Practical and Ethical Solutions for Remote Applied Learning Experiences in Global Health

Virtual global health education partnerships for health professional students: a scoping review

INTRODUCTION

Although there is rising interest in virtual global health (GH) education in light of the COVID-19 pandemic, there has been no report on the body of literature describing virtual education partnerships for health professional students. This scoping review examines virtual GH partnerships involving health professional students, including any barriers identified or best practices and ways to address them.

METHODS

We searched PubMed for studies describing virtual GH education partnerships using keywords related to GH, virtual learning, and partnerships. Inclusion criteria were that the activity was virtual, involved health professional students in two or more countries, and was reported in English or Spanish. In-person clinical electives and interventions that had not yet occurred were excluded. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

The search algorithm yielded 308 articles. Seventeen studies met full inclusion criteria. Four studies described asynchronous formats, whereas 13 were synchronous. Common challenges included scheduling challenges, language barriers, and technological limitations. Suggested improvements included having increased faculty support and expanding partnerships to multiple languages. The median MERSQI score was 8.25 out of 18 possible points.

CONCLUSION

There are limited studies investigating the effectiveness of virtual GH education partnerships, and more robust evaluation is needed to further understand the optimal role of virtual education in teaching GH skills. Despite logistical challenges, virtual partnerships can provide innovative GH education through bidirectional educational exchanges that students find valuable.

Access, interest and equity considerations for virtual global health activities during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Global health activities (GHAs) reduce health disparities by promoting medical education, professional development, and resource sharing between high- and low- to middle-income countries (HICs and LMICs). Virtual global health activities facilitated continuity and bidirectionality in global health during the COVID-19 pandemic. While virtual engagement holds potential for promoting equity within partnerships, research on equitable access to and interest in virtual global health activities is limited.

METHODS

We conducted a cross-sectional, online, mixed-methods survey from January to February 2022 examining access to virtual activities before and during the pandemic across resource settings. Eligible participants were participants or facilitators of global health activities. Closed- and open-ended questions elicited participants' access to and interest in virtual global health engagement.

RESULTS

We analyzed 265 surveys from respondents in 45 countries (43.0% LMIC vs. HIC 57.0%). HIC respondents tended to report greater loss of in-person access due to the pandemic at their own institutions (16 of 17 queried GHAs), while LMIC respondents tended to report greater loss of in-person activities at another institution (9 of 17 queried GHAs). Respondents from LMICs were more likely to gain virtual access through another organization for all 17 queried VGHAs. HIC respondents had significantly more access to global health funding through their own organization (p < 0.01) and more flexibility for using funds. There were significant differences and trends between respondent groups in different resource environments in terms of accessibility to and interest in different virtual global health activities, both during and after the pandemic.

CONCLUSIONS

Our results highlight the need to examine accessibility to virtual global health activities within partnerships between high- and low- to middle-income countries. While virtual activities may bridge existing gaps in global health education and partnerships, further study on priorities and agenda setting for such initiatives, with special attention to power dynamics and structural barriers, are necessary to ensure meaningful virtual global health engagement moving forward.

Decolonizing Global Child Health Education for More Equitable and Culturally Safe Collaborations

Global health (GH) as an academic field is fraught with both historical and present systemic injustice, including unilateral partnerships, power asymmetry in grant funding and research agenda setting, lack of acknowledgment of low- and middle-income countries' contributions, and bias toward high-income countries' institutions. Reflecting on colonialism and White supremacy's legacy is vital for training pediatricians to actively work to create more bidirectional partnerships to improve the health of all children worldwide. In this review, we discuss the present challenges within academic GH and offer four key action steps to decolonize GH education: (1) reflecting on the history of global child health; (2) creating a new language framework; (3) reviewing cultural humility, antiracism, and decolonization curricula; and (4) discussing institutional action steps to decolonize and sustain culturally safe global child health education. [Pediatr Ann. 2023;52(12):e467-e473.].

