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.

Transgender patients face a multitude of health disparities and often a lack of understanding by healthcare professionals. A survey was undertaken of internal medicine residents in a large urban academic training program to determine prior education, attitudes, comfort, and knowledge in providing care for transgender individuals in a primary care setting. Total N=67 respondents (52% of those eligible). A full 97% of residents believe transgender medical issues are relevant to their practice, but only 45% had prior education about the care of transgender patients. Less than one-third of respondents felt comfortable describing hormonal/surgical therapy options or referring to another physician to meet these patient needs. HIV, gonorrhea, and chlamydia risk was underestimated for the trans woman population. Most medical residents did not feel up to date with screening guidelines. In contrast, most residents correctly identified higher rates of depression/suicidality in transgender individuals, as well as lower adherence to human papillomavirus screening recommendations for trans men.

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