Educating and Mentoring Medical Students and

Residents in Global Health: Short and Medium Term

International ExperiencesInis Jane Bardella, MD, FAAFP

Associate Dean Faculty Development & Global Health Initiatives

Professor Department of Family & Preventive Medicine

Chicago Medical School, Rosalind Franklin University

North Chicago, IL USA

Session Objectives Discuss the need and opportunity for sustainable models of

medical education globally that honor God. Explore models and strategies for medical student and resident

GH education & mentoring that maximize in-country partner benefit, minimize harm and disruption, and facilitate sustainability.

Discuss the benefits, challenges and outcomes of short and medium term international experiences for medical students and residents.

Apply these concepts for education & mentoring of future medical education leaders globally.

Rationale

CommandedGo ye therefore, and make disciples of

all nations, baptizing them into the name of the Father and of the Son and of the Holy Spirit: teaching them to observe all things whatsoever I commanded you: and lo, I am with you always, even unto the end of the world.

Matthew 28:19-20 ASV

Rationale Opportunity

More than 25% of US medical students participate in international experiences during medical school.

Most of this interest continues into residency.Students and residents in low-income and middle income

countries desire/demand enhanced education and training. Concern

Wide array of experiences and opportunitiesHarm and disruption from non-evidence-based, non-

biblical-value-based approaches

Rationale

Jesus’ effective modelSpiritual teachingProfessional developmentModelingInteractive discussionExperiential learningEntrustable professional activities (EPAs)

Rationale

ResponsibilityAnd to whomsoever much is given, of him shall much be

required; and to whom they commit much, of him will they ask the more.

Luke 22:48b ASV Who better to teach the next generation?

Value human lifeBelieve we are accountable to God

What better method than living your life as a Christian health professional?

Needs and Opportunities

Needs and Opportunities

High level of student, resident & faculty interest in global health in high-income countries

Desire and need for clinical, research, education development in low- and middle-income countries

Student & resident call to Christian faith-based domestic & international missions

Needs and Opportunities

Global need and desire for health equity – improved morbidity and mortality in all countries

Faculty have a high level of influence on students, patients and colleagues.

Thus, desire and need for …

Needs and Opportunities

…Educationally appropriate, worthwhile experiencesReasonable safety, accountability in experiencesDiscipleship and mentoring of students, residents,

colleaguesDevelopment of low- and middle-income partnersSustained, collaborative, equitable partnerships

focused on the needs and priorities of the partnerMinimizing harm and disruption for the partner

Models and Strategies

CaveatsThink long-term outcomes.

• Spiritual• Professional• Clinical

Inspire and communicate vision.Modeling speaks louder than words.

• Your life is being watched.Students, residents, colleagues desire

meaningful relationships.

Curriculum Models: Literature Search

Independent elective coursesDidacticExperiential

• Clinical

• Project, non-clinical

• Research Selective options for required courses

Required clerkship at an international site

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Curriculum Models: Literature Search

Formal (required) curriculumIntegrated into coursesSpecific global health courses

Tracks, programs, concentrationsDedicated program with requirementsRecognized at graduation

FellowshipsPost residencyMay offer additional degree

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Models and Strategies

Be the US partner.Medical school or residency US partner

• Judeo-Christian values and principles to guide the partnership, even if is a secular institution

US “local” global health site for a medical school or residency

• Required experiences• Elective experiences• Teach, model Judeo-Christian principles,

values, even if the institution(s) is/are secular.

Models and Strategies

Be the low-income partner.Institutional partnership

• Education• Research• Clinical care

Engage faculty• Foundation• Core

Engage students, residents• Clinical• Research• Development project

Models and Strategies

Be an advisor.CareerSpecialtyTake the student/resident with you

Be a mentor.Global health programGlobal health projects and researchStudent/resident Christian groupTake the student/resident with you

Models and Strategies

Be clinical faculty.Consistent involvementPermits credit for experienceSubstantiates your teaching roleProvides opportunity for broader engagement

• Admissions• Curriculum• Affiliations• Research• Development

Models and Strategies

Maximize in-country partner benefit, minimize harm and disruption, and facilitate sustainability.Long-term partnerships with shared vision

and goalsClear expectations, goals, objectivesConsistent involvement and engagementPre-travel preparationPost-travel debriefing

Benefits for Students and Residents

Refinement, clarification of call, vision, directionCan better prepare for the future

Spiritual, academic, professional developmentMore fruitMore effective

Fulfillment of curricular requirements Exploration of new directions, possibilities

Challenges for Students and Residents

Expense Insurance

Medical liabilityTravel

State Department travel warnings For residents, may not have salary and benefits

during experiences outside the US. Appropriate, required supervision Coordination of time with school/program

schedule.

Outcomes for Students and Residents

Clarification of call and life direction Maturity of faith Enhanced knowledge, skills, attitudes for

professional Christian practice Gaining a mentor Initiate opportunities for long term engagement

Application

How can you engage with students and residents?

What are the challenges to consider and address?

What are the potential benefits for you/your practice?

What additional models, approaches should be considered?

Summary

Seek out methods to engage students and residents in your international and local missions endeavors.

Be a mentor.

Be clinical faculty.

Embrace opportunities to disciple and mentor the next generation.