Scenario-Based e-Simulation Design for Global Health Education: Theoretical Foundation and Practical Recommendations

Electronic simulation (e-simulation)-particularly scenario-based e-simulation (SBES)-is an increasingly used, promising educational strategy for global health education that can address gaps in training access, effectiveness, and cost. However, there is little guidance for educators on how to develop an SBES, and guidance is lacking outside the clinical context. Moreover, literature on medical education rarely uses the theoretical basis for e-simulation design and development, including for SBES. Hence, we aim to differentiate and describe the concept, design elements, and theoretical basis of SBES with examples from different topics in global health. In addition to enhancing the understanding of the potential of SBES for global health education, this manuscript also provides practical recommendations for global health educators in designing and developing SBESs based on the existing literature and authors' experiences. Overall, this manuscript will be useful for global health educators as well as other medical educators seeking to develop an SBES for similar skill sets.

Developing a global medicine student pre- and post-travel curriculum

BACKGROUND

The popularity of short-term global health experiences amongst US medical students has been increasing. However, it remains a challenge for medical schools to comprehensively prepare students to work in an international environment and to contribute in ethically responsible and meaningful ways. Students of the Global Medicine program (GMED) of the UIC College of Medicine Center for Global Health set out to develop a pre-and-post travel curriculum that addresses some of these challenges.

METHODS

The students surveyed the literature of 66 published global health curricula and identified aspects of pre-and-post travel training that were found to be under-addressed. They then developed a curriculum in conjunction with GMED faculty that incorporated these identified aspects of pre-and-post travel training.

RESULTS

Five aspects of pre-and-post travel training were identified as being under-addressed in the literature while traveling. These domains include: [1] examining power relations associated with neo-colonization between and within countries; [2] training for bi-directional learning; [3] examining motivations and goals for participating in global health; [4] addressing personal resiliency and psychosocial wellbeing related to students' travel, and; [5] reflecting on the challenging aspects of the fieldwork experience.

CONCLUSIONS

The student-driven curriculum is being integrated into the GMED program through structured didactic sessions, one-on-one mentor meetings and small group discussions. Once students have traveled, the curriculum will be evaluated with the foreign partners they visited.

Decolonizing Global Child Health Education for More Equitable and Culturally Safe Collaborations

Global health (GH) as an academic field is fraught with both historical and present systemic injustice, including unilateral partnerships; power asymmetry in grant funding and research agenda setting; lack of acknowledgment of contributions from low- and middle-income country collaborators; and disadvantageous bias toward low- and middle-income country institutions. Reflecting on the legacies of colonialism and White supremacy is vital for training pediatricians to actively work to improve the health of all children worldwide, within bidirectional and culturally safe partnerships in which power dynamics and ethnocentrism are dismantled. In this article, we discuss the present challenges within academic GH education (GHE) and offer four key action steps to decolonize GHE: (1) reflecting on the history of global child health; (2) creating a new language framework on pertinent concepts in GHE; (3) developing cultural humility, antiracism, and decolonization curricula; and (4) intentional institutional action steps to decolonize and sustain culturally safe global child health education. [Pediatr Ann. 2023;52(9):e344-e350.].

Pediatrics in Disasters: Evolution of a Hybrid Global Health Training Program During the COVID-19 Pandemic

This report describes the Pediatrics in Disasters (PEDS) course during a novel hybrid in-person and virtual format due to the coronavirus disease 2019 pandemic. International and local faculty collaborated on 2021 precourse revisions and course facilitation for multinational in-person and virtual students. Student and facilitator 2021 surveys and 2019 to 2021 student feedback reported overall satisfaction with the course while suggesting needed improvements to maximize international and virtual student participation. The hybrid PEDS course structure successfully achieved course goals and incorporated international faculty. Lessons learned will guide future course revisions and fellow global health educators.

Educational approaches to teach students to address colonialism in global health: a scoping review

INTRODUCTION

The enduring legacy of colonisation on global health education, research and practice is receiving increased attention and has led to calls for the 'decolonisation of global health'. There is little evidence on effective educational approaches to teach students to critically examine and dismantle structures that perpetuate colonial legacies and neocolonialist control that influence in global health.

METHODS

We conducted a scoping review of the published literature to provide a synthesis of guidelines for, and evaluations of educational approaches focused on anticolonial education in global health. We searched five databases using terms generated to capture three concepts, 'global health', 'education' and 'colonialism'. Pairs of study team members conducted each step of the review, following Preferred Reporting Items for Systematic reviews and Meta-Analyse guidelines; any conflicts were resolved by a third reviewer.

