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Professionalism Training in the Global Setting: Program at Ayder Hospital and Mekele University in Ethiopia

Purpose: Using the current partnership between University of Illinois in Chicago, Illinois (UIC) and Ayder Hospital/Mekele University in Mekele, Ethiopia (Ayder), this study evaluated the effectiveness of professionalism training for medical students and resident trainees at Ayder.

 

Background: Threats to professionalism in medicine have led to more universal teaching of professionalism to trainees and practicing physicians. Currently, professionalism is listed by the ACGME as one of the 6 general clinical competencies. Many programs that include  group sessions and standardized patients have been implemented in American institutions, although little research has been directed towards professionalism training in a global health setting. This study aimed to determine the effect of a professionalism training at Ayder.

 

Methods: Participants in a professionalism and communication training were offered participation in a pre- and post-test survey. The survey focused on the perception and function of professionalism in the medical workplace, and included quantitative and qualitative data. The pre- and post-test surveys were conducted prior to and at completion of the training.

 

Results: A convenience sample of medical students and resident trainees at Ayder participated in the pre- and post-test surveys. The training had a positive effect on the perception of professionalism and identified opportunities for behavioral improvement.

 

Discussions: We saw that the professional training was an effective tool for implementing professionalism into medical education curricula in this global health setting. However, further research regarding the long term impact and ability to implement clinical competencies into global health settings will help determine the plausibility of repeating such a study in other sites.

Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, Simulation, Global Health, Public Health,

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The Ethics Experiences and Preparation of Medical Trainees Participating in Short-Term, International Educational Programs: A Systematic Review of the Literature

Background: Responding to demand from medical trainees, educators have developed a spate of short-term, global learning opportunities. However, it is uncertain how well the literature has reported and analyzed the ethical challenges for medical trainees participating in these new programs. This knowledge is important for those designing and reforming global health programs. Therefore, we conducted a systematic review to evaluate the literature addressing ethics preparation and experiences of medical trainees who pursue short-term global health trips.

 

Methods: We devised a set of inclusion and exclusion criteria. Inclusion criteria were four main components: (1) global health, (2) ethics, (3) medical trainees, and (4) short term trips. Articles were excluded if (1) they described or analyzed programs or experiences not supported by a USMLE or ACGME accredited program or (2) were written in a language other than English.   Search strategies were developed in consultation with a librarian for five databases: Pubmed, Embase, Education Source, Academic Search Complete, and Web of Science (Core Collection). A single author analyzed the search results based on the inclusion and exclusion criteria and a team of authors conducted a qualitative content analysis of the resulting papers.

 

Results: The search protocol returned 530 unique papers, of which 56 were qualified based on the inclusion and exclusion criteria. Identified papers fit into three broad categories: (1) Case reports (n=14). These narratives described curriculum or program development, and addressed curricular ethics content aimed at preparation for short-term trips. (2) Non-empirical papers (n=26). Often drawing on personal experience from program development or participation, these essays contained reflective analysis and narratives. (3) Research papers (n=16) that used research methodology to describe the ethical challenges faced by medical trainees on short-term trips.

 

Discussions: Our preliminary results show a nascent literature on ethics for medical trainees embarking on short term, international trips. The case studies and essays are helpful for exchanging program ideas; however, more systematic, empirical studies would be useful to evaluate and guide curricular development.

 

Keywords: Communication Skills, Cultural Diversity/Cultural Competency, Curriculum Development/Evaluation, Global Health, Professionalism

Topics: CREOG & APGO Annual Meeting, 2017, Clerkship Director, Residency Director, Professionalism, Interpersonal & Communication Skills, GME, UME, Global Health,

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Sustainable Global Health Education in Obstetrics & Gynecology: Meeting the Administrative Demands

Background: While resident interest in global health education has increased, the administrative demands of providing a meaningful and safe international experience have also grown.  In 2012, the Department of OBGYN at the Medical College of Georgia (MCG) established a global women’s health program, including an international rotation.

 

Methods: After constructing a program outline, identifying stakeholders, establishing educational goals and objectives, and determining available resources, an educational program in global women’s health was developed.  Barriers related to finance, educational structure, and personal/professional liabilities were resolved.  ACGME requirements were reviewed, including 1) supervision, 2) establishment of competency-based goals and objectives, and 3) evaluation.  A program letter of agreement was signed with the international practice site.

 

Results: Since program inception, 88% of eligible residents (16 of 18) have completed the educational modules and international rotation, averaging four weeks abroad.  Educational goals and objectives are based on epidemiology related to global health and disease-specific clinical practice.  Residents complete online modules and participate in weekly departmental conferences via videoconference.  Residents log procedural data and duty hours while abroad.  A competency-based evaluation is completed by the supervising physician.  The average cost per resident for travel, insurance, and housing is $2,416, paid by the department.  The supervising physician is compensated by the department.  MCG pays resident salary and benefits while abroad.  

