I Schwartz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
| | - Lee S Shearer
- Department of Medicine, Weill Cornell Medical College, New York, NY, US
| | - Eugenia L Siegler
- Department of Medicine, Weill Cornell Medical College, New York, NY, US
| | - Robert N Peck
- Department of Medicine, Weill Cornell Medical College, New York, NY, US
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Kironji AG, Cox JT, Edwardson J, Moran D, Aluri J, Carroll B, Chen CCG. Pre-departure Training for Healthcare Students Going Abroad: Impact on Preparedness. Ann Glob Health 2018; 84:683-691. [PMID: 30779518 DOI: 10.9204/aogh.2378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many medical and nursing schools offer opportunities for students to participate in global health experiences abroad, but little is known about the efficacy of pre-departure training in preparing students for these experiences. OBJECTIVES The primary aim was to identify characteristics of pre-departure training associated with participants' reporting a high level of preparedness for their global health experiences. Secondary objectives included identifying students' preferred subjects of study and teaching modalities for pre-departure training. METHODS A questionnaire was distributed to all medical and nursing students at our institution from 2013 to 2015. Questions addressed prior global health experiences and pre-departure training, preferences for pre-departure training, and demographic information. Findings: Of 517 respondents, 55% reported having a prior global health experience abroad, 77% of whom felt prepared for their experience. Fifty-three percent received pre-departure training. Simply receiving pre-departure training was not associated with perceived preparedness, but pre-departure training in the following learning domains was: travel safety, personal health, clinical skills, cultural awareness, and leadership. Perceiving pre-departure training as useful was also independently associated with self-reported preparedness. Students' preferred instruction methods included discussion, lecture, and simulation, and their most desired subjects of study were travel safety (81%), cultural skills (87%), and personal health (82%). CONCLUSIONS Incorporating travel safety, personal health, clinical skills, cultural awareness, and/or leadership into pre-departure training may increase students' preparedness for global health experiences. Student perceptions of the usefulness of pre-departure training is also associated with self-reported preparedness, suggesting a possible "buy-in" effect.
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Affiliation(s)
| | - Jacob T Cox
- Johns Hopkins School of Medicine, Baltimore, MD, US
| | - Jill Edwardson
- Department of Gynecology and Obstetrics, John Hopkins School of Medicine, Baltimore, MD, US
| | - Dane Moran
- John Hopkins School of Medicine, Baltimore, MD, US
| | - James Aluri
- John Hopkins School of Medicine, Baltimore, MD, US
| | - Bryn Carroll
- John Hopkins School of Medicine, Baltimore, MD, US
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, US
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10
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Lu PM, Park EE, Rabin TL, Schwartz JI, Shearer LS, Siegler EL, Peck RN. Impact of Global Health Electives on US Medical Residents: A Systematic Review. Ann Glob Health 2018. [PMID: 30779519 PMCID: PMC6748170 DOI: 10.29024/aogh.2379] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: The prevalence of global health in graduate medical education in the United States (US) has soared over the past two decades. The majority of US internal medicine and pediatric residency programs now offer global health electives abroad. Despite the prevalence of global health electives among US graduate medical programs today, challenges exist that may impact the experience for visiting trainees and/or host institutions. Previous reviews have predominately focused on experiences of undergraduate medical students and have primarily described positive outcomes. Objectives: The aim of this study was to summarize the overall impact of global health electives on US internal medicine, medicine-pediatric, and pediatric residents, paying specific attention to any negative themes reported in the literature. Methods: An Ovid MEDLINE and Ovid EMBASE literature search was conducted to identify studies that evaluated the effects of global health electives on US internal medicine, medicine-pediatric, and pediatric residents. Findings: Ten studies were included. Four positive themes emerged: (1) improvement of medical knowledge, physical examination, and procedural skills, (2) improvement in resourcefulness and cost-effectiveness, (3) improvement in cultural and interpersonal competence, and (4) professional and career development. Two negative themes were identified: (1) health risks and (2) safety risks. Conclusions: Global health electives provide a number of perceived benefits for US medical trainees; however, we importantly highlight health and safety concerns described while abroad. Global health educators should recognize the host of unique challenges experienced during a global health elective and investigate how to best mitigate these concerns. Incorporation of mandatory pre-, intra-, and post-elective training programs and establishment of universally adopted global health best practice guidelines may serve to address some the challenges visiting trainees encounter while abroad.
