Abstract. The Fogarty International Center (FIC) Global Health Fellows Program provides trainees with the opportunity to develop research skills through a mentored research experience, increase their content expertise, and better understand trends in global health research, funding organizations, and pathways to generate support. The Northern Pacific Global Health Fellows Research and Training Consortium, which hosts one of the FIC Global Health Programs, sought to enhance research training by developing, implementing, and evaluating a competency-based curriculum that uses a modular, asynchronous, web-based format. The curriculum has 8 core competencies, 36 learning objectives, and 58 assignments. Nineteen trainees completed their 11-month fellowship, engaged in the curriculum, and provided preand post-fellowship self-assessments. Self-assessed scores significantly improved for all competencies. Trainees identified the curriculum as one of the strengths of the program. This competency-based curriculum represents a first step toward creating a framework of global health research competencies on which further efforts could be based.

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Urgently needed interventions to reduce disparities in breast cancer treatment should take into account obstacles inherent among immigrant and indigent populations and complexities of multidisciplinary cancer care.

Objective To investigate whether the 2006 American Society for Colposcopy and Cervical Pathology guidelines for conservative management of minimally abnormal Pap tests (atypical squamous cells of undetermined significance human papillomavirus positive and low-grade squamous intraepithelial lesions) and moderate dysplasia (cervical intraepithelial neoplasia 2) in adolescents: 1) resulted in fewer colposcopies and loop electrosurgical excision procedures (LEEP) in adolescents; or 2) resulted in unintended management changes in older age groups. Methods We analyzed data from 1,806 women aged 18 and older attending one of six community health centers who were diagnosed with abnormal Pap tests between 1/1/2004–12/31/2008. We used multivariable logistic regression to examine management differences in women with minimally abnormal Pap tests prior to and after guideline changes. Variables included date of abnormality, site of care, race or ethnicity, language, and insurance type. We used Fisher exact tests to examine rates of LEEP in patients with moderate dysplasia prior to and after guideline publication. Results Among 206 women aged 18–20, rates of colposcopy after a minimally abnormal Pap test decreased from 78% (n=102) to 45% (n=34) after guideline changes (p<0.001). Colposcopy among women over age 21 (n=1542) remained unchanged (greater than 90%). Multivariable logistic regression indicated that both date of abnormality and site of care were associated with colposcopy referral. After guideline changes, management of moderate dysplasia with LEEP in women aged 18–23 decreased from 55% to 18% (p=0.04); rates remained stable in women ages 24 and over (70% vs. 74%) (p=0.72). Conclusion Health care providers quickly adopted new conservative management guidelines for low-income, minority adolescents which may reduce preterm deliveries in these high-risk populations.