Core curricular elements for fellowship training in international emergency medicine

From the ground up: Creating and leading fellowship programs in emergency medicine

BACKGROUND

A methodical and evidence-based approach to the creation and implementation of fellowship programs is not well described in the graduate medical education literature. The Society for Academic Emergency Medicine (SAEM) convened an expert panel to promote standardization and excellence in fellowship training. The purpose of the expert panel was to develop a fellowship guide to give prospective fellowship directors the necessary skills to successfully implement and maintain a fellowship program.

METHODS

Under direction of the SAEM Board of Directors, SAEM Education Committee, and SAEM Fellowship Approval Committee, a panel of content experts convened to develop a fellowship guide using an evidence-based approach and best practices content method. The resource guide was iteratively reviewed by all panel members.

RESULTS

Utilizing Kern's six-step model as a conceptual framework, the fellowship guide summarizes the construction, implementation, evaluation, and dissemination of a novel fellowship curriculum to meet the needs of trainees, educators, and sponsoring institutions. Other key areas addressed include Accreditation Council for Graduate Medical Education and nonaccredited fellowships, programmatic assessment, finances, and recruitment.

CONCLUSIONS

The fellowship guide summarizes the conceptual framework, best practices, and strategies to create and implement a new fellowship program.

A 1-year training program in emergency medicine for physicians in Karachi, Pakistan: Evaluation of learner and program outcomes

BACKGROUND

Pakistan has an underdeveloped and overburdened emergency care system, with most emergency departments (EDs) staffed by physicians not formally trained in emergency medicine (EM). As of January 2020, only nine Pakistani institutions were providing formal EM specialty training; therefore, a training program of shorter duration is needed in the interim.

METHODS

The Certification Program in Emergency Medicine (CPEM) is a 1-year training program in EM consisting of two arms: CPEM-Clinical (CPEM-C), which includes physicians from The Indus Hospital (TIH) ED, and CPEM-Didactic (CPEM-D), including physicians from EDs across Karachi. Both groups participate in weekly conferences, including didactics, small-group discussions, workshops, and journal clubs. CPEM-C learners also receive clinical mentorship from visiting international and TIH EM faculty. Both groups were assessed with preprogram, midterm, and final examinations as well as on clinical skills. Additionally, both groups provided regular feedback on program content and administration.

RESULTS

Twenty-five of the 32 initially enrolled learners completed the program in June 2019. Scores on a matched set of 50 questions administered in the pretest and final examination improved by an average of 15.1% (p < 0.005) for CPEM-C learners and 8.5% (p < 0.0005) for CPEM-D learners, with 93% of learners showing improvement. Clinical evaluations of CPEM-C and CPEM-D learners during the first and fourth quarters showed an average improvement of 1.1 out of 5 (p < 0.05) and 1.2 out of 9 (p < 0.0005) points, respectively. Learner evaluations of the program were overall positive.

CONCLUSIONS

CPEM demonstrated significant improvement in test scores and clinical evaluations in both program arms. Evaluations also suggested that the program was well received. These data, along with CPEM's ability to train physicians from multiple institutions using low-cost, innovative educational strategies, suggest that it may be an effective, transferable mechanism for the expedited development of EM in Pakistan and countries where EM is developing as a specialty.

Motivations for and Challenges in the Development of Global Medical Curricula: A Scoping Review

PURPOSE

The aim of this scoping review is to understand the motivations for the creation of global medical curricula, summarize methods that have been used to create these curricula, and understand the perceived premises for the creation of these curricula.

METHOD

In 2018, the authors used a comprehensive search strategy to identify papers on existing efforts to create global medical curricula published from 1998 to March 29, 2018, in the following databases: MEDLINE; MEDLINE Epub Ahead of Print, In-Process, and Other Non-Indexed Citations; Embase; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; PsycINFO; CINAHL; ERIC; Scopus; African Index Medicus; and LILACS. There were no language restrictions. Two independent researchers applied the inclusion and exclusion criteria. Demographic data were abstracted from publications and summarized. The stated purposes, methods used for the development, stated motivations, and reported challenges of curricula were coded.

