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Rallo MS, Strong MJ, Teton ZE, Murazsko K, Nanda A, Liau L, Rosseau G. Targeted Public Health Training for Neurosurgeons: An Essential Task for the Prioritization of Neurosurgery in the Evolving Global Health Landscape. Neurosurgery 2023; 92:10-17. [PMID: 36519856 DOI: 10.1227/neu.0000000000002169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022] Open
Abstract
The gap between the tremendous burden of neurological disease requiring surgical management and the limited capacity for neurosurgical care has fueled the growth of the global neurosurgical movement. It is estimated that an additional 23 300 neurosurgeons are needed to meet the burden posed by essential cases across the globe. Initiatives to increase neurosurgical capacity through systems strengthening and workforce development are key elements in correcting this deficit. Building on the growing interest in global health among neurosurgical trainees, we propose the integration of targeted public health education into neurosurgical training, in both high-income countries and low- and middle-income countries. This effort will ensure that graduates possess the fundamental skillsets and experience necessary to participate in and lead capacity-building efforts in the developing countries. This additional public health training can also help neurosurgical residents to achieve the core competencies outlined by accreditation boards, such as the Accreditation Committee on Graduate Medical Education in the United States. In this narrative review, we describe the global burden of neurosurgical disease, establish the need and role for the global neurosurgeon, and discuss pathways for implementing targeted global public health education in the field of neurosurgery.
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Affiliation(s)
- Michael S Rallo
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michael J Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Zoe E Teton
- Department of Neurosurgery, University of California - Los Angeles, Los Angeles, California, USA
| | - Karin Murazsko
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Anil Nanda
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Linda Liau
- Department of Neurosurgery, University of California - Los Angeles, Los Angeles, California, USA
| | - Gail Rosseau
- Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Atkinson RB, Khubchandani JA, Chun MBJ, Reidy E, Ortega G, Bain PA, Demko C, Barreiro-Rosado J, Kent TS, Smink DS. Cultural Competency Curricula in US Graduate Medical Education: A Scoping Review. J Grad Med Educ 2022; 14:37-52. [PMID: 35222820 PMCID: PMC8848887 DOI: 10.4300/jgme-d-21-00414.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cultural competency training provides participants with knowledge and skills to improve cross-cultural communication and is required for all graduate medical education (GME) training programs. OBJECTIVE The authors sought to determine what cultural competency curricula exist specifically in GME. METHODS In April 2020, the authors performed a scoping review of the literature using a multidatabase (PubMed, Ovid, MedEdPORTAL) search strategy that included keywords relevant to GME and cultural competency. The authors extracted descriptive data about the structure, implementation, and analysis of cultural competency curricula and analyzed these data for trends. RESULTS Sixty-seven articles met criteria for inclusion, of which 61 (91%) were focused exclusively on residents. The most commonly included specialties were psychiatry (n=19, 28.4%), internal medicine (n=16, 23.9%), and pediatrics (n=15, 22.4%). The shortest intervention was a 30-minute online module, while the longest contained didactics, electives, and mentoring programs that spanned the entirety of residency training (4 years). The sample sizes of included studies ranged from 6 to 833 participants. Eight (11.9%) studies utilized OSCEs as assessment tools, while 17 (25.4%) conducted semi-structured interviews or focus groups. Four common themes were unique interventions, retention of learning, trainee evaluation of curricula, and resources required for implementation. CONCLUSIONS Wide variation exists in the design, implementation, and evaluation of cultural competency curricula for residents and fellows.
