An International Partnership of 12 Anatomy Departments - Improving Global Health through Internationalization of Medical Education

Stepping outside national borders: International active learning educational collaboration events

AIM

This paper discusses the benefits of international collaborations for advanced practice nursing education. It identifies new perspectives and innovative practices to enhance cultural competency.

BACKGROUND

Competent, well-trained advanced practice nurses (APNs) are necessary to provide high-quality and safe patient care, improve access to care, and address health disparities that are no longer geographically bound. In 2021, an international network of advanced practice educators established an active learning program to teach students their role in global citizenship and increase awareness of health disparities. APN students from Scotland, Wales, Minnesota, Houston, and Rotterdam participated in presentations, online discussions, and in-country scholarships.

SOURCES OF EVIDENCE

Growing health disparities have created the need for efficient international collaboration to develop new concepts, approaches, and bidirectional exchange of experiences, culture, and knowledge. Integrating global health into curricula engages students' curiosity and integrates education, research, practice, and leadership while improving cultural competency.

DISCUSSION

Forty-two students participated in the international presentations. The students strongly believed in the benefit of international collaboration and the need for a universal role for the advanced practice nurse. They responded positively to sharing cultural and clinical experiences.

CONCLUSION

The recent global health challenge supported the development of innovative methods to deliver education and created an opportunity for advanced practice students to develop cultural competence and critical thinking. Collaborative solutions are essential to education and healthcare as we move forward in the 21st century.

IMPLICATIONS FOR NURSING PRACTICE

Robust international collaborations have enabled the development of cultural competence and critical thinking. These are crucial elements for advanced practice roles.

The quality of group interactions in medical problem-based learning in China: the roles of intercultural sensitivity and group ethnic composition

BACKGROUND

Chinese universities are increasingly recruiting foreign students, and problem-based learning (PBL) is an effective approach to integrating those students. This study focuses on the role of intercultural sensitivity and group ethnic composition on the quality of group interaction in medical problem-based learning in China.

METHODS

This paper reports an investigation of the differences in three types of group interaction (exploratory questions, cumulative reasoning, and handling conflict) among 139 s-year medical undergraduates from two backgrounds (Chinese and foreign) in a PBL setting. The roles of intercultural sensitivity, group ethnic composition, and students' personal characteristics including age, gender and ethnicity on students' perceptions of the three types of interaction were quantitatively analyzed. A 35-item questionnaire and demographic survey were administered to second year medical undergraduates.

RESULTS

The results indicated that group ethnic composition was a significant negative predictor while intercultural sensitivity was a strong positive predictor of group interactions involving exploratory questions and cumulative reasoning. In addition, group heterogeneity in terms of age and ethnicity were significant predictors of group interaction.

CONCLUSIONS

The findings of this study provide insights for strategically designing effective multiethnic group learning environments that encourage interaction and collaboration.

A thematic analysis of students' discussions on death and body donation in international online focus groups

Historically, Anatomy education is an in-person discipline involving exposure to human body donors that facilitates personal and professional growth through, in part, the initiation of reflection on the topic of death. However, during the COVID-19 pandemic the decreased exposure to cadaveric anatomy for many health professions students may have influenced the depth of their individual reflections on this topic. Accordingly, this study aimed to investigate the effect of an alternate approach-focus group discussions between peers with varying degrees of exposure to cadaveric material-that may offer one strategy to stimulate deep reflection on the topic of death. A programmatic intervention was introduced, wherein students (n = 221) from 13 international universities discussed differences in their anatomy courses during small focus group sessions as part of an online exchange program. An inductive semantic thematic analysis was conducted on responses to an open-ended text-response question on how the activity influenced students' reflections about death. Resulting themes were organized into categories that described the content and topics of the students' discussions as they grappled with this sensitive topic. The students reportedly engaged in deep reflection and expressed an increased sense of connectedness with their peers, despite their disparate exposure levels to cadaveric anatomy and being physically distanced. This demonstrates that focus groups with students experiencing different laboratory contexts can be used to help all students reflect on the topic of death and that interchanges between dissecting and non-dissecting students can initiate thoughts about death and body donation among non-dissecting students.

