Training In Tropical Medicine Research Articles

Awareness and perceptions of medical students and doctors regarding Tropical Medicine education and training in Europe: An international, online-based survey

BackgroundMultifactorial health determinants and shifts in global patterns of disease increase the need for Tropical Medicine training across Europe. A survey of university and postgraduate opportunities in Europe was conducted to identify and analyse gaps. MethodAn online survey was circulated to medical students and doctors in Europe between April and June 2021. Significance tests and a thematic analysis of the data were conducted. Results500 respondents (285 students and 215 doctors) from 27 countries were included. 17.2% of doctors were unsure whether postgraduate training in Tropical Medicine was available in their country. 20% of students and 10.7% of doctors said they were unsure whether they had been taught Tropical Medicine during university. 67.7% of students and 79.1% of doctors stated that the amount of Tropical Medicine training they encountered was or had been “not enough”. ConclusionsRespondents demonstrated great interest in Tropical Medicine. Their self-reported knowledge, awareness, and perceived competence were partly dependent on whether there is specific teaching accessible at the university. Postgraduate training options were available in some countries but not all respondents were aware of these. There is a pressing need for harmonized curricula and expanded postgraduate training to improve Tropical Medicine competencies across Europe.

Using Future Employers' Expectations to Inform Global Health Fellowship Curricula.

Fellowships in global health are increasingly popular and seek to equip physicians with the skills necessary to be effective global health practitioners. Little objective guidance exists on which skills make graduates competitive applicants from the perspective of potential global health employers. We sought to provide objective evidence for the qualifications that make applicants competitive for global health positions by analyzing the listed qualifications for current job openings in large global health organizations. The websites of 48 global health employers were systematically searched for current job postings between May and August 2017. Jobs were included for analysis if a medical degree was listed among the primary degrees accepted, and the job was based primarily in a low- or middle-income country. A total of 5849 employment opportunities were posted during the search period, and 81 (1.4%) of these met inclusion criteria. Twenty-two (27%) jobs required and 35 (43%) preferred a relevant master's degree. Few jobs requested a candidate with a PhD and none mentioned tropical medicine training as a requirement or preference. Twenty-three jobs (28%) required and 19 (23%) preferred candidates to speak another language. Most jobs (69%, 56 of 81) required more than 5 years of relevant experience. Only 11 (13%) jobs were primarily clinical positions. For physicians pursuing a career in global health, most publicly searchable jobs require substantial previous experience and involvement in global health activities beyond clinical practice. Master's degree and language skills are frequently requested candidate qualifications.

Outcomes From U.S. Military-Supported Overseas Training Rotations in Tropical Medicine and Global Health, 2006-2015.

Since 2006, the Division of Tropical Public Health at the Uniformed Services University (USU) has sponsored the Tropical Medicine Training Program (TMTP). Despite practice guidelines stating that global health education should include the collection and evaluation of data on the impact of the training experiences, no quantitative evaluation of program outcomes had previously occurred. The objective of this report was to evaluate TMTP outcomes to guide program improvement. We developed an anonymous, web-based survey to assess program outcomes as part of routine program evaluation. The survey addressed four main areas of potential TMTP impact: (1) career engagement, (2) military service contributions, (3) scholarly activity, and (4) acquisition of knowledge and skills. In February 2016, we sent the survey electronically to 222 program participants between Fiscal Years 2006 and 2015 who had e-mails available in DoD administrative systems. Ninety-eight (44%) of these responded to the survey. TMTP demonstrated impact in several areas. Increased knowledge and skills were reported by 81% of trainees, and 70% reported increased interest in serving at military overseas medical research laboratories. Subsequent career engagement by trainees included seven assignments to overseas research laboratories, 71 military deployments, and 193 short-term military missions. The ability to achieve many of the desired outcomes was associated with time elapsed since completion of formal medical education, including 24% who were still enrolled in graduate medical education. The TMTP has improved the U.S. military's ability to perform surveillance for emerging tropical and infectious diseases and has contributed to force health protection and readiness. Although many of the outcomes, such as service in the overseas research laboratories and military deployments, are dependent on military service requirements, these results remain perhaps the most relevant ways that the TMTP meets global health requirements of the US military and the nation. Additional outcomes from this training are expected to accrue as these participants complete their medical postgraduate training programs.

DoD-Supported Overseas Training Rotations in Tropical Medicine and Global Health, 2000-2015.

