Reflective practice and competencies in global health training: lesson for serving diverse patient populations

Implementation of a re-designed pre-departure training program for global health advanced pharmacy practice experiences

BACKGROUND AND PURPOSE

This article describes the re-design and preliminary impact of a pre-departure global health training program for nine advanced pharmacy practice experience (APPE) sites.

EDUCATIONAL ACTIVITY AND SETTING

The program was re-designed from a half-day orientation to a six-week (six-hour total) program. Students explored global health, cultural competency, adaptability, safety, and travel logistics. The program's impact on student learning was indirectly assessed using closed- and open-ended items on pre- and post-program surveys. Students reported self-perceived agreement with eight statements regarding travel logistics and 17 statements regarding global health.

FINDINGS

Fifty-five students took the pre-course survey, and 47 students took the post-program survey for response rates of 100% and 85%, respectively. Students indicated significant change on 23 out of 25 statements, demonstrating meaningful improvements in agreement in both global health, logistics, and safety. Students were most interested in learning about travel logistics and healthcare information about their specific country upon entry into the program. At the conclusion of the program, students most often reported learning about cultural competency and adaptability. Most students reported no remaining questions. Course design, delivery, and assessment experience was provided for two academic postdoctoral fellows through the implementation of the re-designed program.

SUMMARY

Students perceived improved understanding and comfort with global health concepts and travel logistics after the pre-departure program, despite the diverse nature of rotation sites covered. More research is needed to understand what impact a pre-departure training program has on the overall global health student experience.

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

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

Cultural Competency Curricula in US Graduate Medical Education: A Scoping Review

BACKGROUND

Cultural competency training provides participants with knowledge and skills to improve cross-cultural communication and is required for all graduate medical education (GME) training programs.

OBJECTIVE

The authors sought to determine what cultural competency curricula exist specifically in GME.

METHODS

In April 2020, the authors performed a scoping review of the literature using a multidatabase (PubMed, Ovid, MedEdPORTAL) search strategy that included keywords relevant to GME and cultural competency. The authors extracted descriptive data about the structure, implementation, and analysis of cultural competency curricula and analyzed these data for trends.

RESULTS

Sixty-seven articles met criteria for inclusion, of which 61 (91%) were focused exclusively on residents. The most commonly included specialties were psychiatry (n=19, 28.4%), internal medicine (n=16, 23.9%), and pediatrics (n=15, 22.4%). The shortest intervention was a 30-minute online module, while the longest contained didactics, electives, and mentoring programs that spanned the entirety of residency training (4 years). The sample sizes of included studies ranged from 6 to 833 participants. Eight (11.9%) studies utilized OSCEs as assessment tools, while 17 (25.4%) conducted semi-structured interviews or focus groups. Four common themes were unique interventions, retention of learning, trainee evaluation of curricula, and resources required for implementation.

CONCLUSIONS

Wide variation exists in the design, implementation, and evaluation of cultural competency curricula for residents and fellows.

Impact of Global Health Electives on Neurology Trainees

We surveyed neurologists who completed a global health experience as residents or fellows to assess the impact of the experience. A total of 100% (n = 72) would recommend the experience to others. Most reported improved clinical (86%) and examination (82%) skills. All gained an understanding of different health care systems, and 83% reported deeper commitment to underserved populations. A total of 41 participants (57%) reported more judicious use of resources upon return to the United States. Global health electives had a positive impact on neurology trainees. More attention to the host country perspective and predeparture training may help inform program structure and participant expectations in the future. ANN NEUROL 2021;89:851-855.

Global Health Experiences, Well-Being, and Burnout: Findings From a National Longitudinal Study

OBJECTIVE

Describe the demographics of pediatric and internal medicine/pediatric residents participating in global health (GH) experiences and examine relationships between GH involvement and self-perceived burnout, resilience, mindfulness, empathy, and spirituality.

METHODS

The Pediatric Resident Burnout and Resilience Study Consortium developed a national longitudinal study through collaboration with the Association of Pediatric Program Directors' Longitudinal Educational Assessment Research Network. Electronic surveys were administered to pediatric trainees annually (2016-2018). GH and well-being data were extracted. Descriptive statistics were calculated.

RESULTS

Of 9653 eligible pediatric and medicine/pediatric residents from 55 institutions, 6150 responded to the survey in 1 or more years, with average completion rate of 63.7% over a 3-year period. Controlling for repeat survey-takers, 12.7% (536/4213) of residents reported involvement in a GH-specific pathway, curricula, or track. GH participants were significantly more likely to be unmarried (P < .001), childless (P = .003), and medicine/pediatric trainees (P < .001). Controlling for repeated measures and demographic factors, GH participants demonstrated higher levels of empathic concern (P < .001) and higher spirituality scores in 2 of 3 domains (P < .01/<.05). GH involvement was not associated with lower reports of burnout or improved resilience/mindfulness.

