International Medical Education Research Articles

Navigating the challenges of establishing a new residency program in anatomic pathology based on the Accreditation Council for Graduate Medical Education International standards in the post–Soviet era Kazakhstan: strategies and successes

In 1991, after the dissolution of the Soviet Union, newly independent Kazakhstan faced challenges of a healthcare system in transition. Anatomic pathology practice remains one of the least developed medical specialties in Kazakhstan. Acute shortage of pathologists is a universal phenomenon. There is no subspecialty pathology practice as yet. Residency programs in anatomic pathology are found only in a few tertiary health institutions in the big cities. Nazarbayev University School of Medicine was established in 2015 to reform medical education in Kazakhstan. Prior to this time, in 2010, Nazarbayev University was established to lead higher education reforms in the country. Each school in Nazarbayev University was paired with an international partner to jump-start its trajectory to excellence. Establishing a new residency program in anatomic pathology based on a western pedagogy was a new innovation that needed multi-level stakeholder consultation and support. In partnership with the University of Pittsburgh School of Medicine and its hospital system, the University of Pittsburgh Medical Center, we established the first residency program in anatomic pathology based on the Accreditation Council for Graduate Medical Education International standards in Central Asia. We have identified 5 strategic approaches that led to our rapid success, including targeted strategic partnership; robust engagement with the local stakeholders; adoption and contextualizing of an existing pedagogy; ensuring adequate and fit-for-purpose infrastructure; and organizational restructuring and optimization. We hope that these suggestions will be translatable to help those facing the arduous but exciting task of establishing a new residency program from scratch.

Distributed Medical Education (DME) in psychiatry: perspectives on facilitators, obstacles, and factors affecting psychiatrists' willingness to engage in teaching activities

BackgroundDistributed Medical Education (DME), a decentralized model focused on smaller cities and communities, has been implemented worldwide to bridge the gap in psychiatric education. Faculty engagement in teaching activities such as clinical teaching, supervision, and examinations is a crucial aspect of DME sites. Implementing or expanding DME sites requires careful consideration to identify enablers that contribute to success and barriers that need to be addressed. This study aims to examine enablers, barriers, and factors influencing psychiatrists' willingness to start or continue participating in teaching activities within Dalhousie University's Faculty of Medicine DME sites in two provinces in Atlantic Canada.MethodologyThis cross-sectional study was conducted as part of an environmental scan of Dalhousie Faculty of Medicine’s DME programs in Nova Scotia (NS) and New Brunswick (NB), Canada. In February 2023, psychiatrists from seven administrative health zones in these provinces anonymously participated in an online survey. The survey, created with OPINIO, collected data on sociodemographic factors, practice-related characteristics, medical education, and barriers to teaching activities. Five key outcomes were assessed, which included psychiatrists' willingness to engage in (i) clinical training and supervision, (ii) lectures or skills-based teaching, (iii) skills-based examinations, (iv) training and supervision of Canadian-trained psychiatrists, and (v) training and supervision of internationally trained psychiatrists. The study employed various statistical analyses, including descriptive analysis, chi-square tests, and logistic regression, to identify potential predictors associated with each outcome variable.ResultsThe study involved 60 psychiatrists, primarily male (69%), practicing in NS (53.3%), with international medical education (69%), mainly working in outpatient services (41%). Notably, 60.3% lacked formal medical education training, yet they did not perceive the lack of training as a significant barrier, but lack of protected time as the main one. Despite this, there was a strong willingness to engage in teaching activities, with an average positive response rate of 81.98%. The lack of protected time for teaching/training was a major barrier reported by study participants. Availability to take the Royal College of Physicians and Surgeons of Canada Competency by Design training was the main factor associated with psychiatrists' willingness to participate in the five teaching activities investigated in this study: willingness to participate in clinical training and supervision of psychiatry residents (p = .01); provision of lectures or skills-based teaching for psychiatry residents (p < .01); skills-based examinations of psychiatry residents (p < .001); training/supervision of Canadian-trained psychiatrists (p < .01); and training and supervision of internationally trained psychiatrists (p < .01).ConclusionThe study reveals a nuanced picture regarding psychiatrists' engagement in teaching activities at DME sites. Despite a significant association between interest in formal medical education training and willingness to participate in teaching activities, clinicians do not consider the lack of formal training as a barrier. Addressing this complexity requires thoughtful strategies, potentially involving resource allocation, policy modifications, and adjustments to incentive structures by relevant institutions.