RESULTS

Of the 18,684 publications initially identified, 137 met inclusion criteria. The most common stated purposes for creating curricula were to define speciality-specific standards (50, 30%), to harmonize training standards (38, 23%), and to improve the quality or safety of training (31, 19%). The most common challenges were intercountry variation (including differences in health care systems, the operationalization of medical training, and sociocultural differences; 27, 20%), curricular implementation (20, 15%), and the need for a multistakeholder approach (6, 4%). Most curricula were developed by a social group (e.g., committee; 30, 45%) or Delphi or modified Delphi process (22, 33%).

CONCLUSIONS

The challenges of intercountry variation, the need for a multistakeholder approach, and curricular implementation need to be considered if concerns about curricular relevance are to be addressed. These challenges undoubtedly impact the uptake of global medical curricula and can only be addressed by explicit efforts to make curricula applicable to the realities of diverse health care settings.

COVID-19 Pandemic Prompts a Paradigm Shift in Global Emergency Medicine: Multidirectional Education and Remote Collaboration

To date, the practice of global emergency medicine (GEM) has involved being "on the ground" supporting in-country training of local learners, conducting research, and providing clinical care. This face-to-face interaction has been understood as critically important for developing partnerships and building trust. The COVID-19 pandemic has brought significant uncertainty worldwide, including international travel restrictions of indeterminate permanence. Following the 2020 Society for Academic Emergency Medicine meeting, the Global Emergency Medicine Academy (GEMA) sought to enhance collective understanding of best practices in GEM training with a focus on multidirectional education and remote collaboration in the setting of COVID-19. GEMA members led an initiative to outline thematic areas deemed most pertinent to the continued implementation of impactful GEM programming within the physical and technologic confines of a pandemic. Eighteen GEM practitioners were divided into four workgroups to focus on the following themes: advances in technology, valuation, climate impacts, skill translation, research/scholastic projects, and future challenges. Several opportunities were identified: broadened availability of technology such as video conferencing, Internet, and smartphones; online learning; reduced costs of cloud storage and printing; reduced carbon footprint; and strengthened local leadership. Skills and knowledge bases of GEM practitioners, including practicing in resource-poor settings and allocation of scarce resources, are translatable domestically. The COVID-19 pandemic has accelerated a paradigm shift in the practice of GEM, identifying a previously underrecognized potential to both strengthen partnerships and increase accessibility. This time of change has provided an opportunity to enhance multidirectional education and remote collaboration to improve global health equity.

Global Emergency Medicine Fellowships: Survey of Curricula and Pre-Fellowship Experiences

INTRODUCTION

Lack of accreditation requirements affords global emergency medicine (GEM) fellowships the flexibility to customize curricula and content. A paucity of literature exists describing the state of GEM fellowship programs. We describe the current state of GEM fellowship curricula including which components are commonly included, and highlighting areas of higher variability.

METHODS

We identified GEM fellowships and invited them to participate in a web-based survey. Descriptive statistical analysis was performed.

RESULTS

Of the 46 fellowship programs invited to participate, 24 responded; one duplicate response and one subspecialty program were excluded. The 22 remaining programs were included in the analysis. Nineteen programs (86%) offer a Masters in Public Health (MPH) and 36% require an MPH to graduate. Additionally, 13 programs (59%) offered graduate degrees other than MPH. Fellows average 61 clinical hours per month (95% confidence interval, 53-68). Time spent overseas varies widely, with the minimum required time ranging from 2-28 weeks (median 8 weeks; interquartile range [IQR] 6,16) over the course of the fellowship. The majority of programs offer courses in tropical medicine (range 2-24 weeks, median 4 weeks) and the Health Emergencies in Large Populations course. Only 32% of programs reported offering formal ultrasound training. Fellows averaged 1.3 research projects prior to fellowship and median of 2.5 during fellowship (IQR 1,3). While the majority of GEM fellowship graduates worked at US academic centers (59%), 24% worked in US community hospitals, 9% worked for non-profit organizations, and 9% worked internationally in clinical practice.

CONCLUSION

Our results highlight the wide variability of curricular content and experiences offered by GEM fellowships.

Cross-Sectional Survey of Former International Emergency Medicine Fellows 2010-19

Introduction

International emergency medicine is a new subspecialty within emergency medicine. International emergency medicine (EM) fellowships have been in existence for more than 10 years, but data is limited on the experiences of the fellows. Our goal in this study was to understand the fellowship experience.

