Incorporating Global Health into Family Medicine Training and Practice
Incorporating Global Health into Family Medicine Training and Practice
This theme includes global health program design and implementation, both those educationally driven (medical school and residency electives or tracks) and those driven by humanitarian motives (medical missions, disaster response). It also encompasses the local practice of global health ("GLOCAL") in settings or among populations with striking similarities to those abroad: the underserved, refugees, rural or intercity populations, or post-disaster care.
Over the past 14 years, the University of Rochester Family Medicine Residency Global Health Program has developed a sustainable and longitudinal relationship with the remote community of San Jose de Marcos de Sierra, Intibuca, Honduras. The program is unique in that the goal is primarily to address determinants of health as identified by the community. These projects include providing water filtration at a systems and household level, VIP latrines, improved cook stoves, school and community health education, scholarships, microfinance and improvements to local agriculture. We will provide an overview of how our program is structured and sustained, and highlight specific unique initiatives.
Adopting a Refugee Camp in Uganda, Africa as a Mission Field for Global Health Track Practicum in Medical Shools and Residencies to Provide Sustainable Healthcare
Large Camps along the border of Uganda and South Sudan are home to refugees from South Sudan, DRC and other African nations; some camps house up to 200,000 refugees each. Have you ever yearned to do something exciting, fulfilling and life transforming? Do you dream of traveling abroad for your Global Health practicum? Will you help to provide on-going sustainable healthcare to refugees in Africa? Multiple short-term medical missions to refugee clinics in Africa offer hands-on experience to sharpen your clinical skills and sensitivity, and mentoring by experienced physicians. This will be a test of your compassion, endurance, adventurous spirit, and work ethic. Make new friends in a vibrant African culture. Give hope. You'll be rewarded by deep gratitude for your service. You’ll value what you’ve always taken for granted: life, love, family, clean water, electricity, good roads . . . . Your care and knowledge will make a positive impact in people’s lives.
Advancing Global Health Education and Service by Utilizing Simulations and Workshops at a Global Health Conference
We present a student-organized, sustainable Global Health Conference (GHC) that brings together students and professionals from various health-related disciplines for a collaborative day of discussions, simulations, workshops, and research presentations based around pertinent global health topics. Since the inaugural GHC in 2012, the educational objectives have focused on increasing awareness of global health concerns and disparities, gaining experience on how to address those problems, and practicing how to collaborate in an interprofessional team in simulated scenarios. The 2017 GHC centered on the effect of climate change on the health of the world’s most vulnerable populations. Attendees learned about the nuances of these effects and put to practice applicable skills in simulations about how to address afflicted populations, whether domestic or abroad. Through active engagement at the GHC, participants gain relevant skills, experiences, and enthusiasm to carry into medical service in vulnerable regions and advocate for these populations.
The Hispanic-Latino community represents the largest and fastest-growing minority group in the United States. The trend is the same in Indiana, where the majority of Hispanic-Latinos reside in Indianapolis. Significant health disparities exist for this community, and previous studies have reported barriers to healthcare access for the Indianapolis Hispanic-Latino community. In 2002, barriers such as cost, lack of insurance, and language were identified in a study using a cross-sectional survey tool. In 2016, we used the same survey to identify current barriers, compare them with those reported in 2002, assess the effects of these barriers on metrics such as ED visits, and identify potential ways to improve healthcare access in light of these barriers. Our presentation will discuss these findings, as well as address curricular and service strategies implemented through the Indiana University School of Medicine to improve healthcare access for the Hispanic-Latino immigrant community of Indianapolis.
Adequate prenatal care is an important aspect of maternal health care. Studies have shown that immigrants are late to initiate care due to various factors, and have a higher risk of adverse outcomes. In this study, barriers to prenatal care were investigated in an effort to improve access to care for our refugee population. Subjects were patients in the JPS Health Network who have delivered an infant and are refugees in the U.S. Common barriers for prenatal visits included communication with an interpreter and transportation, and during labor included communication with the interpreter and with the doctor. Overall subjects were satisfied with the care they received, but few visited the doctor more than once a month. These results indicate that language and cultural customs play a large role in refugee women’s health and will help guide future initiatives to improve gaps in maternal health at JPS.
