Global Health Careers Research Articles

Training Toward a Movement: Career Development Insights From the First 7 Years of a Global Health Equity Residency.

The Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine at Brigham and Women's Hospital provides global health training during residency, but little is known about its effect on participants' selection of a global health career. We assessed the perceptions of residency graduates from the first 7 classes to better understand the outcomes of this education program, and the challenges faced by participants. We interviewed 27 of 31 physicians (87%) who graduated from the program between 2003 and 2013 using a convergent mixed-methods design and a structured interview tool that included both open-ended and forced-choice questions. We independently coded and analyzed qualitative data using a case study design, and then wove together the qualitative and quantitative data at the interpretation phase using a parallel convergent mixed-methods design. Entering a career focused on social justice was cited as the most common motivator for selecting to train in global health. Most respondents (83%, 20 of 24) reported they were able to achieve this goal despite structural barriers, such as lower salaries compared with peers, a lack of mentors in the field, poorly structured and undersupported career pathways at their institutions, and unique work-life challenges. A majority of graduates from 1 dedicated residency program in global health and internal medicine reported they were able to continue to engage in global health activities after graduation and, despite identified challenges, reported that they planned long-term careers in global health.

Using Future Employers' Expectations to Inform Global Health Fellowship Curricula.

Fellowships in global health are increasingly popular and seek to equip physicians with the skills necessary to be effective global health practitioners. Little objective guidance exists on which skills make graduates competitive applicants from the perspective of potential global health employers. We sought to provide objective evidence for the qualifications that make applicants competitive for global health positions by analyzing the listed qualifications for current job openings in large global health organizations. The websites of 48 global health employers were systematically searched for current job postings between May and August 2017. Jobs were included for analysis if a medical degree was listed among the primary degrees accepted, and the job was based primarily in a low- or middle-income country. A total of 5849 employment opportunities were posted during the search period, and 81 (1.4%) of these met inclusion criteria. Twenty-two (27%) jobs required and 35 (43%) preferred a relevant master's degree. Few jobs requested a candidate with a PhD and none mentioned tropical medicine training as a requirement or preference. Twenty-three jobs (28%) required and 19 (23%) preferred candidates to speak another language. Most jobs (69%, 56 of 81) required more than 5 years of relevant experience. Only 11 (13%) jobs were primarily clinical positions. For physicians pursuing a career in global health, most publicly searchable jobs require substantial previous experience and involvement in global health activities beyond clinical practice. Master's degree and language skills are frequently requested candidate qualifications.

Building Global Health Capacity at a Minority-Serving Institution in the Bronx: The Potential Role of PhotoVoice and the Geo-Social Pathway Framework in This Endeavor.

Global health training programs for undergraduate students are expanding in the United States, which includes Minority-Serving Institutions (MSIs), but capacity building is needed at MSIs to develop career pathways into the field, especially for those institutions that serve low-income students who live in communities with high health disparities. Often, global health pathways begin by building a global lens through the examination of local health issues coupled with international educational experiences. This approach is limited for students who come from low-income settings with limited funding for international experiences, and as a result, may not see the feasibility of a global health career. However, there may be opportunity in harnessing student motivations and participatory research methods to build interest in a global health career. This article outlines the course, Fundamentals of Global Health, offered at a public MSI in the Bronx. The course was grounded in the Geo-Social Pathway Framework and utilized PhotoVoice to engage students in individual research projects. A constant comparison method was used to analyze papers, photos, reflections, and presentations in order to identify themes. Analysis of course materials submitted by students suggests that they were motivated to examine health disparities using PhotoVoice and that they focused their research projects on their family and community health disparities, or aligned with educational or professional goals to address their community health needs. This course model may inform future training in global health for students at MSIs, but community-based participatory research priority funding is needed to sustain global health at these key institutions.

Global Health Education and Advocacy: Using BMJ Case Reports to Tackle the Social Determinants of Health.

