International Health Electives Research Articles

Global Health Simulation During Residency.

Resident participation in international health electives (IHEs) has been shown to be beneficial, yet not all residents have the opportunity to participate. We sought to determine whether participating in simulated global health cases, via the standardized Simulation Use for Global Away Rotations (SUGAR) curriculum, was useful for all pediatric residents, not merely those planning to go on an IHE. Pediatric residents in our program took part in 2 SUGAR cases and provided feedback via an online survey. Thirty-six of 40 residents participated (90%); 72% responded to the survey. Three of 10 residents not previously planning to work in resource-limited settings indicated participation in SUGAR made them more likely to do so. Nearly all residents (88%) felt SUGAR should be part of the residency curriculum. All felt better prepared for working cross-culturally. While designed to prepare trainees for work in resource-limited settings, SUGAR may be beneficial for all residents.

Experiences of Irish general practice trainees who participate in 4-month rotations in Malawi and Australia

Background: International health electives provide doctors and medical students with unique educational experiences. The HSE South East GP training programme in Waterford, Ireland has run a four-month elective to Malawi since 2006, and also ran a four-month placement in Australia between 2004 and 2011.Aim: The aim of this study was to see whether these overseas electives provide Irish GP trainees with any positive or negative experiences, and to make recommendations regarding future similar rotations abroad.Method: This study used the Delphi survey technique, a qualitative research method. The first round questionnaire asked about challenges faced while overseas, what the trainees learned, and how the placement influenced their clinical practice on their return to Ireland. Doctors were also asked about the benefits and/or limitations of an overseas placement during GP training.Results: These Irish GP trainees reported very positive outcomes from time spent in Malawi and Australia. They reported improved knowledge and skills, and increased awareness of health issues and cultural differences in another country. Moreover, they had an opportunity to reflect and grow personally as doctors.Conclusion: This is the first study looking at an international health elective as part of a vocational training programme in Ireland.

A Homestay Model for Global Health and Medical Education in Resource-Limited Settings

International health electives often overlook important aspects of cultural competency, psychosocial support, and bidirectional exchange. In order to address these shortcomings, we adapted the homestay model to an elective in Kampala, Uganda. Host families consist of local faculty selected based on experience with international students and involvement in medical education. Host families provide accommodations, meals, psychosocial support, counseling, and an informal curriculum of local language, culture, and politics. Participants are encouraged to find ways to give back to their host communities. This well-structured model enhances the experience of all involved by focusing on cultural immersion, social support, and mutual partnership.

Reflection and debriefing: Tools for fostering student emotional learning during and after international health electives

Reflection and debriefing: Tools for fostering student emotional learning during and after international health electives

International health electives in orthopaedic surgery residency training.

Residents in surgical training programs today demonstrate an increasingly strong interest in global health. Given the considerable need for specialists in underserved areas, some surgical residency programs offer international health electives in resource-poor settings to augment resident training. This study aims to quantify and to characterize international health elective opportunities among orthopaedic surgery residency programs across the United States. A web-based survey was distributed to program directors and program coordinators of the 154 U.S. orthopaedic surgery residency programs accredited by the Accreditation Council for Graduate Medical Education. Questions assessed the availability and characteristics of international health electives, the barriers to offering opportunities, and the opinions of program directors regarding the value of international health electives in orthopaedic surgery training. Seventy-three orthopaedic surgery residency programs (47.4% response rate) responded to the survey, with twenty-four responses from program directors and forty-nine responses from program coordinators. Nineteen programs (26.0%) offer international elective training opportunities. Fifty programs had notable barriers to offering international electives. These barriers included lack of training time (thirty-seven programs [74%]), lack of funding (thirty-five programs [70%]), and lack of an international partner to facilitate an international health elective (seventeen programs [34%]). Directors of programs that offer international health electives compared with directors of programs that do not offer these electives felt more strongly that international health electives are important in residency training (mean Likert scale score of 4.2 compared with 2.65; p = 0.00195), that international health electives are valuable for residents (mean Likert scale score of 4.6 compared with 3.53; p = 0.0265), and that exposure to international health care should be required during residency training (mean Likert scale score of 3.0 compared with 1.65; p = 0.0194). A minority of the orthopaedic surgery residency programs that participated in this study offers international health elective opportunities to trainees. Barriers such as time parameters and funding limit their availability. Our results characterize international health electives and highlight potential areas of intervention that could increase their availability to a greater number of residents.

Unchallenged good intentions: a qualitative study of the experiences of medical students on international health electives to developing countries.