The Anatomy Course During COVID-19: The Impact of Cadaver-Based Learning on the Initiation of Reflection on Death

BACKGROUND

During the COVID-19 pandemic, in-person cadaveric dissection laboratories for teaching anatomy were omitted by many schools around the world. While knowledge domains can be easily evaluated via remote exams, non-traditional discipline-independent skills such as those encouraged through reflection on the topic of death are often overlooked. This study investigated how different anatomy course formats played a role in initiating students' reflections on death during the COVID-19 pandemic.

METHOD

In fall 2020, 217 medical, dental, premedical, and health sciences students from 13 international universities discussed differences in their anatomy courses online. Formats of anatomy courses ranged from dissection-based, prosection-based, hybrid (combination of dissection and prosection) to no laboratory exposure at all. Students' responses to the question, "Did/does your anatomy course initiate your thinking about life's passing?" were collected, and they self-reported themes that were present in their reflections on death using a multiple-choice prompt. Statistical analyses to detect differences between students with and without exposure to cadavers were performed using the chi-squared test.

RESULTS

When comparing students who had exposure to human anatomical specimens to those who had no exposure, the majority of students with exposure thought that the course did initiate thoughts about life's passing, compared to students without exposure (P < 0.05). Reflection themes were consistent across groups.

DISCUSSION

These findings indicate that anatomy dissection courses are important for the initiation of students' feelings about the topic of death. Omission of cadaveric dissection- or prosection-based laboratories will decrease the likelihood that students initiate reflection on this topic and gain important transferable skills.

Establishing a Virtual Global Health Education Partnership: The Cleveland-Cusco Connection

INTRODUCTION

The Cleveland-Cusco Connection (CCC) elective was created during the COVID-19 pandemic to continue global health (GH) education for Case Western Reserve University (CWRU) and Universidad Nacional de San Antonio Abad del Cusco (UNSAAC) medical students. The CCC elective was held over Zoom and aimed to promote international collaboration, knowledge about health systems, and perspectives in GH with synchronous and asynchronous learning.

METHODS

Peruvian and US medical students participated in six monthly sessions consisting of student presentations and large and small group discussions. The elective was led collaboratively by CWRU and UNSAAC students. We evaluated students' experience using pre- and post-course surveys.

RESULTS

Nineteen students (76%) completed the post-course survey. The median rating for meeting each course objective was "somewhat effective" on a 5-point scale ranging from "very ineffective" to "very effective." All respondents would recommend the course to a friend. Common barriers included language challenges, fatigue from other coursework, and technology issues. Seven students' pre- and post-course surveys could be linked. The number of students who agreed with the statements assessing course objectives increased for all questions between the pre- and post-test, with only the number agreeing that they understood the Peruvian healthcare system increasing significantly (p < 0.05).

DISCUSSION

The CCC elective provides a valuable GH educational opportunity via a virtual platform. Students reported that learning from their peers was effective and enjoyable.

CONCLUSION

Virtual GH electives like the CCC may offer benefits in terms of cost, equity, and flexibility and merit further investigation.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01626-6.

Virtual global health in graduate medical education: a systematic review

OBJECTIVES

To synthesize recent virtual global health education activities for graduate medical trainees, document gaps in the literature, suggest future study, and inform best practice recommendations for global health educators.

METHODS

We systematically reviewed articles published on virtual global health education activities from 2012-2021 by searching MEDLINE, EMBASE, Cochrane Library, ERIC, Scopus, Web of Science, and ProQuest Dissertations & Theses A&I. We performed bibliography review and search of conference and organization websites. We included articles about primarily virtual activities targeting for health professional trainees. We collected and qualitatively analyzed descriptive data about activity type, evaluation, audience, and drivers or barriers. Heterogeneity of included articles did not lend to formal quality evaluation.

RESULTS

Forty articles describing 69 virtual activities met inclusion criteria. 55% of countries hosting activities were high-income countries. Most activities targeted students (57%), with the majority (53%) targeting trainees in both low- to middle- and high-income settings. Common activity drivers were course content, organization, peer interactions, and online flexibility. Common challenges included student engagement, technology, the internet, time zones, and scheduling. Articles reported unanticipated benefits of activities, including wide reach; real-world impact; improved partnerships; and identification of global health practice gaps.