The Horatio Alger exercise, originally meant to evoke racial and class disparities hidden in society, was adapted to a global health context and successfully conducted at the AAFP Global Health Workshop in 2016, and in other venues. Pre- and post-workshop surveys done revealed surprisingly positive results. Prior to the workshop, 44% of respondents agreed that they were well aware of privilege, bias and oppression in any population; 73.52% agreed to this post-workshop. 16.67% agreed to feeling comfortable about teaching others about unearned privilege, bias and oppression in the pre-workshop survey, and 73.48% agreed post-workshop. We discuss the impact of the workshop by presenting survey data, guided by a panel of educators who attended the workshop, and have subsequently conducted this exercise themselves, discussing their style of using the exercise, common pitfalls, and troubleshooting techniques.
Cracking the Code: Developing Global Health Research Opportunities for Underrepresented Minority College Students
Over the last 10 years, the number of underrepresented minorities (URMs) in medicine and URMs in the general population has disproportionately increased. Pipeline programs have been developed to increase the representation of these groups in health-related fields. As part of a pipeline initiative, eight Napa Valley Community College students participated in a Research Methods Workshop. This workshop was designed to teach the students basic research methods while increasing their knowledge of global health opportunities. Students completed identical pre- and post-training surveys to assess change in knowledge of epidemiological research, data entry, database management, and health issues in Honduras. Knowledge significantly improved across 60% of the measured items. In spring 2017, students worked with residency faculty to extract and analyze patient chart data from three trips to Honduras and will present their findings at a research forum. We will discuss the implementation of the workshop and student experiences.
Creating the Human Trafficking Victim Medical Home in Resident Physician Education: A Synergistic Dynamic of Care
This presentation will provide an overview of human trafficking, with physician guidance on identification of victims, protocols for intervention, and techniques for victim-centered, trauma-informed care. Best practices will be discussed from the development of a highly successful human trafficking medical home providing longitudinal care for victims within a residency clinic. Finally, a comprehensive, yet succinct human trafficking curriculum for resident physician training will be shared, along with preliminary relevancy data from a multi-hospital study indicating its utility and the importance of incorporating human trafficking training into residencies nationwide.
The goal of this talk is to help medical students and residents prepare for international and/or global experiences. Key themes will be explored through images and structured discussion. Importantly, the themes are broad-based and intensely relevant Question 1: How can learners best conceptualize their work in context? We will discuss the difference between medicine and public health in broad terms, and start to differentiate between types of interventions. Question 2: How can one limit being a “cultural voyeur”? We will go over tips to fully experience experiential learning. Question 3: What is the optimal relationship with the host country and established workers/colleagues? We will explore the complex role and nuances of being a medical learner abroad.
Until recently, HIV infection spread fear amongst us all, leading towards progression to AIDS and, ultimately, death. However, with improved treatment, HIV has become more of a chronic disease, with medical management provided in a primary care setting. Family medicine residents will be faced with treating HIV in an office setting on any given day. As a global health enthusiast, the presenter evaluated the current HIV care in a primary care setting in Dominican Republic (DR) – a setting with fewer financial resources – and compared it to U.S. primary care. This session will discuss how overall medical care for HIV is executed at the DR clinic, and the patient care centered model currently in place.
Migrant farmworkers are a largely invisible global population (Summers 2015). Training clinicians to work with vulnerable migrants has been identified as a priority (Pottie 2014). However, while family physicians are trained to elicit individual stories, they are rarely trained in identifying the structural inequities affecting their patients’ health (Metzl 2014). By providing care for migrant farmworkers in labor camps, family medicine residents experience firsthand structural determinants of health likely to be missed within the walls of the usual healthcare facility. We describe two models for utilizing migrant farmworker experiences in family medicine residencies to teach the importance of structural determinants of health. Qualitative data from resident interviews show the ability for these rotations to develop learners' structural competence and humility in a way that traditional curricula do not. Challenges have included competing residency priorities and providing year-round experiences for learners, given the seasonal nature of farm work.
Our refugee patients come to us with histories of trauma and deprivation. U.S. immigration provides primary care physicians with the I648 form, a tool to assist our traumatized and cognitively impaired patients with access to citizenship. In addition to introducing attendees to this form and what U.S. Immigration accepts as reasons for a waiver, the presenter will introduce various mental status tests (the MOCA, and the RUDAS) openly available to assist in the assessment of cognitive losses in refugee populations settling in the U.S.