CONCLUSION

Although GH involvement is associated with increased levels of empathy and spirituality, it was not protective against burnout in this study. This highlights the need to study and promote the well-being of all residents, and perhaps especially those experiencing the challenges of working in low-resource settings. Future efforts should determine the impact of predeparture training, programmatic support, and post-trip debriefing on resident well-being.

Reflective Journaling in Nursing Student Study Abroad Programs: Connecting Experience and Meaning

The purpose of this article is to describe the development and use of a framework of reflective journaling to help nursing and other health professions students understand their health-care experiences in study abroad courses. The framework provides specific, intentional, theory-based guidelines for connecting students' observations and experience with understanding of cultural differences that can lead to cultural humility (Foronda, Baptiste, Reinholdt, & Ousman, 2016).

International experiences during United States ophthalmology residency training: Current structure of international experiences and perspectives of faculty mentors at United States training institutions

Background

There is a high level of interest in international experiences during United States (U.S.) ophthalmology residency training among both program directors and trainees.

Methods

An electronic invitation to a 26-question survey was sent to all 114 U.S. ophthalmology residency program directors. The invitation requested that the survey be completed by the one faculty member who was most involved in overseeing the international experiences for the residents. The survey consisted of multiple choice and Likert-type scale questions. The Mann-Whitney U test was used for analysis of demographic data and Friedman’s test and Wilcoxon-Signed Rank test were used to analyze ranked responses.

Results

Responses were obtained from 70 faculty mentors representing unique programs, yielding a response rate of 61.4%. The majority of programs that responded (88.6%, n = 62) either offered international ophthalmology experiences for residents or supported residents finding their own experiences to go abroad. International experience participation rate among residents correlated with the number of years the experiences had been offered by the programs (p = 0.001). More than half of the respondents (55.0%, n = 33) felt that the residents benefited more than the hosts during these international experiences. Approximately half of the respondents (51.6%, n = 32) believed that additional training beyond what is covered in the standard curriculum to practice ophthalmology in the U.S. is necessary for practicing ophthalmology in an international setting.

Conclusions

There is high interest and participation in international experiences within U.S. ophthalmology residency programs. This high participation warrants further investigation into the long-term impact of these international experiences and how U.S. residency programs can structure these experiences to maximize the benefits to both the residents and the international host communities.

Learning Abroad: Residents' Narratives of Clinical Experiences From a Global Health Elective

BACKGROUND

While resident participation in global health (GH) rotations has grown, little is known about trainee perceptions of the personal value of these international clinical experiences and their importance to the objectives of GH training.

OBJECTIVE

We sought to better understand the clinical scenarios experienced during international rotations that residents perceived as most meaningful and the frequency of these experiences across scenarios and participating residents.

METHODS

Using the conceptual framework of Schön's reflection on action, we asked University of Minnesota GH track pediatric and internal medicine-pediatric residents to describe 10 clinical scenarios they found interesting or impactful during their 2016-2017 GH elective. We conducted a qualitative analysis of the deidentified resident narratives and mapped themes to the Accreditation Council for Graduate Medical Education (ACGME) competencies.

RESULTS

All eligible residents (n = 13) participated, yielding 129 unique clinical scenarios from 7 countries. We identified 5 thematic groups: (1) addressing challenges in making diagnoses in resource-limited settings; (2) dealing with patient outcomes different from those expected in the United States; (3) encountering and managing diseases in a different clinical context; (4) encountering and managing diseases in a different cultural context; and (5) reflecting on learning and self-growth. Of the 129 unique clinical scenarios, 30% (n = 39) had not been previously experienced by participants. Across the 5 themes, all ACGME core competencies were addressed.

CONCLUSIONS

Residents identified meaningful scenarios of their GH experiences that are relevant to the educational and clinical objectives of GH training.

Impact of Global Health Electives on US Medical Residents: A Systematic Review

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.

Impact of Global Health Electives on US Medical Residents: A Systematic Review

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.

Perceived Cultural Competency Skills and Deficiencies Among Pediatric Residents and Faculty at a Large Teaching Hospital

OBJECTIVES

To identify demographic, educational, and experiential factors associated with perceived self-efficacy in cultural competency (PSECC) for pediatric residents and faculty at a large, tertiary-care children's hospital and to identify key barriers to the delivery of culturally competent pediatric care.