Content Resources GHEC/CUGH modules

http://www.cugh.org/resources PRiME

http://www.prime-international.org.uk/home.htm Millions Saved: Proven Successes in Global Health

(Ruth Levine) Understanding Global Health (William Markle, Melanie

Fisher, Jr., Ray Smego) Burden of Disease

http://www.thelancet.com/themed/global-burden-of-disease http://www.who.int/topics/global_burden_of_disease/en/ 24

Content Resources Social Determinants of Health (Michael Marmot, Richard

G. Wilkinson) USAID Global Health eLearning

http://www.globalhealthlearning.org/ Unite for Sight, Global Health eLearning

http://www.uniteforsight.org/global-health-university/courses Kaiser Family Foundation, Global Health Policy

http://kff.org/slides/global-health-policy/ Harvard School of Public Health: Teaching cases (pdf)

and Case Studies (video recordings of lectures) http://www.globalhealthdelivery.org/case-studies/

John Hopkins School of Public Health Open Courseware http://ocw.jhsph.edu/ 25

References

Anandaraja N. Hahn S. Hennig N. Murphy R. Ripp J. The design and implementation of a multidisciplinary global health residency track at the Mount Sinai School of Medicine. Acad Med. 2008 Oct;83(10):924-8.

Arthur MA. Battat R. Brewer TF. Teaching the basics: core competencies in global health. Infect Dis Clin North Am. 2011 Jun;25(2):347-58.

Battat R. Seidman G. Chadi N. Chanda MY. Nehme J. Hulme J. Li A. Faridi N. Brewer TF. Global health competencies and approaches in medical education: a literature review. BMC Med Educ. 2010 Dec 22;10:94.

Campagna AM. St Clair NE. Gladding SP. Wagner SM. John CC. Essential factors for the development of a residency global health track. Clin Pediatr (Phila). 2012 Sep;51(9):862-71.

Chin-Quee A. White L. Leeds I. MacLeod J. Master VA. Medical student surgery elective in rural Haiti: a novel approach to satisfying clerkship requirements while providing surgical care to an underserved population. World J Surg. 2011 Apr;35(4):739-44. 26

References

Dotchin C. van den Ende C. Walker R. Delivering global health teaching: the development of a global health option. Clin Teach. 2010 Dec;7(4):271-5.

Eneriz-Wiemer M. Nelson BD. Bruce J. Chamberlain LJ. Global health training in pediatric residency: a qualitative analysis of faculty director insights. Acad Pediatr. 2012 May-Jun;12(3):238-44.

Hall. T ed. Evert J. Mautner D. Hoffman I. Developing global health curricula: a guidebook for US medical schools. GHEC. 2006.

Francis ER. Goodsmith N. Michelow M. Kulkarni A. McKenney AS. Kishore SP. Bertelsen N. Fein O. Balsari S. Lemery J. Fitzgerald D. Johnson W. Finkel ML. The global health curriculum of Weill Cornell Medical College: how one school developed a global health program. Acad Med. 2012 Sep;87(9):1296-302.

Furin J. Farmer P. Wolf M. Levy B. Judd A. Paternek M. Hurtado R. Katz J. A novel training model to address health problems in poor and underserved populations. J Health Care Poor Underserved. 2006 Feb;17(1):17-24.27

References

Howard CR. Gladding SP. Kiguli S. Andrews JS. John CC. Development of a competency-based curriculum in global child health. Acad Med. 2011 Apr;86(4):521-8.

Izadnegahdar R. Correia S. Ohata B. Kittler A. ter Kuile S. Vaillancourt S. Saba N. Brewer TF. Global health in Canadian medical education: current practices and opportunities. Acad Med. 2008 Feb;83(2):192-8.

Jayaraman SP. Ayzengart AL. Goetz LH. Ozgediz D. Farmer DL. Global health in general surgery residency: a national survey. J Am Coll Surg. 2009 Mar;208(3):426-33.

Khan OA. Guerrant R. Sanders J. Carpenter C. Spottswood M. Jones DS. O'Callahan C. Brewer TF. Markuns JF. Gillam S. O'Neill J. Nathanson N. Wright S. Global health education in US medical schools. BMC Med Educ. 2013 Jan 18;13:3.

Laven G. Newbury JW. Global health education for medical undergraduates. Rural Remote Health. 2011;11(2):1705. 28

References

Nelson BD. Lee AC. Newby PK. Chamberlin MR. Huang CC. Global health training in pediatric residency programs. Pediatrics. 2008 Jul;122(1):28-33.

Peluso MJ. Encandela J. Hafler JP. Margolis CZ. Guiding principles for the development of global health education curricula in undergraduate medical education. Med Teach. 2012;34(8):653-8.

Peluso MJ. Forrestel AK. Hafler JP. Rohrbaugh RM. Structured global health programs in US medical schools: a web-based review of certificates, tracks and concentrations. Acad Med. 2013 Jan;88(1):124-30.

Pottie K. Hostland S. Health advocacy for refugees: Medical student primer for competence in cultural matters and global health. Can Fam Physician. 2007 Nov;53(11):1923-6.

Reza Najem G. A model for offering an International Medicine Seminar Course for US medical students: the 13-year experience of the New Jersey Medical School. J Natl Med Assoc. 1999 Oct;91(10):573-7.

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References

Stanton B. Huang CC. Armstrong RW. Sectish TC. Palfrey J. Nelson BD. Herlihy JM. Alden E. Keenan W. Szilagyi P. Global health training for pediatric residents. Pediatr Ann. 2008 Dec;37(12):786-7, 792-6.

Suchdev PS. Shah A. Derby KS. Hall L. Schubert C. Pak-Gorstein S. Howard C. Wagner S. Anspacher M. Staton D. O'Callahan C. Herran M. Arnold L. Stewart CC. Kamat D. Batra M. Gutman J. A proposed model curriculum in global child health for pediatric residents. Acad Pediatr. 2012 May-Jun;12(3):229-37.

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Murakoze Chane

Shume Falemindarit

Merci Beaucoup

Asante Sana

Mucho gracias

inisbardella@gmail.com