Global Health Training Research Articles

Project PRIME (Psychosocial Response to International Medical Electives): Results from Medical Trainees.

Background: Participation in global health (GH) training experiences is common for US medical trainees (students, residents, and fellows). However, little is known about their experience of "culture shock" (CS), which frequently occurs during these transformative cross‑cultural immersions. Objectives: The objectives of this study include: (1) quantitatively measure medical trainee psychosocial responses to short‑term GH electives, (2) identify factors that influence their CS experiences, and (3) determine if the stage‑based CS conceptual framework applies to medical trainees. Methods: Undergraduate and graduate medical education trainees (UME and GME) who participated in short‑term GH electives between 2016 and 2020 were recruited across nine US institutions. Using a longitudinal survey method, we gathered data predeparture (demographics, resilience, perceived stress (PS), and CS assessments), every 5 days during the elective (CS, PS assessments, and training site conditions), and 30 days postreturn (perceptions of CS experiences). Analyses included summary statistics, linear regressions, and a linear mixed effects model (LMM). Findings: 252 trainees were enrolled, with 140 (56%) included in the LMM. The primary outcome was a culture shock profile (CSP) score, with 96% reporting CS. The only trainee‑specific factor that significantly increased CSP score was trainee type (UME > GME (+22%)). Several GH elective site‑specific factors significantly influenced CSP score (e.g., support network [-10%], role clarity [-11%], and overwhelmed by medical needs [+10%]). CS experiences were variable and did not progress in predictable, stage‑based fashions, which is discordant from common CS descriptions. Conclusions: Culture shock was a near‑universal, diverse experience during GH electives. On‑site training conditions and elective site host factors influenced CS more than trainee factors in this prepandemic cohort. Further research is required to (1) determine the optimal CS "balance" (i.e., promoting transformative learning while mitigating negative professional and personal impacts), (2) offer insight into harmful CS thresholds, (3) identify host perspectives, and (4) inform best practices for GH electives and global partnerships.

Working Towards a Decolonized, Longitudinal, and Equitable Global Health Training and Partnerships Program.

Growth of global health education programs has blossomed over the past two decades in the United States; yet many do not address the roots of colonialism and racism in medicine. This paper highlights the Arrupe Global Scholars and Partnerships Program (AGSPP) at Creighton University, a social justice and innovative five-year MD-MPH global health equity and partnership program for medical students, international partners, and the communities impacted by these partnerships. Using the applied social-ecological model as the global health educational framework, AGSPP launched a training and partnership program grounded in decolonized principles and global health equity. AGSPP developed three pillars of its program and monitoring, learning, and evaluation (MEL) platform to track its indicators and progression towards its goal of working towards eradicating health injustice by promoting equitable access to quality healthcare, especially within communities that are marginalized. The first pillar consists of a five-year MD-MPH and global health equity training program grounded in decolonizing, accompaniment, social justice principles. The second pillar consists of creating equitable and power-balanced international partnerships with four academic medical centers in Rwanda, Nepal, Ecuador, and Dominican Republic. The third pillar implemented was identifying, collaborating, and accompanying local communities listening to their concerns and ideas for solutions. AGSPP's three-pillar framework is built on a foundational ethos of solidarity and justice, intended to deconstruct neocolonialistic processes while advancing health equity, social justice, and pragmatic solidarity. We believe sharing our experiences of creating a program that has an intentional focus on historical context, prioritizing equitable collaboration with partner institutions and communities between the Global South and Global North, will lead to future justice-oriented leaders of tomorrow and serve as an example for additional global health programs who have a similar interest.