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Affiliation(s)
- Rachel B. Atkinson
- Rachel B. Atkinson, MD, is a Resident, Department of Surgery, and Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School
| | - Jasmine A. Khubchandani
- Jasmine A. Khubchandani, MD, is a Resident, Department of Surgery, and Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School
| | - Maria B. J. Chun
- Maria B. J. Chun, PhD, is a Specialist and Associate Chair in Administration and Finance, Department of Surgery, John A. Burns School of Medicine, University of Hawaii
| | - Emma Reidy
- Emma Reidy, MPH, is Senior Project Manager, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| | - Gezzer Ortega
- Gezzer Ortega, MD, MPH, is Lead Faculty for Research and Innovation for Equitable Surgical Care, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical
| | - Paul A. Bain
- Paul A. Bain, PhD, is Reference and Instruction Librarian, Countway Library of Medicine, Harvard Medical School
| | - Caroline Demko
- Caroline Demko, is a First-Year Masters Student, Goldman School of Public Policy, University of California, Berkeley
| | - Jeenn Barreiro-Rosado
- Jeenn Barreiro-Rosado, is a Research Assistant, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| | - Tara S. Kent
- Tara S. Kent, MD, MS, is Associate Professor of Surgery, Vice Chair for Education, and Program Director, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Douglas S. Smink
- Douglas S. Smink, MD, MPH, is Chief of Surgery, Brigham and Women's Faulkner Hospital, Associate Chair of Education and Associate Professor of Surgery, and Core Faculty, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
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Roopnarine R, Boeren E, Regan JA. The Missing Professional Perspective: Medical, Veterinary, and Dual Degree Public Health Student Perceptions of One Health. Front Public Health 2021; 9:704791. [PMID: 34336778 PMCID: PMC8319388 DOI: 10.3389/fpubh.2021.704791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: One Health (OH) is an important concept to design appropriate public health responses to emerging diseases such as COVID-19. How trainee health professionals understand this concept is important to its implementation. In this study, we explored how medical (MD), veterinary (DVM), and dual degree MD and DVM Master of Public Health (MPH) students define OH and its relevance to practice. Methods: Students participated in a survey that included the Readiness for Interprofessional Learning Scale (RIPLS), and two questions requiring them to define and explain the relevance of OH. The transcripts of the OH responses underwent thematic analysis. Role theory was used to explain the variation in how students from these different programmes viewed the concept. Results: The responses of the MD and DVM students in contrast to the dual degree MPH students reflected gaps in their understanding of the concept that pertained to the specific health impacts of global warming; antimicrobial resistance, food security; social, cultural and environmental determinants of zoonoses occurrence, and health policy formation. Discussion: Mitigation of the global risks to public health require a collaborative approach by health professionals. Our findings suggest that MD and DVM students are unaware of many factors that impact patient health outside of their own discipline. The inclusion of dual degree students revealed novel insights that undertaking an MPH may have enabled them to be more aware about the interdisciplinary relevance of OH to their professional practice. We recommend that structured incorporation of OH should inform future medical and veterinary curricula.
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Affiliation(s)
- Rohini Roopnarine
- Department of Public Health and Preventive Medicine, School of Medicine, St. George's University Grenada, Grenada, West Indies
| | - Ellen Boeren
- School of Education, University of Glasgow, Glasgow, United Kingdom
| | - Julie-Anne Regan
- The Centre for Higher Education Studies, University of Liverpool, Liverpool, United Kingdom
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Goez H, Lai H, Rodger J, Brett-MacLean P, Hillier T. The DISCuSS model: Creating connections between community and curriculum - A new lens for curricular development in support of social accountability. Med Teach 2020; 42:1058-1064. [PMID: 32608298 DOI: 10.1080/0142159x.2020.1779919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Medicine's social mandate recognizes the importance of introducing changes to systems and practices to meet the healthcare needs of marginalized populations. Social accountability efforts encompass a wide array of actions, including equity, diversity and inclusion initiatives, and adapting knowledge relevant to practice across education, research, and clinical domains. To influence change in education, ongoing structures and processes are needed to ensure adequacy, relevance, and effectiveness of curricular coverage. In support of this, we created an innovative and creative approach to developing curricular modules to prepare medical students to provide care that is responsive to the cultural, economic, and psychosocial realities of diverse patient populations. The DISCuSS model (Diversity, Identify, Search, Create module (with community engagement), Sustainability, Social accountability) provides a community-engaged, iterative approach to curriculum development relevant to social accountability. Over the past 5 years, we have created nine curricular modules focused on health-related inequities and social concerns, including modules on Indigenous and refugee health, sexual and gender minority health, human trafficking, and addiction. AFMC Graduation Questionnaire results have shown a statistically significant increase in our students 'preparedness to provide care to diverse populations.' The DISCuSS model, which continues to evolve, can be adapted and used in other settings.