Since 2013, BMJ Case Reports (http://casereports.bmj.com/) has published over 70 global health case reports from five continents, written by doctors, nurses, students, and allied health professionals. These cases, a burgeoning repository of evidence of how real patients are affected by disease, trauma, violence, sexual assault, conflict, migration, adverse living and working conditions, and poor access to health care, discuss, in addition to clinicopathological findings, the global health problems affecting each patient. The global health problem analysis examines the problems of individual patients, critically appraises the literature, and describes actual and potential solutions for the patient, the local community, and patients affected by similar issues across the world. At present global health literature and learning materials lack a patient focus and real-life context in the analysis of global health problems. BMJ Case Reports global health case reports are a unique and important tool to learn about and advocate for change in the social, political, cultural, and financial determinants of health as they affect real patients. This growing evidence base brings together clinicians, local service providers, policy makers, and government and non-governmental institutions to effect real change in patients’ lives toward improving health. Each global health case report is an excellent resource for learning, and together, these case reports provide essential reading for anyone embarking on a career in global health, and writing their own case report. The online course (http://casereports.bmj.com/site/misc/GHMA_Mar_2017.pptx) at BMJ Case Reports uses these cases and is free to access.

GROW: a model for mentorship to advance women's leadership in global health.

In this essay, we discuss the under-representation of women in leadership positions in global health (GH) and the importance of mentorship to advance women's standing in the field. We then describe the mentorship model of GROW, Global Research for Women. We describe the theoretical origins of the model and an adapted theory of change explaining how the GROW model for mentorship advances women's careers in GH. We present testimonials from a range of mentees who participated in a pilot of the GROW model since 2015. These mentees describe the capability-enhancing benefits of their mentorship experience with GROW. Thus, preliminary findings suggest that the GROW mentorship model is a promising strategy to build women's leadership in GH. We discuss supplemental strategies under consideration and next steps to assess the impact of GROW, providing the evidence to inform best practices for curricula elsewhere to build women's leadership in GH.

Medical Student Perceptions of Global Surgery at an Academic Institution: Identifying Gaps in Global Health Education.

Robust global health demands access to safe, affordable, timely surgical care for all. The long-term success of global surgery requires medical students to understand and engage with this emerging field. The authors characterized medical students' perceptions of surgical care relative to other fields within global health. An optional, anonymous survey was given to all Johns Hopkins medical students from February to March 2016 to assess perceptions of surgical care and its role in global health. Of 480 students, 365 (76%) completed the survey, with 150 (41%) reporting global health interests. One-third (34%) of responding students felt that surgical care is one of two fields with the greatest potential global health impact in the future, second to infectious disease (49%). A minority (28%) correctly identified that trauma results in more deaths worldwide than obstetric complications or HIV/AIDS, tuberculosis, and malaria combined. Relative to other examined fields, students perceived surgical care as the least preventive and cost-effective, and few students (3%) considered adequate surgical care the best indicator of a robust health care system. Students believed that practicing in a surgical field was least amenable to pursuing a global health career, citing several barriers. Medical students have several perceptions of global surgery that contradict current evidence and literature, which may have implications for their career choices. Opportunities to improve students' global health knowledge and awareness of global surgery career paths include updating curricula, fostering meaningful international academic opportunities, and creating centers of global surgery and global health consortia.

Exploration of Global Health Careers Across the Medical Fields

BackgroundDespite expansion of interest among American medical students in global health (GH), academic medical centers face multiple obstacles to the development of structured GH curricula and career guidance. To meet these demands we sought to provide a systematic analysis of the accounts of GH experts. MethodsWe developed a collaborative, interview-based, qualitative analysis of GH experiences across six career-related themes that are relevant to medical students interested in GH: justification, medical education, economics, research prospects, law and ethics, and work-life balance. Seven GH faculty members were interviewed for 30-90 minutes using sample questions as guidelines. We applied a grounded theory approach to analyze the interview transcripts to discover an emerging theory pertinent to GH trainees. FindingsRegarding justification, 4 respondents defined GH as work with the underserved irrespective of geographic location; 5 respondents found sustainability imperative; and all respondents believe GH creates better physicians. Respondents identified many physician competencies developed through GH medical education, with 5 respondents agreeing that work with underserved populations has transformative potential. Concerning economics, 3 respondents acknowledged GH's popularity among trainees, resulting in increased training opportunities, and 2 respondents emphasized an associated deficiency in program quality. All respondents described career models across specialties. Four respondents noted funding challenges when discussing research prospects. Within the theme of laws and ethics, 4 respondents perceived inadequate accountability, and 6 respondents identified ways to create accountability. Finally, 6 respondents recognized family demands can compromise one's GH career and thus work-life balance. ConclusionDespite diverse perspectives on the meaning and sustainability of GH work, this analysis provides a nascent framework that may inform curricular development for GH trainees. Suggestions are offered for elaborating this framework to fully exploit the transformative potential of GH training in medical education.