CONCLUSIONS

This is the first review to synthesize virtual global health education activities for graduate medical trainees. Our review identified important drivers and challenges to these activities, the need for future study on activity preferences, and considerations for learners and educators in low- to middle-income countries. These findings may guide global health educators in their planning and implementation of virtual activities.

Virtual Adaptation of an International Exchange Program in Medical Education

Medical education has drastically transformed during the COVID-19 pandemic. Measures such as adopting telemedicine visits, minimizing the number of trainees on service, discontinuing external rotations, and converting in-person to online didactics have been broadly and swiftly implemented. While these innovations have promoted greater interconnectivity amongst institutions and made continuing medical education possible, international exchange programs in medical education are still largely disrupted. In response to the changing guidelines and restrictions necessitated by the COVID-19 pandemic, the authors used Kern’s six-step approach to design and implement a virtual curriculum to replace the in-person activities of the 2020–2021 Neurology Peru-Rochester exchange program (NeuroPro). Twenty-seven trainees participated in this virtual adaptation. The average daily attendance was ≥85% and the program was rated 9/10 on average in a feedback survey (63% response rate). The median percentage of correct answers during the pre-test was 64% and it increased to 79% during the post-test (P = 0.003). Virtual adaptation of international exchange programs in medical education is feasible to safely continue international collaborative efforts to promote symbiotic building of local expertise and cross-cultural exchange during the ongoing COVID-19 pandemic and beyond.

Internationalization of Medical Education - Motivations and Formats of Current Practices

PURPOSE

The COVID-19 pandemic has demonstrated the importance for medical professionals to engage in work transcending national borders and to deeply understand perspectives of health in other countries. Internationalization of medical education can play a key role to that end, by preparing culturally competent and globally conscious medical healthcare professionals.The aim of this scoping review is to identify current practices and formats in internationalization in medical education, which to date has received sparse academic attention. The need for this review is heightened amid COVID-19 where a clearer understanding of current internationalization efforts can inform more effective practice. We also explore if the motivations driving internationalization activities in medicine align with current practice and formats based on a framework of thematic categories found in the field of international higher education. In addition, we identify gaps in existing research.

METHODS

Using a scoping review, an international and interdisciplinary research team employed a comprehensive search strategy to identify publications on existing efforts in IoME, published from January 1, 2000, to December 31, 2020, in Scopus, PubMed/Medline, Google Scholar, and Web of Science. Inclusion/exclusion criteria were applied to identify relevant data from publication titles, abstracts, and main texts, which were subsequently summarized. Coding schemes were developed based on models for comprehensive internationalization in higher education.

RESULTS

350 articles met the inclusion criteria. Most articles originated from the high-income countries of the Global North and accounted for a literature base favoring perspectives and understandings that were typically representative of this region. Whereas motivations for internationalizing medical curricula in high-income countries were generally rooted in a model of social transformation/justice/health equity, drivers relating to competition and workforce preparation were common in the low- and middle-income countries.Importantly, the motivations driving internationalization activities generally did not align well with reported internationalization formats, which included student mobility, international curricula at home, and global partnerships. There was a disconnect between what medical curricula/professionals hope to accomplish and the reality of practice on the ground.

DISCUSSION AND CONCLUSION

There is a need for a common definition of internationalization of medical education and a more balanced and unbiased literature base, capturing the full spectrum of internationalization activities existing in both the Global North and South. International partnership frameworks need to equally benefit institutions of both the Global North and Global South. Currently, institutions in the low- and middle-income countries generally cater to the needs and interests of their high-income counterparts. There are concerns about student mobility from high-income countries to low- and middle-income countries. Finally, medical education should be more inclusive and all medical students should gain access to international perspectives and experiences.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01553-6.

Alternatives to Student Outbound Mobility-Improving Students' Cultural Competency Skills Online to Improve Global Health Without Travel

Introduction

Student outbound mobility is a major element in internationalization of medical education and global health education. However, this approach is often criticized, as it is inherently inequitable. Internationalization at home is a newer concept that aims to provide students with international skills and experiences without exchange travel. We report detailed outcomes of an international online program during the COVID-19 pandemic, which aimed to include acquisition of cultural awareness and competency-similar to what the students would have obtained if they had travelled abroad.

