Increasing Opportunities for Trainees to Engage in Global Health Radiology: Radiology In Training.

Abstract

HomeRadiologyVol. 300, No. 2 PreviousNext Reviews and CommentaryFree AccessPerspectivesIncreasing Opportunities for Trainees to Engage in Global Health Radiology: Radiology In TrainingRyan W. England , Anne-Marie Lugossy, Daniel J. MolluraRyan W. England , Anne-Marie Lugossy, Daniel J. MolluraAuthor AffiliationsFrom the Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287 (R.W.E.); and RAD-AID International, Chevy Chase, Md (R.W.E., A.M.L., D.J.M.).Address correspondence to R.W.E. (e-mail: [email protected]).Ryan W. England Anne-Marie LugossyDaniel J. MolluraPublished Online:Jun 15 2021https://doi.org/10.1148/radiol.2021210371MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractSummaryMedical students and radiology trainees play an integral role in serving the global community, and their opportunities to become involved in global health radiology have continued to grow.Dr England is a 4th-year diagnostic and interventional radiology resident at the Johns Hopkins Hospital. He serves on the leadership board of nonprofit global health organization, RAD-AID International, as the manager of the Medical Airship Program, and director of the Geographic Information Systems research program. He is also president of the Johns Hopkins RAD-AID chapter.Download as PowerPointOpen in Image Viewer A Gained Perspective (Dr England)Arriving in Africa as a trainee was eye-opening. As I visited different hospitals and clinics along the islands of Cape Verde, I experienced firsthand the heartbreak of scarcity, broken equipment, and empty staff rooms. Patients traveled hours by foot, filling hot and humid hallways and lobbies for a single scan from our portable US machine. The spectrum of emotions ran from joy watching numerous young pregnant women in their 3rd trimester see their baby for the first time, to extreme sadness diagnosing an older woman with invasive cervical cancer. Going in, I had expected to read cases and learn about diseases that I did not see in my U.S.-based medical training. What I learned instead were life lessons in leadership, diversity, diplomacy, and charity. I experienced the compassion of working with a diverse group of radiology team members to overcome adversities and collectively care for the patient. I was privileged to see radiology’s role in globalized health care, and how radiology contributes to a larger system of services.IntroductionDuring the past decade, trainees have increasingly contributed to global health efforts dedicated to radiology. Professional societies, academic institutions, and nonprofit charity organizations have developed outreach programs for improving access to medical imaging services among underserved and under-resourced populations (1). For instance, the World Health Organization (WHO) and American College of Radiology (ACR) Foundation International Outreach Program are both dedicated to improving access to care in the developing world. The nonprofit charity organization, RAD-AID International, is another such example. With a volunteer pool of more than 13 500 radiology professionals and a growing global presence that to date spans across 83 health care institutions in 38 countries, RAD-AID’s reach currently extends to approximately 189 million people worldwide, demonstrating the broad impact of global health radiology (Figure). The roles and number of trainees in RAD-AID have steadily accelerated with growth of the organization’s outreach programs.Map of RAD-AID International global presence, which includes a volunteer pool of more than 13 500 radiology professionals from around the world. (Image courtesy of Ufara Zuwasti Curran, MD, MSc, Newark Beth Israel Medical Center, Newark, NJ).Download as PowerPointOpen in Image Viewer A foundational approach to RAD-AID’s sustainable capacity building is the focus on multidisciplinary teams that consist of volunteer diagnostic and interventional radiologists, radiation oncologists, radiologic technologists, sonographers, nurses, radiologist assistants, informatics specialists, medical physicists, research fellows, and more. Importantly, medical students and radiology trainees are significant contributors to these multidisciplinary teams, providing them with important opportunities to shape their professional careers, cultivate leadership skills, and build meaningful personal experiences.Growth of Trainee InvolvementRAD-AID International has received a 50-fold increase in its medical student and radiology trainee volunteers within the past decade. This substantial growth may attest to the increasing trainee interest in serving the global community. Specifically, the number of RAD-AID chapters has grown to include more than 80 Accreditation Council for Graduate Medical Education (ACGME)–accredited academic medical centers by 2020. RAD-AID chapters are defined as mentorship-based grassroots groups within academic institutions that provide project guidance and leadership development to trainees, staff, and faculty. With approximately 185 radiology training programs approved by the ACGME, RAD-AID chapter activity alone demonstrates more than 40% training program participation in global health. To accommodate radiology residents’ growing interest in global health, the ACR instituted the ACR Foundation Goldberg-Reeder Resident Travel Grant, which from 2015 to 2019 received a total of 59 applications, ranging from six to 19 applications per year.Advantages and OpportunitiesThe advantages of international radiology are multifactorial, both for the hosting institution and for the trainee. Host institutions benefit from strengthening their imaging capacity through knowledge exchange, and visiting trainees are provided with an opportunity to enhance their competence and confidence in their interpretation and consulting skills (2–4) while under the direct supervision of an attending radiologist. Resource-limited contexts enable trainees to develop initiative, often making diagnoses without relying on advanced imaging modalities such as CT and MRI (2), while developing a sense of cost-consciousness (2,3). Not only are trainees exposed to pathologic conditions not commonly seen domestically, such as advanced stages of disease and tropical conditions and illnesses (2), but also they are provided with the opportunity to develop cultural humility, experiencing firsthand the significant differences in various cultures and health care systems. For example, health providers in low- and middle-income countries are often multidisciplinary generalists, with less subspecialization than is commonly seen in the North American context, lending to inclusivity and increased collaboration between providers (4,5). Global health radiology opportunities for trainees foster global partnerships that often give rise to longer-term collaborations (1,6). Finally, working in under-resourced and underserved communities