Beginning in the summer of 2016, the Department of Family Medicine and Population Health (DFMPH) developed a system to increase participation of third- and fourth-year medical students in global health service, by creating elective offerings building on pre-existing brigade opportunities. A standardized M3/M4 elective application, enrollment, brigade preparation, and evaluation mechanism were developed to facilitate student participation in multiple international environments. To date, 30 students have applied for these new electives, 14 students have traveled on brigades, and 10 applications are pending.
As new Global Health projects are established, it’s important to consider the different options and take into account that these often take place in areas with no or limited access to health care, which can require building expensive infrastructure. It is essential to know local needs and plan accordingly, for the success of the initiative and to ensure sustainability. We have established a series of academic programs and activities, and collaborations with several organizations, to carry out learning, service and research activities while serving the needs of underserved communities throughout Central America. Local and international partners have facilitated resources and made possible the construction of a clinical site that is now home for clinical services. Experiences with different types of projects, building infrastructure, specific programs, and successful sustainability will be shared during this presentation.
There has been increasing interest in global health by U.S. medical trainees; more medical students and residents than ever are going abroad to learn and work. Although this is a very exciting time in global health, it raises several ethical concerns. How can educators send learners abroad in a more ethical manner, allowing them to gain knowledge and experience while also providing benefit for the host country? This presentation will discuss the common ethical pitfalls of sending learners abroad and propose practical solutions to these pitfalls based on current literature and experience. By acknowledging the potential hazards and implementing the proposed solutions, learners can be sent abroad in a more ethical manner, with value for both the learner and host country.
In residency programs around the U.S., increased emphasis is placed on the family physician’s role as a global citizen and culturally-competent healer. Numerous programs, organized as mission trips, develop international electives and offer free medical care to underserved populations in nations abroad. Despite the noble intentions and arguably positive impacts involved in such efforts, there can be significant unintentional harm inflicted on both participants and “beneficiaries.” Thus, it becomes imperative for Family Medicine physicians and residents to commit to service that is anchored in a strengths-based, stakeholder-driven, multidisciplinary approach that maximizes benefit for volunteers and their host communities. These concepts can be elucidated by examining a case study of the partnership between LVHN’s Family Medicine Residency and the NGO Institute for Indian Mother & Child. Literacy and proficiency in this realm of global health can better promote the objectives of developing leadership, service, and astute understanding of complex health systems.
From Global to Local: Development and Utilization of a Local Student-Run Free Clinic to Provide Interprofessional, Cultural, and Clinical Global Health Education for Medical Students
Family medicine is inherently an interdisciplinary specialty that requires an enhanced variety of clinical and interprofessional experiences during education and training. In addition to preparing medical students for the rigors of clinical practice, comprehensive medical education must provide opportunities for students to gain experience that will develop cultural competency, increase the variety of clinical exposure, and develop essential interprofessional skills. Here, we describe a local service-learning project based on global health principles and derived from our medical school’s annual international service trip, which provides medical students with the opportunity to develop not only specialty-independent skills necessary for medical practice, but also skills that are essential for addressing global health problems in any capacity. Moreover, the local service-learning project allows for medical student experiences in community-based health care practices focused on caring for the underserved, which can enhance cultural competency, prepare students for medical practice, and provide an opportunity for socially-embedded learning.
Interest in global health (GH) work among medical trainees has increased greatly over the last 3 decades, with approximately 30% of medical students now participating in GH experiences and many residency programs now offering such experiences. Residency graduates may choose to pursue GH fellowship training, now available in many specialties. The only database of available fellowships in all specialties is now more than five years old. We are updating this database to include current U.S. and Canadian fellowships programs in all disciplines. We are also surveying fellowship program directors to understand the scope of available programs, partners, fellowship graduate activities, challenges and unique aspects of programs. The administration of GH fellowships presents unique challenges, including acquiring financing, finding faculty, and vetting international partnerships.
Global Health in the Era Of Medical Voluntourism: Service Learning from the Host Organization's Perspective
We provide a practice model that aims to be integrative and sustainable in addressing the multifactorial problem of healthcare quality and equity at a small primary care clinic in rural Uganda. Exposure to practice gaps can be frustrating and demoralizing for those participating in service learning, if not partnered with tangible ways to close those practice gaps and lead to improvement in the health of the population served. We describe a framework that may serve as a template for collaboration with organizations who partner with international medical volunteers on a regular basis. Our intention is to foster a consistent learning experience for visiting medical students/residents while growing local human resource capacity in low- and middle-income countries (LMIC).