METHODS

We conducted a cross-sectional assessment of cultural competency (CC) education, training, and skills using an online survey of residents and faculty at a large children's hospital. With our data analysis, we sought associations between PSECC skills, cross-cultural training or work experience, and demographic background. Participants were asked to identify and rank barriers to CC care and additional training they would like to see implemented.

RESULTS

A total of 114 residents (55%) and 143 faculty (65%) who responded to the survey assessing PSECC. Residents were more likely to have had CC training than faculty. More than half of the residents and faculty had participated in an underserved-group clinical experience domestically or abroad. Those residents with underserved-group experience were more likely to be comfortable with interpreter use (P = .03) and culturally sensitive issues (P = .06). Faculty who participated in underserved-group care in the United States were more likely to believe that cultural bias affects care (P = .005). Both identified time constraints, language barriers, and lack of knowledge as chief barriers to acquiring CC, and both desired more training.

CONCLUSIONS

Residents and faculty at a large children's hospital believe that they lack adequate CC training. Underserved-group clinical experiences both domestically and abroad are associated with perceived improved cross-cultural care skills. Increasing the extent and quality of CC education in both resident training and faculty development is needed.

Exploring the possibility of one-on-one mentoring as an alternative to the current student support system in medical education

PURPOSE

The purpose of this study was to explore the possibility of mentoring as an alternative to the current student support system based on our experiences of developing, operating, and evaluating a mentoring program.

METHODS

In 2014 and 2015, a total of 29 mentoring pairs were selected to be trained as mentors and mentees. The mentoring program was evaluated by the following methods. First, at the end of the one-on-one mentoring program, the mentee made a presentation summarizing their experiences and submitted a portfolio. Second, suggestions from the mentors and mentees were gathered from a survey and from a focus group interview. The quantitative data were analysed using descriptive statistics, frequency, and the Mann-Whitney U-test using SPSS version 21.0.

RESULTS

One-on-one mentoring sessions were carried out an average of five times during the semester. The topics of discussion were very diverse, including career coaching, personal counselling, journal club, field trips, leisure activities, and volunteering. Mentors and mentees showed high satisfaction rates regarding the content and administration of the program (mentors: 4.15±0.59, mentees: 4.00±1.58). However, the duration of the mentoring program was given a comparatively low rating (mentors: 3.15±1.09, mentees: 3.24±1.03).

CONCLUSION

Overall, the implementation of the mentoring program was successful. Based on the content of the main activities, we can confirm the possibility of implementing an individualized support program for solving the mentoring issues faced by medical students.

"The era of single disease cowboys is out": evaluating the experiences of students, faculty, and collaborators in an interdisciplinary global health training program

BACKGROUND

Global Health is an inherently interdisciplinary field but overseas training in global health, particularly among health science institutions, has been an 'individual' or 'individual discipline' experience. Team-based training is an approach to global health education which is increasing in popularity; research on team-training demonstrates that teams are more productive than individuals. In 2015, the Johns Hopkins Center for Global Health (CGH) developed the Global Established Multidisciplinary Sites (GEMS) program, an interdisciplinary training program which was designed to establish a new norm in global health training by bringing interdisciplinary teams of faculty and students together to identify and solve complex global health challenges. This research aims to evaluate the program's first year and contribute to the literature on interdisciplinary team training. We conducted 22 in-depth interviews with students, faculty, and local collaborators from 3 GEMS project sites. Findings were analyzed for themes through a framework approach.

RESULTS

The program exposed students, faculty, and collaborators to a wide range of disciplines in global health. Students' desire to learn how other disciplines contribute to global health solutions was an important motivator for joining GEMS; many participants including faculty and collaborators valued exposure to multiple disciplines. Mentorship and communication were a challenge across all teams in part due to members having distinct "disciplinary languages". Balancing disciplinary representation on teams and establishing work plans were also key challenges.

CONCLUSIONS

Based on the data the CGH provides four recommendations for institutions developing global health interdisciplinary teams to optimize team functioning and address challenges in mentorship, language, and roles: 1) address interdisciplinary communication early, 2) develop work plans during group formation, 3) meet as a team prior to travel, and 4) establish regular check ins. This article provides first-hand reflections on interdisciplinary team experiences in a global context and provides a pathway for the development of innovative strategies in global health training.

