Introduction to the Current State of Global Health

ACGME goes Global Leader: Jacquelyn Kuzminski MD, Medical College of Wisconsin Co-Leaders: Maeesh Batra MD MPH, Seattle Children s Hospital Sabrina Butteris MD, University of Wisconsin Hospital and Clinics Ty Dickerson MD, University of Utah Healthcare Lynn C. Garfunkel MD, University of Rochester and Rochester General Hospital Cindy Howard MD MPH, University of Minnesota Christiana Russ MD DTMH, Boston Children's Hospital, Harvard University Nicole St Clair MD, Medical College of Wisconsin Charles Schubert MD, Cincinnati Children s Hospital Parminder Suchdev MD MPH, Emory University

Trainee Interest Graduating medical students in the US & Canada who participated in a global health experience: 6% 43% Source: AAMC 1985 2009 58% of pediatric residents report that GH training was important for selection of training program 30% have plans for positions abroad after residency Garfunkel Acad Peds 2011

As Global Health Programs Increase to Meet Resident Demand, Common Challenges Emerge

Challenges for Residency Programs Developing a Competency based Global Health Curriculum Identifying Mentorship Institutional Support Developing and Maintaining Sustainable Global Partnerships Overseeing global training opportunities Resident safety and well-being Ethical and responsible engagement of colleagues around the world Adequate supervision to ensure patient safety on global health electives Avoid legal issues and additional risks for the resident s institution Cost, funding and time

The next challenges: INDIVIDUALIZED Curriculum All in the same residency box but now new flavors of learning

Doing this Responsibly & Ethically

Small Group Discussion Discussion Question: What careers have previous globally interested trainees from your institution have gone into after graduation?

Career Options: Move to another country to work for a prolonged placement Intermittent short-term work Academic work with GH emphasis Global research career (clinical, bench, public health, etc) Public health career path Work for NGO/consulting Subspecialty fellowship (non-gh ie endocrine, pulmonary, etc) Relief work (locally or internationally) Public Policy Immigrant or Refugee care within the US Indian Health Services Global Health Fellowship

ACGME 2013 Pediatric Residency Educational Unit Requirements: An educational unit should be a block (four weeks or one month) or a longitudinal experience An outpatient educational unit should be a minimum of 32 half-day sessions. (Detail) An inpatient educational unit should be a minimum of 200 hours

A minimum of 6 educational units of an individualized curriculum; The individualized curriculum must be determined by the learning needs and career plans of each resident and must be developed through the guidance of a faculty mentor. (Core) A minimum of 10 educational units of inpatient care experiences, including: (Core) 5 units of inpatient pediatrics 2 units PICU 2 units NICU 1 unit newborn care A minimum of 9 educational units of additional subspecialty experiences, including: (Core) 1 unit Adolescent 1 unit Developmental-behavioral pediatrics 4 units of key subspecialties child abuse; (Core) medical genetics; (Core) pediatric allergy and immunology; (Core) pediatric cardiology; (Core) pediatric dermatology; (Core) pediatric endocrinology; (Core) pediatric gastroenterology; (Core) pediatric hematology-oncology; (Core) pediatric infectious diseases; (Core) pediatric nephrology; (Core) pediatric neurology; (Core) pediatric pulmonology; (Core) pediatric rheumatology. (Core) 3 additional educational units consisting of single subspecialties or combinations of subspecialties. (Core) child and adolescent psychiatry;(detail) hospice and palliative medicine; (Detail) neurodevelopmental disabilities; (Detail) pediatric anesthesiology; (Detail) pediatric dentistry; (Detail) pediatric ophthalmology; (Detail) pediatric orthopedic surgery; (Detail) pediatric otolaryngology; (Detail) pediatric rehabilitation medicine;(detail) pediatric radiology; (Detail) pediatric surgery; (Detail) sleep medicine; or, (Detail) sports medicine. (Detail) A minimum of 5 educational units of ambulatory experiences, including: (Core) 2 units community pediatrics and child advocacy 3 units pediatric emergency medicine and acute illness (2 within the ED) A minimum of 36 half-day sessions per year of a Pediatrics longitudinal outpatient experience. (Core) The sessions must not be scheduled in fewer than 26 weeks per year. (Core)