On June 23rd, 2016, approximately seven and a half inches of rain fell on the town of Rainelle, WV within a 12 to 24-hour period, causing one of the worst flooding events in state history. During the aftermath, Marshall Medical Outreach (MMO), a student-led mobile clinical outreach associated with Joan C. Edwards School of Medicine, responded to a request for assistance in treating the town’s survivors. Medical and pharmacy students, physicians, and hospital administrators partnered with a local clinic to coordinate a disaster relief effort. Within the span of five days, a mobile clinic was established to meet this need. Discussion will focus on disaster relief preparation, how involvement in MMO led to greater preparedness, lessons learned during the experience, and how family physicians are in a unique position to assist with disaster relief.
The UCSD-affiliated Scripps Family Medicine Residency Program (SFMRP) is a community-based training program with core teaching sites located just nine miles from the U.S. Border with Mexico. The Scripps FMRP uses a community-driven approach that emphasizes community medicine and border health throughout the curriculum, including a hands-on application of the Community Oriented Primary Care (COPC) model. Founded in 1998, the Viajes Interinstitucional de Integración Docente, Asistencial y de Investigación (VIIDAI) is a collaborative international public health field project for students and faculty from San Diego State University (SDSU) School of Public Health, Universidad Autónoma de Baja California (UABC), and the School of Medicine at University of California at San Diego (UCSD). FM residents from the SFMRP partnered with the VIIDAI program to enhance health promotion in the rural community of San Quintin. Through focus groups and key informant interviews, workshops are developed and evaluated in response to community needs.
Health Through a Culturally Sensitive Lens: Characterizing the Patient Dynamics of Colonia Margarita Moran, Mexico
Flying Samaritans at the University of California, Los Angeles (UCLA) is an undergraduate student-run organization that serves the community of Colonia Margarita Moran in Tijuana, Mexico through a monthly clinic. In partnership with licensed health care providers, our clinic provides primary care for men, women, and children who face barriers to affordable healthcare due to structural violence, immigration status, financial burdens, or difficulties securing transportation. Undergraduates learn about global health and cultural sensitivity through patient intake, health education programs, community-based research, and physician shadowing. With the help of student volunteers and our public health committee, we collected two years of data on our patient population, including demographics and vital signs, to characterize the needs of Colonia Margarita Moran and improve our health services. We also implemented post-visit surveys to learn more about the community’s available resources and launch a growing database of local healthcare providers and clinics.
Doctors of Tomorrow is a partnership between the University of Michigan Medical School and Cass Technical High School in Detroit, Michigan. This student-led, medical pipeline program, established in 2012, prepares high school students from racially and ethnically underrepresented communities to pursue careers in health professions. With the matriculation of thirteen alumni at the University of Michigan, we see evidence of the pipeline consummating. This longitudinal program of clinical immersion, academic preparation, leadership development, and mentorship from 9th grade through undergraduate studies has fostered strong local collaborations within Detroit and neighboring communities. For example, students are engaged in capstone projects with community partners in Detroit to bring awareness to health disparities faced by inner-city populations. This program is designed to be easily replicated nationally. Family medicine physicians are uniquely positioned to implement and grow a pipeline program of this nature in ways that best fit the unique needs of their communities.
Healthcare professionals have a strong record of service to forgotten people. However, launching into this career tract is associated with high turnover, especially in international and cross-cultural settings. Unique professional skills may be required, because the diseases are different, medical resources are minimal, cultural context is challenging, and for most of us, leadership skills are deficient. Secondly, caring for forgotten people also requires a unique set of personal skills regarding money management, personal health maintenance, and family relationships. Finally, healthcare professionals must wisely choose their path to service, including decisions about a professional specialty, a community to serve, a sending organization, and language learning needs.
At the 2016 Global Health Workshop, the University of Arizona presented a plan for a dedicated, monthly refugee clinic. At the time of this abstract submission, the department has had ten clinics. The presenters will present preliminary qualitative data on lessons learned, barriers to accessing health care for refugees, and gender differences in terms of barriers. After seven months of clinic, we have a better understanding of the best time to call patients for appointment reminders, and types of barriers to care: transportation, childcare, cost of medicines, and formulary limitations. The Family Medicine Department is collaborating with the College of Public Health to go into more depth concerning barrier analysis and ways to improve communication with local refugee agencies. Further clinics will provide more data regarding barriers to attendance at clinic, barriers to obtaining medications, and ways to engage refugee resettlement organizations in health care.