P-1300. Themes to Support Identification of Emerging Infections Diseases

Abstract Background Many outbreaks are first recognized by astute clinicians who notice novel disease presentations, even before statistical anomalies are detected . In our efforts to identify COVID-19 cases using automated surveillance, we noted that the tone and content of clinical notes written early in the pandemic were much different than those written later . We investigated the content of early outbreak notes to identify general patterns that might reflect an emerging disease. Methods This study seeks to identify themes in a sample of clinical notes from Veteran Administration (VA) data. We used a convenience sample of early COVID-19 , early mpox, and CDC Nationally Notifiable Diseases cases as well as inference from a natural language processing (NLP) classifier that the clinical document mentioned communication with a public health authority (as an indicator of concern). These notes were reviewed by a VA infectious disease expert and a VA medical anthropologist with training in global health, the medical explanatory model, and diagnostic decision-making. Thematic analysis was applied to the notes. Results Five main themes were detected in the 100 documents reviewed. 1-Provider discerned something abnormal and included terms such as “unusual presentation”, and “disproportionate” to describe specific symptoms and indicate an element of being surprised. 2-Initiation of protocols for containment or treatment included terms such as “isolate” and “out of concern for… will treat with ” followed by a description of an established protocol for one or more symptoms. 3-Justification of protocol deviation included terms like “insist(ing)” on a type of test or referral to the health authorities. 4-Exposures included terms detailing locations of travel, potentially exposed persons, or locations that may have been sites of initial contraction. 5-Patient voice, as a theme, were described patient fear or agitation. Conclusion Unusual cases can prompt documentation of their exceptionality. Similar patterns may be seen in emerging diseases, such as H5N1, perhaps well before statistical increases are detected in the syndromes they cause. In further research, we will expand on this limited sample and explore NLP systems that could be applied to health records to scan for emerging health threats. Disclosures All Authors: No reported disclosures

Reimagining Global Health: Accelerating Change for a Sustainable Future.

In 2023, an interdisciplinary group of global health experts from five continents convened a plenary panel at the Consortium of Universities for Global Health (CUGH) annual conference entitled "Reimagining Global Health for the 21st Century." At the heart of this viewpoint article lies a fundamental question: How can we reimagine global health to best confront existing challenges and meet the demands of the future? To fully assess the scope of global health challenges and identify sustainable solutions, a clear definition of the aims and strategic approaches is needed. Such an assessment is also critical for progress in promoting equity, including decolonizing global health. Key issues examined are the following: equity, governance, research, education, and sustainability. To assure a sustainable global health enterprise, we propose the following three strategic imperatives as guiding principles: a holistic, unified approach grounded in mutual benefit, joint investment, long‑term collaborative commitment, and solidarity across low‑ to middle‑income countries (LMICs) and high‑income countries (HICs); joint priority setting of investments in research, education, practice, and workforce development; and collaborative governance, maximizing a multisectoral approach among local, national, regional, and global strategies. The viewpoint sets the stage for the development of an action roadmap to develop a unified concept of global health; identify strategies to ensure sustained funding for global health research, education and training, and practice; establish benchmarks and metrics to measure progress; and design a collaborative governance system to promote interconnectedness and engagement among local, regional, national, and global stakeholders.

Rethinking global health training: making the links between theory and practice

Implication Statement International medical electives are viewed as an opportunity for medical students to experience global health firsthand and improve cultural humility. Despite its potential benefits, concerns have been raised regarding harms during placements. These need to be addressed to ensure that international electives are conducted ethically and not only benefit learners but also the communities involved. The University of Saskatchewan has transformed its global health certificate, Making the links, in an effort to address existing concerns. We seek to share the program’s approach and its value to us. Other centres may introduce this approach to help train more equity-oriented healthcare workers.

Global health training opportunities during pediatric hematology/oncology fellowship: Results from a survey of program leaders.

There is growing interest in global health (GH) among medical trainees in the United States. However, providing GH training opportunities at the fellowship level presents several challenges. Understanding of barriers and facilitators to implementing GH training is essential for addressing these challenges. We developed a comprehensive survey of 65 Likert-scale multiple-choice and open-ended questions to assess perspectives of pediatric hematology/oncology fellowships leaders on GH training. The survey was electronically distributed to program leaders at all ACGME-accredited pediatric hematology/oncology fellowships programs, and data were summarized using descriptive analysis. Of 73 eligible programs, we had a 45.2% response rate with 27 complete and 6 partial responses. Respondents represented programs across the United States, including 19 (57.6%) affiliated with NCI-Designated Cancer Centers. Fourteen programs (43.8%) currently offer GH training opportunities, whereas 18 programs expressed interest in future opportunities (15, 83.3%) or plan to offer them soon (3, 16.7%). Major barriers identified include competing training priorities (23, 82.1%), lack of faculty mentors in the division (23, 82.1%), and lack of dedicated institutional funding (20, 71.4%). Key facilitators include the interest and initiative of current fellows (27, 96.4%), dedicated institutional funding (26, 92.8%), and having established international partnerships (26, 92.8%). The study reveals strong interest in GH training in pediatric hematology/oncology fellowships. Despite challenges such as competing priorities and a lack of mentors, significant facilitators include current fellows' initiatives, dedicated funding, and established international partnerships. These insights can help shape future initiatives to incorporate GH into pediatric oncology/hematology fellowship training.

Survey of Hematology/Oncology Program Leaders on Equity and Global Health Opportunities for Fellows.