RESULTS

This search retrieved 1153 unique references; 28 articles were included in the final analysis. The articles centred North American students; their training, their evaluations of educational experiences, their individual awareness and their experiential learning. Few references discussed pedagogical approaches or education theory in guidelines and descriptions of educational approaches. There was limited emphasis on alternative ways of knowing, prioritisation of partners' experiences, and affecting systemic change.

CONCLUSION

Explicit incorporation of anticolonial curricula in global health education, informed by antioppressive pedagogy and meaningful collaboration with Indigenous and low-income and middle-income country partners, is needed in both classroom and global health learning experiences.

Pharmacy student perceptions of remote learning and wellness during the pandemic: Lessons learned from a metropolitan commuter city

INTRODUCTION

The purpose of this study was to assess pharmacy student perceptions of remote learning experiences and personal well-being during the COVID-19 pandemic in a metropolitan commuter city.

METHODS

A survey was developed and sent to pharmacy students from the three pharmacy colleges in New York City in January 2021. The survey domains consisted of demographics, personal well-being, classroom experiences, and pandemic and post-pandemic preferred learning modalities and reasons.

RESULTS

From a total of 1354 students from professional years one, two, and three across the three colleges, completed responses were received from 268 students (20% response rate). More than half of the respondents (55.6%) reported a negative impact of the pandemic on their well-being. More than half of the respondents (58.6%) reported more time to study. When students were asked their preferred mode of pharmacy education delivery during the pandemic and post-pandemic, a quarter (24.5%) preferred remote learning for all courses during the pandemic, and only a quarter (26.8%) preferred traditional classrooms for all courses post-pandemic. Approximately 60% of the respondents preferred some type of remote learning post-pandemic.

CONCLUSIONS

Pharmacy student learning has been and continues to be impacted by the COVID-19 pandemic, especially for pharmacy students in New York City. This study sheds light on the remote learning experiences and preferences of pharmacy students in a commuter city. Future studies could assess pharmacy student learning experiences and preferences after return to campus.

Establishing a Virtual Global Health Education Partnership: The Cleveland-Cusco Connection

INTRODUCTION

The Cleveland-Cusco Connection (CCC) elective was created during the COVID-19 pandemic to continue global health (GH) education for Case Western Reserve University (CWRU) and Universidad Nacional de San Antonio Abad del Cusco (UNSAAC) medical students. The CCC elective was held over Zoom and aimed to promote international collaboration, knowledge about health systems, and perspectives in GH with synchronous and asynchronous learning.

METHODS

Peruvian and US medical students participated in six monthly sessions consisting of student presentations and large and small group discussions. The elective was led collaboratively by CWRU and UNSAAC students. We evaluated students' experience using pre- and post-course surveys.

RESULTS

Nineteen students (76%) completed the post-course survey. The median rating for meeting each course objective was "somewhat effective" on a 5-point scale ranging from "very ineffective" to "very effective." All respondents would recommend the course to a friend. Common barriers included language challenges, fatigue from other coursework, and technology issues. Seven students' pre- and post-course surveys could be linked. The number of students who agreed with the statements assessing course objectives increased for all questions between the pre- and post-test, with only the number agreeing that they understood the Peruvian healthcare system increasing significantly (p < 0.05).

DISCUSSION

The CCC elective provides a valuable GH educational opportunity via a virtual platform. Students reported that learning from their peers was effective and enjoyable.

CONCLUSION

Virtual GH electives like the CCC may offer benefits in terms of cost, equity, and flexibility and merit further investigation.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01626-6.

Virtual global health in graduate medical education: a systematic review

OBJECTIVES

To synthesize recent virtual global health education activities for graduate medical trainees, document gaps in the literature, suggest future study, and inform best practice recommendations for global health educators.