The Office of International Activities (OIA) at University of North Carolina was founded to provide support to students and residents in the area of global health. In order to more fully understand resident physicians’ educational needs, the OIA surveyed incoming first‑year residents of all specialties in July 2012. The residents identified significant barriers impeding their involvement in global health opportunities during residency, including time constraints, finances, and mentorship. In response to the survey results, an interdisciplinary educational initiative was developed at our school. This included obtaining buy‑in from core residency leadership, establishing a pathway to arrange experiences, offering competitive scholarships for travel, and initiating interdisciplinary educational opportunities. Since integrating the programmatic, academic, and leadership endeavors in 2012, we now aim to revisit our residency global health support and assess lessons learned and creative methods for leveraging university-wide resources to robustly support and alleviate barriers for residency participation in global health.
In times of increasing global challenges to health, it is crucial to create a healthcare workforce capable of tackling these complex issues. At LSUHSC New Orleans, we are integrating "Healing Peru,” a grassroots humanitarian mission in the Peruvian Andes, into LSUHSC Global Health education. This effort began in 2015 as part of LSU’s Rural Family Medicine Residency program, and has now expanded into LSUHSC Schools of Medicine, Dentistry, Nursing, and Public Health. Our goal is to demonstrate high standards of ethical conduct and quality of care in one’s contributions to team-based care, and to use the full scope of knowledge, skills, and abilities of professionals from health and other fields to provide care that is safe, timely, efficient, effective and equitable. Finally, we believe that healthcare professionals must be able to perform effectively on teams and in different team roles in a variety of settings. Specifically, in-country global health endeavors naturally lend themselves to IPE engagement and facilitate a concentrated IPE learning opportunity.
Most patients of HIPHOP-Promise Clinic, a student run free clinic in New Brunswick, New Jersey, speak Spanish and have limited English proficiency. Student doctors and physicians of the clinic provide services to patients either by speaking in Spanish, receiving assistance from a bilingual medical student, or using a phone interpretation service. An eight-hour interpreter training program has been implemented over the past three years; it is appropriate to assess whether it provides sufficient education for bilingual medical students to serve as community interpreters in a free clinic setting. Presenters will analyze and share results from survey responses of patients, medical student interpreters, student doctors, both here and at other student-run free clinics nationally, regarding the use of student interpreters in clinics and hospitals.
Meena Apa - Addressing the Impact of Menstruation on Productivity and the Health of Women in Bangladesh Through Medical Student Entrepreneurship, Scholarship and Public Outreach
In many societies worldwide, menstruation is a taboo. During menstruation, women lack access to hygiene products, are shunned, miss school and work, and are at increased health risk. Meena Apa created an anonymous online market to sell pads to urban women. Profits were then used to provide hygiene products to female factory workers. A 2017 survey of these workers showed the number of days missed from work each month due to menstruation decreased from 3 to 0.5 days. This project shows how a program can address a global health issue, how it can be funded, and how its impact can be studied. It can contribute to research in global health and the education of students, including navigating IRB approval. Future aspects of the project will include development of an education program for youth of both genders on menstruation and development of an online market to provide easy access to hygiene products.
Model of a Resident-Led Refugee and Immigrant Primary Care Clinic in an Urban Academic Medical Center
Columbus, Ohio, is home to 15,000-20,000 Bhutanse Nepali refugees who were the victims of ethnic cleansing in Bhutan. Due to decades in refugee camps, this population suffers from high rates of mental health disorders and complicated medical conditions. Among primary care clinics at our large academic medical center (AMC), our resident clinic serves the highest number of Bhutanese Nepali patients. And although these patients comprise a small percentage of the total patient population, their care takes a disproportionate amount of time. In response, residents designed a one-half day a week clinic specifically for these patients, with the goal of sensitivity to each refugee's psychological, social and economic barriers to healthcare. There are many obstacles related to coordinating the logistics of clinic flow and assessing patient needs. However, as part of an AMC, we have the privilege of accessing many resources, a small internal grant, and eager-to-learn resident physicians.
The age of globalization, a growing worldwide immigrant and refugee population, infections that cannot be contained within borders, and numerous other factors have led to an increased interest in global health. To a family medicine resident interested in a career in global health, learning about the diverse aspects and the existing training opportunities in global medicine can present a challenge. An elective rotation during residency can assist in improving insight into the various aspects and the possibilities for post-residency training opportunities in global health. The objective of this project is to elaborate on the development of a new elective global health rotation, and the associated curriculum for residents. Also included are reflections from a two-week, observer-based rotation at various global health programs and a comprehensive list of global health conferences and workshops for residents in the United States.
