Global Health Opportunities in Pediatric Fellowships

Abstract

BACKGROUND: Interest in global health (GH) among pediatric residents continues to grow. GH opportunities in pediatric fellowship programs in the United States are poorly described. We aimed to evaluate GH offerings among accredited general and subspecialty pediatric fellowship programs and identify implementation barriers.METHODS: This was a cross-sectional study by pediatric GH educators from the Association of Pediatric Program Directors Global Health Learning Community and the American Board of Pediatrics Global Health Task Force. Fellowship program directors and GH educators at accredited US pediatric fellowship programs were surveyed. Data were analyzed by using descriptive and comparative statistics.RESULTS: Data were obtained from 473 of 819 (57.8%) fellowship programs, representing 111 institutions. Nearly half (47.4%) offered GH opportunities as GH electives only (44.2%) or GH tracks and/or fellowships (3.2%) (GHT/Fs). Pretravel preparation and supervision were variable. Programs offering GH opportunities, compared to those without, were more likely to report that GH training improves fellow education (81.9% vs 38.3%; P , .001) and recruitment (76.8% vs 35.9%; P , .001). Since 2005, 10 programs with GHT/Fs have graduated 46 fellows, most of whom are working in GH. Of those with GHT/Fs, 71% believe national accreditation of GH fellowships would define minimum programmatic standards; 64% believe it would improve recruitment and legitimize GH as a subspecialty.CONCLUSIONS: GH experiences are prevalent in accredited US pediatric fellowship programs, and programs offering GH perceive that these opportunities improve fellow education and recruitment. Responses suggest that standards for GH opportunities during fellowship would be useful, particularly regarding pretravel preparation and mentorship for trainees.WHAT'S KNOWN ON THIS SUBJECT: Over the past 2 decades, there has been robust growth in global health (GH) opportunities during pediatric residency training. The extent to which this trend has also occurred in accredited pediatric fellowship training programs is not yet well understood nor described.WHAT THIS STUDY ADDS: This is the most comprehensive description to date of GH offerings in pediatric fellowship programs. Of 473 pediatric fellowship programs accredited by the Accreditation Council for Graduate Medical Education and Academic Pediatric Association, nearly half offer GH training during fellowship in the setting of increased fellow interest.

Global health electives in the COVID-19 era: resuming travel and strengthening global health academic partnerships

“…While the final toll of the pandemic has yet to be determined, the indirect effects on preventable diseases, malnutrition, chronic care access, mental health, and adverse economic impacts will have reverberating and longstanding impacts on GH. 19 There are many compelling reasons for HIC-based academic programs to eventually resume site-based, in-person GH electives for trainees: (1) there is a high and sustained trainee demand for GH training; 9,12,13 (2) GH electives offer transformative experiences that encourage and empower trainees to address health inequities and disparities in their careers; [20][21][22][23] (3) the existence of institutional GH partnerships improves both trainee and faculty recruitment; 24 and (4) for institutions that value equity, global engagement is often a priority. Moreover, health professionals with training in GH may leverage their experiences to prepare for and respond to future pandemics and emerging diseases; to recognize and attend to inequities; and to safeguard and advocate for disadvantaged populations.…”

“…For example, recent surveys demonstrated 24.2% of US medical students participated in GH electives during medical school; 9 34% of German medical schools offered GH electives; 10 up to 36% of UK medical students completed GH electives abroad; 11 7.3% of US pediatric residents participated in a GH elective during a given academic year, 55.5% of US pediatric residency programs offered GH electives abroad; 12 and 47.4% of US pediatric fellowship programs offered GH electives abroad. 13 Depending on the level of training and nature of the elective, HIC-based trainees participated in various activities during GH electives, including observation, teaching, research, and direct clinical care. For example, visiting students might observe health systems and clinical care, while visiting faculty and advanced trainees, such as fellows, may be arranged to provide critical patient care staffing at partner sites.…”

Pediatric Hospital Medicine and Global Health: A Fitting Niche for an Emerging Subspecialty

“…This mirrors increased demand and offerings for GH opportunities in other pediatric subspecialty fellowship programs. 26 Finally, GH clinicians' awareness of resource limitations and the resourcefulness gained through their work in lowresource settings are useful in HICs as well. Global health hospitalists can use these perspectives to promote resource consciousness to achieve high-value care 27 and to innovate to improve medical care of children domestically.…”

Integrating Global Health Education and Research in Pediatric Gastroenterology, Hepatology, and Nutrition Fellowship Training

“…With this increased global health exposure, a greater number of pediatric residents desire continued global health experiences in subspecialty training, ultimately affecting their fellowship rank lists (2,3). In response, many pediatric fellowship programs have started to incorporate global health opportunities, including formal global health tracks, into their training curriculum, although there remains a paucity of global health training in many pediatric fellowships, including gastroenterology, hepatology, and nutrition (GHN) (4). A 2018 survey by Crouse et al (4) demonstrated that of the responding pediatric GHN fellowships only 34% offered global health electives, and none had formal global health tracks.…”