Impact of the COVID-19 pandemic on global health research training and education

Access, interest and equity considerations for virtual global health activities during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Global health activities (GHAs) reduce health disparities by promoting medical education, professional development, and resource sharing between high- and low- to middle-income countries (HICs and LMICs). Virtual global health activities facilitated continuity and bidirectionality in global health during the COVID-19 pandemic. While virtual engagement holds potential for promoting equity within partnerships, research on equitable access to and interest in virtual global health activities is limited.

METHODS

We conducted a cross-sectional, online, mixed-methods survey from January to February 2022 examining access to virtual activities before and during the pandemic across resource settings. Eligible participants were participants or facilitators of global health activities. Closed- and open-ended questions elicited participants' access to and interest in virtual global health engagement.

RESULTS

We analyzed 265 surveys from respondents in 45 countries (43.0% LMIC vs. HIC 57.0%). HIC respondents tended to report greater loss of in-person access due to the pandemic at their own institutions (16 of 17 queried GHAs), while LMIC respondents tended to report greater loss of in-person activities at another institution (9 of 17 queried GHAs). Respondents from LMICs were more likely to gain virtual access through another organization for all 17 queried VGHAs. HIC respondents had significantly more access to global health funding through their own organization (p < 0.01) and more flexibility for using funds. There were significant differences and trends between respondent groups in different resource environments in terms of accessibility to and interest in different virtual global health activities, both during and after the pandemic.

CONCLUSIONS

Our results highlight the need to examine accessibility to virtual global health activities within partnerships between high- and low- to middle-income countries. While virtual activities may bridge existing gaps in global health education and partnerships, further study on priorities and agenda setting for such initiatives, with special attention to power dynamics and structural barriers, are necessary to ensure meaningful virtual global health engagement moving forward.

Using "Adopt a Bacterium" as an e-learning tool for simultaneously teaching microbiology to different health-related university courses

The COVID-19 pandemic has posed challenges for education, particularly in undergraduate teaching. In this study, we report on the experience of how a private university successfully addressed this challenge through an active methodology applied to a microbiology discipline offered remotely to students from various health-related courses (veterinary, physiotherapy, nursing, biomedicine, and nutrition). Remote teaching was combined with the "Adopt a Bacterium" methodology, implemented for the first time on Google Sites. The distance learning activity notably improved student participation in microbiology discussions, both through word cloud analysis and the richness of discourse measured by the Shannon index. Furthermore, feedback from students about the e-learning approach was highly positive, indicating its effectiveness in motivating and involving students in the learning process. The results also demonstrate that despite being offered simultaneously to students, the methodology allowed for the acquisition of specialized knowledge within each course and sparked student interest in various aspects of microbiology. In conclusion, the remote "Adopt a Bacterium" methodology facilitated knowledge sharing among undergraduate students from different health-related courses and represented a valuable resource in distance microbiology education.

Use of a hybrid digital training approach for hormonal IUD providers in Nigeria: results from a mixed method study

BACKGROUND

In Nigeria, in-service trainings for new family planning (FP) methods have typically been conducted using a combination of classroom-based learning, skills labs, and supervised practicums. This mixed-methods study evaluated the feasibility, acceptability, provider competency, and costs associated with a hybrid digital and in-person training model for the hormonal intrauterine device (IUD).

METHODS

The study was conducted in Enugu, Kano, and Oyo states, Nigeria, and enrolled FP providers previously trained on non-hormonal IUDs. Participants completed a digital didactic training, an in-person model-based practicum with an Objective Structured Clinical Examination (OSCE), followed by supervised provision of service to clients. Provider knowledge gains and clinical competency were assessed and described descriptively. Data on the feasibility, acceptability, and scalability of the approach were gathered from participating providers, clinical supervisors, and key stakeholders. Training costs were captured using an activity-based approach and used to calculate a cost per provider trained. All analyses were descriptive.

RESULTS

Sixty-two providers took the hybrid digital training, of whom 60 (91%) were included in the study (n = 36 from public sector, n = 15 from private sector, and n = 9 both public/private). The average knowledge score increased from 62 to 86% pre- and post-training. Clinical competency was overall very high (mean: 94%), and all providers achieved certification. Providers liked that the digital training could be done at the time/place of their choosing (84%), was self-paced (79%), and reduced risk of COVID-19 exposure (75%). Clinical supervisors and Ministry of Health stakeholders also had positive impressions of the training and its scalability. The hybrid training package cost $316 per provider trained.

CONCLUSIONS

We found that a hybrid digital training approach to hormonal IUD service provision in Nigeria was acceptable and feasible. Providers demonstrated increases in knowledge following the training and achieved high levels of clinical competency. Both providers and clinical supervisors felt that the digital training content was of high quality and an acceptable (sometimes preferable) alternative to classroom-based, in-person training. This study provided insights into a hybrid digital training model for a long-acting contraceptive, relevant to scale-up in Nigeria and similar settings.

