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Global Health Program Director's Guide: Appendices

A: Global Health Tracks in Pediatric Residency Programs

This list was obtained from a 2013-14 survey of U.S. residency programs, with a 99% response rate.4 Since this survey, many other pediatric residencies now also offer a GH track. Residency applicants interested in GH should ask for details at their program(s) of interest.
1. Advocate Christ Medical Center (College of Medicine at Chicago)
2. Atlantic Health Program
3. Baylor College of Medicine/Texas Children’s Hospital
4. Boston Combined Residency Program in Pediatrics
5. Brown Medical School
6. Case Western Reserve University/Rainbow Babies
7. Children’s Hospital at Dartmouth
8. Children’s Hospital Los Angeles
9. Children’s Hospital of Michigan
10. Children’s Hospital of Philadelphia
11. Children's Mercy Hospital - Kansas City
12. Children’s National Medical Center/George Washington University
13. Cincinnati Children’s Hospital Medical Center
14. Connecticut Children’s Medical Center
15. Creighton/Nebraska Universities
16. Eastern Virginia Medical School
17. Emory University
18. Georgetown University
19. Grand Rapids Medical Education Partners/Helen DeVos Children's Hospital
20. Goryeb Children’s Hospital/Atlantic Health System
21. Hofstra Northwell School of Medicine at Cohen Children’s Medical Center
22. Indiana University School of Medicine
23. Lurie Children’s Hospital, Northwestern University
24. Medical College of Wisconsin – Children’s Hospital of Wisconsin
25. Nationwide Children’s Hospital
26. Nemours Children’s Health System
27. Oregon Health Sciences University 
28. Phoenix Children’s Hospital
29. Stanford University
30. SUNY Upstate Medical University
31. Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine (El Paso)
32. University at Buffalo
33. University of Alabama
34. University of California Davis
35. University of California Los Angeles
36. University of California San Francisco
37. University of Florida
38. University of Illinois at Chicago
39. University of Kentucky
40. University of Louisville School of Medicine
41. University of Maryland
42. University of Massachusetts Medical School
43. University of Minnesota
44. University of Missouri at Kansas City
45. University of Nebraska Medical Center
46. University of Rochester
47. University of Utah
48. University of Virginia
49. University of Washington – Seattle Children’s Hospital 
50. University of Wisconsin
51. Western Michigan University School
52. Yale-New Haven Children’s Hospital
53. Washington University in St. Louis

B: Global Health Track Director Position Description (template)

C: Global Health Track Program Coordinator Position Description (template)

D: Local & Global Electives (1-week schedule examples)

In 2012, both Cincinnati Children’s Hospital Medical Center and Children’s Mercy Kansas City combined their GH and advocacy curricula. Examples of a 1-week snapshot of the local GH elective at each institution are provided below.

E: Evacuation Insurance & Emergency Contact Card

Evacuation insurance: When traveling abroad, it is important to obtain medical evacuation insurance, which provides coverage if a trainee needs to be transported out for medical care. This type of insurance includes a call center staffed 24/7 that an insurance cardholder may call for a variety of types of emergencies. The insurance carrier will assist with in-country care (advising where to seek care) as well as evacuation to the nearest appropriate medical center. Insurance carriers often cover a variety of other types of problems as well. There are numerous carriers that provide coverage for travelers in the event of an emergency, including but not limited to those listed in the table below. It should be noted that there are large variations in the types of services provided, as well as the distance allowance for the evacuation (eg, to the closest medical center, which is associated with lower premium costs compared with a U.S.-based institution, which is costlier). Because this product is both inexpensive and critical in the unlikely event of an emergency, some institutions also consider purchasing it for their trainees as an add-on to existing institutional insurance coverage. It is important that trainees not only have the coverage but also that they can describe what they would do in the event of an emergency.

Additional insurance: There are a number of types of travel insurance beside the standard evacuation insurance, including coverage for hazardous activities (eg, scuba diving, working in war zones, etc), ransom, accidental death and dismemberment, and repatriation of remains.