Creating Flexible and Sustainable Work Models for Academic Obstetrician-Gynecologists Engaged in Global Health Work.

To describe various work models for obstetrics and gynecology global health faculty affiliated with academic medical centers and to identify barriers and opportunities for pursuing global health work. A mixed-methods study was conducted in 2016 among obstetrics and gynecology faculty and leaders from seven academic medical institutions in Boston, Massachusetts. Global health faculty members were invited to complete an online survey about their work models and to participate in semistructured interviews about barriers and facilitators of these models. Department chairs and residency directors were asked to participate in interviews. The survey response rate among faculty was 65.6% (21/32), of which 76.2% (16/21) completed an interview. Five department leaders (45.5% [5/11]) participated in an interview. Faculty described a range of work models with varied time and compensation, but only one third reported contracted time for global health work. The most common barriers to global health work were financial constraints, time limitations, lack of mentorship, need for specialized training, and maintenance of clinical skills. Career satisfaction, creating value for the obstetrics and gynecology department, and work model flexibility were the most important facilitators of sustainable global health careers. The study identified challenges and opportunities to creating flexible and sustainable work models for academic obstetrics and gynecology clinicians engaged in global health work. Additional research and innovation are needed to identify work models that allow for sustainable careers in global women's health. There are opportunities to create professional standards and models for academic global health work in the obstetrics and gynecology specialty.

Integrating Global Health into the Medical Curriculum: Experience of Foreign Students in Ukraine

Program Purpose: Global health is a collaborative trans-national research and action for promoting health for all. 1 We believe that medical education curriculum must change to incorporate rigorous training in biosocial health determinants to ensure that all future health professionals are equipped with the knowledge and skills necessary to practice medicine. For this reason, a 2-day Certificate Course in Global Health for all students in the country, the first of its kind in Eastern Europe, was organized. Method: 107 foreign medical students from Ghana, Nigeria, Namibia, Jordan, Kenya, Zambia, Iraq and a variety of countries attended the course from medical universities all over Ukraine. The program involved 11-sessions and was facilitated by Don Eliseo Lucero-Prisno III MD, a professor of Global Health and Public Health, X’ian-Jiantong-Liverpool University. Student speakers gave Explanatory lectures Result: The trainees were enlightened on the basic theories and concepts including current trends, challenges and debates in global health, global health epidemiology, global health equity, global health tools and approaches, and how to build careers in global health. Attendees were given brief exercises to complete. Discussion: The aim is to develop a curriculum and make it a mainstay in medical education of foreign students in Ukraine. We are also using this as an avenue to build research capacity in upcoming medical professionals of the developing world. Global Health Action 2010

Global Health Career Interest among Medical and Nursing Students: Survey and Analysis

BackgroundGlobal health experiences undertaken in international settings (GHEs) are becoming an increasingly prevalent aspect of health professions education and, as such, merit comprehensive analysis of the impact they have on students and host communities. ObjectiveTo assess the associations between demographic/experiential factors and the interest of health professions students in careers involving global health. MethodsA cross-sectional survey was administered online to a convenience sample of medical and nursing students at Johns Hopkins University. Questions addressed level of interest in a global health career, prior GHEs, and demographic information. Items were either Likert scale or multiple choice. Various regression analyses were performed. FindingsOf 510 respondents, 312 (61.2%) expressed interest in a global health career and 285 (55.9%) had prior GHEs. Multivariate logistic regression found female sex, age ≥27 years, household income <$100,000/y, and a prior research-related GHE independently associated with higher interest in global health careers. On subset analysis of participants with one or more prior GHEs: age ≥27 years, household income <$100,000/y, a prior research-related GHE, and having multiple GHEs were each independently associated with increased interest in a global health career. ConclusionsSimply participating in a global health experience abroad is not significantly associated with interest in a global health career. However, sex, age, household income, and research-related GHEs are significantly associated with global health career interest. These findings may inform the development of global health programs at medical and nursing schools and can guide efforts to increase the number of health care professionals entering global health careers.