In 1999, the Department of Defense developed a tropical medicine training program (TMTP) to train military physicians, medical students, and scientists in performing surveillance activities in an overseas environment. This review describes the competencies, educational approach, program participants, institutional collaborations, and process outcomes of the TMTP from 2000 to 2015. TMTP-sponsored rotations addressed a wide variety of interdisciplinary competencies, many of which have military-unique applications. Rotations consisted of both didactic and experiential (overseas) components. The program provided 282 rotations for 260 trainees between 2006 and 2015, the years for which data were available. The Department of Defense accrues benefits from this training program in three main ways: (1) building a cadre of health care professionals who will go on to work at the overseas research laboratories, (2) supporting force health protection and readiness through experiential tropical medicine training, and (3) engaging in global health collaborations and partnerships. The primary challenges include funding, health and security, trainee and site heterogeneity, supervision, trainee engagement, and burden on the host institution. The program will continue to focus on improvement in these areas, with special attention to trainee preparation, communication with both trainees and host sites, and increasing reciprocity with host sites and their faculty.

Frank William Murphy

Frank Murphy was born in Altrincham and attended grammar school, university and medical school in wartime Manchester. He spent the following 10 years as a clinician in west Africa. Initially...

Recognition of Imported Tropical Infectious Disease in Returned Travelers in a University Hospital Emergency Department

Objective: Healthcare workers practising in Ireland may encounter tropical illness in the re- turned traveler. This study aimed to establish the awareness of tropical diseases in front-line healthcare professionals working in an Irish hospital. Methods: A questionnaire was administered to doctors and nurses working in an Irish univer- sity teaching hospital. The respondents' ability to obtain a travel history, to recognize tropical illness in returned travelers and to demonstrate awareness of the geographical distribution of tropical diseases was evaluated. Results: Fifty clinicians completed the survey (29 doctors and 21 nurses), most of whom had not previously worked in the tropics and had not received formal training in tropical or travel medicine. The following items were not routinely included in their travel histories: illness in traveling companions, water and food consumption, insect and animal bites. Tropical illness was infrequently considered in patients presenting with a variety of common symptoms. There was a poor level of familiarity of several tropical infectious diseases. There was a tendency for doctors to underestimate the prevalence of dengue infection. A substantial proportion of doctors were not confident in their ability to manage a patient with malaria. The educational activities preferred by the majority of respondents were tropical disease manuals, workshops and wall charts. Conclusion: This study highlights a low level of knowledge of tropical medicine among a sample of healthcare workers who may be called upon to assess the returned tropical traveler. Opportunities for training in tropical medicine should be provided to emergency department clinicians.

Knowledge gaps in the diagnosis and management of patients with tropical diseases presenting to Canadian emergency departments: are the gaps being met?

We conducted a needs assessment to identify knowledge gaps in the management of tropical diseases by Canadian emergency physicians and identify available, related continuing medical education (CME) resources. A literature review was conducted to summarize challenges in the management of commonly encountered tropical diseases. An anonymous online survey was administered to Canadian emergency physicians using the Canadian Association of Emergency Physicians survey deployment service in July and August 2012. The survey identified self-reported gaps in knowledge and assessed knowledge using case-based vignettes. A list of CME resources was generated from a review of major academic emergency medicine journals, online cases, and conference topics from emergency medicine associations during 2010-2011. Two independent reviewers assessed the relevance of the resources; differences were resolved by consensus. From 635 citations, 47 articles were selected for full review; the majority (66%) were retrospective chart reviews, few (10.6%) had an emergency medicine focus, and fewer still were Canadian (8.5%). In total, 1,128 surveys were distributed, and 296 (27%) participants were included in the study. Most respondents reported "no" (52.4%) or "some" (45.9%) training in tropical medicine. Most (69.9%) rated their comfort in managing patients with tropical diseases as "low." Few (11.1%) respondents reported a tropical disease being misdiagnosed or mismanaged; 44.1% indicated malaria. The perceived need for further training was high (76.7%). Conference workshops were the most highly requested CME modality, followed by case studies and podcasts. Correct answers to case vignettes ranged from 30.7 to 58.4%. Although 2,038 CME titles were extracted from extensive searches, only 6 were deemed relevant. Most Canadian emergency physicians have had minimal training in tropical diseases, reported a low comfort level in their management, and identified a high need for CME opportunities, which are lacking.