Examples of Travel Insurance Vendors (no single vendor is endorsed by the authors)

View a comprehensive comparison website for insurance vendors.

STA Travel Insurance
800-781-4040

Travel Assist Network Corporation
South Bend, IN
866-500-0333 or 574-272-5400
info@travelassistnetwork.com

Cultural Insurance Services International (CISI)
Stamford, CT
800-303-8120 or 203-399-5130

OnCall international
Salem, NH
800-575-5014 or 603-328-1926

Global Health Elective Emergency Card

This card should be copied—carry with you at all times during your elective and provide a copy to your on-site mentor.

Download Global Heath Elective Card

F: Risk Reduction Agreement (template)

G: Global Health Electives Post-Exposure Guidelines (template)

H: Global Health Elective Pre-Travel Health Self-Assessment (template)

Adapted from the Global Child Health Educational Modules Project “Preparation for Global Health Electives” preparation packet, St Clair et al, AAP and CUGH, 2013.

  • This form is voluntary and is intended to help identify potential physical or mental health issues that may be exacerbated by working in an unfamiliar setting. Please consider completing this form and taking it to your physician at your travel medicine appointment. Please also feel free to consult with your program director (or international elective advisor) about any medical or mental health questions or concerns that you may have related to your travel and international work.
  • You should be aware that elective sites may not be able to accommodate your individual needs or circumstances.
  • Failure to report a medical condition could impair the ability of your residency training program to assist in the setting of an emergency.

Download Global Health Elective Pre-Travel Self-Assessment form.

I: Culture Shock & Communication

Adapted with permission from an original document written by Sabrina Butteris, MD, and James Conway, MD, for the University of Wisconsin’s Global Health Institute; revised 3/12/18. Also referenced in the Global Child Health Educational Modules Project “Preparation for Global Health Electives” preparation packet, St Clair et al, AAP and CUGH, 2013.

Congratulations! You are about to embark on a memorable and valuable experience. The purpose of this guide is to help you begin to think about and prepare for the feelings you are likely to experience during your time abroad and to understand the rationale behind the guidelines for communication for participants in GH elective electives. Although no two people have the same experience or react in the same way, there are general patterns that apply to everyone. Culture shock is a well-described phenomenon that affects all travelers to varying degrees. Whether you are a seasoned traveler, or this is your first trip, you may find that the natural adjustments that occur during your time in your host community are amplified. You will be living in a new place and adapting to a new work environment.

Being cognizant of your feelings and emotions as they relate to situations you encounter during your GH elective will help you to moderate your reactions, improve your interactions with colleagues, and walk away with a more complete picture of the community in which you will be spending time. Private documentation of your reflections throughout your elective will provide you with some protection from unnecessary cultural misunderstandings and offenses.

Culture Shock: An Overview

What Is It?

“The loss of emotional equilibrium that a person suffers when he moves from a familiar environment where he has learned to function easily and successfully to one where he has not.”

– Arthur Gordon

Why Does It Happen?

Over the course of our lives, our own culture becomes deeply engrained via habitual, learned behaviors. Our culture quickly becomes invisible to us. We believe that the way we have grown to know life is the way that it should be, that it is “normal.” Without knowing it, our ways of living become ingrained as moral claims. When we enter a new culture, we experience an abrupt loss of familiarity. We try to understand the different norms and guidelines that dictate life in the new culture. We are forced to re-learn how to live day to day. Although we strive to do what is appropriate, we often don’t know exactly what that is. This creates a sense of social isolation, and differences subconsciously become classified as senseless, irrational, or even immoral.

What Are the Signs and Symptoms?

As with many conditions, culture shock is manifested on a spectrum ranging from mild uneasiness to unhappiness to true psychological panic. Although the list below is not exhaustive, it is likely that you will experience some of the following:

  • Frustration
  • Irritability
  • Hypersensitivity
  • Mental fatigue
  • Boredom
  • Lack of motivation
  • Physical discomfort
  • Disorientation about how to work with/relate to others
  • Suspicion (feeling like everyone is trying to take advantage of you)
  • Excessive concern for cleanliness
  • Loss of perspective

Stages of Culture Shock

There are many different versions of the stages of culture shock; however, they vary mostly in complexity rather than true content. The most commonly used stages are described as follows:

  • Honeymoon – new things seem exciting; see similarities
  • Rejection (shock) – everything feels difficult; see only differences
  • Regression – glorification of home; critical of new things; superior attitude develops
  • Acceptance/negotiation – routine develops; sense of humor returns
  • Reverse culture shock – incorporating the “new” you into your “old” life.