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Affiliation(s)
- Paul M Lu
- Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, US
| | - Elizabeth E Park
- Department of Medicine, Weill Cornell Medical College, New York, NY, US
| | - Tracy L Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
| | - Jeremy I Schwartz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
| | - Lee S Shearer
- Department of Medicine, Weill Cornell Medical College, New York, NY, US
| | - Eugenia L Siegler
- Department of Medicine, Weill Cornell Medical College, New York, NY, US
| | - Robert N Peck
- Department of Medicine, Weill Cornell Medical College, New York, NY, US
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11
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Arora G, Esmaili E, Pitt MB, Green A, Umphrey L, Butteris SM, St Clair NE, Batra M, O'Callahan C. Pediatricians and Global Health: Opportunities and Considerations for Meaningful Engagement. Pediatrics 2018; 142:peds.2017-2964. [PMID: 30054345 DOI: 10.1542/peds.2017-2964] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 11/24/2022] Open
Abstract
Pediatric practitioners whose expertise is primarily focused on the care of children within health settings in the United States are increasingly engaged in global child health (GCH). The wide spectrum of this involvement may include incorporating short-term or longer-term GCH commitments in clinical care, teaching and training, mentoring, collaborative research, health policy, and advocacy into a pediatric career. We provide an overview of routes of engagement, identify resources, and describe important considerations for and challenges to better equipping US pediatric practitioners to participate in meaningful GCH experiences. This article is part of a series on GCH describing critical issues relevant to caring for children from an international perspective.
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Affiliation(s)
- Gitanjli Arora
- Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California;
| | - Emily Esmaili
- Department of Pediatrics, Lincoln Community Health Center, Durham, North Carolina.,Center for Health Policy and Inequalities Research and Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | - Michael B Pitt
- Department of Pediatrics, University of Minnesota and University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Andrea Green
- Departments of Pediatrics and Pediatric Primary Care, University of Vermont Children's Hospital, Burlington, Vermont
| | - Lisa Umphrey
- Doctors Without Borders/Médecins Sans Frontiéres, Sydney, Australia
| | - Sabrina M Butteris
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nicole E St Clair
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maneesh Batra
- Department of Pediatrics, University of Washington, Seattle, Washington; and
| | - Cliff O'Callahan
- Department of Pediatrics, Middlesex Hospital and University of Connecticut, Middletown, Connecticut
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12
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Arora G, Hoffman RM. Development of an HIV Postexposure Prophylaxis (PEP) Protocol for Trainees Engaging in Academic Global Health Experiences. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1574-1577. [PMID: 28445222 DOI: 10.1097/acm.0000000000001684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PROBLEM Global health (GH) education programs have become increasingly common in U.S. medical schools and graduate medical education programs, with growing numbers of medical students, residents, and fellows participating in clinical experiences in settings with high HIV prevalence and limited resources. However, there are no guidelines for provision of HIV postexposure prophylaxis (PEP) to trainees engaging in these academic GH experiences. APPROACH Faculty of the Global Health Education Programs (GHEP) at the David Geffen School of Medicine at UCLA and GH partner institutions recognized the need for PEP access for trainees engaged in GH experiences. In 2013-2014, key UCLA faculty collaborated in the development of the UCLA GHEP PEP Protocol, which includes provision of PEP medications to trainees prior to departure, an on-call infectious disease/HIV specialist to advise trainees who have exposures, and a system for following up with exposed trainees while on the GH rotation and after their return. OUTCOMES Between February 2014 and September 2016, 112 medical students and 110 residents received education on the PEP protocol during their predeparture orientation. The protocol was used for 28 exposures (27 occupational, 1 nonoccupational), with PEP recommended in 3 occupational cases (all needlesticks) and the single nonoccupational case. There were no reported HIV seroconversions. NEXT STEPS The authors plan to formally evaluate the PEP protocol, conduct a qualitative assessment with trainees and both UCLA and GH partner faculty, and discuss best practices with institutions across the United States and with GH partners.
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Affiliation(s)
- Gitanjli Arora
- G. Arora is assistant clinical professor, Department of Pediatrics, Division of Palliative Medicine, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, California. R.M. Hoffman is associate clinical professor, Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
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13
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Bensman RS, Slusher TM, Butteris SM, Pitt MB, On Behalf Of The Sugar Pearls Investigators, Becker A, Desai B, George A, Hagen S, Kiragu A, Johannsen R, Miller K, Rule A, Webber S. Creating Online Training for Procedures in Global Health with PEARLS (Procedural Education for Adaptation to Resource-Limited Settings). Am J Trop Med Hyg 2017; 97:1285-1288. [PMID: 28820680 DOI: 10.4269/ajtmh.16-0936] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The authors describe a multiinstitutional collaborative project to address a gap in global health training by creating a free online platform to share a curriculum for performing procedures in resource-limited settings. This curriculum called PEARLS (Procedural Education for Adaptation to Resource-Limited Settings) consists of peer-reviewed instructional and demonstration videos describing modifications for performing common pediatric procedures in resource-limited settings. Adaptations range from the creation of a low-cost spacer for inhaled medications to a suction chamber for continued evacuation of a chest tube. By describing the collaborative process, we provide a model for educators in other fields to collate and disseminate procedural modifications adapted for their own specialty and location, ideally expanding this crowd-sourced curriculum to reach a wide audience of trainees and providers in global health.
