Global Health Experiences Research Articles

How the Social Contract Can Frame International Electives.

Short-term experiences in global health (STEGHs) are common ways trainees engage in global health activities, which can be viewed by students as either altruistic or opportunistic. This article explores how STEGHs express the social contract medicine has with society, emphasizes areas of breakdown in this social contract, and calls for medical schools, licensure boards, STEGH-sponsoring organizations, and professional societies to take active roles in addressing these ethical challenges.

Facilitating Critical Self-Exploration by Global Health Students.

Much has been written about the need for participants on global health service-learning experiences to contemplate ethical features of their involvement. This literature tends to neglect the role of self-interest in global engagement, however. This article explores how awareness of one's own interests is critical to successfully engaging in global health experiences and proposes how US-based health professions students and trainees can practice critical self-exploration. Six themes beginning with the letter I (identity, ideology, ignorance, imagination, intention, and investment) are introduced as guides to nourish conscientious, collaborative global health learning and practice.

"The World Is Our Campus": Student Satisfaction With an International Nursing Education Partnership.

The purpose of this study was to explore nursing students' perceptions of global health experiences from an international partnership. Nursing organizations have identified global health care as core knowledge. To address global health care competencies and culture awareness, activities were designed by nursing faculty in Finland and the United States. A mixed-method questionnaire was given to 111 students. Data suggest contact with international nursing peers and learning activities increased understanding of health issues in another culture and increased student self-confidence and communication. Developing a partnership between nursing schools can result in positive global health learning experiences for students.

How Should Schools Respond to Learners' Demands for Global Health Training?

In the past decade, more students than ever entered medical school with the desire, if not the expectation, of participating in meaningful global health experiences. Schools must now weigh benefits to students of global experiences against burdens of students' learning experiences on institutions and individuals with whom schools partner. Most often, global health training is done as offsite immersion rotations in research or clinical settings. This article explores ethical dimensions of expanding global health offerings while respecting local partners' goals by focusing on the experience of the University of Pennsylvania's global health training programs.

Introducing S-PACK (SUGAR’s Pre-Departure Activities Curricular Kit): A Comprehensive Preparation Curriculum for Global Health Experiences

Purpose: Pre-departure preparation is recommended for all trainees and providers engaging in global health (GH) experiences. A recent publication offered a list of “Top Ten Considerations for Short-Term Global Health Engagement.” (Figure 1) It can be difficult for busy educators to develop and implement pre-departure training that addresses all Top Ten Considerations. We sought to create an easily implementable, modifiable curriculum for educators to prepare trainees for GH experiences in resource-limited settings. Methods: Twenty-seven educators from the Midwest Consortium of Global Child Health Educators …

Elizabeth Madigan, PhD, RN, FAAN

Elizabeth Madigan began her nursing career with her bachelor of science in nursing (BSN) from Wright State University and has been on a journey of progressive roles, organizations, and forward-thinking endeavors since that time. She received her MS from The Ohio State University, and began her career in formal leadership positions, including a position as Director of Home Care in Columbus, Ohio, and as assistant chief nursing officer in a hospital at the age of 30.

Contribution of short-term global clinical health experience to the leadership competency of health professionals: a qualitative study

ObjectivesGlobalisation has increased the opportunities for health professionals working in developed countries to provide clinical and educational support in developing countries. However, how these experiences contribute to the leadership competency...

Not Above the Law: A Legal and Ethical Analysis of Short-Term Experiences in Global Health.

Background:Persons from high-income countries have multiple opportunities today to participate in “short-term experiences in global health” (STEGHs) in low-resourced countries. STEGHs are organized through religious missions, service learning, medical internships, global health education, and international electives. An issue of increasing concern in STEGHs is “hands-on” participation in clinical procedures by volunteers and students with limited or no medical training. To address these concerns, best practices and ethical standards have been developed. However, not all STEGH organizations adhere to these guidelines, and some actively or tacitly allow unethical and potentially illegal practices.Objectives:This paper considers the legal framework within which STEGHs operate. It assesses whether certain STEGH practices break laws in the US and/or host countries or violate international “soft” legal norms. Two activities of particular concern are: practicing medicine without a license and drug importation and distribution.Conclusions:Many activities undertaken in STEGHs would be illegal if they took place on US soil. In addition, these same activities are often illegal in the host countries where STEGHs operate, although compliance is unevenly enforced. Many STEGH activities violate World Health Organization guidelines for ethical conduct in humanitarian activities.Recommendations:This paper encourages STEGH organizations to end unethical and potentially illegal activities; urges regulatory and non-regulatory stakeholders to alter policies that motivate participation in illegal or unethical STEGH activities; and encourages host countries to enforce their local and national health laws.