Postgraduate training in tropical medicine: The value of on-site experience

Postgraduate training in tropical medicine: The value of on-site experience

La formation en médecine tropicale en France

Tropical medicine was a key element of the medical structures provided by France to our former colonies and, later; to countries within the scope of our international cooperation. hI recent decades, France has drastically reduced its bilateral commitments to countries in the tropics, and especially in sub-Saharan Africa. At the same time, the teaching of tropical medicine, which was highly regarded even beyond our borders, has lost a good deal of its expertise. Initially available in a few large French centers, and ensured by teachers with extensive field experience, training in tropical medicine is now offered in many universities. However; their programs and educational objectives, focusing mainly on infectious and parasitic diseases, no longer meet the healthcare priorities of southern countries, which are facing an epidemiological transition and the rise of non communicable diseases. Few teachers now have recognized expertise in tropical medicine. These changes have had negative consequences for research programs in tropical medicine and for the image of French assistance to developing countries. In this context, the followving perspectives should be considered: 1) training in tropical medicine should be enhanced by the creation of a national diploma recognized by international bodies. 2) The creation of a doctoral course in tropical medicine is a prerequisite for achieving this goal, and the future diploma must include a significant research component. 3) Teaching in tropical medicine must become more practical and be ensured by teachers with extensive field experience. 4) Training in tropical medicine should be part of a bilateral relationship with countries in the tropics, each party contributing its expertise while respecting that of its partners. 5) Training in tropical medicine should be backed uip by high-level scientific research based on enhanced synergy of our current networks (Institute for Research and Development, Network of overseas Pasteur Institutes, universities, etc.). 6) Teaching of tropical medicine should be coordinated by a supra-university structure whose mission is to ensure coherence. 7) Success in all these objectives will require strong political commitment. This is the only way to restore the enviable position which France occupied in the recent past.

A survey of the beliefs regarding international emergency medicine among fourth-year medical students planning on matching in emergency medicine

BackgroundWith the recent growth of fellowships in international emergency medicine, the authors sought to evaluate medical students’ attitudes toward international emergency medicine and to determine the effects these attitudes have on their residency selection.MethodsStudy design: Cross-sectional survey. Data collection: An anonymous, eight-question online survey was distributed to all members of the American Academy of Emergency Medicine Resident and Student section. This survey was also distributed to fourth-year medical students rotating through the Emergency Department at Los Angeles County and the University of Southern California.ResultsNinety-eight surveys were collected, 61 from rotating students and 37 from the AAEM mailing. There were no statistically significant differences in responses between the two groups. Of the respondents, 49.4% of have been exposed to IEM, and 46.9% have participated in international health projects. Ninety-four percent agree that IEM is an exciting career option. Seventy-nine percent said programs with IEM opportunities are more appealing than those without, and 45% said the presence of IEM opportunities would be an important factor in rank list; 53% believe that IEM requires formal public health training, and 63% believe it requires tropical medicine training; 68.3%of respondents speak a language in addition to English. This subset was more likely to have participated in IEM projects previously (p = 0.026) but not more likely to make match choices based on IEM.ConclusionsHalf of medical students surveyed had prior experience in international health, and most agree that international emergency medicine is an exciting career option. Over two thirds believe that the presence of IEM opportunities will be a factor in their match list decision.

What is Tropical Medicine?

Copyright: © 2013 Miller A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. At first sight this seems a question with an obvious response and not one that requires debate in the editorial columns of a tropical medicine journal. However, the answer may be more complex than appears at first sight and perhaps it may therefore benefit from a more detailed exploration. The obvious response is that the discipline of “Tropical Medicine” refers to the practice of medicine in the tropics. But does it refer to all medical practice that takes place within the Tropics, does it refer to the practice of medicine within resource poor settings or does it refer to the diagnosis and treatment of infectious and parasitic diseases found in a tropical environment? There is no standard definition of Tropical Medicine. In the UK, doctors who wish to specialize in Tropical Medicine (TM) must first train in General Internal Medicine (GIM) and secure their exam to gain Membership of the Royal College of Physicians (MRCP). They then follow the training pathway for specialists in Infectious Disease (ID) with the addition of doing a full time course of study for the Diploma of Tropical Medicine & Hygiene (DTM&H). Study is carried out at either the London or Liverpool Schools of Tropical Medicine and the diploma is conferred either by the Royal College of Physicians of London or the Liverpool School of Tropical Medicine. Additionally trainees who wish to be certified in TM must spend at least 2 years of their training at the UK centre approved for TM training (currently Liverpool, London and Birmingham) and spend a year working overseas in a resource poor setting. In many other countries, TM does not exist as a distinct specialty but is incorporated into the practice of Infectious Disease. In the US, it is not a board certified specialty but there are several credentialed courses available. These days, Tropical Medicine is often referred to as global/geographical health or international health and it encompasses a number of sub specialties such as refugee healthcare, travel medicine and expedition or remote/wilderness medicine.