Distilled into its most basic form, the stages of culture shock can be simplified as follows:

  • At first, we think it is charming
  • Then we think it is evil
  • Then we think it is different.

(From William Drake & Associates, Managing Culture Shock)

Reactions

Typical reactions include assuming the problem lies with everyone else (ie, something is wrong with “them,” not “us”), overvaluing our own culture, defining our culture in moral terms (natural, rational, civilized, polite), undervaluing the new culture and seeing it as chaotic or immoral, and stereotyping in an attempt to make the world predictable.

When Culture Shock Leads to Cultural Insensitivity

How we react to the culture shock we are experiencing is the crux of what causes well-intentioned people to display unsavory behaviors. Culturally insensitive and inappropriate situations arise when our behavior, actions (or reactions), and responses reflect the stage of culture shock that we are experiencing. To make matters worse, when we are feeling the most frustrated, we have the least amount of information available to help us understand why things happen the way that they do. Although our understanding of the system increases over time, it is impossible to fully understand the complex set of interactions occurring simultaneously. Being aware of our emotional reactions and always attempting to increase our understanding will not only enhance the experience but also decrease the likelihood that something we do will reflect poorly on our program, our colleagues, or ourselves.

Culture Shock and the Internet

In today’s world of email, social media, and blogs, the public sharing of thoughts, ideas, and feelings has become commonplace. As opposed to individualized personal communication (phone calls or letters), these modes of communication allow for complete, real-time transparency of thought. In the context of GH experiences and reactions to the stages of culture shock, this level of transparency can be damaging. With an incomplete understanding of the culture in which one is living, a well-intentioned writer may unintentionally use descriptors that are culturally insensitive or unacceptable. The thoughts, perceptions, and feelings about a host community will inevitably change as a visitor passes through the various stages of culture shock. Reflecting on these emotions and experiences in a forum that could be available to others not only poses ethical and professional dilemmas but also has the potential for lasting cultural misunderstandings and transgressions that will impact the individual as well as the institution. As the sharing of information becomes increasingly easy, the risk for inadvertent viewing of that same material also increases. Far too often, communication intended for family or friends is forwarded or accessed by those who may not fully understand or appreciate the context.

Successfully Navigating the Seas of Cultural Humility

Culture shock affects even the most seasoned and experienced traveler. All writers feel that they have been both self-aware and sensitive as they are creating and sharing their observations. However, the process of culture shock involves shifting perceptions of one’s surroundings over time. This constantly evolving experience and the ease of information dissemination makes the risks associated with electronic sharing of critical importance for all partners in GH relationships.

Although culture shock is an unavoidable phenomenon, understanding how the adjustment to a new culture can affect thoughts and behaviors may allow visitors to better moderate their reactions. Incorporating this knowledge into private and thoughtful reflection is a key element of developing cultural humility. Combined with patience and adaptability, this practice can lead to meaningful, lifelong relationships between global partners.

Commitment to Professionalism: Communication Guidelines 

First and foremost, remember that you are a visitor and a guest. Your role during your GH experience should reflect this attitude. You are to uphold the highest standards of professionalism, respect, and courtesy.

Throughout your GH elective, you will be acting not only as an ambassador on behalf of your training program but also of the United States. Your behavior during your field experience not only has the ability to impact the health of the partnership with your host site but also directly reflects on the character of those from your training program.