The study assesses the current state of global oncology (GO)/hematology training opportunities in US fellowship programs. We developed a comprehensive survey of 64-Likert multiple-choice and open-ended questions. The survey was electronically distributed to fellowship program leaders at Accreditation Council for Graduate Medical Education-accredited adult hematology/oncology fellowships. Program directors received three reminders after which survey was sent to assistant program directors or division heads for programs not represented. A total of 171 programs were eligible for the survey. We received 42 (24.6%) responses; 40 were included in the analysis, and two were excluded for declined consent and incomplete responses. The programs include large academic (81.6%) and community hospitals (10.5%). Of the respondents, 18 (48.6%) reported offering some opportunities for global health training, and half reported interest among current fellows. Most programs (29, 82.9%) had three or fewer faculty engaged in GO research. Institutional training grants were available in 15 (39.5%) programs, of which six (40%) allowed for global health research. Of the 18 programs offering global health training activities, most (15, 83.3%) report less than a quarter of their trainees currently participate in GO experiences. The most commonly perceived barriers to GO opportunities include competing priorities (85.3%) and lack of faculty mentors with GO-related experience (82.4%). Conversely, the most commonly perceived facilitators include established partnerships outside the United States (97.0%) and dedicated institutional funding (93.9%). Our survey demonstrates that although there is significant interest among fellowship trainees, a minority of the fellowship programs offer GO opportunities. Providing GO opportunities would require programs to establish partnerships with institutions outside the United States and to have systematic approaches of addressing other barriers, including enhancing funding and mentorship.

The Value of International Exchange Programs for Physician Assistants: Surveying a US-Netherlands Advanced Practice Provider Exchange Program.

International exchange programs between physician assistants (PAs) and other advanced practice providers (APPs) from different countries can facilitate opportunities for global health training and experiences. This article examines a survey of 5 PAs, 4 nurse practitioners, and 1 certified nursing specialist working in the United States (US) about their experience collaborating in an international exchange program with APPs in the Netherlands. Ten APPs in the United States anonymously answered an 8-item survey on their experience in an international exchange program with APPs in the Netherlands with a 100% response rate. The survey contained questions regarding the impact of the program on cultural competence, professional development, and perception of health care systems. All respondents agree or strongly agree that the program contributed to APP growth in cultural competence and professional development. Eighty percent of respondents found APP practices in the United States compared with the Netherlands to be somewhat or extremely similar, with differences noted in training and education, patterns of utilization, and roles in procedures. Free responses indicate APPs are used similarly in the Netherlands and the United States, while APP training models and health care infrastructure in the 2 countries have notable differences. Survey results examined in this article underscore how an international exchange program can not only enrich individual professional paths but also positively contribute to the broader global health care landscape. The lessons learned, shared experiences, and insights gained have the potential to shape health care practices on an international scale, fostering a collaborative and interconnected future for health care providers worldwide.

Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries.

Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.

Long-term trends in international medical electives fees: a database mining study.

Abroad medical electives are recognized as high-impact practice and considered a necessity to provide global health training. As of recently, the COVID-19 pandemic and its related travel restrictions prohibited most international elective activities. Another important barrier to abroad electives that received comparably little attention is elective and application fees, which - combined - may be as high as $5000 per month, and may prevent students with limited financial resources from applying for an international elective. Elective fees have never been systematically analyzed and trends in teaching and application fees have rarely been subject to dedicated scientific investigations. Using data from two large elective reports databases, the authors addressed this gap in the literature. The authors analyzed trends in abroad elective fees within the last 15 years in some of the most popular Anglo-American elective destinations among students from Germany, including the United States of America, Australia, New Zealand, the Republic of South Africa, Ireland and the United Kingdom. The authors identified n = 726 overseas elective reports that were uploaded between 2006 and 2020, of which n = 438 testimonies met the inclusion criteria. The United Kingdom and Australia were the most popular elective destinations (n = 123 and n = 113, respectively), followed by the Republic of South Africa (n = 104) and the United States of America (n = 44). Elective fees differed substantially-depending on the elective destinations and time point. Median elective fees were highest in the United States of America (€ 1875 for a 4-week elective between 2018-2020), followed by the Republic of South Africa (€ 400) and Australia (€ 378). The data also suggests an increasing trend for elective fees, particularly in the United States. Rising fees warrant consideration and a discussion about the feasibility of reciprocity and the bidirectional flow of students in bidirectional exchange programs.

