Reentry to Pediatric Residency After Global Health Experiences

Abstract

BACKGROUND AND OBJECTIVE: Although nonphysician reentry transitions have been characterized in literature, little is known about the reentry physicians in general, or residents in particular. We conducted a qualitative study to explore pediatric residents' reentry, using reverse culture shock as a conceptual framework.METHODS: Eighteen pediatric residents who completed global health experiences in Africa (9 categorical residents with 1-month elective, 9 global child health residents with 12-month training) participated in interviews that included a card-sort to solicit emotional responses consistent with the conceptual framework. Data in the form of interview transcripts were coded and analyzed according to principles of grounded theory.RESULTS: All pediatric residents, despite variable time abroad, reported a range of emotional responses on reentry to residency. Global child health residents felt disconnection and frustration more intensely than categorical residents, whereas categorical residents felt invigoration more intensely than global child health residents. Although residents met with program leadership after their return, no resident described these meetings as a formal debriefing, and few described a deliberate strategy for processing emotions on reentry.CONCLUSIONS: Consistent with reverse culture shock, pediatric residents felt a range of emotions as they move toward a steady state of acculturating back into their residency program. Residency programs might consider creating safety nets to help cultivate support for residents when they reenter training. WHAT'S KNOWN ON THIS SUBJECT:Although nonphysician reentry transitions have been characterized in the literature, little is known about the reentry of residents after either shortterm (1-month elective) or long-term (12-month training) global health experiences abroad. WHAT THIS STUDY ADDS:Reverse culture shock may be a useful conceptual framework for understanding the range of emotions felt by pediatric residents when they reenter residency after global health experiences, particularly if these experiences were long term.

Global Health: Preparation for Working in Resource-Limited Settings

“…The emergence or exacerbation of mental health concerns in the context of increased stress, high patient morbidity and mortality, and navigating culture shock during GH experiences has also been reported. 74,84,85 Outside of personal health, there may be safety risks inherent in traveling to places with political, social, religious, or racial unrest. 77…”

“…• Frustration is often caused by knowing what one would normally do to manage a clinical condition and finding that the normal approach is not possible because of a lack of familiar supplies and resources. These limited resources may include a lack of medication or equipment, decreased laboratory and/or imaging support, fewer human resources, and team structures or clinical roles that differ from what one is used to (eg, task shifting and differing expectations of the role of nurses or medical students) 84,87 ;…”

“…• Floundering occurs when one is faced with managing unfamiliar medical conditions and not knowing what to do or where to get help 84,88,89 ;…”

“…• Failure is experienced when a patient does not respond as expected or when one is faced with higher mortality and morbidity 75,84,88 ; and…”

Creating Online Training for Procedures in Global Health with PEARLS (Procedural Education for Adaptation to Resource-Limited Settings)

“…[1][2][3] Proper preparation for these experiences is essential to reduce harm to patients and optimize provider and partner collaboration. 4,5 Yet while predeparture preparatory curriculum has become increasingly common in graduate medical education, it is far from universal and less commonly available to practitioners who have already completed their training. 1,6 Many of the existing preparatory curricula have focused on addressing knowledge gaps within tropical medicine and creating an awareness of the challenges of working across cultures.…”