Prioritizing the privacy of host communities and individuals within those communities and a commitment to developing culturally sensitive collaboration require the use of great discretion when communicating details of your experience with those outside of the host community. Refer to your training program’s privacy policies regarding patient information and patient photography and uphold the same privacy standards at your host site. The use of internet-based venues for communication is strongly discouraged. Full disclosure and transparency of purpose must be provided to those being photographed (including how the photograph may be used and who will be able to see it) and permission should always be obtained from both the patient (or parent) and the hosting institution.

Resources and Further Reading around Culture Shock

  1. Foster J. Cultural Humility and the Importance of Long-Term Relationships in International Partnerships. JOGNN. 2009;38:100-107.
  2. Kamei R. Why Dying Doesn’t Seem to Matter: The Influence of Culture on Physicians in Bali, Indonesia. Acad Med. 2003 Jun;78(6):635.
  3. Koehn P. Globalization, Migration Health, and Educational Preparation for Transnational Medical Encounters. Globalization and Health. 2006;2(2).
  4. Kumagai A, Lypson M. Beyond Cultural Competence: Critical Consciousness, Social Justice, and Multicultural Education. Acad Med. 2009 Jun;84(6):782-787.
  5. Levi A. The Ethics of Nursing Student International Clinical Experiences. JOGNN. 2009;38:94-99.
  6. Pedersen, Paul. The Five Stages of Culture Shock: Critical Incidents Around the World. Contributions in Psychology, No. 25. Westport, Conn: Greenwood Press, 1995.
  7. Tervalon, Melanie (1998). Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Undeserved 9 (2): 117–125.
  8. The Cultural Orientation Resource Center
  9. Culture Crossing Guide
  10. Kwintessential Guide
  11. Communication styles: Getting to Si, Ja, Oui,Hai, and Da. Meyer, E. Harvard Business Review. Dec 2015.

Finally, presentations given on return should be mindful of portraying the host community in a way that would be considered respectful and culturally appropriate in that setting. Presentations should be reviewed with your GH faculty mentor and/or the host institution prior to being delivered. 

J: Professionalism Agreement/Code of Conduct (template)

K: Guidelines for Donations & Customs Considerations

Adapted from the Global Child Health Educational Modules Project “Preparation for Global Health Electives” preparation packet, St Clair et al, AAP, and CUGH, 2013, and with permission from Sabrina Butteris, MD, Ann Behrmann, MD, and James Conway, MD, University of Wisconsin Department of Pediatrics

Donations are generally discouraged and should be neither an expectation nor a requirement for trainees participating in field experiences. This document provides some guidelines for those who choose to provide gifts or donations.

Categories of Donations and Potential Pitfalls

Material Goods and Gifts

It is often customary to bring gifts to the family or professional who is hosting a trainee. When a gift is something particularly requested by the host or is an item that holds meaning for the visitor, it can have a long-lasting positive impact for both the host and visitor.

Giving material goods or gifts to patients, strangers, and colleagues can pose ethical dilemmas. The giving of gifts by a visiting physician in a medical setting jeopardizes the professional relationship that exists between patient and medical personnel. Even small gifts can alter the therapeutic relationship and establish unrealistic expectations for future visitors (eg, the expectation of hospitalized children that all visitors will bring toys, stickers, or pens based on their experience with a prior visiting trainee who brought them these items). A similar phenomenon may exist when gifts are given to strangers or acquaintances in the community. For group travel, the coordination of gifts for hosts will avoid embarrassment or misunderstandings.

Money and Scholarship Requests

For many participating in a field experience, there will be a large discrepancy between the wealth and resources available to visiting trainees and the people with whom they will work. The cost of a trainee’s plane ticket alone may surpass the annual salary of some patients or hosting colleagues. This disconnect may create an undeniable but often unspoken difficulty for both the host and visitor. Visitors may encounter situations in which they are asked for money or sponsorship/scholarship for a co-worker, patient, or friend. The limitations, future obligations, and sustainability of such donations are frequently problematic. Additionally, differentiating between multiple requests or escalating requests creates ongoing difficulty for visitors. Again, the expectation that all visitors will provide similar support creates the potential for difficulty for future visitors.