The Benjamin H. Kean Travel Fellowship in Tropical Medicine: Assessment of Impact at 15 Years.

.The Benjamin H. Kean Fellowship in Tropical Medicine is an American Society of Tropical Medicine and Hygiene initiative that provides medical students with funding for international clinical or research experiences lasting at least 1 month. Of the 175 Kean fellows from 1998 to 2013, 140 had current available e-mails, and 70 of the 140 (50%) responded to a survey about their fellowship experience. Alumni indicated that the Kean Fellowship had a high impact on their career plans with regard to preparation for (N = 65, 94.2%) and inspiration to pursue (N = 59, 88.1%) a career in tropical medicine and global health. Continued involvement in tropical medicine and global health was common: 52 alumni (74.3%) were currently working in tropical medicine or global health, 49 (71.0%) had done so in the interim between the Kean fellowship and their current position; and 17 of 19 Kean fellows (89.4%) who had completed all medical training and were now in professional practice continued to work in tropical medicine and global health. Alumni had been highly productive academically, publishing a total of 831 PubMed-indexed manuscripts, almost all on tropical medicine or global health topics, in the period between their fellowship year and 2013. Alumni reported strengths of the fellowship including funding, networking, and flexibility, and suggested that more networking and career mentoring would enhance the program. The Benjamin H. Kean fellowship program has been highly successful at inspiring and fostering ongoing work by trainees in tropical medicine and global health.

Global Health Master’s Students: Demographics and Career Goals

The Master of Science in Global Health (MSGH) at Northwestern University is a new competency-based graduate degree program designed to prepare students for careers in global health. The purpose of our research is to determine the market characteristics for this degree, provide student backgrounds that will guide curricular and programmatic improvements, and determine if these students intend to pursue degrees in global health. This study examines survey responses from students admitted to the MSGH program between 2014 and 2015. Survey data were collected by the Northwestern University School of Professional Studies (SPS) as part of the online admissions application process. During the same period, all active students in the program were invited to complete a separate, online survey asking about their global health experience, skills and career goals. Application responses were analyzed using descriptive statistics. Free-text responses from the survey were hand-coded using 10 categorical variables developed through an inductive process. Fifty-four individuals were admitted to the MSGH program within 12 months of its inception. Of these 78% were female and the average age was 36. Of those who responded to questions about current employment, 57% were working in a health science field, 11% in government or public administration, and less than 10% responded in all other categories. Responses from the online survey revealed that most students had some prior global health experiences primarily in the medicine and mission/volunteer categories, 45% and 50% respectively. Responses regarding career aspirations were spread evenly across categories and nearly all students intended to join the global health workforce. Medicine was identified most frequently as a desired field for future careers (30%), followed by government and policy (25%). The wide variety of disciplines represented in students’ previous work histories underscores and supports the interprofessional nature of the field and the workforce. This diversity extends to both educational backgrounds and prior field experience and necessitates pedagogical techniques that can appeal to a wide array of students, particularly a majority female population. Findings regarding desired future employment suggests that career advising will need to adapt to market demands, prioritizing project and program management related careers.

LO15: Not a hobby anymore: Establishment of the Global Health Emergency Medicine organization at the University of Toronto to facilitate academic careers in global health for faculty and residents

Introduction/Innovation Concept: Demand for training in global health emergency medicine (EM) practice and education across Canada is high and increasing. For faculty with advanced global health EM training, EM departments have not traditionally recognized global health as an academic niche warranting support. To address these unmet needs, expert faculty at the University of Toronto (UT) established the Global Health Emergency Medicine (GHEM) organization to provide both quality training opportunities for residents and an academic home for faculty in the field of global health EM. Methods: Six faculty with training and experience in global health EM founded GHEM in 2010 at a UT teaching hospital, supported by the leadership of the ED chief and head of the Divisions of EM. This initial critical mass of faculty formed a governing body, seed funding was granted from the affiliated hospital practice plan and a five-year strategic academic plan was developed. Curriculum, Tool, or Material: GHEM has flourished at UT with growing membership and increasing academic outputs. Five governing members and 9 general faculty members currently run 18 projects engaging over 60 faculty and residents. Formal partnerships have been developed with institutions in Ethiopia, Congo and Malawi, supported by five granting agencies. Fifteen publications have been authored to date with multiple additional manuscripts currently in review. Nineteen FRCP and CCFP-EM residents have been mentored in global health clinical practice, research and education. Finally, GHEM’s activities have become a leading recruitment tool for both EM postgraduate training programs and the EM department. Conclusion: GHEM is the first academic EM organization in Canada to meet the ever-growing demand for quality global health EM training and to harness and support existing expertise among faculty. The productivity from this collaborative framework has established global health EM at UT as a relevant and sustainable academic career. GHEM serves as a model for other faculty and institutions looking to move global health EM practice from the realm of ‘hobby’ to recognized academic endeavor, with proven academic benefits conferring to faculty, trainees and the institution.