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Affiliation(s)
- Helly Goez
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Hollis Lai
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Joanne Rodger
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | | | - Tracey Hillier
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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Sisk B, Green A, Chan K, Yun K. Caring for Children in Immigrant Families: Are United States Pediatricians Prepared? Acad Pediatr 2020; 20:391-398. [PMID: 31790799 DOI: 10.1016/j.acap.2019.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A growing number of children in the United States are from immigrant families. We conducted a national survey to examine pediatricians' self-rated preparedness to care for children in immigrant families. METHODS A 2017 survey of American Academy of Pediatrics members assessed respondent characteristics, formal training in and experience with global, public, or immigrant health, and preparedness to care for children in immigrant families. Descriptive statistics and a multivariable logistic regression model examined associations between characteristics, formal training, experience, and preparedness. RESULTS The survey response rate was 47% (n = 758/1628). One third of respondents (33.6%) reported being unprepared to care for children in immigrant families. In bivariate analyses, respondents who had graduated from medical school outside of the United States, had previous education on immigrant health care, or had recent international global health experience were most likely to report feeling prepared to care for children in immigrant families. Multivariable regression model results indicated that prior education on immigrant health (adjusted odds ratio [AOR] 4.07; 95% confidence interval [CI] 2.68, 6.32), graduation from medical school outside the United States (AOR 2.35; 95% CI 1.22, 4.67), and proficiency in a language other than English (AOR 1.78; 95% CI 1.14, 2.80) were independently associated with preparedness. CONCLUSIONS One in 3 US pediatricians report being unprepared to care for children in immigrant families. Wider implementation of graduate and continuing medical education on immigrant child health is needed to ensure that practicing pediatricians have the appropriate skills and knowledge to care for this patient population.
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Affiliation(s)
- Blake Sisk
- Department of Research, American Academy of Pediatrics (B Sisk), Itasca, Ill.
| | - Andrea Green
- Department of Pediatrics, University of Vermont Children's Hospital, Larner College of Medicine at the University of Vermont (A Green), Burlington, Vt
| | - Kevin Chan
- Institute of Better Health and Children's and Women's Health, Trillium Health Partners (K Chan), Mississauga, ON, Canada; Department of Pediatrics, University of Toronto (K Chan), Toronto, ON, Canada
| | - Katherine Yun
- Department of Pediatrics, Children's Hospital of Philadelphia (K Yun), Philadelphia, Pa; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine (K Yun), Philadelphia, Pa
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Abstract
Longitudinal and collaborative global health research curricula to train a well-versed global health corps through skills building in assessment and evaluation are lacking. A without-walls research curriculum was offered to medical and public health students between 2007 and 2015. Mentored cross-disciplinary research projects were developed and implemented in partnership with communities. A multilevel mixed methods design, including semi-structured interviews, post-curriculum surveys, presentations, publications, postgraduation metrics, and feedback from project sites, evaluated educational outcomes. Students (N = 25; aged 27 ± 1.9 years; 90.5% female) participated in the studies in 12 countries, resulting in 26 national-level presentations and 24 peer-reviewed publications, including per student average and range of Institutional Review Board submission (0.95; 0-3), poster presentation (0.85; 0-3), oral presentation (0.65; 0-2), and peer-reviewed submission (1.05; 0-4). On average, the studies (40% mixed methods) lasted 2 years. Analyses and manuscript writing were the most challenging; data collection and presentations were the most rewarding. Majority of the participants strongly agreed with achieving skills in community engagement, interviewing techniques, research design and implementation, research dissemination, and career development. Interview themes included expectations and learning goals, effective mentorship, impact on career goals, and ethical learning. Mentorship qualities were accessibility, real-time problem solving, research expertise, advocate, and balancing guidance with independence. Project sites' feedback was overwhelmingly positive regarding the projects' impact. Postgraduation participants hold positions in humanitarian organizations, research programs serving the underserved, and primary care residencies, fellowships, and faculty. This experience illustrates the feasibility and effectiveness of mentored global health research and underlines the crucial link between community collaboration and scholarship for effective global health practice.
