Global health training starts at home: A unique US-based global health clinical elective for residents

Abstract

Background: Many physicians planning to work in global health lack adequate formal training. Globalized cities create opportunities to integrate global health training into residency programs, preparing clinicians for less supported experiences abroad. Aim: To develop a clinical elective to advance residents' knowledge and skills in global health and fieldwork abroad. Methods: Two-week comprehensive elective was offered to PGY2 combined medicine-pediatrics residents. We incorporated clinical exposures and global health topics. Global health experts were involved as teachers and preceptors. Clinical exposure included: tropical medicine with laboratory sessions; travel medicine; tuberculosis; immigrant and continuity; and human rights clinics. Didactic components and supplemental readings included socio-political issues, global public health, and health challenges of populations from developing regions. We assessed resident satisfaction using questionnaires and focus groups. Results: Residents reported usefulness and relevance of sessions and topics as (4) very good (scale: (1) poor to (5) excellent), and quality of sessions and teaching as very good to excellent (4.2). Residents' baseline knowledge and understanding of global health issues improved by around 50%. Conclusion: Our experience supports the feasibility and usefulness of clinical and didactic training in global health issues at home. A multidisciplinary approach, collaboration with academic and non-academic institutions, experienced faculty, and departmental commitment are vital.

Comparative Analysis: Potential Barriers to Career Participation by North American Physicians in Global Health

“…Given the community-oriented nature of global health work, population-based intervention strategies and public health skill sets are extremely useful. However, only 30% of US medical schools offer any training or counseling for students prior to departing for global health experiences; thus, many students and residents go unprepared which limits their efficiency and effectiveness [28]. Working as a clinician-educator in a resource-poor setting may be significantly different from practice during training, requiring a different set of skills in cultural sensitivity, emotional intelligence, and ethical behavior in the setting of extremely challenging circumstances.…”

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

“…4,[6][7][8] Medical experience with underserved populations in the United States and other countries enhances resident efficacy. [9][10][11] Other factors associated with resident cross-cultural preparedness include formal CC training curricula, mentoring, and faculty engagement in cross-cultural issues. 7,8,[12][13][14] Researchers have used focus groups to solicit the attitudes and beliefs of residents and faculty about CC training, but few researchers describe CC training, skills, knowledge, or perceived self-efficacy of pediatric faculty, and none directly compare the perceived needs of pediatric residents and faculty.…”

“…This is to carefully differentiate between culturespecific knowledge (eg, Maasai tribal practices of umbilical cord care) and CC skills (eg, discussing safe newborn care with families who practice traditional childrearing practices). 2,9,[24][25][26] Culture-specific knowledge, although valuable and often perceived by learners as especially valuable, does not adequately prepare pediatricians to care for culturally diverse patient populations at home or abroad. 1,4,9,11 We hypothesized that higher PSECC is associated with formal CC training and cross-cultural experiences.…”

“…2,9,[24][25][26] Culture-specific knowledge, although valuable and often perceived by learners as especially valuable, does not adequately prepare pediatricians to care for culturally diverse patient populations at home or abroad. 1,4,9,11 We hypothesized that higher PSECC is associated with formal CC training and cross-cultural experiences. Our goal is to describe the results of the survey and suggest further improvements in CC curricula for residents and faculty.…”

New trends of short-term humanitarian medical volunteerism: professional and ethical considerations

“…Established relationships between Western medical centres and supporting organisations for international medical volunteering can facilitate learning and direct supervision by expert faculty. Ideally, training should be incorporated longitudinally into medical education and residency programmes, and trainees should be encouraged to participate in supervised electives or projects abroad or in domestic LRSs, such as Indian reservations, inner-city clinics or medical services for immigrants and refugees 83. Written educational materials should be provided supplementary to in-person teaching 40.…”