Assessment of First-Year Student Pharmacists’ Intercultural Competency Skills Using a Validated Scale and International Scenarios

Objective. To assess first-professional year student pharmacists' level of intercultural competency using international scenarios and a validated scale. Methods. The Wesleyan Intercultural Competence Scale (WICS), a validated questionnaire, was administered to student pharmacists to self-assess their intercultural skills based on their responses to various situations that students encounter in international settings. Student pharmacists rated 16 items on a 5-point Likert scale ranging from "very inaccurate" to "very accurate." Their responses allowed their intercultural competency skills to be ranked among six developmental stages. Results. The 48 participants had traveled outside of the United States an average of 2.6 times, and 34 (71%) of them spoke another language besides English. Students' average comfort level with working with culturally diverse health care students was 4.5 out of 5, and their average comfort level with working with patients of different cultures and background was 4.6 out of 5. The students' average overall score on the WICS was 21.9 out of 36, which indicated the majority of the students were in the acceptance phase of cultural competency. Conclusion. The results of this study can inform pharmacy school faculty and administrators regarding the importance of developing targeted and/or comprehensive cultural competency training for student pharmacists, in both the didactic and experiential settings, especially during global health experiences.

Promoting Health Equity Through Purposeful Design and Professionalization of Resident Global Health Electives in Obstetrics and Gynecology

To design an Obstetrics and Gynecology (OBGYN) residency elective in global health that meets ACGME standards and simultaneously promotes health equity. A 4-week elective was established for US residents in a high-volume African district hospital that served as a site for OBGYN rotations for the national internship training program. Clear clinical, operative, and teaching requirements were delineated for US OBGYN residents. Resident formal didactic outputs were incorporated into the intern OBGYN curriculum. The program was evaluated through assessment of resident experience and contribution to local training, as well as assessment of intern competency in OBGYN. Scottish Livingstone Hospital, a public district hospital in Molepolole, Botswana. Second- to fourth-year OBGYN residents from US training programs, working with Batswana medical interns under on-site faculty supervision. From May 2016 to June 2018, 18 residents from 9 US OBGYN residency programs participated in the elective. Under supervision, US residents performed 116 major and 77 minor gynecologic surgeries, and teach-assisted Batswana interns and medical officers in 76 cesarean deliveries. Residents led or contributed significantly to 25 didactic education sessions as part of the formal intern OBGYN curriculum. During this period, 24 Batswana interns rotated through the hospital's department of OBGYN, and all 24 trainees met required OBGYN competencies prior to completing their internship. Matching US resident demand for global health experiences to equitable global health programming while maintaining ACGME training guidelines poses a challenge to OBGYN residency training programs. This elective provides a model OBGYN global health elective that addresses host-identified needs, broadens residents' skills, and meets standards for postgraduate OBGYN training. Purposeful global health electives for US residents embedded in longitudinal programs provide an opportunity for residents to contribute to broader global health efforts that promote health equity.

Tips for a Successful Global Health Sabbatical.

There is a high demand for global health experiences among medical students. However, creating and engaging successful global health experiences for students is not without significant challenges for faculty. Lack of broad global health knowledge, first hand experiences in a variety of global health settings, and limited faculty engagement in global health activities at their home institutions may limit overall effectiveness. Thus, sabbaticals may provide unique opportunities for faculty reinvigoration and development of new teaching and/or research activities in global health. This viewpoint stems from my sabbatical experiences in South Africa and Botswana during the 2016–17 academic year and includes important tips for ensuring a successful global health sabbatical.

P124: Canadian faculty experience of participating in a global health partnership working to build emergency medicine capacity in Ethiopia