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Affiliation(s)
- Ramin Asgary
- Department of Global Health, Milken Institute of Public Health, George Washington University, Washington, District of Columbia; Department of Medicine, Weill Cornell Medical College, New York, New York; Doctors Without Borders, New York, New York
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Rule ARL, Reynolds K, Sucharew H, Volck B. Perceived Cultural Competency Skills and Deficiencies Among Pediatric Residents and Faculty at a Large Teaching Hospital. Hosp Pediatr 2018; 8:554-569. [PMID: 30166315 DOI: 10.1542/hpeds.2017-0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To identify demographic, educational, and experiential factors associated with perceived self-efficacy in cultural competency (PSECC) for pediatric residents and faculty at a large, tertiary-care children's hospital and to identify key barriers to the delivery of culturally competent pediatric care. METHODS We conducted a cross-sectional assessment of cultural competency (CC) education, training, and skills using an online survey of residents and faculty at a large children's hospital. With our data analysis, we sought associations between PSECC skills, cross-cultural training or work experience, and demographic background. Participants were asked to identify and rank barriers to CC care and additional training they would like to see implemented. RESULTS A total of 114 residents (55%) and 143 faculty (65%) who responded to the survey assessing PSECC. Residents were more likely to have had CC training than faculty. More than half of the residents and faculty had participated in an underserved-group clinical experience domestically or abroad. Those residents with underserved-group experience were more likely to be comfortable with interpreter use (P = .03) and culturally sensitive issues (P = .06). Faculty who participated in underserved-group care in the United States were more likely to believe that cultural bias affects care (P = .005). Both identified time constraints, language barriers, and lack of knowledge as chief barriers to acquiring CC, and both desired more training. CONCLUSIONS Residents and faculty at a large children's hospital believe that they lack adequate CC training. Underserved-group clinical experiences both domestically and abroad are associated with perceived improved cross-cultural care skills. Increasing the extent and quality of CC education in both resident training and faculty development is needed.
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Affiliation(s)
- Amy R L Rule
- Perinatal Institute and Division of
- Hospital Medicine and
| | - Kim Reynolds
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Heidi Sucharew
- Hospital Medicine and
- Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
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Arora G, Esmaili E, Pitt MB, Green A, Umphrey L, Butteris SM, St Clair NE, Batra M, O'Callahan C. Pediatricians and Global Health: Opportunities and Considerations for Meaningful Engagement. Pediatrics 2018; 142:peds.2017-2964. [PMID: 30054345 DOI: 10.1542/peds.2017-2964] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 11/24/2022] Open
Abstract
Pediatric practitioners whose expertise is primarily focused on the care of children within health settings in the United States are increasingly engaged in global child health (GCH). The wide spectrum of this involvement may include incorporating short-term or longer-term GCH commitments in clinical care, teaching and training, mentoring, collaborative research, health policy, and advocacy into a pediatric career. We provide an overview of routes of engagement, identify resources, and describe important considerations for and challenges to better equipping US pediatric practitioners to participate in meaningful GCH experiences. This article is part of a series on GCH describing critical issues relevant to caring for children from an international perspective.