Methods

The study employed a cross-sectional survey in which participants were asked about their demographics, fellowship program, and advanced degree. Participants consisted of former fellows who completed the fellowship between 2010–19. The survey consisted of both closed and open-ended questions to allow for further explanation of former fellows’ experience. Descriptive analysis was conducted on the quantitative survey data while content analysis was conducted to ascertain salient themes from the open-ended questions.

Results

We contacted 71 former fellows, of whom 40 started and 36 completed surveys, for a 51% response rate (55.6% women). Two-year fellowships predominated, with 69.4% of respondents. Prior to fellowship, a subset of fellows spoke the native languages of their service sites: French, Spanish, Haitian Creole, Mandarin, or Kiswahili. Half the respondents spent 26–50% of their fellowship in field work, with 83.3% of institutions providing direct funding for this component. Many respondents stated a need for further institutional support (money or infrastructure) for fieldwork and mentoring. Non-governmental organizations comprised 29.7% of respondents’ work partners, while 28.6% were with academic institutions in country, focused mostly on education, health systems development, and research. The vast majority (92%) of respondents continued working in global EM, with the majority based in American academic institutions. Those who did not cited finances and lack of institutional support as main reasons.

Conclusion

This study describes the fellow experience in international EM. The majority of fellows completed a two-year fellowship with 26–50% of their time spent in fieldwork with 83.3% of institutions providing funding. The challenges in pursuing a long-term career in global EM included the cost of international work, inadequate mentorship, and departmental funding.

Global health and the Royal College of Emergency Medicine: a cross-sectional survey of members and fellows

BACKGROUND

There is growing interest in global health participation among emergency care doctors in the UK. The aim of this paper was to describe the demographics of members and fellows of the Royal College of Emergency Medicine involved in global health, the work they are involved in, as well as the benefits and barriers of this work.

METHODS

We conducted a survey to include members and fellows of the Royal College of Emergency Medicine describing the context of their global health work, funding arrangements for global health work and perceived barriers to, and benefits of, global health work.

RESULTS

The survey collected 1134 responses of which 439 (38.7%) were excluded. The analysis was performed with the remaining 695 (61.3%) responses. Global health involvement concentrated around South Asia and Africa. Work contexts were mainly direct clinical service (267, 38%), curriculum development (203, 29%) and teaching short courses (198, 28%). Activity was largely self-funded, both international (539, 78%) and from UK (516, 74%). Global health work was not reported to contribute to appraisal by many participants (294, 42.3%). Funding (443, 64%) and protected time (431, 62%) were reported as key barriers to global health productivity.

DISCUSSION

Participants largely targeted specialty development and educational activities. Lack of training, funding and supported time were identified as barriers to development. Galvanising support for global health through regional networks and College support for attracting funding and job plan recognition will help UK-based emergency care clinicians contribute more productively to this field.

Towards developing a consensus assessment framework for global emergency medicine fellowships

Background

The number of Global Emergency Medicine (GEM) Fellowship training programs are increasing worldwide. Despite the increasing number of GEM fellowships, there is not an agreed upon approach for assessment of GEM trainees.

Main body

In order to study the lack of standardized assessment in GEM fellowship training, a working group was established between the International EM Fellowship Consortium (IEMFC) and the International Federation for Emergency Medicine (IFEM). A needs assessment survey of IEMFC members and a review were undertaken to identify assessment tools currently in use by GEM fellowship programs; what relevant frameworks exist; and common elements used by programs with a wide diversity of emphases. A consensus framework was developed through iterative working group discussions. Thirty-two of 40 GEM fellowships responded (80% response). There is variability in the use and format of formal assessment between programs. Thirty programs reported training GEM fellows in the last 3 years (94%). Eighteen (56%) reported only informal assessments of trainees. Twenty-seven (84%) reported regular meetings for assessment of trainees. Eleven (34%) reported use of a structured assessment of any sort for GEM fellows and, of these, only 2 (18%) used validated instruments modified from general EM residency assessment tools. Only 3 (27%) programs reported incorporation of formal written feedback from partners in other countries. Using these results along with a review of the available assessment tools in GEM the working group developed a set of principles to guide GEM fellowship assessments along with a sample assessment for use by GEM fellowship programs seeking to create their own customized assessments.