Piloting an International Clinical and Public Health Training Site in Ecuador: Initial Steps and Lessons Learned
As the U.S. population is becoming increasingly diverse, it is important to develop global health curricula and international clinical training opportunities. International rotations can enrich the medical training of residents and students through exposure to new cultures, medical systems, socioeconomic realities, and disease pathology. Such training reinforces physical examination skills, while fostering the desire to practice medicine among underserved and multicultural populations. This presentation will focus on initial steps taken and lessons learned in planning and implementing an international clinical and public health training site in rural Ecuador. We will discuss the development of partnerships, identification of opportunities, curriculum development and pilot testing, experiences and lessons learned, and future directions. This initiative is a result of strategic partnerships between two U.S. Family Medicine residency programs and their affiliated medical university located on the U.S. Border with Mexico, the Ecuadorian Ministry of Public Health, and an Ecuadorian non-profit organization.
MedPACt, the University of Central Florida College of Medicine’s student-run global health interest group, began organizing annual medical relief trips to the Dominican Republic soon after the club’s inception. In 2016, when Zika began posing a threat to volunteer safety, the group shifted its focus to Apopka, FL – a local community, predominantly inhabited by indigent, and therefore underserved, immigrant farmworkers and their families. Soon after, MedPACt began planning similar relief work to serve a strikingly similar population in rural Peru. Here, we present a comparison of planning processes for free clinics in the Dominican Republic, United States, and Peru, with an emphasis on selecting medications, garnering community support, building interprofessional teamwork, and educating volunteers about sustainable treatment options. The similarities between the three clinics has helped health professions students hone their skills, while demonstrating how global health service organizations can adapt planning strategies to serve patients in diverse locales.
As resident interest in global health increases, more residencies are developing global health rotations. Ethical guidelines recommend the development of well-structured programs for trainees within long term partnerships between sending institutions and host organizations. The Christ Hospital/University of Cincinnati Family Medicine Residency has over 20 years of experience training residents in global health. For many years, the program enjoyed a long-term partnership in Honduras through the non-governmental organization (NGO) Shoulder to Shoulder. However, since security issues limited the program’s ability to continue working in Honduras, the program has worked to establish a new partnership with Wuqu Kawoq, sending regular teams of residents and faculty to Guatemala. This presentation will offer practical solutions for programs on the development of partnerships with NGOs, balancing the dual mission of offering quality educational and ethical global health rotations for residents and students, while also providing benefits to the community and organization on the ground.
USC PH Department of Family Medicine has instituted a prenatal outreach program designed to reach uninsured, Spanish-speaking families by overcoming language, cultural, and financial barriers to prenatal care in Columbia, SC. The program uses a group visit model with an established curriculum. Group visits begin at a local free clinic that primarily serves the Latino community, and the group visits transition to our family medicine center by the third trimester. A global fee comparable to Medicaid reimbursement is set to cover the costs to the hospital, and the patients are offered discounts in laboratory testing and ultrasounds. We will report outcome data on this program for the first thirty mother/infant couplets enrolled. Our data will include GA at the time of enrollment, group attendance, birth weight at delivery, and birth outcomes.
Question: What procedures should be emphasized in FM residencies to prepare for medical practice in a global health setting? While global health education for family medicine residents has developed extensively, there have been few publications describing which procedures are appropriate for individuals who plan to work in low-resource settings. This session proposes a list of procedures to guide FM residents in their global health goals, and can help residencies in their educational offerings. Apart from general knowledge-based competencies, there exist no formal recommendations for global health procedural training for FM residents. The presenter will propose procedures which can serve as a guide for residents interested in international work. Further analyses are warranted on which procedures are used most often in low-resource settings, and ways to standardize training.
The Hofstra Northwell School of Medicine's Department of Family Medicine recently decided to explore the value of short-term global health experiences (sometimes known as "mission trips") to supplement the global health educational opportunities offered to the students, residents and faculty. The original method of training required two-to four-week rotations at fixed sites in four countries. Those participating in electives did any number of rotations, while those pursuing the track certification completed the full 12 weeks over the course of a two year period. The training did not, however, allow for the learners to experience short-term visits with an interdisciplinary team. In October 2016, we piloted the program, and as of 2017 we have incorporated it into our curriculum. We will review the pros and cons of embarking on this process.