Introduction: Global health partnerships (GHPs) between high income and low income countries are a means of capacity building in education. Literature often focuses on the GHP structure and output, along with retention and experience of local trainees, but neglects the experience of involved faculty. Here, we survey Canadian teaching faculty participating in the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) to describe characteristics of participants and their experience in the program. Methods: EM faculty participating in TAAAC-EM teaching trips from 2011-2016 were invited to complete an online survey in February 2017. Teaching faculty travel for one month and undergo an extensive selection process, pre-departure training and post-trip debriefing. Quantitative and qualitative data were collected and analyzed using basic statistics and inductive thematic analyses respectively. Results: Overall, 19 (N = 30, 63.3%) faculty completed the survey, of which 13 had prior global health experiences (range 1 to > 12 months). On a scale of 1-7, participants rated their mean overall experience as a 5.9 and preparation as a 5.7. Among respondents, 79% would participate in future TAAAC-EM activities, 79% would engage in future global health endeavours, 95% said the experience improved their satisfaction of practicing clinical medicine and 89% said it improved their enjoyment of teaching medicine. However, while 58% stated they would recommend this experience without hesitation to colleagues, the remaining 42% said they would recommend this experience with caveats. This latter group had a lower rated preparedness (MD = 1.398, p = 0.003) and TAAAC-EM experience (MD = 1.545, p = 0.001). Major themes in qualitative responses included that the participants felt that intrinsic motivation and flexible predispositions were necessary to participate. Intrinsic motivation for global health involvement included appreciation and impact for GH, and personal growth. Regarding flexibility, respondents highlighted the importance of having a flexible demeanor to understand, accommodate and ethically address cultural differences and practicing in another context. Conclusion: The type of faculty to recruit for GHPs may require flexible predispositions and intrinsic motivation for GH. These qualities combined with adequate preparation can facilitate overall faculty experiences on global health trips.

A Comprehensive Framework to Optimize Short-Term Experiences in Global Health (STEGH)

Increasing demand for Short-term Experiences in Global Health (STEGH), particularly among medical trainees, has seen a growth in programming that brings participants from high-income countries to low and middle-income settings in order to engage in service, teaching or research activities. Historically the domain of faith-based organizations conducting “missions”, STEGH are now offered by diverse groups including academic institutions, non-profit organizations, and the private sector, either as dedicated for-profits or through corporate social responsibility arms.The growing popularity of STEGH has resulted in concerns about their negative impacts on host communities. Traditional STEGH are often crafted with little or no input from host community leaders, and this results in activities that do not address locally identified priorities. Other concerns include culturally incongruent programming and the creation of parallel systems that disrupt established local services and redirect scarce local resources, which fosters dependency instead of building capacity. One concern specific to trainees also includes trainee provision of services beyond their scope and training level.To address these concerns, this paper presents a comprehensive framework that aims to categorize promising interventions that might promote greater responsibility in STEGH. Based on the micro-meso-macro framework, this paper proposes various interventions as incentives and disincentives to be deployed at the individual, program, and societal levels to promote greater responsibility in STEGH. Deployed altogether, the interventions contemplated by this framework would foster the optimal context required to encourage responsibility, minimize harms, and optimize host community outcomes for STEGH.

Pre-departure Training for Healthcare Students Going Abroad: Impact on Preparedness

Background:Many medical and nursing schools offer opportunities for students to participate in global health experiences abroad, but little is known about the efficacy of pre-departure training in preparing students for these experiences.Objectives:The primary aim was to identify characteristics of pre-departure training associated with participants’ reporting a high level of preparedness for their global health experiences. Secondary objectives included identifying students’ preferred subjects of study and teaching modalities for pre-departure training.Methods:A questionnaire was distributed to all medical and nursing students at our institution from 2013 to 2015. Questions addressed prior global health experiences and pre-departure training, preferences for pre-departure training, and demographic information.Findings:Of 517 respondents, 55% reported having a prior global health experience abroad, 77% of whom felt prepared for their experience. Fifty-three percent received pre-departure training. Simply receiving pre-departure training was not associated with perceived preparedness, but pre-departure training in the following learning domains was: travel safety, personal health, clinical skills, cultural awareness, and leadership. Perceiving pre-departure training as useful was also independently associated with self-reported preparedness. Students’ preferred instruction methods included discussion, lecture, and simulation, and their most desired subjects of study were travel safety (81%), cultural skills (87%), and personal health (82%).Conclusions:Incorporating travel safety, personal health, clinical skills, cultural awareness, and/or leadership into pre-departure training may increase students’ preparedness for global health experiences. Student perceptions of the usefulness of pre-departure training is also associated with self-reported preparedness, suggesting a possible “buy-in” effect.

Pre-departure Training for Healthcare Students Going Abroad: Impact on Preparedness.

Many medical and nursing schools offer opportunities for students to participate in global health experiences abroad, but little is known about the efficacy of pre-departure training in preparing students for these experiences. The primary aim was to identify characteristics of pre-departure training associated with participants' reporting a high level of preparedness for their global health experiences. Secondary objectives included identifying students' preferred subjects of study and teaching modalities for pre-departure training. A questionnaire was distributed to all medical and nursing students at our institution from 2013 to 2015. Questions addressed prior global health experiences and pre-departure training, preferences for pre-departure training, and demographic information.Findings: Of 517 respondents, 55% reported having a prior global health experience abroad, 77% of whom felt prepared for their experience. Fifty-three percent received pre-departure training. Simply receiving pre-departure training was not associated with perceived preparedness, but pre-departure training in the following learning domains was: travel safety, personal health, clinical skills, cultural awareness, and leadership. Perceiving pre-departure training as useful was also independently associated with self-reported preparedness. Students' preferred instruction methods included discussion, lecture, and simulation, and their most desired subjects of study were travel safety (81%), cultural skills (87%), and personal health (82%). Incorporating travel safety, personal health, clinical skills, cultural awareness, and/or leadership into pre-departure training may increase students' preparedness for global health experiences. Student perceptions of the usefulness of pre-departure training is also associated with self-reported preparedness, suggesting a possible "buy-in" effect.