Tropical Medicine Training in the Department of Defense

OVERVIEW With increased emphasis by the Department of Defense (DoD) on stabilization of the peace, including medical stability operations, deployment to tropical environments will not decrease in the foreseeable future. Although every medical provider should have some training in the recognition of tropical diseases, a growing need exists for providers with advanced training in the diagnosis, treatment, and prevention of these illnesses. Too often, all providers are incorrectly assumed to possess detailed knowledge about these conditions rarely seen in the continental United States. Tropical medicine practitioners must be knowledgeable in relevant aspects of infectious diseases, preventive medicine, parasitology, and entomology. They must be competent in the diagnosis of tropical diseases, including the application of laboratory and radiologic techniques in austere settings. Critically, they must understand the impact of tropical diseases on deployed military personnel and endemic communities alike. The DoD offers several courses in tropical medicine that vary in length, scope, detail, and target audience. Here we seek to increase awareness of the availability and scope of these courses. This list is not exhaustive and excludes locally produced courses and courses that focus on a single area of tropical medicine. The courses described herein include the Masters of Tropical Medicine and Hygiene (MTM&H) at the Uniformed Services University of the Health Sciences (USU), the Masters of Public Health (MPH) with a concentration in Tropical Public Health (TPH) at USU, the Training in Tropical Medicine and Travelers’ Health Course at USU, courses within the U.S. Military Tropical Medicine (MTM) program, the Global Medicine Course, the Walter Reed Army Institute of Research (WRAIR) Tropical Medicine Course, the Military Medical Humanitarian Assistance Course (MMHAC), and the training program offered by the Armed Forces Health Surveillance Center (AFHSC) and USU.

Global Health Training for Residents

To the Editor: We agree with Drain and colleagues1 that global health training should become an integral part of residency training and be tailored for each specialty. In such training, we maintain that particular emphasis should be given to tropical medicine, which encompasses those diseases that are most often encountered in underdeveloped countries. But because tropical medicine is a vast discipline, residency programs cannot include it as a whole in their curricula. Therefore, we propose that programs concentrate on those diseases that cause the most burden, as defined by the Global Network for Neglected Tropical Diseases: ascariasis, trichuriasis, hookworm infection, schistosomiasis, lymphatic filariasis, trachoma, onchocerciasis, leishmaniasis, Chagas disease, leprosy, human African trypanosomiasis, dracunculiasis, and Mycobacterium ulcerans infection (Buruli ulcer). Together, these infections pose a high burden on society.2 Much has to be done to raise medical educators’ awareness of the need to teach about tropical medicine. For example, the American Board of Internal Medicine infectious diseases board exam does not include the topic of tropical medicine as such, and information on parasites makes up only 4% of the content.3 And the European Union of Medical Specialties Board of Infectious Diseases training curriculum4 recommends tropical medicine training as an option, not a requirement.5 But the teaching of tropical medicine should no longer be optional or regarded as an “interesting” elective; the increase in globalization makes it imperative for this topic to be incorporated into the mainstream of residency education. Francisco M. Pherez, MD Internal medicine and infectious disease specialist in private practice, St. Louis, Missouri. Polly K. David, MD Internal medicine and infectious disease specialist in private practice, St. Louis, Missouri.