Medical Supplies and Equipment

Medical supplies and equipment are commonly donated by both individuals and institutions. However, the donation of medical equipment may present challenges. Items may be inappropriate for the setting (testing for a disease for which treatment is not readily available), require substantial training for appropriate and safe use (ventilators that require multidisciplinary training and expertise), be dependent on another product to function (laboratory equipment that requires reagents for use), require specialized parts or maintenance (patient monitors that require a technician for repair or diagnostic support), be single-use products (resulting in problems for safe disposal), require a significant entry tax, or be unable to be safely adapted (electronics with differing voltages or connections), to cite just a few examples of the possible complications related to donated items. Although the person donating or bringing an item has often gone to great trouble to ensure its safe transport and delivery, their good will can result in complications they could not have predicted. Medical supplies should only be brought pursuant to the request of the host institution, with attention to the logistical challenges previously noted.

Trainees may consider bringing current medical or surgical texts (written in or translated to the appropriate language, if necessary) to donate to the hosting supervisor or preceptor for use in the clinic or hospital library. Although CD-ROM versions of medical texts may be useful and light to carry, it is important to keep in mind that computer access may be limited by electrical outages or prohibitive user fees.

Pharmaceuticals

Donations of medications are a particularly problematic category that deserves special attention. Downstream complications of donated pharmaceuticals can be costly, both financially and individually. Inappropriate use of medications can result in disability and death. What may seem obvious in one setting can be much less clear in an alternate environment.

Common pitfalls related to donations of pharmaceutical products include the following:

  • Labeling that may be unclear or in a language difficult to understand
  • Double standard for safety (eg, expired drugs)
  • Samples provided when no option exists for continued prescription (eg, sample medications for hypertension given to a patient who has chronic hypertension)
  • Drugs not relevant to the situation (eg, drugs for dementia sent to a children’s hospital)
  • Facility lacks capacity to store or safely prepare medications (eg, lack of refrigeration, lack of clean water to prepare suspensions)
  • Drugs unknown to the local health professionals and patients (eg, prescribed or used inappropriately, side effects not appreciated or inability to monitor for side effects if required laboratory testing is not available, “benign” medications such as vitamins or ibuprofen that can be taken in excess and have significant side effects)
  • No system in place for safe dispensing of donated drugs (eg, no syringes or dispensing cups, no staff to sort, illiterate patient population requiring pictographs rather than written instructions)
  • Sorting of donated medications requires substantial time and effort
  • Disposal of unused or inappropriate medications (eg, may require substantial cost for safe disposal such as incineration)
  • Drugs do not reach intended recipients (eg, they are sold in unregulated or “black” markets)
  • Drugs do not comply with local policies or standard treatment guidelines.

It is typically less expensive to purchase drugs locally or from specialist nonprofit procuring agencies closer to the site. Local procurement, which involves only a fraction of the transport costs, encourages locally sustainable drug availability. Provision of funds for direct procurement from specialist nonprofit agencies such as the IDA Foundation is the most helpful strategy when supplies are not available locally.

Five Core Principles for All Donations

(adapted from WHO Guidelines for Drug Donations, revised 1999)

All donations should:

  1. Be of maximum benefit to the recipient
  2. Respect the wishes and authority of the recipient
  3. Not create double standards in quality or sustainability
  4. Result from effective communication between donor and recipient
  5. Not create future expectations that cannot be met.

Guidelines and Recommendations Regarding Donations

Many potential pitfalls exist with respect to well-intended donations and gifts. The following guidelines should be used to minimize unforeseen complications.

  • Give your host the opportunity to guide you to ensure that your gift is welcome, appropriate, and needed. Recognize that the initial communication should be worded in a way that allows you to inquire about what is needed or desired by your hosts without committing you to bringing things that you cannot reasonably provide.
  • Employ the five core principles cited above. Prior to any donation, ask yourself if the donation meets all five principles. If it does not meet the core principles, strongly consider leaving it home.
  • Do not distribute gifts or donations directly to patients. If you do bring things with you to donate, consider giving them to your hosting supervisor or the head of the hosting organization and asking them to distribute the donations as they see fit.
  • Avoid all drug donations. If you are ever in a situation where drug donation is essential, abide by all elements of the WHO Guidelines for Drug Donations.
  • Prior to making a donation, research what the in-country tax will be for each donation and determine who will cover those costs.

