Global health education for medical students: New learning opportunities and strategies

Figures & data

Table 1.  Hopkins global health course for medical students competencies and learning objectives

Day	Themes	Learning objectives
All	Overall Course competencies	Goal 1: To identify, describe and discuss the need for an integrated, interdisciplinary approach to global health problems
		Goal 2: To recognize, describe and discuss the challenges and opportunities for global health issues to impact clinical practice.
		Goal 3: To identify, describe and discuss why a global perspective is needed to solve public health problems
		Goal 4: To critically examine global health issues, as they are encountered in future practice and training, especially with regards to immigrant and travelers’ health
		Goal 5: To identify, describe and discuss six major global determinants of health:
		– Global burden of disease
		– Healthcare delivery systems
		– The environment and health
		– Health and human rights
		– Social determinants of health
		– Health policy, programs and health
1	Maternal health & Measuring the burden of disease	• To compare rates, risk factors, clinical presentation and management of high risk pregnancy in the US and Ethiopia
		• To learn the definitions, data sources and limitations of the following disease burden metrics:
		– Total fertility rate
		– Maternal mortality rate
		– Neonatal mortality rate
		– Infant mortality rate
		– Under 5 mortality rate
		– Life expectancy at birth
		– Disability adjusted life years (DALY)
		• To learn the Millennium Development Goals
		• To learn and compare the rates and causes of maternal and infant death in the US and Ethiopia
2	Child health & Mutli-sector prevention of disease	• To compare rates, risk factors, clinical presentation and management of childhood pneumonia in the US and Uganda
		• To compare clinical, research and public health strategies to prevent childhood death from pneumonia in the US and Uganda
3	Emerging diseases & geography, environment and health	• To compare rates, risk factors, clinical presentation and management of multi-drug resistant TB in the US and Pakistan
		• To compare and discuss the most important emerging diseases in the US and Pakistan
		• To create a differential diagnosis of diseases of travelers, based on geographic and environmental exposures
		• To understand the impact of geography and environment on vector-borne, water-borne and zoonotic diseases
4	Chronic diseases & international research ethics	• To compare rates, risk factors, clinical presentation and management of heart disease among South Asians in the US and India
		• To compare and discuss research priorities to prevent and treat heart disease among South Asians in the US and in India
		• To compare the review a case study and critical debate of the ethical principal of justice
		• To critically debate the question: Do researchers have a duty to provide the highest available or local standard of clinical care for all research study participants, regardless of location?

Table 2.  Recommended GHEC and AAMC competencies related to Global Health

GHEC	AAMC
(1) An understanding of, and respect for, the roles of other healthcare professionals, and of the need to collaborate with others in caring for individual patients and in promoting the health of defined populations	(1) Knowledge of the important non-biological determinants of poor health and of the economic, psychological, social and cultural factors that contribute to the development and/or continuation of maladies.
(2) Knowledge of the important non-biological determinants of poor health and of the economic, psychological, social, and cultural factors that contribute to the development and/or continuation of maladies	(2) Knowledge of the epidemiology of common maladies within a defined population, and the systematic approaches useful in reducing the incidence and prevalence of those maladies.
(3) Knowledge of the epidemiology of common maladies within a defined population, and the systematic approaches useful in reducing the incidence and prevalence of those maladies	(3) The ability to indentify factors that place individuals at risk for disease or injury, to select appropriate tests for detecting patients at risk for specific diseases or in the early stage of disease, and to determine strategies for responding appropriately
(4) The ability to define and describe a population, its demography, cultural and socioeconomic constitution, circumstances of living, and health status; and to understand how to gather health information about this population. Defining the population includes the use of rates, incidence, prevalence, and demographic descriptors to characterize its health, disease (with awareness of the community from which the patient comes), and social and behavioral risk factors.	(4) The ability to retrieve (from electronic databases and other resources), manage, and utilize biomedical information for solving problems and making decisions that are relevant to the care of individuals and populations.
(5) Respect for cultural and socioeconomic diversity, willingness to work through systems, willingness to work in collaboration with other members of the healthcare team, and willingness to accept at least partial responsibility for the health of populations.	(5) Knowledge of various approaches to the organization, financing, and delivery of healthcare.
	(6) A commitment to provide care to patients who are unable to pay and to be advocates for access to healthcare for members of traditionally underserved populations

Figure 1. Clinical case discussion of childhood pneumonia in the US and Uganda Faculty and students of the Johns Hopkins University and Makerere University Schools of Medicine.

Table 3.  Overview of the Hopkins Global Health Course for medical students

	Large group activities			Small group activities
Day	Theme	Partner institution	Case discussions	Theme	Activity	Other activities
1	Maternal health	Addis Ababa University School of Medicine in Ethiopia	High Risk Pregnancy in Baltimore and Addis Ababa	Measuring the Burden of Disease	Estimate, Compare and Discuss Maternal and Neonatal Mortality in Ethiopia and the US	Film “War Dance”
2	Child health	Makerere University School of Medicine in Uganda	Childhood Pneumonia in Baltimore and Kampala	The Multi-Sector Prevention of Disease	Compare Research Priorities to Prevent Childhood Deaths from Pneumonia in Uganda and the US	Faculty Discussion Hopkins in Haiti
3	Emerging diseases	Indus Hospital in Pakistan	MDR-TB in Baltimore and in Karachi	Geography, Environment and Health	Develop and Discuss Differential Diagnoses and Risk Factors for Clinical Cases of Infections in Travelers	Faculty Discussion Hopkins in Eastern DRC
4	Chronic diseases	BJ Medical College in India	Heart Disease in South Asians in Baltimore and Pune	International Research Ethics	Structured Case-based Debate of the Ethics of a Clinical Trial of Diabetes Treatment In India and the US	Faculty Discussion Hopkins in the World