L’École du Pharo : cent ans d’enseignement de la médecine tropicale

1907-2007: one hundred years separate this year's intake from the first students to enroll at the Pharo School. 1907: in February, the first class, called the "Marseillaise", entered the new School of Colonial Medicine (Ecole d'application du Service de santé des troupes coloniales), where they received theoretical and practical training in tropical medicine. 2007: the latest class, recruited through a national examination, will join the Tropical Medicine Institute of the Army health service in May, for the first autonomous training program in supervised ambulatory primary care. The past hundred years have seen many upheavals. After the colonial period and the two world wars, followed by decolonization and technical assistance for young independent nations, globalization has brought the continents together, shrunk distances, and led to an intermingling of populations. Pharo students are still posted overseas, but no longer on the same types of mission. The lengthy postings to the Sahara, sub-Saharan Africa, Madagascar, Southeast Asia and Oceania have been supplanted by shorter stays and overseas operations in a variety of theaters (not just the intertropical regions), to provide healthcare support for French military forces and medical assistance to local populations. The teaching of tropical medicine has had to adapt to these changes. The concept itself has evolved too: from exotic diseases to colonial medicine, from major endemics to public health, and from humanitarian medicine to international healthcare. The increase in migratory fluxes and cultural exchanges means that tropical medicine is now a global discipline. This teaching activity potentially caters for all physicians, as malaria, dengue or cholera could strike at any time in the very heart of our provinces, or invite themselves into the general practitioner's office. Although mainly confronted by imported diseases, physicians specializing in travel medicine and infectious diseases, along with microbiologists and parasitologists, must also be specialists in tropical medicine. Others must master the theoretical and practical aspects of the discipline--especially therapists called on to work overseas with humanitarian missions, in war situations or after catastrophes. This is notably the case of military doctors. The teaching aims are not only to recognize, diagnose and treat diseases that are prevalent in intertropical regions. Practitioners must also be capable of adapting to local conditions, which can be extremely tough or hostile, and be able to manage diseases that are more often cosmopolitan than specifically tropical. Modern teaching of tropical medicine must comprise a common core that is obligatory for all medical students during their basic training. It can be completed by diplomas in different disciplines (epidemiology, medical biology, special surgeries, pediatrics, vaccination, combating malaria, etc.), possibly during continuous medical training. Cutting-edge training will be reserved for physicians who are called on to practice far from their university or hospital base, in isolated or difficult situations. Thus, a hundred years after their peers of the old "Marseillaise", the 2007 Pharo class will be first to take a diploma in overseas medical missions--the latest in a series of change intended to keep pace with a rapidly changing world

Problemas y propuestas de mejora en la atención sanitaria a los inmigrantes económicos

To analyse existing problems in health care to economic immigrants from the point of view of health and social professionals, health authorities and economic immigrants and to know which will be their proposals and priorities to improve economic immigrants's health assistance. Qualitative approach study made in Majorca island. (Spain). Three focus groups and three nominal groups with health and social workers from primary health care and hospital services were carried out as well as two partially structured interviews to health authorities, one Autonomic Authority and one Governmental Authority, and twelve partially structured interviews to economic immigrants identified trough key informants. Health and social workers perceive the increase in the number of economic immigrants as a massive arrival. The main problems identified are: access restrictions to public health services for economic immigrants, the follow-up of these patients and diagnostic difficulties because lack of training in tropical medicine. Health and social workers's first proposal for improving this situation is their own training in tropical medicine. Autonomic Authority priorities are to guarantee access to public health services for all immigrants and to look actively for health problems in these population. Governmental Authority, instead, holds the legalization for all. In fact, economic immigrants are not concerned on health care because legalization and housing problems. The main barriers identified by health and social workers in health care to economic immigrants are: access restrictions, follow-up and lack of training in tropical medicine. Health and social first proposal to improve this situation is their own training in tropical medicine while Autonomic and Central Authorities's priorities are not the same. For economic immigrants, health assistance is not their biggest concern.

Chairman's concluding remarks

Having been trained at the London School of Hygiene and Tropical Medicine, I am a tropical medicine man in the tradition of Sir Patrick Manson, that is, a parasitologist. In his address inaugurating the London School of Tropical Medicine in 1899, entitled The Need for Special Training in Tropical Medicine, Manson stated that ‘the peculiar dis tribution of a large class of tropical diseases depends, in the first place, on the fact that they are entozoal diseases, in the second place, that the entozoa concerned require intermediate and definitive hosts, and, in the third, that one or other of these hosts requires a high atmospheric temperature, in other words are native to warm climates.’ He went on, ‘today the protozoan and the helminth, as regards tropical pathology, are in the ascendant.’ This belief still holds sway, as the great British and American tropical medical journals remain largely devoted to parasitic infections.

Medical News

<h3>CALIFORNIA</h3><h3>Book Plates of Physicians.—</h3> The Huntington Library at San Marino is developing a collection of book plates of physicians. Doctors who have book plates of their own or of others are invited to forward copies to the library to be entered in the collection. <h3>New School of Tropical Medicine.—</h3> A School of Tropical and Preventive Medicine is to be developed in Loma Linda, in conjunction with the School of Medicine of the College of Medical Evangelists. Both graduate and undergraduate medical students will be given training in tropical medicine. Special short courses will be conducted for nonmedical missionaries preparatory to their departure for overseas posts. Dr. Harold N. Mozar, assistant professor of internal medicine of the school of medicine, has been named director of the new unit. During World War II Dr. Mozar served in New Guinea and was chief of the Communicable Diseases Section of the 47th General

Training in Tropical Medicine

Training in Tropical Medicine