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Affiliation(s)
- Gitanjli Arora
- Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California;
| | - Emily Esmaili
- Department of Pediatrics, Lincoln Community Health Center, Durham, North Carolina.,Center for Health Policy and Inequalities Research and Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | - Michael B Pitt
- Department of Pediatrics, University of Minnesota and University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Andrea Green
- Departments of Pediatrics and Pediatric Primary Care, University of Vermont Children's Hospital, Burlington, Vermont
| | - Lisa Umphrey
- Doctors Without Borders/Médecins Sans Frontiéres, Sydney, Australia
| | - Sabrina M Butteris
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nicole E St Clair
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maneesh Batra
- Department of Pediatrics, University of Washington, Seattle, Washington; and
| | - Cliff O'Callahan
- Department of Pediatrics, Middlesex Hospital and University of Connecticut, Middletown, Connecticut
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Webber S, Butteris SM, Houser L, Coller K, Coller RJ. Asset-Based Community Development as a Strategy for Developing Local Global Health Curricula. Acad Pediatr 2018; 18:496-501. [PMID: 29427688 DOI: 10.1016/j.acap.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND A significant and growing proportion of US children have immigrant parents, an issue of increasing importance to pediatricians. Training globally minded pediatric residents to address health inequities related to globalization is an important reason to expand educational strategies around local global health (LGH). METHODS We developed a curriculum in the pediatric global health residency track at the University of Wisconsin in an effort to address gaps in LGH education and to increase resident knowledge about local health disparities for global community members. This curriculum was founded in asset-based community development (ABCD), a strategy used in advocacy training but not reported in global health education. RESULTS The initial curriculum outputs have provided the foundation for a longitudinal LGH curriculum and a community-academic partnership. Supported by a community partnership grant, this partnership is focused on establishing a community-based postpartum support group for local Latinos, with an emphasis on building capacity in the Latino community. CONCLUSIONS Aspects of this curriculum can serve other programs looking to develop LGH curricula rooted in building local partnerships and capacity using an ABCD model.
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Affiliation(s)
- Sarah Webber
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wis.
| | - Sabrina M Butteris
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wis
| | - Laura Houser
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wis
| | | | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wis
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Gladding SP, McGann PT, Summer A, Russ CM, Uwemedimo OT, Matamoros Aguilar M, Chakraborty R, Moore M, Lieh-Lai M, Opoka R, Howard C, John CC. The Collaborative Role of North American Departments of Pediatrics in Global Child Health. Pediatrics 2018; 142:peds.2017-2966. [PMID: 29895523 DOI: 10.1542/peds.2017-2966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 11/24/2022] Open
Abstract
Appeals for health equity call for departments of pediatrics to improve the health of all children including those from underserved communities in North America and around the world. Consequently, North American (NA) departments of pediatrics have a role in global child health (GCH) which focuses on providing health care to underserved children worldwide. In this review, we describe how NA departments of pediatrics can collaboratively engage in GCH education, clinical practice, research, and advocacy and summarize best practices, challenges, and next steps for engaging in GCH in each of these areas. For GCH in low- and middle-income countries (LMICs), best practices start with the establishment of ethical, equitable, and collaborative partnerships with LMIC communities, organizations, and institutions engaged in GCH who are responsible for the vast majority of work done in GCH. Other best practices include adequate preparation of trainees and clinicians for GCH experiences; alignment with local clinical and research priorities; contributions to local professional development and ongoing monitoring and evaluation. Challenges for departments include generating funding for GCH activities; recruitment and retention of GCH-focused faculty members; and challenges meeting best practices, particularly adequate preparation of trainees and clinicians and ensuring mutual benefit and reciprocity in NA-LMIC collaborations. We provide examples of how departments have overcome these challenges and suggest next steps for development of the role of NA departments of pediatrics in GCH. Collaborative implementation of best practices in GCH by LMIC-NA partnerships can contribute to reductions of child mortality and morbidity globally.
