Global health training among U.S. residency specialties: a systematic literature review

Figures & data

Table 1. Characteristics of the 15 articles describing global health training among 12 training specialties.

Training specialty	Study author and publication date	Data collection	Study year	Response rate	Percentage with global health training	Challenges
Emergency Medicine	Havryliuk et al. 2014 [10] Kerry et al. 2013 [11]	E-mail Survey Web-based search	2010–11 2011	102 /192* (53%) 155 programs searched	74% (75/102) 41% (64/155)	Lack of funding (42%) Lack of preparation for international work (40%)
Family Medicine	Schultz et al. 1998 [12] Kerry et al. 2013 [11]	Mail Survey Web-based search	1996 2011	144 /192 (75%) 451 programs searched	54% (73/144) 22% (97/451)	Lack of funding Lack of supporting faculty
Internal Medicine	Kolars et al. 2011 [13] Kerry et al. 2013 [11]	E-mail Survey Web-based search	2009 2011	279 /366 (76%) 380 programs searched	57% (160/279) 20% (75/380)	Lack of funding Lack of supervision Lack of interest by residents
Neurology	Lyons et al. 2014 [14]	E-mail Survey	2012–13	131 /208^┼ (63%)	50% (65/129)	Lack of funding (86%) Lack of partnerships (55%) Lack of supervision (40%)
Obstetrics and Gynecology	Eichelberger et al. 2015 [15] Hung et al. 2013 [16]	E-mail Survey Web-based search	2013 2010–11	105 /236 (45%) 243 programs searched	28% (29/105) 17% (41/243)	Lack of funding (80%) Time constraints (71%) Constraints by ACGME (31%) Intensive service requirements Smaller class size
Ophthalmology	Coombs et al. 2015 [17]	E-mail Survey	2012–13	59 /116 (51%)	54% (32/59)	Lack of funding (78%) Inadequate resident coverage (67%) Constraints by ACGME (63%) Lack of partnerships (33%)
Orthopaedic Surgery	Shultz et al. 2015 [18]	E-mail Survey	Does not mention	73 /154 (47%)	26% (19/73)	Intensive service requirements (74%) Lack of funding (70%) Lack of partnerships (34%)
Pediatrics	Butteris et al. 2015 [19] Kerry et al. 2013 [11]	Phone, in-person or by E-mail Survey Web-based search	2013–14 2011	198 /199 (99%) 198 programs searched	58% (115/198) 33% (65/198)	Lack of funding Lack of administrative support Lack of partnerships Lack of sharing of curricular and other resources Lack of evaluation tools
Plastic Surgery	Nayar et al. 2015 [20]	E-mail Survey	2013	64 /81 (79%)	41% (26/64)	Constraints by RRC (71%) Lack of funding (66%) Salary support (63%)
Preventive Medicine	Bussell et al. 2015 [21]	E-mail Survey	2013	23 /42 (55%)	83% (19/23)	Lack of funding (87%) Scheduling (57%) Lack of partnership (35%) Lack of supervision (30%) Liability concerns (26%) Constraints by ACGME (26%)
Psychiatry	Tsai et al. 2014 [22]	Web-based search	2010–11	183 programs searched	9% (17/183)	Cultural and/or language Lack of partnerships Lack of funding
Surgery	Knudson et al. 2015 [23]	E-mail Survey	Does not mention	48 /253 (19%)	71% (34/48)	Lack of funding Intensive service requirements Cultural differences Gaining support from chair, dean, CMO Meeting the needs of the host Logistics: housing/certification Local issues such as strikes
	Wackerbarth et al. 2015 [24]	Web-based search	2014–15	239 programs searched	18% (42/239)	Administrative constraints Lack of funding Accreditation

Abbreviations: ACGME = Accreditation Council for Graduate Medical Education; RRC = Residency Review Committee

* 156 ACGME-accredited & 36 non ACGME-accredited

^┼ Only U.S. residency programs in a survey of U.S. and Canadian programs

^¶ Percentages of challenges were not available for all articles

Figure 1. Flow diagram for identification, screening, eligibility, and inclusion of records.

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Kerry VB, Walensky RP, Tsai AC, et al. US medical specialty global health training and the global burden of disease. J Glob Health. 2013;3:020406. DOI:10.7189/jogh.03.020304

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Schultz SH, Rousseau S. International health training in family practice residency programs. Fam Med. 1998;30:29–33.

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Kolars JC, Halvorsen AJ, McDonald FS. Internal medicine residency directors perspectives on global health experiences. Am J Med. 2011;124:881–885. DOI:10.1016/j.amjmed.2011.04.003

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Lyons JL, Coleman ME, Engstrom JW, et al. International electives in neurology training: a survey of US and Canadian program directors. Neurology. 2014;82:119–125. DOI:10.1212/WNL.0000000000000019

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Eichelberger KY, Morse JE, Connolly A, et al. Opportunities and barriers in global women’s health training during obstetrics and gynecology residencies in the USA. Int J Gynaecol Obstet. 2015;128:148–151. DOI:10.1016/j.ijgo.2014.08.016

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Hung KJ, Tsai AC, Johnson TR, et al. Scope of global health training in U.S. obstetrics and gynecology residency programs. Obstet Gynecol. 2013;122:1101–1109. DOI:10.1097/AOG.0b013e3182a9c1c8

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Coombs PG, Feldman BH, Lauer AK, et al. Global health training in ophthalmology residency programs. J Surg Educ. 2015;72:e52–D59. DOI:10.1016/j.jsurg.2015.04.007

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Shultz PA, Kamal RN, Daniels AH, et al. International health electives in orthopaedic surgery residency training. J Bone Joint Surg Am. 2015;97:e15. DOI:10.2106/JBJS.M.01189

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Butteris SM, Schubert CJ, Batra M, et al. Global health education in US pediatric residency programs. Pediatrics. 2015;136:458–465. DOI:10.1542/peds.2015-0792

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Nayar HS, Salyapongse AN, Mount DL, et al. The current state of global surgery training in plastic surgery residency. Plast Reconstr Surg. 2015;136:e830–e837. DOI:10.1097/PRS.0000000000001817

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Bussell SA, Kihlberg CJ, Foderingham NM, et al. Global health education in general preventive medicine residencies.. Am J Prev Med. 2015;48:593–598. DOI:10.1016/j.amepre.2014.12.013

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Tsai A, Fricchione G, Walensky R, et al. Global health training in U.S. graduate psychiatric education. Acad Psychiatry. 2014;38:426–432. DOI:10.1007/s40596-014-0092-0

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Knudson MM, Tarpley MJ, Numann PJ. Global surgery opportunities for U.S. surgical residents: an interim report. J Surg Educ. 2015;72:e60–e65. DOI:10.1016/j.jsurg.2015.03.010

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Wackerbarth JJ, Campbell TD, Wren S, et al. Global opportunities on 239 general surgery residency web sites. J Surg Res. 2015;198:115–119. DOI:10.1016/j.jss.2015.05.023

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