Central Role of Relationships in Promoting Careers in Global Health

Central Role of Relationships in Promoting Careers in Global Health

The PHI/GHFP-II Employers' Study: The Hidden Barriers Between Domestic and Global Health Careers and Crucial Competencies for Success

BackgroundAn ongoing discussion in global health in the United States centers on the future of the US-trained global health workforce and how best to prepare professionals for this career path. The Public Health Institute, through its Global Health Fellows Program (I and II), has been in a unique position to identify the shifting employment dynamic in global health. ObjectivesThe purpose of the survey was to gather information on global health employers' hiring practices and insights into the importance of nonclinical skills in contributing to successful professional work; preparedness of graduates with needed nonclinical skills; and the value of domestic work experience for global health careers. The focus was on individuals primarily raised in the United States who studied global health in either graduate or undergraduate settings. MethodsA web-based survey and telephone interviews were conducted in early 2015. Overall, 49 project directors from 32 organizations participated. FindingsKey findings included: •Eighty-five percent of respondents agreed or strongly agreed that academia could better prepare students in nonclinical skills.•The most commonly valued nonclinical skills were program management, monitoring and evaluation, communication with client, counterpart and community, strategy and project design, and collaboration and teamwork.•Sixty-four percent of respondents had hired domestic health professionals for global health positions. However, only 4% indicated that they had hired 5 or more.•The top skills that candidates with domestic experience only were found to lack included understanding public health in an international development context and characteristics like flexibility, creativity, and cultural sensitivity. ConclusionsThe process of preparing professionals for global health work has fallen behind emerging realities, including globalization, ever-evolving technologies, and advances in health care. Universities must provide an increased curricular emphasis on nonclinical skills, both interpersonal and business related, as well as the international experience that is valued in the global health workplace.

Impact of International Collaborative Training Programs on Medical Students' Research Ability.

International collaborative training programs for graduate students are widespread, but studies on their educational impact are limited. As an advanced cancer institute in China, Cancer Hospital Chinese Academy of Medical Science (CHCAMS) attaches great importance to international exchanges and cooperation within graduate education. The Department of Epidemiology of CHCAMS has been involved in several existing international training programs and has also launched a short-term training program in cooperation with foreign universities and institutes from 2008. Fogarty International Clinical Research Scholars and Fellows (FICRS-F) Program and the Fulbright-Fogarty Fellowship Program are the most typical examples of our practice in international cooperation on graduate education over these years. Our department has gained substantial experience in graduate-level international collaborative training, focused on cancer epidemiology. This paper is a brief introduction to the practice of different programs in our department and students' achievements during and after training. Moreover, we attempt to serve as a reference and help promote the training of graduate students pursuing careers in cancer research or global health by other universities or research institutes.