BackgroundIrish medical students have a long and proud history of embarking on international health electives (IHEs) to broaden their experience in the developing world. Although there are many opinions in the literature about IHEs, there is a dearth of empirical research that explores the experience and the value of these experiences to medical students. Most students who participate in these IHEs from Irish medical schools are members of student IHE societies, which are entirely run by students themselves. There are varying levels of preparation and interaction with the medical schools in planning these experiences. This study explores the experiences of a sample of students who completed IHEs in 2012.MethodsThis qualitative study used anonymized one-on-one interviews with medical students in Irish medical schools who completed IHEs to developing countries in 2012. Students were recruited using online noticeboards of student societies and e-mail. Purposive sampling was used to find students from different medical schools, some who had travelled with medical student IHE societies and others who had travelled independently. Seven male and seven female students participated. Interviews were conducted until saturation was reached. Data were then analyzed thematically.ResultsThe main themes identified were the perceived benefits of IHEs, the difficulties experienced with the distribution of charitable donations, the emotional impact on the students of participating in the IHEs, awareness of scope of practice by students, and issues with the current structure of IHEs.ConclusionsThe informal relationship that currently exists between student societies and the medical schools results in poor accountability and reporting requirements on IHEs. Clearer guidelines and identification of learning outcomes for students would be helpful. The findings are relevant to medical students internationally.

The current status of international partnerships for child surgery in sub-Saharan Africa.

Disparity still exists in the surgical care between sub-Saharan Africa and developed countries. Several international initiatives have been undertaken in the past decades to address the disparity. This study looks at the impact of these programs in child surgery in Sub-Saharan Africa. Review of electronic databases Medline and African Index Medicus on international partnerships for child surgery in Sub-Saharan Africa was undertaken. Four types of international initiatives were identified and consist of periodic medical missions; partnerships between foreign medical institutions or charities and local institutions; international health electives by surgical residents; and training of individual surgeons from developing countries in foreign institutions. The results of these efforts were variable, but sustainability and self-reliance of host nations were limited. Sociocultural factors, dearth of facilities, and lack of local governments' commitment were main impediments to effective local development or transfer of modern protocols of surgical management and improvement of pediatric surgical care at the host community level. Current initiatives may need improvements with better understanding of the sociocultural dynamics and local politics of the host nation, and improved host nation involvement and commitment. This may engender development of locally controlled viable services and sustainable high level of care.

Perspectives of South American physicians hosting foreign rotators in emergency medicine.

BackgroundEmergency Medicine (EM) is increasingly becoming an international field. The number of fellowships in International EM in the USA is growing along with opportunities to complete international health electives (IHEs) during residency training. The impact on host institutions, however, has not been adequately investigated. The objective of this study is to assess the experience of several South American hospitals hosting foreign EM residents completing IHEs.MethodsAnonymous, semi-structured one-on-one interviews were conducted with physicians working in Emergency Departments in three hospitals in Lima, Peru and one hospital in Buenos Aires, Argentina. All participants reported previously working with EM foreign rotators. Interviews were analyzed qualitatively and coded for common themes.ResultsThree department chairs, six residents, and 15 attending physicians were interviewed (total = 24). After qualitative analysis of interviews, two broad theme categories emerged: Benefits and Challenges. Most commonly reported benefits were knowledge sharing about emergency medical systems (78%), medical knowledge transfer (58%), and long-term relationship formation (42%). Top challenges included rotator Spanish language proficiency (70%) lack of reciprocity (58%), and level of training and rotation length (25%). Spanish proficiency related directly to how involved rotators became in patient care (e.g., taking a history, participating in rounds) but was not completely prohibitive, as a majority of physicians interviewed felt comfortable speaking in English. Lack of reciprocity refers to the difficulty of sending host physicians abroad as well as failed attempts at building long-lasting relationships with foreign institutions. Lastly, 25% preferred rotators to stay for at least 1 month and rotate in the last year of EM residency. This latter preference increased knowledge transfer from rotator to host.ConclusionsOur research identified benefits and challenges of IHEs in Emergency Medicine from the perspective of physician hosts in several hospitals in South America. Our results suggest that IHEs function best when EM residents rotate later in residency training and when relationships are maintained and deepened among those involved including host physicians, rotators, and institutions. This leads to future rotators, project collaboration, research, and publications which not only benefit individuals involved but also the wider field of Emergency Medicine.

Lessons from an elective in Sierra Leone.

Lessons from an elective in Sierra Leone.

Do Medical Students Need International Health Electives?

Do Medical Students Need International Health Electives?