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.

Research Capacity Training on Environmental Health and Noncommunicable Diseases in the Country of Georgia: Challenges and Lessons Learned during the COVID-19 Pandemic

COVID-19 presented challenges for global health research training programs. The Clean Air Research and Education (CARE) program, which aims to enhance research capacity related to noncommunicable diseases and environmental health in the country of Georgia, was launched in 2020—as the COVID-19 pandemic began. At its foundation is mentorship and mentored research, alongside formal didactic training, informal training/meetings, and other supports. Current analyses examined CARE’s initial 1.5 years (e.g., program benefits, mentorship relationships) using data from an evaluation survey among trainees and faculty in January 2022. Trainees (100% response rate: n = 12/12; 4 MPH, 8 PhD) and faculty (86.7% response rate: n = 13/15; 7 Georgia-based, 6 United States-based) rated factors related to mentor-mentee relationships highly, particularly mutual consideration of each other’s thoughts, opinions, and perspectives; one major challenge was completing goals planned. Trainees and faculty identified several growth experiences and program benefits (e.g., skills development, expanding professional network) but also identified challenges (e.g., meeting program demands, communication gaps, unclear expectations)—exacerbated by the pandemic. Findings underscore the importance of strong mentorship relationships and that the pandemic negatively impacted communication and clarity of expectations. Given the likely ongoing impact of the pandemic on such programs, program leaders must identify ways to address these challenges.

Perceived roles, benefits and barriers of virtual global health partnership initiatives: a cross-sectional exploratory study

Background

Virtual global health partnership initiatives (VGHPIs) evolved rapidly during the COVID-19 pandemic to ensure partnership continuity. However the current landscape for VGHPI use and preference is unknown. This study aimed to increase understanding of GH partners’ perspectives on VGHPIs.

Methods

From 15 October to 30 November 2020, An online, international survey was conducted using snowball sampling to document pandemic-related changes in partnership activities, preferences for VGHPIs, and perceived acceptability and barriers. The survey underwent iterative development within a diverse author group, representing academic and clinical institutions, and the non-profit sector. Participants from their professional global health networks were invited, including focal points for global health partnerships while excluding trainees and respondents from the European Economic Area. Analysis stratified responses by country income classification and partnership type. Authors used descriptive statistics to characterize responses, defining statistical significance as α = 0.05.

Results

A total of 128 respondents described 219 partnerships. 152/219 (69%) partnerships were transnational, 157/219 (72%) were of > 5 years duration, and 127/219 (60%) included bidirectional site visits. High-income country (HIC) partners sent significantly more learners to low- to middle-income country (LMIC) partner sites (p < 0.01). Participants commented on pandemic-related disruptions affecting 217/219 (99%) partnerships; 195/217 (90%) were disruption to activities; 122/217 (56%) to communication; 73/217 (34%) to access to professional support; and 72/217 (33%) to funding. Respondents indicated that VGHPIs would be important to 206/219 (94%) of their partnerships moving forward. There were overall differences in resource availability, technological capacity, and VGHPI preferences between LMIC and HIC respondents, with a statistically significant difference in VGHPI acceptability (p < 0.001). There was no significant difference between groups regarding VGHPIs’ perceived barriers.

Conclusions

The pandemic disrupted essential partnership elements, compounding differences between LMIC and HIC partners in their resources and preferences for partnership activities. VGHPIs have the potential to bridge new and existing gaps and maximize gains, bi-directionality, and equity in partnerships during and after COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41256-022-00244-4.

Taking Pause: A COVID-19 Student Reflection on Global Health Research Opportunities, Training, and Institutional Reform

Restrictions to research due to COVID-19 have required global health researchers to factor public health measures into their work and discuss the most ethical means to pursue research under safety concerns and resource constraints. In parallel, global health research opportunities for students have also adapted to safety concerns and resource constraints. Some projects have been canceled or made remote, but inventively, domestic research opportunities have been created as alternatives for students to continue gaining global health learning competencies. Knowing the ethical challenges inherent in short-term student global health research and research in strained health systems, it is intriguing why these safer alternatives were not previously pervasive in global health education. This paper provides perspectives from students training at academic institutions in the US on how COVID-19 disrupted student research and what can be learned from the associated shifts in global health research. Additionally, the authors take this opportunity to advocate for academic institutions from high-income countries to reflect on long-standing global health research conventions that have been perpetuated and bolster training for students conducting global health research. The authors draw on their experiences, existing literature, and qualitative interviews with students who pursued global health research during COVID-19.