Sorry, you need to enable JavaScript to visit this website.

Global Health Program Director's Guide: Introduction

Key Points

enlightenedMany trainees (residents and fellows) are seeking ethically sound, partnership-based global health (GH) training opportunities during residency.

enlightenedIn addition to trainee demand, there are national and international calls for training globally minded, globally competent pediatricians.

enlightenedGH education provides a framework for multidisciplinary training in cross-cultural care, human rights, health disparities, and advocacy.

enlightenedWhen considering pediatric GH education, there are several tiers of trainees: (1) all pediatric trainees; (2) pediatric trainees engaging in GH electives; and (3) pediatric trainees seeking to incorporate GH into their careers. This guide is appropriate for all tiers of trainees.

enlightenedThe purpose of the guide is to provide a comprehensive, practical resource for pediatric residency and fellowship program directors to incorporate GH education into their respective training programs.

 

Background

In 2015, the American Academy of Pediatrics (AAP) and the American Board of Pediatrics (ABP) convened a Pediatric Global Health (GH) Leadership Conference to develop a set of global child health goals that could be addressed by the pediatric community. Multiple stakeholders attended, including faculty from various institutions engaged in GH initiatives, and representatives from the International Pediatric Association, the AAP, the ABP, the Canadian Pediatric Society, the Association of Pediatric Program Directors (APPD), the Accreditation Council for Graduate Medical Education-International, the Global Pediatric Education Consortium, the Consortium of Universities for Global Health, the Academic Pediatric Association, the Council of Pediatric Subspecialties, the United States Agency for International Development, and the Liberia College of Physicians and Surgeons. 

One of the recommendations made by representatives from the ABP GH Task Force and the wider GH education community was to develop a Program Directors Guide to Global Health in Pediatric Residency Education. The ABP Global Health Task Force Trainee Workgroup was charged with this task, which led to the development of the guide and required close collaboration, review, and co-authorship from national stakeholders.

There are many compelling reasons to incorporate GH training into core aspects of pediatric residency and fellowship education, including: 

  • To better serve patients of all ethnicities and backgrounds in high-income countries, including refugees, immigrants, children living in poverty, and victims of human trafficking; 
  • To improve the health of children worldwide by training pediatricians to engage in partnerships and capacity development; 
  • To meet trainee demand for GH education and global experiences during training;
  • To foster a culture of globally minded pediatricians who are trained to recognize health inequities, human rights issues, and advocacy opportunities in both high- and low-income settings.

Defining Global Health

Global health is defined as collaborative transnational research and action for promoting health for all.1 It is important to note that this definition specifies “all” and not “others.” GH not only involves medicine outside of one’s borders; it encompasses principles important to the care of children in all regions. In 2007, the Federation of Pediatric Organizations suggested that pediatric GH training should include topics such as human rights, travel medicine, medical tourism, international adoptions, immigration, child marriages, and an analysis of some of the differing structures in health care delivery systems.2 Additional proposals for GH training for pediatric training programs have been provided in the literature since 2007 and will be summarized in this guide.

Why This Guide?

This guide’s author group, and many national organizations, are advocating for exposure to GH-specific topics for all pediatric learners. Many skills germane to GH are necessary for all pediatric trainees, including effective use of interpreters, care of immigrants and travelers, cultural humility, and recognition of social determinants of health.3,4 Trainees need not have a passport to practice GH; diseases do not respect borders, and resource limitation is not unique to low- and middle-income countries. 

Implementing GH curricula within pediatric training presents unique challenges. Merely having an opportunity for trainees to participate in an international elective is not sufficient. In fact, without adequate preparation and partnership, these experiences can be detrimental to trainees and the patients and health system at the host site. If training programs are offering GH electives, the other pillars of GH education should be concomitantly considered, including stateside curriculum, pre-departure preparation, post-return debriefing, and evaluation. (Figure 1)

Training programs are increasingly challenged to fit the expanding expectations for and from their trainees into the same fixed time frame, including many expectations outside of the GH field. Fortunately, this implementation guide is designed to support residency and fellowship programs of all sizes to meet these demands and offers resources pertinent to all of the pillars of GH education.

In addition to laying out the competencies specific to GH work, this guide provides strategies to incorporate training into existing residency and fellowship frameworks; reviews all aspects of GH electives, including medical-legal logistics and pre-travel preparation; provides an overview of what a dedicated GH track typically entails; discusses trainee assessment and program evaluation; and considers strategies for preparing interested trainees for GH work in fellowship and careers. Throughout the guide, we will provide several modifiable resources for individual and program use, including a comprehensive GH Education Checklist. Our hope is that this manual is valuable for program directors who may have little to no GH experience while offering meaningful resources and content even for seasoned GH educators.
 
The purpose of this guide is to provide a comprehensive, practical resource for incorporating GH education into pediatric residency and fellowship training programs. When considering pediatric GH education, there are several tiers of trainees to consider: (Figure 2)

  1. All pediatric trainees (Tier 1)
  2. Pediatric trainees engaging in GH electives (Tier 2)
  3. Pediatric trainees seeking to incorporate GH into their careers (Tier 3).

 

This guide is appropriate for all three tiers of trainees. However, while many of the principles in this guide can also be applied to the third tier of trainees, the authors suggest that program directors seek further assistance from faculty mentors with GH experience to meet Tier 3 learners’ needs (eg, through the development of a GH track, global training partnerships, and/or GH-specific fellowship). 

“The additional training provided by the Global Health Track is extremely valuable. It reminds us of issues in our community and globally that need to be addressed and re-ignites that desire to help and give back. It provides us opportunity to connect with like-minded people and hear how we can too become advocates and address local and global health disparities now and in the future…I am grateful to be a part and have the opportunity to go abroad and experience medicine through the lens of a different culture.”

-Anonymous trainee