Adopting an Ethical Approach to Global Health Training

Global health training opportunities for medical students and residents have proliferated in recent years. These short-term elective rotations allow trainees to learn about global health issues by participating in various aspects of education and health care in resource-limited settings. Recently published consensus-based ethical guidelines have suggested considerations for the design of international electives that address the activities of host and sending sites, visiting students and residents, and sponsors.The authors analyze the value of global health training opportunities for medical students, residents, faculty, host and sending institutions, and other stakeholders from the perspective of the Botswana-University of Pennsylvania Partnership, a program that has provided global health experiences for health care trainees for more than 10 years. Drawing from the Working Group on Ethics Guidelines for Global Health Training framework, they illustrate the ethical and logistical challenges faced by the program's organizers and the solutions that they implemented alongside their host site partners. They conclude with a summary of recommendations to guide implementation of ethically sound international health electives in resource-limited settings.

Clinical Topics in Global Health: A Practical Introduction for Pre-Clinical Medical Students

Abstract Introduction The Clinical Topics in Global Health course introduces students to the most important global health problems with a focus on clinical practice. This multi-disciplinary, skills...

A Case for an International Health Elective Training Program During Residency: A Four-Points Call for Action

Background: International Health Electives (IHE) are becoming more popular among graduate training programs. This is likely due to the high demands from graduating medical students who are seeking to have an international health experience during their post-graduate training. Despite the important educational experiences associated with an IHE, this opportunity does not exist in all graduate medical programs and fewer have formal established programs. Summary: We are suggesting that graduate training programs are in a unique position to provide such experiences to our future physicians, in turn creating immediate benefits to host nations as well as long-term impacts on our society in the United States. We are proposing Four Points for stakeholders involved in training future physicians to use as they consider designing such opportunities for future trainees. The four points include: residents are capable of providing service to host nations, improve the quality of care to communities in the U.S., foster graduating medical students' global health interests and increase global health mentorship. Conclusions: We hope that addressing these four points will reemphasize the importance of establishing an IHE in all graduate training programs.

An international health elective in Haiti: a case for osteopathic medicine.

As global health education becomes increasingly important, more physicians are participating in international health electives (IHEs). Haiti is a favorable site for an IHE because of its substantial health care needs and rich culture. Although both osteopathic and allopathic physicians can provide effective health care to Haitians, osteopathic physicians may be particularly well suited to serve in Haiti because of their training in osteopathic manipulative treatment (OMT). Because OMT's laying of the hands (high touch) is similar to the touch inherent to Haiti's traditional ethnomedical practices, osteopathic physicians' use of OMT can enhance trust among Haitians and increase Haitians' willingness to work with westernized medical practitioners. In addition, an IHE in a low-resource country such as Haiti can provide osteopathic physicians with a global outlook on medicine and a range of critical communication and clinical skills. The authors advocate for the development of an IHE in Haiti for osteopathic physicians.

Does participation in international health electives during pre-clinical years influence a student and #8217;s interest in primary care?

This pilot study aimed to characterize the effect of participation in an international health elective (IHE) during the preclinical years on a student’s interest in pursuing a career in family medicine and primary care specialties. 100 first- and second-year medical students were surveyed on their participation in IHEs and family medicine interest group (FMIG) and family medicine-related activities, meetings, and conferences. A total of 44 students responded to the survey. 35 students (79.5%) had participated in an IHE outside of the United States. The percentage of IHE participants who had attended at least one FMIG event was significantly higher than the percentage of IHE non-participants (80% versus 33.3%; p=0.006) but there was no significant difference in any other variable studied. Despite limitations, our pilot study suggests that first and second year medical school students participating in IHEs are more likely than those not participating to attend at least one FMIG event; however there is no difference in students reported interest in primary care or family medicine as a specialty choice. As previous reviews have noted a paucity of neutral or negative studies in the literature, we hope that our observations of a possible lack of effect of participation in IHEs in the preclinical years on students’ interest in primary care adds to the existing literature.

International health electives: strengthening graduate medical education.

An international health elective (IHE) can be an important component of the medical education and professional development of a physician. It provides essential global health skills that are crucial in a globalized society. Graduate medical education has an opportunity to deliver such skills to our health care workforce while addressing the pending workforce shortage and the uneven distribution of primary care physicians across the United States. Currently, there is a call for graduate medical education programs to create more training sites and to undergo reform that will help fill residency slots and train more primary care physicians. The author proposes that graduate medical education programs incorporate international health electives into their accredited residency programs. This addition could potentially strengthen their programs while making them more appealing to qualified candidates.