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Affiliation(s)
| | - Tina M Slusher
- Hennepin County Medical Center. Minneapolis, Minnesota.,University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Sabrina M Butteris
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Michael B Pitt
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
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14
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Arora G, Russ C, Batra M, Butteris SM, Watts J, Pitt MB. Bidirectional Exchange in Global Health: Moving Toward True Global Health Partnership. Am J Trop Med Hyg 2017; 97:6-9. [PMID: 28719333 PMCID: PMC5508910 DOI: 10.4269/ajtmh.16-0982] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/26/2017] [Indexed: 11/07/2022] Open
Abstract
Although there has been rapid growth in global health educational experiences over the last two decades, the flow of learners remains overwhelmingly one directional; providers from high-resourced settings travel to limited-resourced environments to participate in clinical care, education, and/or research. Increasingly, there has been a call to promote parity in partnerships, including the development of bidirectional exchanges, where trainees from each institution travel to the partner's setting to learn from and teach each other. As global health educators and steering committee members of the Association of Pediatric Program Directors Global Health Pediatric Education Group, we endorse the belief that we must move away from merely sending learners to international partner sites and instead become true global health partners offering equitable educational experiences. In this article, we summarize the benefits, review common challenges, and highlight solutions to hosting and providing meaningful global health experiences for learners from limited-resourced partner institutions to academic health centers in the United States.
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Affiliation(s)
- Gitanjli Arora
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Christiana Russ
- Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Maneesh Batra
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Sabrina M. Butteris
- Department of Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jennifer Watts
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Michael B. Pitt
- Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
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15
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Imperato PJ, Bruno DM, Monica Sweeney M. Ensuring the Health, Safety and Preparedness of U.S. Medical Students Participating in Global Health Electives Overseas. J Community Health 2017; 41:442-50. [PMID: 26882901 DOI: 10.1007/s10900-016-0169-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Global health electives based in resource-poor countries have become extremely popular with medical students from resource rich ones. As the number of such programs and participants increase, so too do the absolute health and safety risks. It is clear from a number of published reports that many institutions provide little or no meaningful preparedness for students and do little to ensure their health and safety. These deficiencies together can affect students, their foreign hosts, and sponsoring institutions. The School of Public Health at the State University of New York, Downstate Medical Center, and its predecessor, the Department of Preventive Medicine and Community Health, have sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purposes of this elective are to provide students with an opportunity to observe the health care and public health systems in resource-poor countries, provide medical service, and have a cross-cultural experience. Over the course of the past 35 years, 386 students have participated in this global health elective in more than 41 resource-poor countries. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews, has resulted in the selection of highly mature, adaptable, and dedicated students who have performed well at overseas sites. Appropriately preparing students for an overseas global health experience in resource-poor countries requires the investment of much professional and staff time and effort. At the SUNY Downstate School of Public Health, these resources have underpinned our Global Health in Developing Countries elective for many years. As a result, the elective is characterized by meticulous organization, extensive preparedness measures for students, and continuous monitoring of site and country safety. The health of students is ensured by one-on-one assessment of immunization needs, anti-malarials, and the provision of a five-day supply of post-exposure HIV prophylaxis. Students sign agreements regarding the legal issues, immunizations, and anti-malarials recommended as well as HIV post-exposure prophylaxis. They are also required to obtain medical evacuation insurance provided by the university, and medical care insurance valid overseas. Student travel plans are also approved as is in-country lodging. The focus of our 6-8 week global health elective is not clinical medicine. Rather, it is to enable students to learn about the health care and public health systems in a resource-poor country. Through that focus, they also come to understand the causes of health and health care disparities that exist in the country to which they are assigned. Our students are greatly advantaged with regard to cross-cultural understanding since our school is located in New York City's Borough of Brooklyn, where 40 % of the population was born outside of the U.S. Our comprehensive effort at risk management for this global health elective includes a thorough debriefing for each student upon his/her return. Special attention is given to ascertaining illness or injury while overseas, and, when necessary, immediate referral is made to an appropriate university clinical department where a student can be appropriately case managed. Meticulous oversight, careful selection of safe overseas sites, and attention to preparing students have resulted in significant risk reduction and successful experiences for the majority of our 386 students. This article describes the model we have developed for ensuring the health, safety, and preparedness of students participating in our global health elective.
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Affiliation(s)
- Pascal James Imperato
- School of Public Health, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, MSc 43, Brooklyn, NY, 11203, USA.
| | - Denise M Bruno
- School of Public Health, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, MSc 43, Brooklyn, NY, 11203, USA
| | - M Monica Sweeney
- School of Public Health, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, MSc 43, Brooklyn, NY, 11203, USA
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16
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Mishori R, Eastman A, Evert J. Improving the Safety and Security of Those Engaged in Global Health Traveling Abroad. GLOBAL HEALTH: SCIENCE AND PRACTICE 2016; 4:522-528. [PMID: 28031296 PMCID: PMC5199171 DOI: 10.9745/ghsp-d-16-00203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/04/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Ranit Mishori
- Georgetown University School of Medicine, Global Health Initiatives, Department of Family Medicine, Washington, DC, USA.
| | - Andrew Eastman
- Georgetown University/Providence Hospital Family Medicine Residency Program, Washington, DC, USA
| | - Jessica Evert
- University of California, San Francisco, Child Family Health International, San Francisco, CA, USA
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