Method

Sixty-eight students from 12 international universities participated in international small peer group collaborative work, and online networking. Perceived improvement of cultural competency using Likert scale and open-ended questions was used as a measure of success. Furthermore, students' definition of cultural competency in the different countries was obtained.

Results

Students improved their cultural competency skills. Data analysis supported statistically significant improvement of the above skills after the program, in comparison to the start of the program.

Discussion

Internationalization of medical education can be achieved at home-via structured online peer exchanges-and can provide students with intercultural skills and networking opportunities that are typically achieved via international in-person travel. The above represents a socially just and equitable way to reach all students and can result in improvement of their cultural competency, preparing them for their work in global health, and thereby resulting in improvement of global health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-021-01332-9.

Eleven-year experience implementing a dental undergraduate research programme in a prestigious dental school in China: Lessons learned and future prospects

OBJECTIVE

To summarise the lessons learned from implementing a dental undergraduate research programme over the past eleven years and identify key elements to guarantee the success of dental undergraduate research in the future.

MATERIAL AND METHODS

An overview of 80 research projects from 2007 to 2017 was provided, consisting of 239 participating undergraduates and 47 faculty advisors. Students' academic performance was compared between participating and non-participating undergraduates. An anonymous questionnaire was designed and distributed to participants, with VAS satisfaction assessment, Likert-scale items and open-ended questions. Questions focused on overall satisfaction, motivation, benefits to student career development and essential elements for the dental undergraduate research programme in the future.

RESULTS

The undergraduate participants had significantly better scores of GPAs (3.41 vs 3.21; P < 0.0001), obtained more awards on the honour rolls (0.53 vs 0.30; P = 0.0171) and published more peer-reviewed articles (1.62 vs 1.31; P = 0.0253) than non-participants. Seventy-two undergraduates (75.79%) and thirty-eight advisors (80.85%) responded to the questionnaire. The overall satisfaction was scored as 78.18/100 and 72.36/100 amongst advisors and students, respectively. Interest was considered the best motivation for participation by students (3.81/5.00) and advisors (4.00/5.00). The research programme was beneficial to students' overall career development. Essential roles played by the dental school, faculty and undergraduates were suggested to improve the research environment.

CONCLUSION

The dental undergraduate research programme has positive effects on students' academic performance. The support of the dental school, the engagement of qualified faculty, the interest and autonomy of students and camaraderie amongst these three key elements are essential for the research programme in the future.

Initiating Students' Reflections on Life's Passing in the Anatomy Course - an International Observation at 14 Universities

BACKGROUND

Medical and dental students' feelings and thoughts about the topic of death and life's passing are often associated with learning in the gross anatomy course, when students begin working with a deceased body donor in order to study human anatomy. Little is known of whether the format of anatomy teaching has an impact on these experiences. An observational study was performed to capture the initiation of students' sentiments on the topic of life's passing during the anatomy course at 14 international universities, identify common themes regarding these thoughts, and to study the connection to variations in anatomy course formats and included elements.

METHOD

Preclinical anatomy students reflected on one question (i.e., "How did your experience in the anatomy laboratory bring about your reflections on the meaning of life and human existence as well as the sanctity of one's passing?"). Written assignments were collected and anonymously coded. Information on anatomy courses was obtained via faculty questionnaires.

RESULT

A variety of themes were identified at the different schools, correlated with different anatomy formats and elements. Results indicate that the courses that offer hands-on cadaveric dissections may play an important role in triggering these sentiments.

DISCUSSION

The initiation of students' sentiments about the topic of death varies and includes several themes. There can be a connection to the way anatomy is taught, particularly if hands-on comprehensive cadaveric dissection or prosections are included.

CONCLUSION

In summary, anatomy courses can initiate students' thinking about life's passing - particularly in schools that offer hands-on cadaveric dissections or prosections.

Neuroanatomy Teaching in Australian and New Zealand Medical Schools

BACKGROUND

Graduate doctors' knowledge of central and peripheral nervous system anatomy is below an acceptable level. New technologies have been introduced to enhance education in the context of integrated curricula and reduced anatomy teaching hours in medical schools. However, it is unknown how varied this instruction has become between universities. This mixed methods study aimed to describe neuroanatomy teaching in medicine across Australia and New Zealand.