A Post-Fellowship Support Framework for Rural Doctors: the Queensland experience

Background International workforce shortages have prompted many initiatives to recruit, train and retain rural doctors, including Australia’s emerging National Rural Generalist Pathway. This project explored an important component of retention, rural doctors' post-Fellowship support needs, to develop and validate a post-Fellowship support framework. There has been considerable international attention on social accountability in medical education and how medical schools and other institutions can address the needs of the communities they serve. The recognition that rural and remote communities globally are underserved has prompted numerous educational approaches including rurally focused recruitment, selection, and training. Less attention has been paid to the support needs of rural doctors and how they can be retained in rural practice once recruited. Methods The project team reviewed international and Australian rural workforce and medical education literature and relevant policy documents to develop a set of guiding principles for a post-Fellowship support framework. This project utilised a mixed methods approach involving quantitative and qualitative methodologies. A range of rural doctors, administrators, and clinicians, working in primary and secondary care, across multiple rural locations in Queensland were invited to participate in interviews. Thematic analysis was undertaken. Results The interviews validated ten interconnected guiding principles which enabled development of a grounded, contextually relevant approach to post-Fellowship support. This framework provides a blueprint for a retention strategy aiming to build a strong, skilled, and sustainable medical workforce capable of meeting community needs. Conclusions The ten principles were designed in the real-world context of a mature Queensland Rural Generalist Pathway. Four themes emerged from the inductive thematic analysis: connecting primary and secondary care; valuing a rural career; supporting training and education; and valuing rural general practice. These themes will be used as a basis for engagement and consultation with rural stakeholders to develop appropriate retention and support strategies.

25th anniversary of the Department of Cardiac Surgery at the University Medical Center Maribor: advancing hearts, changing lives : A quarter century of commitment.

In 1996, Slovenia witnessed aprofound transformation in its cardiac care landscape with the establishment of the Department of Cardiac Surgery at the University Medical Centre Maribor. This momentous milestone heralded the birth of the nation's second heart surgery center revolutionizing cardiovascular care accessibility. Today, the Department of Cardiac Surgery stands as aregional hub, delivering specialized cardiac surgical services to Slovenia's northeastern region and beyond. Its unwavering commitment to excellence, patient-centered care, and adherence to international guidelines reflects its dedication to providing top-tier cardiac care. As the department commemorates its 25thanniversary, this article offers areflective overview of its establishment, development, growth and future trajectory for further development in an ever-changing era of cardiovascular medicine. The article also highlights the department's active involvement in international collaborations, scientific research, medical education, and innovations in minimally invasive cardiac surgery.

ABSTRACTS FROM INTERNATIONAL MEDICAL EDUCATION CONFERENCE (IMEC) 2023

ABSTRACTS FROM INTERNATIONAL MEDICAL EDUCATION CONFERENCE (IMEC) 2023

Designing a Situational Judgment Test for Use in Medical School Admissions.