Essential Disaster Medicine Education, Training and Competencies

Abstract Despite the increasing risk of disasters and health crises worldwide, we are failing to equip the new generation of health care workers with basic education and training in disaster medicine and global public health. Unfortunately, the teaching of disaster medicine is underrepresented in several countries worldwide. Learning Objectives Understand the role of education and training as integral components of disaster preparedness. Recognize the fundamentals of adult learning and competency-based education and training. Discover the general principles of education and training in disaster medicine. Explore the state of the art of simulation-based training in disaster medicine.

A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice

IntroductionAccountability is a complex idea to unpack and involves different processes in global health practice. Calls for accountability in global health would be better translated to action through a better...

Ten-year evaluation of an immersive global health medical school course using a four-principle equity framework

IntroductionResponding to a growing need for health care professionals equipped with global expertise in local and international settings, an innovative global health medical school course was developed that combines rigorous didactics, mentorship, cross-cultural training, and international experiences to build students’ cultural humility and clinical skills.MethodsRecognizing that global health service trips and courses can unintentionally exacerbate inequities and power imbalances, this course was evaluated using the four principles of Melby et al.’s Guidelines for Implementing Short-term Experiences in Global Health. These principles include skill building in cross-cultural effectiveness and cultural humility, bidirectional participatory relationships, local capacity building, and long-term sustainability.ResultsThe course was developed with long-standing global partners and includes a capstone project that is intended to strengthen local capacity with benefits to the site and student. Student course evaluations, supervisors’ observations of students, and supervisor feedback forms indicate that this course achieves these principles. Furthermore, there is evidence that students developed cultural humility, acquired foundational science knowledge and relevant skills, and changed their medical practice.DiscussionThis approach could serve as a model for institutions seeking to enhance training in global health for medical students.

Strengthening Mentorship in Global Health for US Medical Students.

US medical students demonstrate strong interest in receiving global health training. In 2012, the Center for Global Health (CGH) at the University of Illinois College of Medicine (UICOM) developed a Global Medicine (GMED) program to match this interest. From its initiation, mentorship has been a key component of the GMED program. More recently, this has been strengthened by applying additional evidence-informed approaches toward mentoring. These include the "mentor up" approach, a "network of mentors," and an individualized development plan (IDP). Applying these changes were associated with increases in the number of student abstract presentations and peer-reviewed journal publications. Mentorship based upon evidence-informed approaches should be a key component of global health education in academic medical centers.

A scoping and web-based review of current practices and lessons learnt in development and sustainability of global health emergency medicine fellowships

Background: Despite a high perceived interest in advanced global health training among Canadian emergency medicine trainees, only one global health emergency medicine (GHEM) fellowship existed in Canada at the time of this review. We conducted a scoping and web-based review to summarize the components of, and lessons learnt through development and implementation of global health emergency medicine fellowship programs to date, to inform program development. Methods: We conducted a scoping and web-based review by systematically searching electronic databases from inception to 2021 for articles and websites (2022) describing global health emergency medicine training programs based in high income countries. Results: From 2957 articles and 62 websites identified, eight articles and 43 websites were included in the review. Fellowships are generally structured as follows: 1–2 years duration curriculum including clinical skills, and course and field work focused on education, research or administration, funded by fellows’ clinical hours. Details on trainees’ experiences, international work, and program outcomes were lacking. Conclusions: This review highlights the need for information on lessons learnt through development and implementation of GHEM fellowship programs, and experiences and outcomes of trainees to date, to inform program improvements to optimize the benefits of GHEM fellowship training. Registration: Open science framework; https://doi.org/10.17605/OSF.IO/UAH35 February 19th, 2018.

A global matchmaking web platform facilitating equitable institutional partnerships and mentorship to strengthen health workforce training capacity

The critical human resources deficit in the healthcare sector in low-resource settings (LRS) has an overwhelming impact on health outcomes and disparities in growth and development of the global healthcare workforce. There is a lack of qualified trainers and mentors and this makes it challenging to connect existing capacity gaps with existing expertise and established programs. Through global health partnerships, training programs, and mentorship, individuals and institutions from around the globe can connect to share training resources and strengthen clinical and research capacity in LRSs. Global health partnerships focused on capacity building face many challenges including; unequal access to information about potential partners and training opportunities, a lack of transparency regarding each institutions training priorities, and inequity and absent reciprocity within global health partnerships that have disproportionate power division between high-resource and LRSs. This initiative, the Consortium of Universities for Global Health Capacity Strengthening Platform (CUGH-CPS) (CUGHCapacityBuilding.org), aims to empower institutions and individuals in LRSs to address these challenges and drive partnership engagement through avenues that are beneficial to the LRS agent needs and context by leading the prioritization of training capacity development across clinical and research domains. The CUGH-CPS helps to identify and create a platform for the dissemination of training and mentorship needs from LRS institutions and share this information with the global community. This manuscript describes this new initiative officially launched to a global audience at the April 2023 CUGH meeting.