METHODS

An electronic survey was sent to Australian (n = 22) and New Zealand (n = 2) medical schools, endorsed by the Royal Australasian College of Surgeons. Academics were asked to comment on the course, content, instruction, and assessment of neuroanatomy for the 2019 academic year.

RESULTS

Ninety-two percent (22/24) of medical schools responded. Neuroanatomy content and instructional methodology was highly variable between institutions. The average time dedicated to teaching neuroanatomy was 46.0 hours (±38.1) with a range of 12-160 hours. Prosections (77%) and models (77%) were used at most universities. Dissection was utilized at 13 of 22 (59%) universities. Incorporation of new technologies was highly variable, the most common being 3-dimensional software (59%) and eBook (55%). Adoption of any virtual reality technologies was low (36%). Seven universities used an established curriculum (29%), whereas most did not (61%). Academics indicated anxiety and motivation were key elements of student engagement.

CONCLUSIONS

Results demonstrate widespread heterogeneity in the way neuroanatomy is taught to medical students. A standardized curriculum may improve collaboration between universities and facilitate translation of future research in the area into practice.

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.

The influence of mixing international and domestic students on competency learning in small groups in undergraduate medical education

BACKGROUND

Medical curricula are increasingly internationalized, with international students being mixed with domestic students in small group learning. Small group learning is known to foster competency learning in undergraduate medical education, specifically Communication, Collaboration, Leadership, and Professionalism. However, it is unclear what happens with the learning of competencies when international students are introduced in small groups. This study explores if students in international small groups master the competencies Collaboration, Leadership and Professionalism at the same level as students in domestic groups in an undergraduate medical curriculum.

METHOD

In total, 1215 Students of three academic year cohorts participated in the study. They were divided into four learning communities (LCs), per year cohort, in which tutor groups were the main instructional format. The tutorials of two learning communities were taught in English, with a mix of international and Dutch students. The tutorials of the other two learning communities were taught in Dutch with almost all domestic students. Trained tutors assessed three competencies (Collaboration, Leadership, Professionalism) twice per semester, as 'Not-on-track', 'On-track', or 'Fast-on-track'. By using Chi-square tests, we compared students' competencies performance twice per semester between the four LCs in the first two undergraduate years.

RESULTS

The passing rate ('On-track' plus 'Fast-on-track') for the minimum level of competencies did not differ between the mixed and domestic groups. However, students in the mixed groups received more excellent performance evaluations ('Fast-on-track') than the students in the homogenous groups of Dutch students. This higher performance was true for both international and Dutch students of the mixed groups. Prior knowledge, age, gender, and nationality did not explain this phenomenon. The effect could also not be explained by a bias of the tutors.

CONCLUSION

When students are educated in mixed groups of international and Dutch students, they can obtain the same basic competency levels, no matter what mix of students is made. However, students in the mixed international groups outperformed the students in the homogenous Dutch groups in achieving excellent performance scores. Future research should explore if these findings can be explained from differences in motivation, perceived grading or social network interactions.

How to Internationalize Medical Education using Concepts in Internationalization of Higher Education

This article was migrated. The article was marked as recommended. Internationalization of higher education is a well-researched area with a long history. At a time of increasing globalization, particularly in light of recent global health events, the internationalization of medical education may play an important role in medical school teaching - increasing future medical collaboration and building a global medical community. Internationalization of medical education is a less researched discipline and often limited to areas of Global Health. It is typically not part of the standard medical curriculum. While internationalization of medical education has overlapping themes with Global Health education, it has a much wider scope (i.e., preparation of global citizen physicians, international employability, collaboration, cultural and international understanding). Lessons learned from concepts in internationalization of higher education can aid in the realization of internationalization of medical education programs and establish IoME as a distinct area of educational research. This paper suggests elements to consider when implementing programs in internationalization of medical education. Guided by the analysis of an existing program in internationalization of medical education, important components are highlighted from the perspective of concepts found in internationalization of higher education. Several elements that are important features in internationalization of higher education are emphasized - institutional partnerships, goal setting, variety of internationalization at home concepts, international classroom features, multi-directional student mobility, and sustainability. The authors aim to shed light on the area of internationalization of medical education, widen its scope from Global Health education, and introduce it as a field of study for educational research. Adapting models and concepts of international higher education can help with establishing this field.