Conclusion

There are currently no widely used assessment frameworks for GEM fellowship training. The working group made recommendations for developing standardized assessments aligned with competencies defined by the programs, that characterize goals and objectives of training, and document progress of trainees towards achieving those goals. Frameworks used should include perspectives of multiple stakeholders including partners in other countries where trainees conduct field work. Future work may evaluate the usability, validity and reliability of assessment frameworks in GEM fellowship training.

Using Future Employers' Expectations to Inform Global Health Fellowship Curricula

BACKGROUND

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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

A Novel Approach to Combining Pediatric Emergency Medicine and Global Health Fellowships

OBJECTIVES

To describe the creation of the first known combined Pediatric Emergency Medicine-Global Health (PEM-GH) fellowship for graduates of pediatric or emergency medicine residency programs.

METHODS

We detail the necessary infrastructure for a successfully combined PEM-GH fellowship including goals, objectives, curriculum, timeline, and funding. The fellowship is jointly supported by the department of pediatrics, section of pediatric emergency medicine (PEM), and the hospital. Fellows complete all requirements for the PEM fellowship and Global Health, the latter requiring an additional 12 months of training. Components of the Global Health fellowship include international fieldwork, scholarly activity abroad, advanced degree coursework, disaster training, and didactic curricula.

RESULTS

Since 2005, 9 fellows (8 pediatric-trained and 1 emergency medicine-trained) have completed or are enrolled in the PEM-GH fellowship; 3 have graduated. All fellows have completed or are working toward advanced degrees and have or will participate in the disaster management course. Fellows have had 7 presentations at national or international meetings and have published 6 articles in peer-reviewed journals. Of the three graduates, all are working in academic PEM-GH programs and work internationally in Africa and/or Latin America.

CONCLUSIONS

Our response to a global trend toward improvement in PEM care was the development of the first combined PEM-GH fellowship program. Recognizing the value of this program within our own institution, we now offer it as a model for building such programs in the future. This fellowship program promises to be a paradigm that can be used nationally and internationally, and it establishes a foundation for a full-fledged accredited and certified subspecialty.

Bridging the gap--planning Lifestyle Medicine fellowship curricula: A cross sectional study

BACKGROUND

The emerging field, Lifestyle Medicine (LM), is the evidence-based practice of assisting individuals and families to adopt and sustain behaviors that can improve health. While competencies for LM education have been defined, and undergraduate curricula have been published, there are no published reports that address graduate level fellowship in LM. This paper describes the process of planning a LM fellowship curriculum at a major, academic teaching institution.

METHODS

In September 2012 Harvard Medical School Department of Physical Medicine and Rehabilitation approved a "Research Fellowship in Lifestyle Medicine". A Likert scale questionnaire was created and disseminated to forty LM stakeholders worldwide, which measured perceived relative importance of six domains and eight educational experiences to include in a one-year LM fellowship. Statistical procedures included analysis of variance and the Wilcoxon signed-rank test.

RESULTS

Thirty-five stakeholders (87.5%) completed the survey. All domains except smoking cessation were graded at 4 or 5 by at least 85% of the respondents. After excluding smoking cessation, nutrition, physical activity, behavioral change techniques, stress resiliency, and personal health behaviors were rated as equally important components of a LM fellowship curriculum (average M = 4.69, SD = 0.15, p = 0.12). All educational experiences, with the exception of completing certification programs, research experience and fund raising, were graded at 4 or 5 by at least 82% of the responders. The remaining educational experiences, i.e. clinical practice, teaching physicians and medical students, teaching other health care providers, developing lifestyle interventions and developing health promotion programs were ranked as equally important in a LM fellowship program (average M = 4.23, SD = 0.11, p = 0.07).

CONCLUSIONS

Lifestyle fellowship curricula components were defined based on LM stakeholders' input. These domains and educational experiences represent the range of competencies previously noted as important in the practice of LM. As the foundation of an inaugural physician fellowship, they inform the educational objectives and future evaluation of this fellowship.