Taking it Global: Structuring Global Health Education in Residency Training

To meet the demand by residents and to provide knowledge and skills important to the developing physician, global health (GH) training opportunities are increasingly being developed by United States (U.S.) residency training programs. However, many residency programs face common challenges of developing GH curricula, offering safe and mentored international rotations, and creating GH experiences that are of service to resource-limiting settings. Academic GH partnerships allow for the opportunity to collaborate on education and research and improve health care and health systems, but must ensure mutual benefit to U.S. and international partners. This article provides guidance for incorporating GH education into U.S. residency programs in an ethically sound and sustainable manner, and gives examples and solutions for common challenges encountered when developing GH education programs.

Evaluation and Support Mechanisms of an Emerging University-wide Global Health Training Program

BACKGROUND

Global health education is in high demand in the United States, across the continuum of learning, and field experiences are an essential part of this education. However, evaluations of these programs are limited.

OBJECTIVES

The aim of this study was to evaluate a field placement program at Johns Hopkins University, in Baltimore, Maryland, to understand how to better support student training overseas and faculty mentorship.

METHODS

We used qualitative and quantitative methods to gather data from program reporting requirements (152 student surveys and 46 experiential narrative essays), followed by 17 semistructured interviews, and 2 focus groups. Data were analyzed through manual coding and a socioecological model served as an analytical and a synthesizing framework.

FINDINGS

A series of factors influence the participants' experience in overseas placements spanning across 4 aggregate levels, from individual to societal, including opportunity for professional advancement, independence, loneliness and illness, mentorship quality, funding, institutional partnership building, opportunity for public health contribution, and for development of cultural competency. Faculty and students thought that the program was beneficial to the learning experience, particularly for its contribution to experiential knowledge of a low- and middle-income country setting and for developing cross-cultural relationships. Communication and scope of work were 2 areas in which students and faculty members often had different expectations and many students emerged having cultivated different skills than they or their mentor initially expected. Students found the experience useful for both their academic and professional careers and faculty members saw mentorship, one of their professional responsibilities, emerge.

CONCLUSIONS

Many socioecological factors influence an overseas field experience, which in turn produces important effects on students' career choices, and faculty members appreciate the opportunity to serve as mentors. The most vital support mechanisms suggested for faculty and students included available funding, clear preparation, and communication facilitation across the experiential continuum.

Reentry to Pediatric Residency After Global Health Experiences

BACKGROUND AND OBJECTIVE

Although nonphysician reentry transitions have been characterized in literature, little is known about the reentry physicians in general, or residents in particular. We conducted a qualitative study to explore pediatric residents' reentry, using reverse culture shock as a conceptual framework.

METHODS

Eighteen pediatric residents who completed global health experiences in Africa (9 categorical residents with 1-month elective, 9 global child health residents with 12-month training) participated in interviews that included a card-sort to solicit emotional responses consistent with the conceptual framework. Data in the form of interview transcripts were coded and analyzed according to principles of grounded theory.

RESULTS

All pediatric residents, despite variable time abroad, reported a range of emotional responses on reentry to residency. Global child health residents felt disconnection and frustration more intensely than categorical residents, whereas categorical residents felt invigoration more intensely than global child health residents. Although residents met with program leadership after their return, no resident described these meetings as a formal debriefing, and few described a deliberate strategy for processing emotions on reentry.

CONCLUSIONS

Consistent with reverse culture shock, pediatric residents felt a range of emotions as they move toward a steady state of acculturating back into their residency program. Residency programs might consider creating safety nets to help cultivate support for residents when they reenter training.

The role of graduate medical education in global health: proceedings from the 2013 Academic Emergency Medicine consensus conference

The past 40 years have seen expanded development of emergency medicine (EM) postgraduate residency training programs worldwide. An important part of this educational experience is the ability of resident trainees to participate in experiences abroad. However, little is known about how these experiences shape trainees and the populations they serve. During the 2013 Academic Emergency Medicine consensus conference, a group of educators met to define and outline current trends in graduate medical education (GME) emergency care research. The authors discuss future research questions bridging the gap of GME and global health.

Views from the Global South: exploring how student volunteers from the Global North can achieve sustainable impact in global health

BACKGROUND

The body of research and practice regarding student volunteer abroad experiences largely focuses on ensuring the optimal learning experience for the student from the Global North, without equivalent attention to the benefits, if any, to the host institution in the Global South. In this debate article, we examine an often overlooked component of global student volunteer programs: the views of the local partner on what makes for a mutually beneficial partnership between volunteers from the Global North and institutions in the Global South.