It has long been acknowledged that professional competencies are required for success in medical school, residency training, and medical practice. Over the last decade, medical schools have begun to introduce standardized assessments of professional competencies, but many still rely on interviews to assess these competencies, which occur after about half of the applicant pool has already been screened out. In this article, the authors discuss the development, evaluation, and launch of the Association of American Medical Colleges (AAMC) situational judgment test (SJT) for use in medical school admissions. The AAMC SJT is designed to assess an examinee's understanding of effective and ineffective behaviors related to the core competencies for entering medical students, including service orientation, social skills, cultural competence, teamwork, ethical responsibility to self and others, reliability and dependability, resilience and adaptability, and capacity for improvement. The authors evaluate the evidence for the need for SJTs in medical school admissions by exploring common derailers in medical school, gaps in the admissions process regarding information about professional competencies, and the challenge of conducting holistic review in a high-volume context. They summarize existing research from the employment, international medical education, and residency selection contexts suggesting that SJT scores are positively associated with subsequent performance and may add value to the admissions process. The authors discuss 5 goals that were the foundation for developing the AAMC SJT: (1) assess the professional competencies needed for success in medical school using a proven method, (2) enable holistic review in a high-volume admissions context, (3) create and share a program of research to support the appropriate use of SJT scores, (4) signal the need for preparation in professionalism to learners, and (5) balance the need for a new assessment with minimizing the burden and risk for applicants.

Collaborating to Overcome the Barriers to Implementing Planetary Health Education for Medical Students: The International Medical Education Collaboration on Climate and Sustainability (IMECCS)

Medical education is lagging behind advances in planetary health knowledge due to the considerable barriers to introducing new topics into medical curricula. This potentially leaves doctors of the future ill-equipped to deal with the health challenges associated with environmental degradation. The recently conceived ‘infusion’ approach by the Icahn School of Medicine at Mount Sinai, New York, USA, represents a promising method for integrating planetary health topics into medical education. Adopting this approach, the International Medical Education Collaboration on Climate and Sustainability (IMECCS) was founded, with the goal of empowering healthcare students and faculty members worldwide to integrate planetary health education into their curricula. IMECCS consists of medical students and faculty members at universities in the USA, UK, and Honduras with experience in introducing planetary health topics into medical curricula. Based on discussions of challenges and successes, the group created an online open-access resource bank designed to enable a medical student or faculty member, without prior experience, to implement a planetary health curriculum and infuse these topics into existing teaching sessions at their institution.

A Paradigm Shift from International to Transnational Medical Education

In recent years, the number of medical students seeking international opportunities has grown. To satisfy these demands, collaborative international programs have been developed. However, the benefits of these programs are limited as they employ an international medical education (IME) approach where only the students are exchanged. In this commentary, we discuss the current models of IME and propose a paradigm shift to a transnational approach wherein the student, faculty, and curriculum are exchanged allowing for increased integration and awareness of cultural and educational approaches to treatment that can be retained and incorporated into future practice to advance healthcare across the globe.

FAIMER Global Faculty Development: A Sustainable Partnership Model to Advance Health Professions Education.

The Foundation for Advancement of International Medical Education and Research (FAIMER), a member of Intealth, offers longitudinal faculty development programs (LFDPs) in health professions education (HPE) and leadership through its International FAIMER Institute (IFI) in the United States and FAIMER Regional Institutes (FRIs) globally. FAIMER fosters mutual collaboration and delineates shared responsibilities for FRI development in partnership with local institutions, using an adapted hub-and-spoke organizational design. This paper describes FAIMER's model, its sustainability, and its impacts at individual, institutional, and national levels. IFI was launched in 2001 in Philadelphia, Pennsylvania, as a 2-year part-time hybrid LFDP; with the COVID-19 pandemic onset, IFI transitioned to a fully online program. Since FAIMER's launch, 11 FRIs developed in Brazil, Chile, China, Egypt, India, Indonesia, and South Africa, each modeled on the IFI curriculum and adapted to local context. The more than 1,600 IFI and FRI graduates (fellows) from over 55 countries now form a global community of health professions educators who have shared exposure to HPE methods and assessment, leadership and management, educational scholarship and research, and project management and evaluation. Across all global locations and program formats, fellows self-reported a similar increase in knowledge and skills in HPE. All programs center on the fellows' institutional projects as experiential learning; these projects have focused primarily on educational methods and curriculum revisions. An increased quality of education was reported as the top impact resulting from fellows' projects. As a result of these programs, fellows have influenced education policy in their countries and established academic societies for HPE, thus contributing to recognition of the HPE academic specialty. FAIMER has successfully developed a sustainable model for advancing HPE globally, creating a vibrant network of health professions educators who have influenced country-specific educational policy and practice. FAIMER's model offers one approach to building global capacity in HPE.