Student Objectives and Learning Experiences in a Global Health Elective

International health electives offer unique experiences for medical students to develop clinical skills and cultural competencies in unique and diverse environments. Medical students have been increasingly pursuing these learning opportunities despite the challenges. However, their goals in pursuing these opportunities and the relation between their learning objectives and actual experiences have not been studied adequately. It is important to assess these programs based on student objectives and whether those objectives are met. Thirty-seven medical students from five cohorts at a US medical school completed pre-post questionnaires regarding their global health elective objectives and learning experiences. The questionnaires included mostly open-ended questions and a Likert-scale rating of their overall experience. Qualitative thematic analysis involved inductive coding and followed a content-driven immersion-crystallization approach. Quantitative program evaluation measures yielded descriptive statistics. Five general objectives and four types of learning experiences were identified. Student objectives were: (1) to observe the practice and organization of health care in another country; (2) improve medical/surgical skills; (3) improve language skills; (4) learn about another culture; and (5) deepen knowledge of infectious diseases. All of their objectives were achieved. Moreover, one learning theme, "self-reflection and personal growth," was not a student objective. Quantitative assessment showed that most students had a favorable elective experience. Program challenges were also identified. Students in a global health elective were able to fulfill self-identified learning objectives, while also gaining other unexpected yet important lessons. Students' learning objectives also should be considered in evaluating learning experiences in international health electives.

Self-financing students in private medical schools

Self-financing students in private medical schools

Survey of International Clinical Education in Physical Therapist Education

Background and Purpose. International opportunities, including international clinical education (ICE), appear to be increasingly offered in education of physical therapist students. ICE encompasses experiences designed primarily for student learning at a site outside of country where physical therapist program is located. Little research exists regarding use of ICE in physical therapist education. The specific purposes of this study were to (1) explore potential program differences between those with and without ICE; (2) discover current use, locations, and durations of ICE opportunities; (3) gather general information about ICE models, including their development, implementation, and evaluation; and (4) examine faculty perceptions of barriers and benefits regarding ICE. Subjects. The participants were directors of clinical education/academic coordinators of clinical education (DCEs/ACCEs) from US-based physical therapist education programs (n = 110). Methods. Direct mailing and listserv postings were used to recruit participants who then completed an Internet-based survey. Results. Of 110 respondents, 40.9% reported that they offered ICE. Of those programs that did not offer ICE, 18.8% (12 out of 64) planned to develop such opportunities in subsequent 2 years. Most ICE programs were 6 to 8 weeks in length, and were located in high-, upper-, or middle-income countries. The majority of ICE opportunities were in outpatient and hospital settings, and most clinical instructors were non-US citizens whose education was commensurate with US-level training. Commonly perceived barriers to ICE included expense, lack of faculty time and knowledge, and difficulty with site coordination. Perceived benefits were positive impact on cross-cultural competency, student personal development, and global awareness. Discussion and Conclusion. This study was first to explore broad use of ICE in US-based physical therapist education programs. Further research and professional dialogue are warranted to explore its present use and perhaps shape future application of ICE. Key Words: International, Clinical education, Global health. BACKGROUND AND PURPOSE Many factors, including rapidly developing technology and greater ease of travel, have contributed to an increasingly connected world. In this changing environment, impact of internationalization is becoming more evident across higher education.1 Knight2 defines internationalization as the process of integrating an international, intercultural or global dimension into purpose, functions or delivery of post-secondary education.(P2) As a reflection of this integration, international opportunities appear to be more prevalent in curricula of many health care profession programs located inside and outside of United States, including medicine,3-9 nursing,1015 and physical therapist education.16-21 A wide range of models are described in this literature. While overlap occurs among them, they may be grouped into 3 broad categories: community service; (2) service and learning, often termed international service-learning (ISL); and (3) student learning. Various terms are found in literature to describe experiences developed primarily for student learning at international locations: study abroad, global or global health training/education/electives/experiences, and international or international health electives/ clinical placements/ clinical rotations/internships/clinical education.3-11,15,19 Global health education also may refer to coursework that addresses health care systems and/or common health problems in countries outside United States, but may or may not include an international experience for student.3 In discussion that follows, term international clinical education (ICE) will be used to encompass all activities focused on student learning at international sites. …

47 Limitations to International Health Electives Encountered by Emergency Medicine Residents: A Survey of Emergency Medicine Residents in Ohio

In recent years there has been an increase in the number of countries who recognize emergency medicine as a specialty as well as an increase in the number of international health electives available to residents. Additionally, current literature suggests residents receive significant educational and personal benefits from taking part in international health electives that they would not gain otherwise. With the current increase in opportunities available to emergency medicine residents, why are more residents not participating in international health electives? The purpose of this study was to determine the level of interest and identify the obstacles emergency medicine residents in Ohio have pertaining to international health electives opportunities.