Global Health Training Research Articles

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.

Evolving partnership: A National Center for Global Health and Medicine Resilient Training Model for clinical research professionals during the COVID-19 pandemic.

The clinical trial industry has encountered challenging circumstances in which the increasing number of trials outpaces the number of trial specialists. For instance, there has been an unprecedented demand for clinical trials following the Covid-19 pandemic, which has worsened the global shortage of qualified personnel. It is therefore imperative to produce more qualified clinical trial professionals. An adaptive and collaborative training model was implemented by the National Center for Global Health and Medicine through the Department of International Trials. This aimed at building capacity among health workers in developing countries and providing them with the skills to be able to conduct all phases of the clinical trial from protocol design to publication of results. It also seeks to foster collaboration and partnership between local health workers and international experts. Since 2016, we have implemented a Japan-led training program, and since 2020, the COVID-19 pandemic has ushered in a shift from a single Train-the-trainer model (ToT) to a mixed model, the Evolving Partnership Training (ePT). In this model, we applied four different methods: train-the-trainer, needs-oriented training, open symposiums, and advanced learning. The total number of training participants increased exponentially from a total of 41 between 2016-2020 to 2,810 in 2021. Our experience has proven that despite the constraint of the pandemic, the ePT is a viable approach compared to a single method for providing quality training and increasing the number of participants.

Knowledge is Power: Assessing Academic Decolonization through Bidirectionality of Training in Global Health Fellowships


 
 
 There is significant support for decolonization in global health medical education, yet there is little documented on the inclusion of physicians from low- and middle-income countries (LMICs) into U.S.- based training. This paper aims to explore the options that are available to physicians from LMICs to receive academic training in global health at U.S.-based institutions and contemplate solutions that align with the ideals of sustainability and decolonization. A narrative review conducted through library databases and a web-based search of academic websites were carried out in 2022 to find programs that discussed inclusion of physicians from LMICs into U.S.-based global health fellowships. Fifteen articles were found that discussed the inclusion of physicians from LMICs into a U.S.-based program. From the web-based search, five programs plainly stated the acceptance of physicians from LMICs. Therefore, there are limitedcurrent U.S.-based academic programs accepting physicians from LMICs, based on a literature search and applicant requirements published online. This shows an important gap in training that is meant to focus on health equity and decolonization, particularly in the realm of knowledge sharing. However, this study was limited by what data was formally published through journal articles or online. Programs that have bidirectional aspects may exist but have no publication or formal website.
 
 

Consensus Competencies for Postgraduate Fellowship Training in Global Neurology.

Use a modified Delphi approach to develop competencies for neurologists completing ≥1 year of advanced global neurology training. An expert panel of 19 United States-based neurologists involved in global health was recruited from the American Academy of Neurology Global Health Section and the American Neurological Association International Outreach Committee. An extensive list of global health competencies was generated from review of global health curricula and adapted for global neurology training. Using a modified Delphi method, United States-based neurologists participated in 3 rounds of voting on a survey with potential competencies rated on a 4-point Likert scale. A final group discussion was held to reach consensus. Proposed competencies were then subjected to a formal review from a group of 7 neurologists from low- and middle-income countries (LMICs) with experience working with neurology trainees from high-income countries (HICs) who commented on potential gaps, feasibility, and local implementation challenges of the proposed competencies. This feedback was used to modify and finalize competencies. Three rounds of surveys, a conference call with United States-based experts, and a semistructured questionnaire and focus group discussion with LMIC experts were used to discuss and reach consensus on the final competencies. This resulted in a competency framework consisting of 47 competencies across 8 domains: (1) cultural context, social determinants of health and access to care; (2) clinical and teaching skills and neurologic medical knowledge; (3) team-based practice; (4) developing global neurology partnerships; (5) ethics; (6) approach to clinical care; (7) community neurologic health; (8) health care systems and multinational health care organizations. These proposed competencies can serve as a foundation on which future global neurology training programs can be built and trainees evaluated. It may also serve as a model for global health training programs in other medical specialties as well as a framework to expand the number of neurologists from HICs trained in global neurology.

Global Mental Health Meets Social Innovation: the HOW matters

IntroductionMental health conditions are rising globally, and COVID-19 has exacerbated the situation. We often think that massive money investments and training of specialized mental health providers, such as psychiatrists, will help alleviate the demand-supply challenge. But the reality is different. Despite all efforts over the last years, the mental health treatment gap, the percentage difference between the number of people needing treatment for mental illness and the number of people receiving treatment, is still 50+% in countries like Germany. The investment of money and the training of specialized mental health providers alone will not be sudcient to decrease this number.ObjectivesWe need to learn from and with partners from low- and middle-income countries (LMIC), in which a shortage of resources has prevented a signihcant investment in mental health but also has inspired the innovation and implementation of novel approaches to decrease the mental health treatment gap. This reshaped approach allows us to move from Northern Ventriloquism (high-income countries teach LMIC what to do) to honest cross-cultural bidirectional learning. Furthermore, it will hll the “how” gap.MethodsWe know WHY we should act in the (global) mental health field. We also know WHAT we should do. The main question remaining is HOW we can implement any of the activities. To fill this “how” gap, the Dresden-based NGO On The Move e.V. designed an annual 8-week program funded by the European Union, which centers around a global mental health and social innovation curriculum and aims to create spaces of empowerment towards mentally healthier communities. Our participants come from four higher education institutions in Germany, Ghana, and Kenya.ResultsThe program, which was recently awarded the TU Dresden internationalization award in the category “Innovative International Research Cooperation,” encourages participants to learn from and with each other. To enable an holistic approach to mental health and diversify the pool of mental health champions, the program includes participants from all fields. Since the start of the program, hundreds of culturally sensitive mental health-related Youtube videos have been recorded and distributed widely in the communities of the participants. The number of participant-led advocacy events has also increased.ConclusionsContextually, we will discuss core concepts, such as human-centered and community-based approaches, and how they relate to filling the “how” gap in our presentation. We might not have a blueprint of solutions in terms of decreasing the mental health treatment gap; however, our recommendations can support innovative and customized solutions. From a process perspective, we will compare existing global mental health training curricula with our curriculum and highlight transcultural learning opportunities; we will also discuss the elements of our program that empower our trainees.Disclosure of InterestNone Declared

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

Background: Despite significant 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.