Customs Considerations for Donations

It is not uncommon for medical supplies and pharmaceuticals to be confiscated and/or taxed heavily by customs officials. If you are bringing supplies, it is very useful to have the following available for customs officials:

  • A letter from a government representative stating that they are aware of the incoming supplies and are interested in having them brought in-country for the purposes of health care at a local clinic or hospital
  • A letter from the host recipient (eg, hospital administrator) stating that they are aware of the incoming supplies and are interested in using them
  • Any pertinent information regarding the supplies (eg, instructions, warranties, expiration dates, original packaging, original medication bottles, etc)
  • If applicable, an informational letter from the stateside donor or source of supplies
  • Funds available to cover in-country taxes.

Resources

  1. IDA Foundation (formerly the International Dispensary Association)
    Note: WHO approved Interagency Emergency Health Kit
  2. UNICEF  - Supply catalogue
    Note: Useful only if you are working with a NGO registered with UNICEF with specific emergency packs containing medical supplies or medical equipment, pharmaceuticals, nutritional rehabilitation, education, shelter, and sanitation.
  3. MAP Travel Packs 

L: Global Health Training Readiness Assessment

This checklist is intended to be a snapshot “readiness assessment” for training programs as they navigate development of a GH training infrastructure. It is recommended that all programs strive for completion of the components in Step 1. Completion of the Step 2 checklist is pertinent for programs that engage their trainees in GH electives. The Step 3 checklist is useful for programs creating or maintaining a GH track or fellowship (with additional checklist components individualized to the institution).

Download Program Readiness Assessment for Global Health Training (PDF).

Download Program Readiness Assessment for Global Health Training (Word).

M: Resources for Finding an Elective

Adapted from the Global Child Health Educational Modules Project “Preparation for Global Health Electives” preparation packet, St Clair et al, AAP and CUGH, 2013. Additions and edits for this list are welcome; please contact nstclair@wisc.edu.

  • Explore options available at your training program, hospital, medical school, or university
    • If your residency program does not offer a GH elective, investigate what GH projects or partnerships exist in other hospital departments. Surgeons, emergency medicine physicians, ophthalmologists, anesthesiologists, infectious disease physicians, and many others often participate in GH work or volunteer projects overseas.
    • Investigate what programs are available to local medical students; such programs often offer clinical, public health, community-based, or research opportunities for trainees as well.
    • Investigate whether any other departments at local universities have global programs for their undergraduate and graduate students. If there is no multidisciplinary GH center or division, consider contacting schools of nursing, pharmacy, engineering, agriculture, veterinary medicine, etc. Efforts to improve GH do (and must) involve other disciplines beyond medicine.
  • Partner with other area training programs that have established GH electives
    • Find out what other trainees are doing in GH. Emergency medicine, family practice, internal medicine, surgery, ob-gyn, and other pediatric programs may have partner sites for electives abroad or may at least have had some trainees arrange overseas electives. Contact their chief residents or program directors to learn more.
  • Network through professional organizations in which students, residents, fellows and faculty are involved in global health work to identify elective opportunities
    Examples include the following:

  • Investigate established electives offered by other training institutions 
    An internet search will yield many GH elective opportunities offered through training institutions, often associated with elective fees. It is important to carefully research those opportunities and review them with faculty mentors who are knowledgeable about GH. Of course, you will need to seek approval from and coordinate with your own program advisor.
    Examples include the following:

    • Global Health Learning Opportunities (GHLO, pronounced “glow”)
      An international elective application service offered through the Association of American Medical Colleges (AAMC). The service is available to those at participating institutions.
    • Baylor International Pediatric AIDS Initiative (BIPAI)
      Offers learning experiences for over 100 learners (students and residents) annually. Available spots are typically filled 8 to 10 months in advance.
  • Investigate established electives offered by NGOs and others
    Frequently, electives offered by NGOs are associated with elective fees, which support the NGO and training costs. The programs listed below are just some examples. You will need to seek approval from and coordinate with your own program advisor. (Note: Inclusion in the list does not constitute endorsement by the authors).
    Examples include the following:

  • Contact NGOs and medical volunteer organizations that permit trainees to participate in their programs
    The following websites offer lists of organizations that, in addition to their overseas work, may accept trainees for short-term elective periods.