Reconfiguring a One-Way Street: A Position Paper on Why and How to Improve Equity in Global Physician Training.

Large numbers of U.S. physicians and medical trainees engage in hands-on clinical global health experiences abroad, where they gain skills working across cultures with limited resources. Increasingly, these experiences are becoming bidirectional, with providers from low- and middle-income countries traveling to experience health care in the United States, yet the same hands-on experiences afforded stateside physicians are rarely available for foreign medical graduates or postgraduate trainees when they arrive. These physicians are typically limited to observership experiences where they cannot interact with patients in most U.S. institutions. In this article, the authors discuss this inequity in global medical education, highlighting the shortcomings of the observership training model and the legal and regulatory barriers prohibiting foreign physicians from engaging in short-term clinical training experiences. They provide concrete recommendations on regulatory modifications that would allow meaningful short-term clinical training experiences for foreign medical graduates, including the creation of a new visa category, the designation of a specific temporary licensure category by state medical boards, and guidance for U.S. host institutions supporting such experiences. By proposing this framework, the authors hope to improve equity in global health partnerships via improved access to meaningful and productive educational experiences, particularly for foreign medical graduates with commitment to using their new knowledge and training upon return to their home countries.

Igniting a Paradigm Shift in Family Medicine in Nigeria: Lessons From a Global Health Experience.

Igniting a Paradigm Shift in Family Medicine in Nigeria: Lessons From a Global Health Experience.

Remote Supervision in Short-Term Global Health Experiences.

The global health development community is increasingly examining the phenomenon of short-term experiences in global health (STEGH), with an aim to mitigate the negative impacts of such activities on host communities. Appropriate supervision is one strategy, but various barriers (e.g., institutional requirements) limit the availability of qualified supervisors. Remote supervision represents one potential model to provide supervision that may mitigate the negative impacts of STEGH. This paper reports observed outcomes from a description of a pilot remote supervision program employed in a global health program for Canadian undergraduate students. Benefits for learners included greater confidence and independence, greater perceived effectiveness in conducting their project abroad, and reassurance of remote support from their supervisor, supplemented with day-to-day guidance from the local partner. Host communities reported greater trust in the bidirectional nature of partnership with the visiting institution, empowerment through directing students' work, and improved alignment of projects with community needs. Finally, faculty noted that remote supervision provided greater flexibility and freedom when compared to traditional in-person supervision, allowing them to maintain professional duties at home. Collectively, this pilot suggests that remote supervision demonstrates a potential solution to mitigating the harms of STEGHs undertaken by learners by providing adequate and appropriate remote supervision.

Interprofessional education between medical students and nurse practitioner students in a Global Health course

BackgroundFew global health experiences include intentionally-directed interprofessional training. We aim to prospectively evaluate the impact of a global health elective in facilitating interprofessional education (IPE) and promoting cultural sensitivity.MethodsWe included in our study, medical and nursing students who participated in the 2015 and 2016 cohorts of the Nicaragua Global Health course. The course consisted of a 12-week curriculum, and included an in-country immersion where students were organized into small-groups that participated in a variety of interprofessional activities. Students filled out pre- and post-course surveys. We performed quantitative analysis on numeric data and qualitative analysis on open-ended questions.ResultsOf 39 total students enrolled in the course, 26 (18 medical and 8 nursing students) participated in the study and filled out the pre- and post-course surveys. Mean competency scores increased for all questions between pre- and post-course surveys, and of these, 5 of 7 reached statistical significance. Qualitative themes identified included: 1) the importance of understanding other team member’s roles and relative strengths; 2) the value provided by the breaking down of traditional power dynamics between clinicians.ConclusionsGlobal health experiences represent a unique and under-utilized opportunity for facilitating IPE.

Participation in global health delivery: Survey results from the Society of Gynecologic Oncology

•Gynecologic oncologists face multiple barriers in participating in global health.•Several barriers may be addressed at the institutional level.•Most global health experiences involved direct patient care, while only a small proportion involved research.•Gynecologic oncologists receive little structured training in global health.