Global health equity as the focus of graduate medical education

Abstract

Context and setting Although steady and dramatic medical advances have characterised our generation, a very significant proportion of the world's population continues to suffer and die from preventable and treatable diseases. Doctors wishing to impact these inequities often undertake direct medical service provision in resource-poor settings or health services research as a means to this goal. Why the idea was necessary Most doctors become interested in international health while completing their graduate medical education. However, they lack specific training that would empower them to impact on global health, including skills in public health, health advocacy, programme development, economics, ethics and service-based research. The Howard Hiatt Residency in Global Health Equity and Internal Medicine was established in 2004 at Brigham and Women's Hospital (BWH), a Harvard Medical School-affiliated, academic medical centre with a long history of community service and innovative health programming. What was done A 4-year training programme for medical residents in global health equity was developed. Specific new core competencies were defined as guideposts of successful training that will supplement the existing competencies defined by ACGME (Accreditation Council for Graduate Medical Education). It is expected that residents who complete the programme will be well poised to become leaders in the field of global health equity and to participate in meaningful clinical fieldwork and research on health equity issues. Early in training, residents are matched with a primary clinical and research mentor who is senior in the field of health disparities. Year 1 of the programme consists of a standard internal medicine internship, with ambulatory electives focused on resource-poor communities. In Year 2, residents alternate between clinical rotations and blocks focused on health equity topics. Year 2 also includes 1 month spent visiting international project sites in low-income and middle-income countries to gain a better understanding of operations at each site. At the beginning of Year 3, residents receive formal instruction in quantitative and qualitative research methodology and select a primary field site for further clinical training and research. The residents then spend an additional 3 months during Year 3 and 6 months during Year 4 at the selected project site carrying out the planned work. Joint didactics inclusive of trainees in Years 2, 3 and 4 include monthly grand rounds, research and clinical seminars. Evaluation of results and impact Both process and outcome evaluations will be used to assess the programme's success. Successful completion of a health disparities project by the residents will also be required. In the longterm, continued work on the part of residents in the field of health disparities will be tracked as a marker of programme success. To date, 6 residents have been enrolled in the programme and are in Years 2 and 3. The Howard Hiatt Residency in Global Health Equity and Internal Medicine at BWH offers a unique training track for medical residents interested in addressing the most pressing health problems facing the world today. The programme aims to provide a solid foundation on which trainees can build as they enter careers in global health equity.