  • Consider participating in a short-term medical mission appropriate for trainees
    The type of work varies, and groups should be carefully examined to ensure that proper supervision will be available and that the work provides an appropriate educational experience.
    Examples include the following:

    • Operation Smile: Plastic and reconstructive surgery teams that also offer educational experiences for pediatric residents (and fourth-year medical students). Apply for their Regan Scholarship here.
    • MEDICO (Medical, Eye, and Dental International Care Organization) conducts short-term trips to Honduras.
  • Contact religious/missionary groups with which you would be comfortable working Examples include the following:
  • Consider a foreign language study/clinical care combined elective
    Examples include the following:

  • If research is your passion, potential projects and mentors might be found among GH research organizations
    Help address the 10/90 gap with work on matters relevant to resource-limited settings. Only an estimated 10% of the total global funding for health research ($160+ billion annually) is used for research into the major health problems affecting 90% of the world's population.
    Examples include the following:

  • Consider a local GH elective
    You may be able to work at a clinic or program in your own community that serves the needs of immigrant or refugee populations. You might also consider a border health elective or working with the Indian Health Service (see below).
    Examples include the following:

    • STEER Program (South Texas Environmental Education and Research)
      Offers an international experience without leaving the United States with a 1-month, community-based educational experience in the study of border health. For students, residents, and practicing physicians interested in learning how environment, public health, and medicine shape health for those on the U.S.-Mexico border. Two sites, with over 25 contributing expert faculty.
    • Indian Health Service (IHS)
      Offers medical student and resident elective opportunities on or near Alaskan Native or Indian American reservations.
    • AMSA Global Health Scholars Program
      During residency in the United States, work with an assigned program mentor to broaden your views and experiences in GH education. Program is 6 months and consists of conference calls, attending a national conference, and advocacy work.

N: Packing List (template)

Adapted from the Global Child Health Educational Modules Project “Preparation for Global Health Electives” preparation packet, St Clair et al, AAP and CUGH, 2013.

Note: This list is not exhaustive, and not all listed items need to be packed. The list is provided as a guide for what to consider packing for a GH elective.

Download Packing List (PDF).

Download Packing List (Word).

O: Themes & Best Practices for Short-Term Engagement

Source: St Clair et al. Global Health: Preparation for Working in Resource-Limited Settings. Pediatrics, e20163783. https://doi.org/10.1542/peds.2016-3783.

The table below summarizes themes identified in the literature (obtained from a collective literature search performed by manuscript authors pertaining to preparation recommendations for providers across all specialties) and provides examples of recommendations to address those themes. For the citations pertinent to each recommendation, refer to the original manuscript.

Download Themes and Best Practices Identified in the Literature for Short-Term Global Health Engagement table.

P: Choose Your Own Adventure: Case Scenarios

These cases were utilized at an APPD workshop in 2015 (led by Drs. Butteris, St Clair, Arora, Batra, Kuzminski, Pitt, Russ, and Schubert). They are not meant to be all-inclusive but are instead intended to prompt residency program directors regarding important considerations in the development of an infrastructure for GH electives.

Download Case Scenarios Pertaining to GH Electives.

Q: Trainee Planning Timeline & Checklist (template)

Adapted from the Global Child Health Educational Modules Project “Preparation for Global Health Electives” preparation packet, St Clair et al, AAP and CUGH, 2013

For residents whose programs have established GH electives, refer to program-specific checklists.

Download Trainee Planning Timeline and Checklist (PDF).

Download Trainee Planning Timeline and Checklist (Word).

R: Trainee Assessments (template)

This can be modified to fit with characteristics specific to the trainee’s elective site.

Download Trainee Assessments for Global Health Electives.