METHODS

We systematically reviewed articles published on virtual global health education activities from 2012-2021 by searching MEDLINE, EMBASE, Cochrane Library, ERIC, Scopus, Web of Science, and ProQuest Dissertations & Theses A&I. We performed bibliography review and search of conference and organization websites. We included articles about primarily virtual activities targeting for health professional trainees. We collected and qualitatively analyzed descriptive data about activity type, evaluation, audience, and drivers or barriers. Heterogeneity of included articles did not lend to formal quality evaluation.

RESULTS

Forty articles describing 69 virtual activities met inclusion criteria. 55% of countries hosting activities were high-income countries. Most activities targeted students (57%), with the majority (53%) targeting trainees in both low- to middle- and high-income settings. Common activity drivers were course content, organization, peer interactions, and online flexibility. Common challenges included student engagement, technology, the internet, time zones, and scheduling. Articles reported unanticipated benefits of activities, including wide reach; real-world impact; improved partnerships; and identification of global health practice gaps.

CONCLUSIONS

This is the first review to synthesize virtual global health education activities for graduate medical trainees. Our review identified important drivers and challenges to these activities, the need for future study on activity preferences, and considerations for learners and educators in low- to middle-income countries. These findings may guide global health educators in their planning and implementation of virtual activities.

Perceived roles, benefits and barriers of virtual global health partnership initiatives: a cross-sectional exploratory study

Background

Virtual global health partnership initiatives (VGHPIs) evolved rapidly during the COVID-19 pandemic to ensure partnership continuity. However the current landscape for VGHPI use and preference is unknown. This study aimed to increase understanding of GH partners’ perspectives on VGHPIs.

Methods

From 15 October to 30 November 2020, An online, international survey was conducted using snowball sampling to document pandemic-related changes in partnership activities, preferences for VGHPIs, and perceived acceptability and barriers. The survey underwent iterative development within a diverse author group, representing academic and clinical institutions, and the non-profit sector. Participants from their professional global health networks were invited, including focal points for global health partnerships while excluding trainees and respondents from the European Economic Area. Analysis stratified responses by country income classification and partnership type. Authors used descriptive statistics to characterize responses, defining statistical significance as α = 0.05.

Results

A total of 128 respondents described 219 partnerships. 152/219 (69%) partnerships were transnational, 157/219 (72%) were of > 5 years duration, and 127/219 (60%) included bidirectional site visits. High-income country (HIC) partners sent significantly more learners to low- to middle-income country (LMIC) partner sites (p < 0.01). Participants commented on pandemic-related disruptions affecting 217/219 (99%) partnerships; 195/217 (90%) were disruption to activities; 122/217 (56%) to communication; 73/217 (34%) to access to professional support; and 72/217 (33%) to funding. Respondents indicated that VGHPIs would be important to 206/219 (94%) of their partnerships moving forward. There were overall differences in resource availability, technological capacity, and VGHPI preferences between LMIC and HIC respondents, with a statistically significant difference in VGHPI acceptability (p < 0.001). There was no significant difference between groups regarding VGHPIs’ perceived barriers.

Conclusions

The pandemic disrupted essential partnership elements, compounding differences between LMIC and HIC partners in their resources and preferences for partnership activities. VGHPIs have the potential to bridge new and existing gaps and maximize gains, bi-directionality, and equity in partnerships during and after COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41256-022-00244-4.

Taking Pause: A COVID-19 Student Reflection on Global Health Research Opportunities, Training, and Institutional Reform

Restrictions to research due to COVID-19 have required global health researchers to factor public health measures into their work and discuss the most ethical means to pursue research under safety concerns and resource constraints. In parallel, global health research opportunities for students have also adapted to safety concerns and resource constraints. Some projects have been canceled or made remote, but inventively, domestic research opportunities have been created as alternatives for students to continue gaining global health learning competencies. Knowing the ethical challenges inherent in short-term student global health research and research in strained health systems, it is intriguing why these safer alternatives were not previously pervasive in global health education. This paper provides perspectives from students training at academic institutions in the US on how COVID-19 disrupted student research and what can be learned from the associated shifts in global health research. Additionally, the authors take this opportunity to advocate for academic institutions from high-income countries to reflect on long-standing global health research conventions that have been perpetuated and bolster training for students conducting global health research. The authors draw on their experiences, existing literature, and qualitative interviews with students who pursued global health research during COVID-19.