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Affiliation(s)
- Sophia P Gladding
- Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota;
| | | | - Andrea Summer
- Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Christiana M Russ
- Division of Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Omolara T Uwemedimo
- Department of Pediatrics and Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
| | | | - Rana Chakraborty
- Division of Infectious Diseases, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Molly Moore
- Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Vermont, Burlington, Vermont
| | - Mary Lieh-Lai
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Robert Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Cynthia Howard
- Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; and
| | - Chandy C John
- Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; and.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University of Medicine, Bloomington, Indiana
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Abstract
BACKGROUND While interest and opportunities for global health experiences (GHE) continue to grow, the preparation of students and health professionals alike to engage in these GHEs remains limited. AIMS This article provides tips for reflexivity prior to undertaking a GHE and suggests ways to debrief the experience in order to ensure that trainees and professionals that engage in GHEs can both help their intended communities and also get the most out of the experience. METHODS The authors conducted a scoping review using Medline, PubMed and Google scholar using searching the terms: global health, global health experience, global health research, and international medical elective. We supplemented this search with our own experiences working with international partners. CONCLUSIONS GHEs should be undertaken with reflexivity prior to, during and subsequent to the experience in order to ensure that all collaborators in the partnership meet their intended goals.
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Affiliation(s)
- Rabia Khan
- a The Wilson Center, Faculty of Medicine, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - Brian Hodges
- a The Wilson Center, Faculty of Medicine, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | | | - Donald Cole
- a The Wilson Center, Faculty of Medicine, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
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12
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Alpern JD, Davey CS, Song J. Perceived barriers to success for resident physicians interested in immigrant and refugee health. BMC Med Educ 2016; 16:178. [PMID: 27421774 PMCID: PMC4946089 DOI: 10.1186/s12909-016-0696-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/16/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Cross-cultural care is recognized by the ACGME as an important aspect of US residency training. Resident physicians' preparedness to deliver cross-cultural care has been well studied, while preparedness to provide care specifically to immigrant and refugee populations has not been. METHODS We administered a survey in October 2013 to 199 residents in Internal Medicine, Pediatrics, and Medicine/Pediatrics at the University of Minnesota, assessing perceived knowledge, attitudes, and experience with immigrant and refugee patients. RESULTS Eighty-three of 199 residents enrolled in Internal Medicine, Pediatrics and Medicine/Pediatrics programs at the University of Minnesota completed the survey (42 %). Most (n = 68, 82 %) enjoyed caring for immigrants and refugees. 54 (65 %) planned to care for this population after residency, though 45 (54 %) were not comfortable with their knowledge regarding immigrant and refugee health. Specific challenges were language (n = 81, 98 %), cultural barriers (n = 76, 92 %), time constraints (n = 60, 72 %), and limited knowledge of tropical medicine (n = 57, 69 %). 67 (82 %) wanted more training in refugee and immigrant health. CONCLUSIONS The majority of residents enjoyed caring for immigrant and refugee patients and planned to continue after residency. Despite favorable attitudes, residents identified many barriers to providing good care. Some involved cultural and language barriers, while others were structural. Finally, most respondents felt they needed more education, did not feel comfortable with their knowledge, and wanted more training during residency. These data suggest that residency programs consider increasing training in these specific areas of concern.
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Affiliation(s)
- Jonathan D Alpern
- Department of Infectious Disease, University of Minnesota, 800 North 3rd St. Apt 520, Minneapolis, MN, 55401, USA.