Global Health Perspectives on Race in Research: Neocolonial Extraction and Local Marginalization.

Best practices in global health training prioritize leadership and engagement from investigators from low- and middle-income countries (LMICs), along with conscientious community consultation and research that benefits local participants and autochthonous communities. However, well into the 20th century, international research and clinical care remain rife with paternalism, extractive practices, and racist ideation, with race presumed to explain vulnerability or protection from various diseases, despite scientific evidence for far more precise mechanisms for infectious disease. We highlight experiences in global research on health and illness among indigenous populations in LMICs, seeking to clarify what is both scientifically essential and ethically desirable in research with human subjects; we apply a critical view towards race and racism as historically distorting elements that must be acknowledged and overcome.

Characteristics of Global Health Careers among Graduates of a Global Health Equity Residency Training Program in the United States.

The number of global health (GH) physician training programs in the United States has increased in the past decade. Few studies have explored the demographics of individuals in these programs, the impact of global health training on career development, and specific factors associated with whether graduates achieve a career in global health. We aimed to describe characteristics of program graduates and quantify which previously identified factors were associated with achieving a self-defined career in GH among a cohort of graduates from one GH post-graduate training program in a highly resourced academic medical center in the United States between 2003 and 2018. We conducted a cross-sectional survey and analyzed differences between participants who self-identified as having a career in GH compared to those who did not. Among 59 individuals invited to participate, 53 (89.9%) responded to the survey. Having a GH mentor was associated with having a career in GH (OR 10.3; p = 0.004). Those who had a GH career were more likely to have a clearly-defined career path (p = 0.03), have institutional support in their current job (p = 0.00006), be able to manage the split between their GH and non-GH work (p = 0.0001), find funding to achieve their objectives in GH (p = 0.01), invest in their personal and family life (p = 0.05), and split work abroad and domestically with few challenges (p = 0.01). We present sociodemographic and career characteristics for graduates from a GH training program in a highly resourced academic medical center in the United States. Mentorship, institutional support, funding, ability to balance GH with non-GH work, and time spent domestically or abroad are key factors associated with successful careers in GH. If institutional funding is allocated to strengthen these aspects of GH training, we anticipate more sustained GH career development.

Evolving partnership: the National Center for Global Health and Medicine Training Model for clinical research professionals

Evolving partnership: the National Center for Global Health and Medicine Training Model for clinical research professionals

Response to Mass-Casualty Incidents and Outbreaks: A Prehospital Disaster Training Package Developed for the National Emergency Medical Service in Sierra Leone

Introduction:In 2018 Sierra Leone, a country highly prone to disasters, launched its first National Emergency Medical Service (NEMS) aiming to strengthen the provision of essential health services to the population with the long-term goal of creating a resilient health system able to effectively respond to and recover from emergencies. The Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM), together with the Italian NGO Doctors with Africa (CUAMM), under the supervision of the Ministry of Health and Sanitation (MoHS), developed a prehospital Disaster Training Package (DTP) delivered to all NEMS personnel to boost the prehospital management of mass-casualty incidents (MCIs) and outbreaks.Method:The DTP was designed following the six-step approach to curriculum and training development with the ultimate goal of creating a workforce comprising qualified emergency responders with specific professional competencies to respond to outbreaks and MCIs. The DTP included a first phase in which NEMS local trainers underwent a training-of-trainers (ToT) course, enabling them to deliver cascade trainings to 16 district ambulance supervisors, 441 paramedics, 441 ambulance drivers, and 36 operators working in the NEMS operation center.Results:Starting on July 19, 2021, the ToT course was delivered to the seven national trainers. All trainers successfully passed the final examination and achieved high scores in the practical sessions, demonstrating active participation, commitment to the project, and good awareness. Following the ToT course, the series of cascade trainings started on August 2, 2021, delivered by the just-trained national trainers under the direct supervision of the two training managers.Conclusion:The NEMS’ DTP is the very first Disaster Medicine training course delivered to prehospital healthcare providers in Sierra Leone. The authors believe that the provision of the DTP to all NEMS personnel has the potential to improve Disaster Medicine culture among health professionals in the Country.