Medical residency training in the U.S. rests on 100 years of history that sends new doctors to U.S. hospitals to learn the intricacies of their chosen specialty, from cardiac and cancer care to family medicine. What residency programs are learning is how to integrate global health into that training.
That’s where Janis P. Tupesis from the University of Wisconsin School of Medicine and Public Health and Global Health Institute comes in. “The big push in a lot of disciplines is to integrate global health in residency training,” says Tupesis, an emergency physician, former UW Emergency Medicine residency director and current Graduate Medical Education-Global Health Institute liaison. “To develop new programs, you need to pay attention to how you go about it. How do we effectively and fairly partner with overseas medical groups?”
Tupesis explores those answers in two recent academic papers and a podcast released through the American Academy Emergency Medicine Resident and Student Association. He is also a volunteer technical consultant for the World Health Organization’s Emergency, Trauma and Acute Care Division, where he’s working on the division’s goal to create and implement an e-learning course. It’s based on the WHO Basic Emergency Care Course and will be available to tens of thousands of health care workers around the world.
Tupesis has worked on numerous global health and education projects in Liberia, Ethiopia and South Africa. “An ever-evolving body of literature and science shows when your students go abroad it gives them a different perspective,” he says.
“All of the core tenants of medicine are incredibly well-outlined in those (global) experiences, from broadened medical knowledge to understanding the social determinants of health.”—Janis Tupesis
Residents increasingly look for global health education, and the Accreditation Council for Graduate Medical Education is also looking for an international global health track or one that takes residents to resource-limited or urban settings in the U.S. In “Taking It Global: Structuring Global Health Education in Residency Training,” lead author Gitanjli Arora from Kaiser Permenente Los Angeles, Tupesis and colleagues discuss how to incorporate ethical and sustainable global health education into U.S. residency programs. The article was published in the May 2017 Journal of General Internal Medicine.
Common challenges face global health education efforts
Resident training must be structured differently than medical school programs since residents are hospital employees, not students. Residents, who have earned their medical degree, agree to work for a hospital for a given period of time, and Medicare pays for part of that training. “Medicare won’t pay for you to be in Ethiopia,” Tupesis says. Residents also face administrative challenges when they work abroad, and hospitals face equal challenges to bring international residents into U.S. hospitals.
“A number of common challenges face global health education efforts, including: lack of access to didactic global health curricula and/or faculty expertise, limited partnerships with international institutions, concerns of burdening international partners rather than being of service, insufficient program funding, low levels of institutional support, and a multitude of logistical, legal, regulatory and administrative barriers,” according to the Internal Medicine article. The authors propose and explore four questions to guide the development of global health programs:
- Who are you teaching?
- How are you teaching?
- What are the goals of your global health program?
- What are your resources?
UW-Health is among the pioneers in global resident education with a decade of experience in offering residents and fellows a pathway to clinical and educational experiences abroad. Over the past five years, UW-Health has had more than 20 different clinical disciplines participating in programs in more than 20 countries. In his podcast for emergency medicine residents, Tupesis draws on that history to help listeners prepare for an international rotation, thinking about cultural humility, communications and what they will learn.
Resident concerns the same everywhere
In a second article. “Attitude of interns toward implementation and contribution of undergraduate Emergency Medicine training: Experience of an Ethiopian Medical School,” published in April in the African Journal of Emergency Medicine, Tupesis and colleagues found that Ethiopian medical students and residents are interested in more formal emergency medicine training at the Addis Ababa University School of Medicine. “We believe that there is a general consensus of the relevance of having undergraduate emergency medicine training and the further integration of emergency care into other clinical rotations,” the authors concluded. They recommended beginning emergency medical training in pre-clinical years focusing on skills such as clinical care, communication, leadership and education.
Tupesis served as a mentor for the project that allowed residents to assess their department, and he had done similar work in the U.S. “Learners and trainees have very similar goals and objectives and similar problems wherever you are,” he says.
By Ann Grauvogl/ July 12, 2017