A New Master's Degree in Global Health: Reflections on a 5-year Experience

BackgroundThe University of California–San Francisco's (UCSF) Master of Science (MS) degree in global health sciences, a 1-year degree program started in 2008, is the first accredited master's degree in global health in the country. ObjectiveThe aim of this study was to review the genesis and structure of the MS degree program, and describe its progress over its first 5 years. MethodsWe reviewed the program's teaching methods, academic curriculum, course evaluations, and backgrounds and outcomes of the first 127 graduates. Student opinions were gathered from anonymous course evaluations. Student outcome data and graduates' perspectives were gathered through a voluntary, anonymous, online survey. We reflect on student demand, program strengths and weaknesses, and future academic directions. FindingsThe program's structure arose from three learning objectives identified by the Curriculum Committee: a multidisciplinary approach to the foundations of global health, an emphasis on research design and methods, and an application of theory to international fieldwork. The resulting broad curriculum has attracted students of diverse backgrounds, which has enriched classroom discussions. Over the first 5 years, the program revised its fieldwork project criteria to allow more flexibility in design, leading to a higher rate of publication and enabling students to graduate with an academic portfolio. Students have reported that the high faculty-to-student ratio has fostered strong mentorship relationships; this is vital as 66% of graduates work in academics. Graduates have reflected that group work in the program appropriately prepared them for their work environment. The program's experience has guided its response to: pressure to focus on medical aspects of global health; students' needs for career skill-building; financial challenges; and trends toward online didactics. ConclusionsThe recent surge in interest in global health careers has created demand for academic programs. UCSF has designed the MS degree program to balance breadth and depth of learning in a multidisciplinary curriculum, and combine career preparation and theoretical learning in a one-year academic degree. The challenges of balancing breadth and depth of learning in a multidisciplinary program, and combining career preparation and theoretical learning in a one-year academic degree, have informed UCSF's MS program design.

Addressing the "Global Health Tax" and "Wild Cards": Practical Challenges to Building Academic Careers in Global Health.

Among many possible benefits, global health efforts can expand the skills and experience of U.S. clinicians, improve health for communities in need, and generate innovations in care delivery with relevance everywhere. Yet, despite high rates of interest among students and medical trainees to include global health opportunities in their training, there is still no clear understanding of how this interest will translate into viable and sustained global health careers after graduation. Building on a growing conversation about how to support careers in academic global health, this Perspective describes the practical challenges faced by physicians pursuing these careers after they complete training. Writing from their perspective as junior faculty at one U.S. academic health center with a dedicated focus on global health training, the authors describe a number of practical issues they have found to be critical both for their own career development and for the advice they provide their mentees. With a particular emphasis on the financial, personal, professional, and logistical challenges that young “expat” global health physicians in academic institutions face, they underscore the importance of finding ways to support these career paths, and propose possible solutions. Such investments would not only respond to the rational and moral imperatives of global health work and advance the mission of improving human health but also help to fully leverage the potential of what is already an unprecedented movement within academic medicine.

Graduate public health training in healthcare of refugee asylum seekers and clinical human rights: evaluation of an innovative curriculum.

An innovative curriculum was developed to equip public health students with appropriate attitude and skills to address healthcare of asylum seekers. Implemented in 2005 the curriculum included: (1) didactic sessions covering epidemiology and health sequelae of torture, asylum laws, and approaches to identify survivors' healthcare needs; (2) panel discussions with survivors and advocates; and (3) participating in medico-legal process of asylum seeking. Complementary mixed methods evaluations included pre- and post-curriculum questionnaires, formal curriculum evaluations, final papers and oral presentations. 125 students participated. Students showed improved knowledge regrading sequelae of abuse and survivors' healthcare needs (P<0.01), improved attitudes towards working with survivors (P<0.05) and self-efficacy in identifying at-risk populations and addressing healthcare of survivors (P<0.05). Students reported increased desire to pursue global health and human rights careers. As an advocacy and cultural competency training in public health practice addressing healthcare of refugees domestically, this curriculum was well received and effective, and will also help students better serve other similar populations. Population case-based domestic opportunities to teach global health and health and human rights should be effectively utilized to develop a well-equipped global health corps.

A Pilot Curriculum in International Surgery for Medical Students

As medical student interest in global surgical care grows, a comprehensive curriculum is necessary to understand surgical care in resource-limited environments. We developed a surgical elective encompassing a multiyear medical student curriculum, with the goal of improving students' understanding of global surgical care, consisting of a junior seminar and a senior clerkship. This student elective focused on the global burden of surgical disease, ethics of care in low-resource settings, and care of marginalized U.S. Students who participated in the fourth year clerkship at a tertiary center in Northern India completed a reflective essay on their experience. Qualitative analysis was conducted using constant comparison and axial coding to establish a grounded theory. Medical students showed a desire to serve the poor, build collaborative relationships, and integrate international health into their future career. This novel curriculum provides students a clinical and public health basis to understand challenges of surgical care in low-resource environments while laying the groundwork for students with a future career in global health.