Immunization requirements in medical school accreditation standards

Healthcare workers (HCW) are at risk of contracting vaccine-preventable diseases and spreading these infections to their patients. Vaccination against preventable diseases prior to clinical training can mitigate this risk. Accreditation guidance can be used as an opportunity to enforce desirable norms and standards. Standards from 144 national accreditation organizations spanning 123 member states listed in the Directory of Organizations that Recognize/Accredit Medical Schools by the Foundation for Advancement of International Medical Education and Research were reviewed and summarized. Findings were further stratified by World Bank income group and WHO region. While higher-income countries were more likely to have accreditation guidelines available than lower- or middle-income countries, few national medical school accreditation bodies specifically request immunization status of trainees as a standard. Further, almost none mention specific antigens for which immunity should be assessed. These findings should be used by medical school and other health professional training accreditation bodies to inform future policy direction to protect trainees as future HCW.

Striking up a Conversation: Exploring Advising in Graduate Programs in Health Professions Education.

Advising is happening across the medical education continuum, within non-medical graduate education programs, and is central to the advancement of said learners. This suggests that advising should play a role in graduate health progressions education (HPE) programs. To explore advising curricula among HPE programs, we conducted a website review of all published HPE programs on the Foundation for Advancement of International Medical Education and Research's website. We recognized the lack of information published on advisory roles in graduate HPE programs. This prompted a literature review, which revealed a similar gap. Advising serves to benefit a student, advisor, and program thus carrying importance and need for discussion. This article is intended to kick-start a scholarly discussion about advising within graduate HPE programs.

Global Health Initiatives: The University of Minnesota Experience in Karnataka, India

Features| April 2023 Global Health Initiatives: The University of Minnesota Experience in Karnataka, India James V. Harmon, MD, PhD, FACP, FACS; James V. Harmon, MD, PhD, FACP, FACS Search for other works by this author on: This Site PubMed Google Scholar Kanchi Muralidhar, MD, PhD; Kanchi Muralidhar, MD, PhD Search for other works by this author on: This Site PubMed Google Scholar Twinkle Agrawal, MBBS, MD; Twinkle Agrawal, MBBS, MD Search for other works by this author on: This Site PubMed Google Scholar Kumar G. Belani, MBBS, MS, FACA, FAAP, SAMBA-F Kumar G. Belani, MBBS, MS, FACA, FAAP, SAMBA-F Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor April 2023, Vol. 87, 20–21. https://doi.org/10.1097/01.ASM.0000924976.71277.4d Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation James V. Harmon, Kanchi Muralidhar, Twinkle Agrawal, Kumar G. Belani; Global Health Initiatives: The University of Minnesota Experience in Karnataka, India. ASA Monitor 2023; 87:20–21 doi: https://doi.org/10.1097/01.ASM.0000924976.71277.4d Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: india, world health The University of Minnesota (UOM) established the Office of International Medical Education and Research (IMER) in 1998 to fulfill its mission of international health to promote medical student education, clinical experiences, and research for graduate, postgraduate trainees, and faculty. Due to the wide-reaching impact of the specialty, an anesthesiologist was appointed to the executive committee. India is currently the largest world democracy and was chosen for partnership sites given its rich culture, economic and sociopolitical position, large rates of fluency in English among health professionals, and relative safety for trainees and faculty (asamonitor.pub/3JVem2k). Strong relationships between institutions in India and the Department of Anesthesiology at the UOM facilitated collaboration between the Indian College of Anaesthesiologists (ICA), ASA, and the Society for Ambulatory Anesthesia (SAMBA), fostering partnerships between these professional societies. This report provides valuable information for anesthesiologists interested in global health. It provides an example of sharing and... You do not currently have access to this content.

