Global Health Training and Electives for Residents


Drain PK, Holmes KK, Skeff KM, Hall TL, Gardner P. Global health training and ?international clinical rotations during residency: current status, needs, and ??opportunities. Academic Medicine. 2009;84(3):320-5.

Although this is not the newest article, I think that it is a good place to start in discussing global health training and electives for residents. After almost 6 years of working in Tanzania as the faculty coordinator for a bilateral resident exchange program between WCMC-NY and Bugando Medical Centre, I have been surprised how very little has been written regarding this important topic. This review article and its discussion are consistent with our own experience and opinions. The articles referenced in this review are mostly from US and Canadian residency programs, and we do not have much (if any) data from the Middle East, but I feel that most of the principals are still applicable.

The article is divided into 3 sections:

1. Current Status of Global Health Training for Residents

  • Given the large immigrant populations in most developed countries, ensuring a healthy domestic population now requires greater knowledge of diseases that typically occur in distant geographic regions. From my brief experience at WCMC-Q, this seems particularly true in Middle Eastern countries like Qatar where the immigrant population outnumbers the local population.
  • Most medical schools in the US have already integrated global health training in the curriculum but residency programs have been much slower to do so. Even those residency programs that offer global health electives offer limited support and structure for these electives.
  • In the US in 2006, 50% of US pediatric programs reported offering global health electives and 7% had a formal global health track or certificate program [1].
  • According to several recent studies related to US residents, more than 50% of residents report that the availability of global health training and electives influenced their residency selection.
  • Global health electives have been shown to have several lasting benefits:
    • Better understanding of tropical diseases and of the advanced stages of pathology often seen in tropical settings.
    • Improved physical examination skills and appreciation for how medicine can be practice with less utilization of advanced imaging and laboratory investigations.
    • Residents participating in global health electives are more likely to pursue careers of work in under-served communities.
    • Improved medical knowledge and cross-cultural sensitivity to immigrant health issues [2].

2.Needs and Barriers for Expanding Global Health in Residency

  • Despite the fact that the majority of American residents express interest in Global Health Electives, a recent US survey of pediatric residents reported that only 10% actually participated in such an elective during residency [1].
Stakeholder Barriers
accreditation organizations and review comittees
  • Have not developed core competencies or training guidelines for residents doing ICRs"
  • Do not officially recognize time spent doing clinical training in another country
  • Generally have not helped to foster an exchange between domestic residency programs and foreign institutions
Residency administration and program directors
  • Do not provide scheduled time for residents to participate in ICRs
  • Do not provide administrative support to assist residents in finding appropriate ICRs
  • Often do not provide adequate finacial support for ICRs
  • Face finacial constraints
  • Face scheduling conflicts
  • Would be required to spend time a way from family
  • Must spend significant time locating an ICR
The American Academy of Pediatrics has developed core competencies and guidlines for international clinical rotations.

I think that this table summarizes the major barriers to advancing Global Health in Residency. Since this paper was written, the Working Group on Ethics Guidelines for Global Health Training (WEIGHT) has published what they call Ethics and Best Practice Guidelines for Training Experiences in Global Health [3].

3. Opportunities and The Way Forward

  • Core competencies should be developed for Global Health Training and Electives in each specialty and subspecialty. Preliminary development of such core competencies has begun in the US [4].
  • Accreditation boards should move to provide credit for Global Health Electives while creating regulations to assure that these electives are structured, safe and well-supervised.
  • Twinning partnerships should be encouraged with bilateral exchange of residents.
  • Residents should be allowed call-free time for a minimum of 6 weeks at the host institution (not including travel time). These global electives are best scheduled in 2nd or 3rd years of residency. Overlapping with prior and future residents is ideal for continuity
  • Financial support should be provided including salary and travel assistance.
  • According to the article, there should be 2 major goals for efforts to expand global health elements in residency training programs:
    • First, all residents should receive education in the spectrum of relevant global health topics, including training in cross-cultural appreciation and working with translators. This universal global health training can take the form of global health journal clubs, seminar series, or local outreach to immigrant populations. In our experience, talks given by residents returning from global health electives are also highly beneficial.
    • Second, carefully designed global health electives should be available and financially-supported for all residents interested in such experiences.

For further reading on these topics consider:

  1. Anspacher M, Frintner MP, Denno D, Pak-Gorstein S, Olness K, Spector J, O'Callahan C.Global health education for pediatric residents: a national survey. Pediatrics. 2011:128(4):e959-65.
  2. Bjorklund AB, Cook BA, Hendel-Paterson BR, Walker PF, Stauffer WM, Boulware DR..Impact of global health residency training on medical knowledge of immigrant health. American Journal of Tropical Medicine & Hygiene. 85(3):405-8, 2011 Sep.
  3. Crump JA. Sugarman J. Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and best practice guidelines for training experiences in global health. American Journal of Tropical Medicine & Hygiene. 2010;83(6):1178-82.
  4. Calhoun JG, Spencer HC, Buekens P..Competencies for global heath graduate education.Infectious Disease Clinics of North America. 2011;25(3):575-92.
  5. Hau D, DiPace J, Peck R, Johnson W. Global Health Training During Residency: The Weill Cornell Tanzania Experience. Journal of Graduate Medical Education. 2011:421-424.

Reviewed in February 2013 by:
Robert Peck M.D.
Associate Professor of Medicine and Pediatrics
Weill Cornell Medical College NY
Weill Bugando Medical College