Global health training starts at home: A unique US-based global health clinical elective for residents

Figures & data

Table

Practice points

Global health issues are relevant at home and within the US, and cities with diverse population provide opportunities to train residents and prepare them for work in the field, both within the US and abroad. Offering a domestic clinical global health elective for medical residents is warranted, feasible, and necessary in the context of the changing landscape of public health and considering the global health challenges at home. Residency programs could use their local resources to develop and maintain such global health exposures. Collaboration with academic and non-academic organizations and institutions, experienced faculty, and departmental support are vital components to the success of such programs.

Table 1.  Goals

1 Global health exposure	To familiarize residents with major global health issues in the US, their sociopolitical and human rights aspects, and strategies to address them effectively
2 Clinical and applicable skills	To provide residents with clinical and population-based skills in the diagnosis and management of tropical diseases; health issues facing immigrants, transient populations and international travelers in the US; and the clinical presentation of human rights abuses
3 Global health career development	To prepare residents for related clinical and public health positions in the US

Table 2.  Competencies/objectives

Clinical skills competencies
(a) General competencies for practice in resource-limited cross-cultural settings	• Use an evidenced-based clinical approach to the care of patients from urban and ethnically diverse settings • Identify and apply standardized guidelines (e.g., WHO/UNICEF) for the diagnosis and treatment of conditions common to developing countries, and adapt them to the individual needs of specific patients in urban immigrant populations • Effectively diagnose and evaluate an asylee with a history of torture, and write a medical affidavit as part of the asylum seeking process • Appropriately utilize interpreters and communicate effectively with patients and families who speak other languages • Develop skills to provide appropriate health education to patients and communities with varying levels of education and health literacy, while demonstrating cultural sensitivity • Know and/or access appropriate global health related medical resources and apply them to the care of relevant patient populations in the US
(b) Specific clinical and practical competencies for residents	• Describe the presentation and prevention strategies of, and diagnose and manage, the following specific diseases in the US, based on local and international guidelines: ○ Malaria. Hepatitis A and B. HIV/AIDS and related infections/complications. Tuberculosis. Major pathologic parasites. Other common tropical diseases. Common international travelers diseases ○ Describe prevention methods for international travelers • Know and perform the appropriate lab techniques for identification of malaria and other common tropical diseases at home • Interview and perform physical and psychological evaluations and examinations of torture survivors
Non-clinical competencies	• Learn the demographics and common forms of torture, psychological and physical sequelae of torture, and the principles of interviewing and writing a medical affidavit • Describe US asylum law, worldwide epidemiology of torture, and advocacy options to improve the health status of survivors • Describe effective interventions, including prevention and treatment, for reducing mortality and morbidity of children under 5 (e.g. vitamin A supplementation, exclusive breastfeeding, etc.) • List the major vaccine-preventable diseases and the immunizations available in developing regions, and know the current international vaccine policies and recommendations (WHO EPI). Know how to identify immunization needs in various settings • Identify conditions that contribute to morbidity and impaired cognitive development in the developing world, such as intestinal parasites, hearing loss, birth complications, anemia, infections (e.g. cerebral malaria), nutritional deficiencies, injuries, and environmental toxin exposures • Recognize the health and psychological impact of activities affecting populations, including displacement, war trauma, torture, human rights abuses, human trafficking, child soldiers and child labor

Source: Houpt et al. 2007; GHEC 2011.

Table 3.  Curriculum evaluation (n = 10)

Curriculum evaluation by residents: (Likert scale: 1 “poor” and 5 “excellent”)
Variety of topics		3	60%
Overall usefulness and relevance		4	80%
Likelihood to recommend to colleagues		4.5	90%
Quality of clinical sessions	HRC	4.5	90%
	TB/Chest Clinic	3.5	70%
	Tropical Clinic	5	100%
	Continuity Clinic	4	80%
Preceptors’ teaching and open discussions	HRC	4	80%
	TB	3.5	70%
	Tropical	4.3	86%
	Travel	4.75	95%
	Immigrant/continuity	4	80%

Houpt E, Pearson R, Hall T. Three domains of competency in Global Health Education: Recommendations for all medical students. Acad Med. 2007; 82: 222–225

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Global Health Education Consortium (GHEC) [Internet]. 2011. [Accessed July 2011] Available from http://www.globalhealth-ec.org/GHEC/Home/GHvIHdef_home.htm

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