ACGME 2013 Pediatric Residency Educational Unit Requirements: Emergency Medicine Inpatient Pediatrics Individualized Curriculum Key Subspecialty Emergency Medicine Inpatient Pediatrics Individualized Curriculum Key Subspecialty Emergency Medicine Inpatient Pediatrics Individualized Curriculum Key Subspecialty Community Pediatrics/Advocacy Inpatient Pediatrics Individualized Curriculum Key Subspecialty Community Pediatrics/Advocacy Inpatient Pediatrics Individualized Curriculum Additional Subspecialty Continuity Clinic PICU Individualized Curriculum Additional subspecialty Continuity Clinic PICU Additional subspecialty Continuity Clinic NICU Adolescent NICU Development Newborn

What Career Paths Would You Like to Discuss? (vote) Move to another country to work for a prolonged placement Intermittent short-term work Academic work with GH emphasis Global research career (clinical, bench, public health, etc) Public health career path Work for NGO/consulting Subspecialty fellowship (non-gh ie endocrine, pulmonary, etc) Relief work (locally or internationally) (Maneesh) Public Policy Immigrant or Refugee care within the US Undifferentiated Indian Health Services Global Health Fellowship

Small Group Activity: identify a recorder and reporter for the group Discussion questions: What Knowledge/Skill/Attitudes are necessary to be successful in the career you have chosen? Using the tool provided, begin to identify what, if any, education units required by the ACGME may teach these skills.

Large Group Discussion Identify your Career Path List 5 Knowledge/Skill/Attitudes your group felt was necessary for this career path and how each skill may be taught

Common Themes Knowledge/Skill/Attitude Necessary to Pursue This Career Path Current Required Educational Unit that May Teach the Needed Skill New Educational Unit Necessary? (Yes/No) If New Unit Required, Describe the Unit

Concluding Comments Global Health Can be incorporated into your ALREADY EXISTING curriculum Starting with an idea of the resident s desired career path can assist advisors in creating and individualized learning plan for residents

Creating an Individualized Curriculum does not need to be a Solo Adventure! Thank You for Your Participation

AAP Global Health Curriculum Toolkit http://www2.aap.org/sections/ich/toolkit.htm

Resources ACGME Program Requirements for Graduate Medical Education in Pediatrics. Proposed Effective Date: July 1, 2013 Cabral, S.A. Soares de Moura, A.T. and Berkelhamer, J.E. Overview of Global Health Issues facing Children. Pediatrics.129;1. 2012. Campagna, AM. St. Clair, N. Gladding, SP, Wagner, SM and John, CC. Essential Factors for the Development of a Residency Global Health Track Clinical Pediatrics. July 2012. Drain PK, Primack A, Hung D, Fawzi W, Homes K, Gardner P. Global health in medical education: a call for more training and opportunities. Acad Med. 2007;82(3):226-230. Frenk, J. Chen, L. et al, Health professionals for a new Century: transforming education to strengthen health systems in an interdependent world The Lancet. Vol 376. Dec 4, 2010. Garfunkel L, Howard C. Expand Education in Global Health: It is Time. Acad Pediatr. 2011;11(4):260-2. Nelson BD, Lee AC, Newby PK, Chamberlin MR, Huang CC. Global health training in pediatric residency programs. Pediatrics. 2008 Jul;122(1):28-33. Suchdev PS, Shah A, Derby KS, Hall L, Schubert C, Pak-Gorstein S, Howard C, Wagner S, Anspacher M, Staton D, O'Callahan C, Herran M, Arnold L, Stewart CC, Kamat D, Batra M, Gutman J. A proposed model curriculum in global child health for pediatric residents. Acad Pediatr. 2012 May;12(3):229-37. Epub 2012 Apr 7.