We believe that family medicine is an integral part of global health education that is multidisciplinary and encompasses travel medicine, tropical medicine, wilderness medicine, and public health. Global health emphasizes health determinants, challenges, and solutions that go beyond national borders and affect everyone. Global health is essentially primary care and is a family medicine specialty with the AAFP formation of the Center of Global Health Initiatives in 2014. Recognizing this importance, we have recently created a nongovernmental organization (NGO) called the Residents for Global Health & Service that is based within the Aria Jefferson Health Family and Emergency Medicine Residency Program. The goal of our organization is to increase knowledge in areas of global health by providing learning opportunities that will offer an understanding and appreciation of culture & health disparities in different regions of the world with the intent of encouraging greater participation in health services in underserved areas. Through these global health experiences we want to expose and understand the health challenges that go beyond a “medical mission” ideology to a practical impact-driven one that is public health centered, with the objective to improve quality of health that is sustainable and empowers the community. This poster presentation focuses on our first project in a rural mountainous region in Nepal, which we undertook in November of 2016, to perform primary health screening, promote basic health hygiene and education, and support primary schools. We hope that through this presentation that we will encourage others to have a greater appreciation and involvement in global health as an essential specialty in family medicine.
There are a myriad of different issues to explore when teaching global health in a family medicine residency: history, cross-cultural awareness, social conflict, economics, prejudice, and social action, to name only a few. Reading books together can be a much more effective approach to sharing and discussing these issues than attempts to lecture on the same topics. We will give an overview of how our book club is organized, and will include a list of books we have read over the last 14 years, highlighting some particular books we think are especially high yield.
As medical providers, we are often ineffective in communicating with patients who speak rare dialects. Few studies have assessed the efficacy of visual aid use to augment communication with these patients in fast-paced medical environments. Therefore, this case presentation aims at reviewing the effects on patient outcomes and patient satisfaction that visual aids can have when administered during the time-sensitive labor and delivery process. We discuss the case of a Mandarin-speaking patient and her husband, who presented to an obstetrical unit where the only available option for English-to-Mandarin translation was via phone interpretation. Through the use of visual aids, we were able to improve patient understanding, increase patient focus, engage the patient and family, more quickly communicate time-critical information and instructions, and decrease distractions by eliminating the need for the phone interpreter.
Over the past ten years, global health competencies have been developed to clarify key areas of learning for health professionals. Competencies run the gamut from ‘basic’ to ‘advanced’, from broadly applicable to specific to students who intend a future career in global health. With so many options, how are global health educators to choose? This presentation proposes that global health medical education should prioritize training on health care disparities, a subset of health disparities. Unlike the broader category of health disparities, which can appear daunting, health care disparities are within the purview and sphere of influence of all family physicians. Valuable opportunities exist in global health to reinforce the twin solutions of addressing health care disparities through person-centered and equitable health care, whether those disparities are identified here or abroad.
Full spectrum family medicine ideally involves recognition of the world view of health care and health care disparities. In 2016, Mid-Michigan Health Family Medicine Residency initiated its inaugural global health curriculum and based it on an international medicine elective rotation. The program was introduced after recognizing the need to continue training residents in and promoting full-spectrum family medicine. The team, composed of two senior resident physicians and one faculty physician, partnered with the Carolina Honduras Health Foundation in helping to deliver care to Limón, Honduras and 14 surrounding rural villages. Many aspects of care were addressed, but oral hygiene was an area of significant concern. A curriculum comprised of training videos and physician instructions on proper oral health was developed. In addition to toothbrushes and toothpaste provided via donation, children seen in the clinic received dental varnish applications to help prevent against tooth decay and dental caries.
Translating Recommendations to Reality: Implementing the New Interprofessional Global Health Competencies for Medical Student Education
Recent literature on global health education has captured the need to adapt our content and competencies to meet the changing landscape of global health practice. As approximately 30% of U.S.medical schools offer didactic courses in global health, the current challenge is in transformation of existing programs to re-conceptualize how to teach global health, and to reconsider the roles that our future physicians will inhabit as global health practitioners. Our experience in this reflects both the logistical challenges of adapting to a rapidly changing field, and opportunities discovered along the course. In this session, we will share our lessons learned from applying an interprofessional global health competencies framework to guide program revision, including a discussion of our adaptations based on local needs and resources, partnerships, and institutional focus.