provide trainees with direct patient contact in situations that may not occur domestically, further contributing to cultural humility while perfecting communication skills when faced with significant language barriers (2). Exposure to global health radiology can thus create long-term impacts on their careers and future patients, broadening the notion of disparities in access to health care within local and global contexts.Opportunities for trainees to become involved in global health radiology include taking part in either domestic or international outreach projects as part of a multidisciplinary team, designed to support underserved communities with an emphasis on creating sustainable capacity development. Through this experience, the trainee can appreciate the entire radiology landscape—from patient interface, imaging equipment, and technologist’s role in providing care to image quality, reporting of results, and follow up with community providers. For example, artificial intelligence (AI) donated to low-resource hospitals by RAD-AID is giving radiology residents the opportunity to see first-hand how AI can help address resource scarcities in health care settings and also see the potential barriers to AI adoption in low- and middle-income countries.However, global health radiology has expanded beyond only addressing impoverished communities, resource constraints, and access to medical imaging. Emphasis is increasingly directed to addressing racial disparities and systemic racism. For example, in 2020, studies reported disparate mortality rates from cancer and COVID-19 among racial groups, heightening the focus on race relations in global health strategies (7). Thus, participation in global health radiology reinforces trainee awareness of racial diversity and trains them to combat race-related barriers to health care equality.Training Program IntegrationFor radiology residency and fellowship programs wishing to offer global health opportunities, they can opt to partner with RAD-AID programs, providing their trainees with structured and comprehensive global health outreach experience while supporting RAD-AID goals and partner objectives (6). This can be accomplished by forming a RAD-AID chapter (instructions found at https://rad-aid.org/view-chapters/). There are additional global health organizations offering opportunities for medical imaging professionals, many of which are listed on the ACR’s reference web site (https://www.acr.org/Member-Resources/Volunteer/international-outreach/Resources). The WHO also provides information on volunteer and internship opportunities (https://www.who.int/careers/internship-programme), which aim to assign professionals with diverse academic backgrounds to programs that will enhance their educational experience while exposing them to the work of the WHO. In addition, Wood et al (3) describe the fundamental components for a global health radiology curriculum, including (a) global and public health education, (b) targeted travel medicine education, (c) basic imaging proficiency, and (d) practice attitudes and accountability. Finally, Pool et al (6) report on the implementation of a 4-year global health pathway for radiology residents, with a focus on US delivery to resource-poor regions, providing trainees with longitudinal didactic and hands-on experiences in global health.Concurrently, medical students are provided with opportunities to get involved in global health outreach. Partnered with RAD-AID, programs offer students comprehensive global health experience, with the goal of providing a deep understanding of radiology’s role in global health, the issues that impact radiology services in underserved regions, and the methods used in planning, implementing, and monitoring a radiology project (8). Medical students who complete the program earn a RAD-AID Global Health Radiology Medical Student Training Certificate and can go on to participate in a field project either locally or abroad (instructions found at https://rad-aid.org/programs/medical-students/).Barriers to ImplementationDespite increased global health radiology opportunities, programs wishing to incorporate a global health curriculum or elective may face barriers to implementation. From the perspective of the trainee, logistical and financial barriers may prohibit participation. However, some of these organizations provide grant support to trainees interested in global health projects, along with in-kind donations (hardware, software, supplies, educational content, etc) to low-resource hospital sites for reinforcing the project. In addition, residents have found support from their home institution, professional societies, and foundations. Obstacles from the perspective of a training program or medical school can also be multifactorial. For example, a national survey of pulmonary and critical care medicine fellowship programs on global health–related training opportunities reported that the most common barriers to implementation included competing priorities for lecture content, absence of mentors with global health experience, lack of funding, and lack of protected time (9). Although radiology training programs may face similar challenges, partnering with global organizations allows for the connection to a global network of volunteers and chapters for collaboration, helping to overcome many of these barriers.Future Directions and ConclusionOverall, the overwhelming benefits to international radiology experience outweigh potential barriers. In keeping with the ACGME Diagnostic Radiology Milestones, global health radiology opportunities reinforce the six core competencies for residency training (5,10), offering trainees a unique experience to hone their skills and expertise while contributing to their growth as radiology professionals. Future directions of global health radiology include awareness of global health organizations as well as acknowledging the complex roles of economic scarcity and systemic racism in national and international health care systems. This applies to trainees at all levels, including medical students, residents, and fellows. To accomplish this, medical schools and residencies can begin by partnering with global health organizations and taking the initiative to establish a dedicated elective resident and/or fellow global health curriculum, and/or a program chapter. Only by paving the way for trainees to participate in global health can they begin to address inequities on a global scale.Disclosures of Conflicts of Interest: R.W.E. disclosed no relevant relationships. A.M.L. disclosed no relevant relationships. D.J.M. disclosed no relevant relationships.AcknowledgmentsWe thank Brad Short, MLA, CAE, Joan Lynch, and Brandy William of the ACR Foundation for sharing data about the ACR Foundation Goldberg-Reeder Resident Travel Grant in support of this article. We thank Ufara Zuwasti Curran, MD, MSc, for her analysis of RAD-AID data in the creation of the figure.