Detecting residents at risk of attrition – A Singapore pathology residency's experience

The SingHealth Pathology Residency Program (SHPRP) is a 5-year postgraduate training program in Singapore. We face the problem of resident attrition, which has a significant impact on the individual, program and healthcare providers. Our residents are regularly evaluated, using in-house evaluations as well as assessments required in our partnership with the Accreditation Council for Graduate Medical Education International (ACGME-I). We hence sought to determine if these assessments were able to distinguish residents who would attrite from residents who would graduate successfully. Retrospective analysis of existing residency assessments was performed on all residents who have separated from SHPRP and compared with residents currently in senior residency or graduated from the program. Statistical analysis was performed on quantitative assessment methods of Resident In-Service Examination (RISE), 360-degree feedback, faculty assessment, Milestones and our own annual departmental mock examination. Word frequency analysis of narrative feedback from faculty assessment was used to generate themes.Since 2011, 10 out of 34 residents have separated from the program. RISE, Milestone data and the departmental mock examination showed statistical significance in discriminating residents at risk of attrition for specialty-related reasons from successful residents. Analysis of narrative feedback showed that successful residents performed better in areas of organization, preparation with clinical history, application of knowledge, interpersonal communication and achieving sustained progress. Existing assessment methods used in our pathology residency program are effective in detecting residents at risk of attrition. This also suggests applications in the way that we select, assess and teach residents.

The Pros and Cons of Use of Handheld Electronic Devices During Ward Rounds and the Impact of the COVID-19 Pandemic.

The exponential use of handheld electronic devices (HEDs) among healthcare providers has shown the potential to enhance clinical workflows and improve patient care. However, the challenges and risks of carrying these devices during ward rounds and their impact on postgraduate trainees' (PGTs') training in general and more specifically during the COVID-19 pandemic need to be explored. A cross-sectional mixed-methods online survey was conducted to evaluate the perceptions of trainees and faculty at Accreditation Council for Graduate Medical Education International accredited residency and fellowships programs in Qatar on the use of HEDs on clinical workflow, trainees' education, and the impact of the COVID-19 pandemic. One hundred and fifty-eight participants were enrolled in the study (87 postgraduate trainees and 71 faculty). Exploratory data analysis and descriptive statistics were performed using STATA version 12 and thematic analysis of 301 qualitative responses to the survey open-ended questions using Atlas. ti qualitative software, version 9.4.0. Almost all PGTs, 83 (95.4%), and faculty 43 (62.3%) use HEDs during ward rounds. Accessibility of patient information by PGTs 73 (94.8%) and faculty 46 (84.4%) and work efficiency were the main perceived benefits. Hindering communication between team members, disruption of interaction with patients, increased risk of infection and breach of patient confidentiality were among the challenges associated with their use. Carrying devices reduced the frequency of hand hygiene practices and physical examinations of patients by trainees. The COVID-19 pandemic led to a decrease in the use of HEDs by both faculty [38(64%)] and PGTs [42(60%)]. HEDs' use is valued by both faculty and PGTs in enhancing workflow, trainees' education, patient experience, and patient care during the COVID-19 pandemic. Graduate medical education leaders should adopt measures to monitor their use during ward rounds as they can negatively impact trainees' education, reduce interaction with patients, increase the risk of infection, and breach patient confidentiality.

