Pediatric residency programs support global health education

By Will Boggs MD

NEW YORK (Reuters Health) - More than half of the U.S. pediatric residency programs surveyed offer international field experiences and nearly as many offer domestic field experiences in support of global health education.

"The groundswell of interest in global health has not just persisted, but grown among pediatric trainees," Dr. Sabrina M. Butteris, from the University of Wisconsin School of Medicine and Public Health, Madison, told Reuters Health by email. "Pediatric programs have responded and are working toward best practices, but there is still much work to be done."

Global health seeks to improve health and achieve equity in health for all people worldwide. Medical students and residents report increased interest in global health issues.

Dr. Butteris and colleagues described the current landscape of global health education in U.S. pediatric residency programs and identified program characteristics associated with key global health curricular elements in an August 10 Pediatrics online report.

Among the 198 programs responding, 24.7% had a global health track, and 7.3% of their residents went on an international rotation during the 2013-2014 academic year.

Of the 127 programs that offered international or domestic field experiences, 84 (66.1%) provided pretravel preparation.

Eighty-four programs had international partnerships in 153 countries with a focus on clinical (84.5%), education (53.6%), and research (26.2%).

Large residency programs were more likely than small residency programs to have global health tracks, educational elements, or international rotations.

Program directors identified funding, administrative support, availability of sustainable international partnerships, sharing of curricular and other resources, and program evaluation tools as their most common needs.

"The impact of global health partnerships, particularly those involving trainees (who by definition require orientation, assessment, and supervision), on colleagues and institutions in resource-limited settings cannot be overstated," the researchers noted, "and should be monitored in these regions. By coordinating efforts, orientation, and schedules across programs working in the same areas, some of the burden imposed on partners abroad could be offset."

"As a community we must ensure that all residents participating in global health rotations are well prepared and that we make progress in coordinating our programs stateside rather than leaving that work to our already overextended colleagues abroad," Dr. Butteris said.

"In terms of the bigger picture of what is happening in global health among graduate medical education programs, this is just the tip of the iceberg," she explained. "There are many unknowns as we look across specialties; one can only begin to imagine the scope of global health partnerships if we were to include all specialties. This is one of the greatest challenges in global health today -- knowing who is doing what and with whom. Without this critical piece of information it is hard to imagine how the desperately needed work of coordinating efforts could take place. Hopefully this is a step in the right direction."

"There are hundreds of thousands of children in the United States who live in poverty and can be reached within a one- to two-hour automobile drive instead of a 24-hour air flight," Dr. Gordon E. Schutze, from Baylor College of Medicine, Houston, Texas, wrote in a related editorial. "These children seem to get forgotten in many of the discussions about global health, and I would encourage programs to make sure that their trainees have a robust experience with this population before attempting to tackle the rest of the globe."

"It is now up to those in charge of these global health training programs to make sure the residents are adequately supported financially, work in programs that can support a visiting learner in a safe environment, provide a great educational experience, and have adequate time to make the most of their opportunity," Dr. Schutze concluded. "The programs that can do this will attract great residents, provide an outstanding global health experience, and are more likely to have graduates continue this type of work for the rest of their lives, and that would be a great win for everyone involved."

Dr. Kevin Forsyth, from Flinders University, Adelaide, South Australia, Australia, who is also Board Director, Global Pediatric Education Consortium, told Reuters Health by email, "One of the key findings here is the need for coordination in global health experiences for residents. Each program trying to set this up, run it, support it, ensure quality, all independently, is not the right direction to go. There should be a national coordination program to assist smaller schools, to assist with training of those who travel, to assist in placements and supervision distally. Without such national coordination, this will never really get off the ground or be as effective as it needs to be."

"I am working at the international level to try and get coordination for support of child training in under-resourced countries," Dr. Forsyth said. "We are having a global summit on this in August 2016 with the International Pediatric Association."

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1P1ciQg and http://bit.ly/1WcCNHY

Pediatrics 2015.

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