Availability and diversity of training programs for responders to international disasters and complex humanitarian emergencies

Introduction: Volunteers and members of relief organizations increasingly seek formal training prior to international field deployment. This paper identifies training programs for personnel responding to international disasters and complex humanitarian emergencies, and provides concise information – if available- regarding the founding organization, year established, location, cost, duration of training, participants targeted, and the content of each program. Methods: An environmental scan was conducted through a combination of a peer-reviewed literature search and an open Internet search for the training programs. Literature search engines included EMBASE, Cochrane, Scopus, PubMed, Web of Science databases using the search terms “international,” “disaster,” “complex humanitarian emergencies,” “training,” and “humanitarian response”. Both searches were conducted between January 2, 2013 and September 12, 2013. Results: 14 peer-reviewed articles mentioned or described eight training programs, while open Internet search revealed 13 additional programs. In total, twenty-one training programs were identified as currently available for responders to international disasters and CHE. Each of the programs identified has different goals and objectives, duration, expenses, targeted trainees and modules. Each of the programs identified has different goals and objectives, duration, expenses, targeted trainees and modules. Seven programs (33%) are free of charge and four programs (19%) focus on the mental aspects of disasters. The mean duration for each training program is 5 to 7 days. Fourteen of the trainings are conducted in multiple locations (66%), two in Cuba (9%) and two in Australia (9%). The cost-reported in US dollars- ranges from $100 to $2,400 with a mean cost of $480 and a median cost of $135. Most of the programs are open to the public, but some are only available by invitation only, such as the International Mobilization Preparation for Action (IMPACT) and the United Nations Humanitarian Civil-Military Coordination (UN-CMCoord) Field Course. Conclusions: A variety of training programs are available for responders to disasters and complex humanitarian emergencies. These programs vary in their objectives, audiences, modules, geographical locations, eligibility and financial cost. This paper presents an overview of available programs and serves as a resource for potential responders interested in capacity-building training prior to deployment.

More than just a hobby: building an academic career in global emergency medicine

BACKGROUND

As the specialty of emergency medicine (EM) continues to spread around the world, a growing number of academic emergency physicians have become involved in global EM development, research, and teaching. While academic departments have always found this work laudable, they have only recently begun to accept global EM as a rigorous academic pursuit in its own right.

OBJECTIVE

This article describes how emergency physicians can translate their global health work into "academic currency" within both the clinician-educator and clinician-researcher tracks.

DISCUSSION

The authors discuss the impact of various types of additional training, including global EM fellowships, for launching a career in global EM. Clearly delineated clinician-researcher and clinician-educator tracks are important for documenting achievement in global EM.

CONCLUSIONS

Reflecting a growing interest in global health, more of today's EM faculty members are ascending the academic ranks as global EM specialists. Whether attempting to climb the academic ladder as a clinician-educator or clinician-researcher, advanced planning and the firm support of one's academic chair is crucial to the success of the promotion process. Given the relative youth of the subspecialty of global EM, however, it will take time for the pathways to academic promotion to become well delineated.

Experience with the core curricular elements for international emergency medicine fellowships

Background

The number of international emergency medicine (IEM) fellowships available in the US has grown dramatically since the inception of subspecialty training in 1994 Bayram et al. (Acad Emerg Med 17:748–757, 2010). These fellowships vary according to their curricular structure, intensity of fellow exposure and requirements for program completion. The variety of fellowship structures may have negative connotations for graduates from its fellowships and reflect upon the translatability of their skill sets.

The recent article “Core Curricular Elements for International Emergency Medicine Fellowships” Alagappan and Holliman (Emerg Med Clin 23(1):1–10, 2005) was designed as a curricular development tool and enumerates seven foci within the broad field of IEM.

Objectives

The authors of this article describe their experience using this curriculum development tool. Individual experiences in each of the seven categories described in the “Core Curricular Elements” article were identified and undertaken within the typical 2-year training period.

Discussion

A curricular structure is described that integrates exposure to all seven areas along with the Master’s of Public Health (MPH) degree, the clinical component and the academic component thematic to existing fellowships. Benefits of this curriculum include increased exposure to multiple areas of IEM, potential for greater standardization and increased translatability of skill set. Disadvantages include superficial exposure to areas of IEM and potentially decreased travel time.