Developing an African medical and health professions student regional elective exchange program: approaches and lessons learned

Background: Given the significant gap in International Medical Elective (IME) opportunities for African health professions students, the Educational Commission for Foreign Medical Graduates and the Foundation for Advancement of International Medical Education and Research (ECFMG|FAIMER) launched an African regional elective exchange program through the Global Educational Exchange in Medicine and the Health Professions (GEMx) in 2016. This paper provides an overview of the development of the GEMx program, the pillars of implementation, and lessons learned. Methods: The authors conducted a longitudinal qualitative study utilizing in-depth interviews with institutional leaders, program leaders, and faculty, participant observation through symposia, strategic planning meetings, staff meetings, and document review of the annual progress reports, strategic plans, and newsletter articles, abstracts, and concept notes. Common categories were identified and incorporated into a matrix to create themes. Data were analyzed using the manifest content approach guided by a literature review. Results: The key pillars for implementation of the GEMx Africa regional elective exchange program included: the commitment from African training institutional networks and their member institutions that enabled electives to be offered, the GEMx Charter (multilateral agreement) that enabled reciprocity and diversity of elective opportunities, GEMx web-based application system that enabled the centralization of the application process and real-time feedback on acceptance, GEMx Africa Regional Coordination Center in Kampala, Uganda that lead the development and implementation in Africa, and ECFMG mini-grants that helped defray elective costs. Conclusions: Through the development of multilateral partnerships across the continent, the GEMx regional elective exchange program contributed towards bridging a long-existing gap of inadequate opportunities for African health professions students to enhance their global exposure and strengthen their knowledge and skills. .

International aspects in healthcare and medical education: Scientometric trends and knowledge maps before the COVID-19 pandemic.

Literature shows that healthcare and medical education are associated with the countries/institutes' developments, and reviewing the global patterns can shed light on various aspects of this competition. The study aims to investigate the current research aspects on the internationalization of healthcare and medical education and assess its trends worldwide. In this descriptive study, based on documents in Web of Science (n = 609), PubMed (n = 395), and Scopus (n = 6598), scientometric methods and knowledge visualization techniques were applied to evaluate global scientific production and trends from 1900 to 2020. Results were preprocessed in BibExcel (version 2016-02-20) to create a mapping file, and word co-occurrence analysis was applied to evaluate the publications. Scientific maps, authors' networks, and countries'/institutes' contributions were depicted using VOS (Visualization of Similarity) viewer and NetDraw. For trend analysis, highly frequent words were examined at intervals before 2000, 2000-2004, 2005-2009, 2010-2014, and 2015-2019. Altogether, 129 countries and 14536 (co)authors with 7007 affiliations contributed to the production of 6895 documents. Of the 2378 journals, the top 20 journals published 1298 (18.83%) articles. The top 20 authors together contributed to 247 papers (3.58%). High-income countries made up the most prolific nations. Also, institutes from North America, Europe, and Oceania pioneered production and cooperation. Highly co-occurring words were international cooperation, medical education, medical school, curriculum, medical research, and medical students. The countries/institutions' efforts in internationalizing healthcare and medical education are reflected in the publications in the databases of Web of Science, PubMed, and Scopus. Thus, the findings offer evidence-based information about past and present trends and help researchers and policymakers understand their global impact.

Online role-plays: An asynchronous pedagogy for introducing tenets of interprofessional education and practice among Indian healthcare professionals

ABSTRACT Educators worldwide are seeking innovative teaching strategies for engaging remote learners. This study explores the impact of an online role-play on students’ perceptions regarding Interprofessional education (IPE) and the usage of online role-play as a pedagogic approach. An online role-play for introducing fundamentals of IPE was organised as an activity during the monthly discussion forum of Foundation for Advancement of International Medical Education and Research (FAIMER) fellowship at one of the regional centres in India. After the role-play, the six role-players provided a written semi-structured reflective feedback while 22 observers responded to an open-ended questionnaire. The obtained data were qualitatively analysed using an inductive approach. The role-player’s reflections highlighted pre-requisites, strengths and challenges of an online role-play, whereas the observers reported an appreciation of the value of online role-play in learning interprofessional competencies. This study highlights online role-play as an innovative approach to remotely introduce the tenets of IPE.