| | - Cynthia S Davey
- University of Minnesota, Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, Minneapolis, MN, USA
| | - John Song
- Department of Medicine, University of Minnesota, Center for Bioethics, Minneapolis, MN, USA
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13
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Hoffman SJ, Silverberg SL. Training the next generation of global health advocates through experiential education: A mixed-methods case study evaluation. Can J Public Health 2015; 106:e442-9. [PMID: 26680437 DOI: 10.17269/cjph.106.5099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 10/15/2015] [Accepted: 08/14/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This case study evaluates a global health education experience aimed at training the next generation of global health advocates. Demand and interest in global health among Canadian students is well documented, despite the difficulty in integrating meaningful experiences into curricula. METHODS Global health advocacy was taught to 19 undergraduate students at McMaster University through an experiential education course, during which they developed a national advocacy campaign on global access to medicines. A quantitative survey and an analysis of social network dynamics were conducted, along with a qualitative analysis of written work and course evaluations. Data were interpreted through a thematic synthesis approach. RESULTS Themes were identified related to students' learning outcomes, experience and class dynamics. The experiential education format helped students gain authentic, real-world experience in global health advocacy and leadership. The tangible implications for their course work was a key motivating factor. While experiential education is an effective tool for some learning outcomes, it is not suitable for all. As well, group dynamics and evaluation methods affect the learning environment. CONCLUSION Real-world global health issues, public health practice and advocacy approaches can be effectively taught through experiential education, alongside skills like communication and professionalism. Students developed a nuanced understanding of many strategies, challenges and barriers that exist in advocating for public health ideas. These experiences are potentially empowering and confidence-building despite the heavy time commitment they require. Attention should be given to how such experiences are designed, as course dynamics and grading structure significantly influence students' experience.
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14
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Rhee DS, Heckman JE, Chae SR, Loh LC. Comparative analysis: potential barriers to career participation by north american physicians in global health. Int J Family Med 2014; 2014:728163. [PMID: 25405030 PMCID: PMC4227322 DOI: 10.1155/2014/728163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/13/2014] [Accepted: 09/29/2014] [Indexed: 06/04/2023]
Abstract
Physician interest in global health, particularly among family physicians, is reflected by an increasing proliferation of field training and service experiences. However, translating initial training involvement into a defined and sustainable global health career remains difficult and beset by numerous barriers. Existing global health literature has largely examined training experiences and related ethical considerations while neglecting the role of career development in global health. To explore this, this paper extrapolates potential barriers to global health career involvement from existing literature and compares these to salary and skills requirements for archetypal physician positions in global health, presenting a framework of possible barriers to sustained physician participation in global health work. Notable barriers identified include financial limitations, scheduling conflicts, security/family concerns, skills limitations, limited awareness of opportunities, and specialty choice, with family practice often closely aligned with global health experience. Proposed solutions include financial support, protected time, family relocation support, and additional training. This framework delineates barriers to career involvement in global health by physicians. Further research regarding these barriers as well as potential solutions may help direct policy and initiatives to better utilize physicians, particularly family physicians, as a valuable global health human resource.
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Affiliation(s)
- Daniel S. Rhee
- Department of Pediatric Surgery, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Jennifer E. Heckman
- Department of Urology, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Sae-Rom Chae
- Department of Internal Medicine and Pediatrics, University of Illinois at Chicago, Room 1405, 840 S. Wood Street, Chicago, IL 60612, USA
| | - Lawrence C. Loh
- Dalla Lana School of Public Health, University of Toronto, 155 College Street West, 6th Floor, Toronto, ON, Canada M5T 3M7
- Department of Family Medicine, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
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Abstract
Short-term humanitarian medical volunteerism has grown significantly among both clinicians and trainees over the past several years. Increasingly, both volunteers and their respective institutions have faced important challenges in regard to medical ethics and professional codes that should not be overlooked. We explore these potential concerns and their risk factors in three categories: ethical responsibilities in patient care, professional responsibility to communities and populations, and institutional responsibilities towards trainees. We discuss factors increasing the risk of harm to patients and communities, including inadequate preparation, the use of advanced technology and the translation of Western medicine, issues with clinical epidemiology and test utility, difficulties with the principles of justice and clinical justice, the lack of population-based medicine, sociopolitical effects of foreign aid, volunteer stress management, and need for sufficient trainee supervision. We review existing resources and offer suggestions for future skill-based training, organisational responsibilities, and ethical preparation.
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Affiliation(s)
- Ramin Asgary
- Department of Medicine, New York University School of Medicine, , New York, New York, USA
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