Conclusion

The result is a plausible curriculum where fellows would gain exposure to more areas of IEM than they may have otherwise while still earning their MPH, working clinical shifts and carrying out academic fellowship requirements. The authors conclude that this structure allows fellowships to continue drawing on their strengths, provides a more well-rounded fellowship experience and increases structure without requiring standardization.

Improving knowledge and process for international emergency medicine fellowship applicants: a call for a uniform application

Background. There are currently 34 International Emergency Medicine (IEM) fellowship programs. Applicants and programs are increasing in number and diversity. Without a standardized application, applicants have a difficulty approaching programs in an informed and an organized method; a streamlined application system is necessary. Objectives. To measure fellows' knowledge of their programs' curricula prior to starting fellowship and to determine what percent of fellows and program directors would support a universal application system. Methods. A focus group of program directors, recent, and current fellows convened to determine the most important features of an IEM fellowship application process. A survey was administered electronically to a convenience sample of 78 participants from 34 programs. Respondents included fellowship directors, fellows, and recent graduates. Results. Most fellows (70%) did not know their program's curriculum prior to starting fellowship. The majority of program directors and fellows support a uniform application service (81% and 67%, resp.) and deadline (85% for both). A minority of program directors (35%) and fellows (30%) support a formal match. Conclusions. Program directors and fellows support a uniform application service and deadline, but not a formalized match. Forums for disseminating IEM fellowship information and for administering a uniform application service and deadline are currently in development to improve the process.

The academic health center in complex humanitarian emergencies: lessons learned from the 2010 Haiti earthquake

On January 12, 2010, a 7.0-magnitude earthquake struck Haiti. The event disrupted infrastructure and was marked by extreme morbidity and mortality. The global response to the disaster was rapid and immense, comprising multiple actors-including academic health centers (AHCs)-that provided assistance in the field and from home. The authors retrospectively examine the multidisciplinary approach that the University of Chicago Medicine (UCM) applied to postearthquake Haiti, which included the application of institutional structure and strategy, systematic deployment of teams tailored to evolving needs, and the actual response and recovery. The university mobilized significant human and material resources for deployment within 48 hours and sustained the effort for over four months. In partnership with international and local nongovernmental organizations as well as other AHCs, the UCM operated one of the largest and more efficient acute field hospitals in the country. The UCM's efforts in postearthquake Haiti provide insight into the role AHCs can play, including their strengths and limitations, in complex disasters. AHCs can provide necessary intellectual and material resources as well as technical expertise, but the cost and speed required for responding to an emergency, and ongoing domestic responsibilities, may limit the response of a large university and hospital system. The authors describe the strong institutional backing, the detailed predeployment planning and logistical support UCM provided, the engagement of faculty and staff who had previous experience in complex humanitarian emergencies, and the help of volunteers fluent in the local language which, together, made UCM's mission in postearthquake Haiti successful.

Developing a Career in Global Health: Considerations for Physicians-in-Training and Academic Mentors

BACKGROUND

Global health is an expansive field, and global health careers are as diverse as the practice of medicine, with new paths being forged every year. Interest in global health among medical students, residents, and fellows has never been higher. As a result, a greater number of these physicians-in-training are participating in global health electives during their training. However, there is a gap between the level of trainee interest and the breadth and depth of educational opportunities that prepare them for a career in global health.

OBJECTIVE

Global health experiences can complement and enhance each step of traditional physician training, from medical school through residency and fellowship. Global health experiences can expose trainees to patients with diverse pathologies, improve physical exam skills by decreasing reliance on laboratory tests and imaging, enhance awareness of costs and resource allocation in resource-poor settings, and foster cultural sensitivity. The aim of this article is to describe issues faced by physicians-in-training and the faculty who mentor them as trainees pursue careers in global health.

METHODS

We conducted a narrative review that addresses opportunities and challenges, competing demands on learners' educational schedules, and the need for professional development for faculty mentors.

CONCLUSIONS

A widening gap between trainee interest and the available educational opportunities in global health may result in many medical students and residents participating in global health experiences without adequate preparation and mentorship. Without this essential support, global health training experiences may have detrimental consequences on both trainees and the communities hosting them. We discuss considerations at each training level, options for additional training, current career models in global health, and challenges and potential solutions during training and early career development.