Flexibility in primary medical programs: A scoping review

Introduction: Students and universities increasingly seek flexibility in learning options, however terms such as flexible are not consistently defined in the medical education literature. This review aimed to 1) propose a definition for flexibility in medical education and 2) create a typology of contemporary examples of how flexibility has been operationalised in medical education. Method: A systematic scoping review of papers published in English since 2009 was undertaken. The focus was on papers reporting initiatives to create flexibility in primary medical programs. Results: Based on review of 1,641 search returns and 140 full-text articles, two interconnected concepts were identified: flexibility and individualisation. Flexibility describes mechanisms that allow students choice in how they allocate time and resources to meet the requirements of their course, including time-variable progression, acceleration, deceleration, articulated degree entry and exit options, and pedagogical approaches that reduce time required in classrooms. Individualisation describes options that enable student-driven direction, extension or expansion of medical education into special interest areas, including dual degrees, breadth subjects, curriculum tracks, elective service-learning pathways, electives and selectives. Conclusions: Though not always clearly defined as such, international medical education literature describes a rich variety of flexibility and individualisation initiatives. While the constructs of flexibility and individualisation are interconnected, they can assist curriculum designers to differentiate between the mechanisms that enable flexibility in how students meet course requirements and the mechanisms that enable individual choice in what students study. Flexibility and individualisation initiatives target different needs, including both students’ needs and medical workforce needs; they also suggest different institutional and financial implications. Consensus on and consistent use of common terminology about flexibility and individualisation initiatives will improve the “searchability” and synthesis of research on such initiatives and their impacts and enablers, as well as encourage further research, publication and synthesis of outcomes of such initiatives.

Characteristics of International Rotations for Undergraduate Medical Education at United States Medical Schools: A National Study.

Medical education is criticized that it does not prepare students to serve in an increasingly globalized society. Evidence that global educational experiences can alleviate these concerns have contributed to the rise in international medical education experiences. This study explores surrounding characteristics and institutional support for international rotations across medical schools in the US. The authors conducted a sequential mixed methods exploratory national survey of international rotation coordinators at 185 US medical schools and 15 semi-structured interviews in fall 2018. Quantitative data were analyzed with descriptive statistics and qualitative data were coded and analyzed using interpretive description to identify themes across data. There were 57 responses to the survey for an overall response rate of 31%, with 77% percent of respondents (n = 44) indicating that their medical school offered international rotations. Fifteen individuals representing 13 medical schools were identified as interviewees for the second stage of the study. International rotation coordinators described components of international rotations, including partnerships with host communities, use of third-party organizations, and supporting administrative and academic structures. Although international rotations are common in medical education, they are not positioned as core academic programming within medical schools. This leads to challenges in planning, implementation, and evaluation, and immense variation in rotation components across medical programs. Future research should explore best practices for pre-departure preparation, post-travel debriefing, and evaluation of student activity as well as impact on the host site. Additional research should include exploration of unique benefits of international versus domestic sites, and aspects of sustainable partnerships between medical schools and host communities.

Patient and Physician Factors Associated with First Diagnosis of Non-affective Psychotic Disorder in Primary Care.

Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first diagnosis of psychotic disorder. We used modified Poisson regression models to examine patient and physician factors associated with a first diagnosis of psychosis in primary care. Among people with early psychosis (n = 39,449), 63% had help-seeking contacts in primary care within six months prior to first diagnosis. Of those patients, 47% were diagnosed in primary care and 53% in secondary/tertiary care. Patients factors associated with lower likelihood of diagnosis in primary care included male sex, younger age, immigrant status, and comorbid psychosocial conditions. Physician factors associated with lower likelihood of diagnosis in primary care included solo practice model, urban practice setting, international medical education, and longer time since graduation. Our findings indicate thatprimary care is an important contact for help-seeking and diagnosis for a large proportion of people with early psychosis. Forphysicians less likely to diagnose psychosis in primary care, targeted resources and interventions could be providedto support them in caring for patients with early psychosis.