S: General Pediatrics Fellowship Curriculum (example)

This curriculum was created for a general pediatrics GH fellowship. It is provided only as an example. Training programs would need to adapt their curriculum to meet their specific subspecialty and trainee needs.

Download Curriculum for a General Pediatrics Global Health Fellowship.

T: Combined Subspecialty Fellowship Goals & Objectives (example)

These goals and objectives were created for a combined pediatric emergency medicine/GH fellowship. They are provided only as an example. Training programs would need to adapt their goals and objectives to meet their specific subspecialty and trainee needs.

Download Goals/Objectives for a Combined Subspecialty-Global Health Fellowship

U: Combined Subspecialty Training Pathway (example)

This training pathway was created for a combined pediatric emergency medicine/GH fellowship. It is provided only as an example. Training programs would need to adapt their training pathways to meet their specific subspecialty and trainee needs.

V: Non-Standard Training Pathway Petition Letter to ABP (sample)

This petition letter was created for a combined pediatric emergency medicine - GH fellowship. It is provided only as an example. Training programs would need to adapt their petition letters to meet their specific subspecialty and trainee needs. Additional details can be found at the ABP website.

Download a Sample Non-Standard Training Pathway Petition Letter to the ABP.

W: Draft Schedule/Block Diagram for Petition Letter (template)

This schedule was created for a combined pediatric emergency medicine - GH fellowship. It is provided only as an example. Training programs would need to adapt their schedules to meet their specific subspecialty and trainee needs.

Download a Draft Schedule/Block Diagram for a Fellow to Include with ABP Petition Letter.

X: Resources After Residency Training

Clinical Work
Abroad

There are many opportunities for board-eligible or board-certified pediatricians to work abroad clinically. Several medical schools have ongoing projects in developing countries and hire pediatricians to work clinically or to provide teaching and training. Programs such as the Baylor Pediatric Aids Initiative or the Rwanda HRH program hire and send pediatricians to their sites for 1 year or longer. Many NGOs, including faith-based organizations, also hire pediatricians to work abroad. Organizations such as Partners in Health and Doctors without Borders hire pediatricians to work at international sites and may include disaster relief. These positions usually require at least a 6- to 12-month commitment.

Baylor International Pediatric AIDS Initiative
Texas Children's Hospital Global Health Baylor College of Medicine
Seed Global Health
Médecins Sans Frontières
Samaritan's Purse
Catholic Medical Mission

Some residents who choose to work solely within the United States find unique avenues to continue their GH interest. These positions can include working with the Indian Health Service, recent immigrants, refugees, international adoptions, pre-travel screenings, or even in a general pediatrics clinic with a predominately underserved population.

Policy Work

Residents who are interested in working on GH policy with organizations such as the WHO or UNICEF can explore these opportunities through internships as a way to learning more about careers in these fields. The CDC also has a training program, the EIS program, which trains candidates for a career with the CDC.

Research

Several research training opportunities are available for trainees who want to explore a career in GH research. The Fogarty scholars program provides funding for research training for early career research scholars. The Doris Duke foundation has a similar program for early stage investigators.

GH in Academics

With the surge of interest in GH, many pediatric residency training programs are incorporating formal GH programs into their residency programs. Many medical schools also have developed GH pathway programs within their medical school curriculum. Trainees who are interested in pursuing an academic career may wish to incorporate GH into their career by serving as faculty in these programs. In addition, graduates can join/support a professional organization with a focus on GH.  

Other Resources

The following organizations can be resources for residents who are interested in pursuing a career in GH:

Books providing comprehensive descriptions of GH opportunities and job opportunities include the following:

Helpful GH-related listservs include the following:

Y: Memorandum of Understanding (example)

This is pertinent for bidirectional trainee partnerships and could be simplified to meet the basic ACGME requirements for non-partnership elective program letters of agreement (see Chapter 4). Any MOU should be generated by your institution’s medicolegal team and reviewed by institutional leadership and the graduate medical education office. This template is not specifically endorsed by the ABP or other affiliates.

Download Memorandum of Understanding.