Global Health in Residency
Milwaukee’s population is culturally diverse, and within the confines of Children’s Hospital of Wisconsin we serve a global community. Given the current U.S. national government’s dedication to improving healthcare in this country, as well as local efforts by the Board of Directors of the Children’s Hospital and Health System of Wisconsin to have the healthiest children in the nation, it is imperative that we train future physicians to confidently treat all patients, regard-less of ethnic background. Sixty percent of the residents who receive training at Children’s Hospital remain in Wisconsin to care for children in our community—a community that continues to see a large influx of immigrants, international adoptees, growing healthcare disparities and increasing demand for medical pre and post-travel counseling.
To best serve our community, and to equip our pediatric trainees to become competent pediatricians globally, the Department of Pediatrics developed a Global Health Training Track in 2010. This three-year longitudinal training opportunity, offered by application to incoming interns, provides a core curriculum on the medical, cultural, and ethical issues involved in health care in low resource settings, both locally and globally. Track members are paired with Global Health mentors, participate in quarterly Global Health Journal Clubs, and engage in both local and global clinical and educational activities that address health disparities.
As a culmination of this training experience, members of the Global Health Training Track are encouraged to participate in a medical elective in a low resource global setting, examples of which include a non-governmental clinic in Southern Belize and a rural health center in southeast Uganda. Data has shown that such experiences, coupled with strong preparation, mentorship, and debriefing, can have significant benefits, including:
Improved physical examination and procedural skills1
Increased comfort with diagnostic skills2
Greater awareness of cost issues in medicine, with less reliance on expensive diagnostic tests1
Improved USMLE Boards scores3
Higher awareness of the role of cultural and socioeconomic factors, sensitivity to patient context, and the importance of com-munication1,4
Additionally, trainees who participate in global health rotations are more likely to choose careers in primary care, work in underserved communities, and commit to reducing health disparities. 2,45-11
Interest in participating in global health activities is growing, and residency applicants are increasingly seeking pro-grams that offer global health-related training and electives. In 1995, 25% of residency programs nationwide offered international electives; in 2005, this was over 50%. Formal global health training tracks, similar to what was established at CHW in 2010, are also rising, and are becoming increasingly important in resident recruitment. Fifty-eight percent of pediatric residents in 2009 reported that global health training was an important factor in their choice of training programs, and nearly 30% had plans to seek either long-term or short-term positions abroad.12
1. Niemantsverdriet S, Majoor GD, van der Vleuten CP, Scherpbier AJ. I found myself to be a down to earth Dutch girl: a qualitative study into learning outcomes from international traineeships. Med Educ. 2004:38:747-757.
2. Gupta AR, wells CK, Horwitz RI, et al. The International Health Program: the fifteen-year experience with Yale University’s internal medicine residency program. Am J Trop Med Hyg. 1999;1019-1023.
3. Waddell WH, Kelley +PR, Suter E, Levit EJ. Effectiveness of an international health elective as measured by NBME Part II. J Med Educ. 1976;51:468-472.
4. Haq C, Rothernberg D, Gjerde C, et al. New world views: preparing physicians in training for global health week. Fam Med. 2000;32:566-572.
5. Drain PK, Holmes KK, Skeff KM, et al. Global health training and international clinical rotations during residency: current status, needs, and opportunities. Acad Med. 2009;84:320-325.
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8. Chiller TM, De Mieri P, Cohen I. International health training. The Tulane Experience. Infect Dis Clin North Am. 1995;9:439-443.
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10. Godkin M, Savageau J. The effect of medical students international experiences on attitudes toward serving underserved multicultural populations. Fam Med. 2003;35:273-278.
11. Ramsey AH, Haq C, Cjerde CL, Rothenberg D. Career influence on an international health experience during medical school. Fam Med 2004;36:412-416.
12. Anspacher M, Denno D, Pak Gorstein S, et al. National survey of pediatric residency training in global health. Pediatric Academic Societies Annual Meeting, Vancouver, BC, Canada, 2010;2839.98.