DISCUSSION

To guide our discussion, we drew upon the experiences of a Kenyan NGO with a Canadian student volunteer in the summer of 2012, organized via a formalized partnership with a Canadian university. We found that the approach of the NGO to hosting the student mirrored the organizational behaviour theories of Margaret J. Wheatley, who emphasized a disorderly or 'chaotic' approach to acquiring impactful change, coupled with a focus on building solid human relationships. Rather than following a set of rigid goals or tasks, the student was encouraged to critically engage and participate in all aspects of the culture of the organization and country, to naturally discover an area where his priorities aligned with the needs of the NGO. Solid networks and interpersonal connections resulted in a process useful for the organization long after the student's short-term placement ended.

SUMMARY

Our discussion reveals key features of successful academic volunteer abroad placements: equal partnership in the design phase between organizations in the Global North and Global South; the absence of rigid structures or preplanned tasks during the student's placement; participatory observation and critical engagement of the student volunteer; and a willingness of the partners to measure impact by the resultant process instead of tangible outcomes.

International electives at the university of Minnesota global pediatric residency program: opportunities for education in all Accreditation Council for Graduate Medical Education competencies

PURPOSE

Globally competent pediatricians are in demand because of the increasing numbers of children from immigrant families living in the United States and the shortages of health care workers in low-income countries where the majority of the worlds' children live. This study sought to better understand the educational outcomes of international electives taken by pediatric residents training in global health.

METHODS

Thirty-two pediatric residents who participated in an international elective as part of a global health curriculum completed reflective essays which were analyzed for themes from 2006 to 2010. During the first-order analysis, the emergent themes mapped to the Accreditation Council for Graduate Medical Education (ACGME) competencies. In response, a second-order analysis re-examined the essays with an additional researcher to support categorization consistent with the ACGME competencies.

RESULTS

More than 90% of essays described experiences related to medical knowledge, patient care and systems-based practice. More than 50% included reflections on practice-based learning and improvement, professionalism, and interpersonal and communication skills. Residents also described the impact on their personal and professional development.

CONCLUSION

International electives can provide educational opportunities for residents to develop competency in each of the 6 ACGME domains and to reevaluate their life purpose and career goals. In addition to opportunities to increase their medical knowledge, patient care and communication skills, residents find international electives rich learning environments for systems-based practice, practice-based learning/improvement, and professionalism, domains that can be challenging to teach. These findings support the importance of international electives in global health in meeting core requirements in residency training.

The resident decision-making process in global health education: appraising factors influencing participation

The globalization of pediatric graduate medical education is ongoing; thus, this study was conducted to begin to explore the nature of resident interest in global health (GH) training and to further identify potentially modifiable factors influencing participation in away rotations. The authors surveyed all residents at Cincinnati Children's Hospital Medical Center to identify factors influencing participation in education efforts and away rotations. With a participation rate of 79.4% (n = 143), 5 key factors emerged as most significant in the decision-making process amid all participants. Among residents who had previous experience, 82.1% were interested in participating in an away elective compared with 58.3% of those without experience (P = .002). Residents with previous experience abroad were also more likely to plan to integrate GH into their careers (61.7% vs 26.7%, P < .0001). This article describes specific obstacles to resident participation in GH education and documents the association between previous experience and significant interest in long-term involvement.

Opportunities in global health education: a survey of the virtual landscape

BACKGROUND

A new generation of medical students is seeking residency programs offering global health education (GHE), and there is growing awareness of the benefits this training provides. However, basic factors that have an impact on its implementation and its effect on the residency match are insufficiently understood. The purpose of this study was to explore the extent of online information on GHE available to potential US pediatric residency program applicants.

METHODS

Pediatric residency programs' websites were systematically examined in 2007, 2008, and 2009 to extract available information on GHE.

RESULTS

In 2007, 147 websites (76.2%) had no information available on GHE; 40 (20.7%) mentioned international opportunities; and 6 (3.1%) provided evidence of a global health track or program. In 2008, 123 websites (63.1%) had no information available on GHE; 57 (29.2%) mentioned international opportunities; and 15 (7.7%) had a formal program. In 2009, 105 websites (53.6%) had no information available on GHE; 70 (35.7%) mentioned international opportunities; and 21 (10.7%) had a formal program. Between 2007 and 2009, the percentage of pediatric residency programs with information on GHE available nearly doubled from 23.8% to 46.4%. Within the same period, the number of formal GHE programs offered more than tripled.

CONCLUSIONS

By the 2009-2010 academic year, the websites for nearly half of the residency programs mentioned international experiences, yet only a small number of these residencies appeared to have developed a formal GHE program. Further, the websites for many residency programs did not include information on the international opportunities they offered, with programs running the risk of failing to attract and ultimately match global health-minded applicants.