 

Discussions: As popularity for global health education has grown, the administrative requirements have become prescriptive to ensure a meaningful educational experience.

 

Keywords: Curriculum Development/Evaluation, Global Health, Underserved Communities

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, Global Health,

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SUGAR in OB/Gyn: A Multi-Institutional Collaboration to Develop Cases for Simulation Use for Global Away Rotations (SUGAR)

Background:

Simulation Use for Global Away Rotations (SUGAR) is an open source curriculum initially developed by a collaborative of pediatricians to allow residents to experience and debrief common practical and emotional challenges of working in resource-limited settings. The original curriculum included 8 pediatric simulation cases with facilitators trained at over 80 institutions. A multi-disciplinary group was formed to harness the principals of the SUGAR curriculum to provide simulation training for residents in specialties beyond pediatrics.

 

Methods:

OB/Gyn collaborators were trained to facilitate SUGAR cases. New OB-Gyn simulation cases were developed, formatted, and piloted with multi-disciplinary groups of residents at our academic institution over a three-year period.

 

Results: Three new OB/Gyn SUGAR cases were developed and piloted with the goal of allowing residents to experience and debrief common medical management and emotional complexities faced in resource-limited settings. The following medical topics are addressed: obstructed labor, postpartum hemorrhage, eclampsia, female genital cutting. The following negative emotional experiences/adaptive characteristics are addressed: frustration/adaptability, floundering/awareness of resources, failure/adjustment & humility. Facilitator and resident feedback is under evaluation. Collaborators agreed that the content would be made available for free for use in global health education on the training website http://sugarprep.org/

 

Discussions: By creating, piloting, and open-sourcing simulation cases in OB/Gyn, the SUGAR curriculum can be expanded to fill a need of global health educators in OB/Gyn. SUGAR simulations hold promise to expand resident preparation for international electives in resource-llimited settings.

 

Keywords: Cultural Diversity/Cultural Competency, Global Health, Interdisciplinary, Simulation

Topics: CREOG & APGO Annual Meeting, 2017, Student, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Simulation, Global Health,

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Non-verbal Communication and Patient Satisfaction in a Predominantly Latino Obstetric Population

Background: Modern day patient-centered care has shifted the physician/patient paradigm, from a paternalistic model, to one where the goal is to share management and decision making. Patient satisfaction now takes a high priority. Our qualitative study suggests that satisfaction relies heavily on non-verbal communication.

 

Methods: The study took place at White Memorial Medical Center (WMMC), a teaching hospital in Los Angeles, California. WMMC serves a Hispanic population, comprising 88% of its deliveries in 2014. Twelve focus groups were conducted, involving 42 obstetric patients. Following IRB protocol, participants recruited were provided with a gift card. A bilingual/bicultural PhD/RN conducted the focus groups. Sessions were audio recorded. Focus groups were transcribed verbatim and analyzed using constructivist grounded theory methods.

 

Results: Non-verbal communication influenced patient satisfaction. Elements of communications mentioned by our patients included facial expressions, tone of voice, body posture and touch.

 

Discussions: Our study was designed to identify factors influencing patient satisfaction. Limitations include those generally applicable to qualitative research. Literature suggests non-verbal communication has a role in establishing the patient-provider relationship. In our population it appears significant. We suggest improved resident education might facilitate improvement in this area. We propose an educational curriculum, based on an understanding of different theoretical models and their perspectives on patient agency, for the WMMC OBGYN program using our data.  

 

Keywords: Assessment, Communication Skills, Community Health, Cultural Diversity/Cultural Competency, Curriculum Development/Evaluation, Professionalism, Teaching Skills, Underserved Communities

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Residency Director, Patient Care, Professionalism, Interpersonal & Communication Skills, GME, Assessment, Global Health,

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Global Health Preparation: Implementing Obstetrics and Gynecology Simulation for Non-Obstetrical Residents in a New Frontier

Background: Many specialists outside of Obstetrics and Gynecology spend considerable time in other countries providing women’s health care. This simulation session focused on optimizing their skills in caring for women and improving their confidence levels surrounding routine OB/GYN care.

 

Methods: Didactic and experiential training was developed by Obstetrics and Gynecology faculty specifically for non-obstetrical residents preparing for a global health rotation. The course sought to develop understanding of six common obstetric and gynecologic conditions and recognition of emergencies that could be managed by non-obstetric trainees.  Participants completed a pre- and post-test self-assessment utilizing a 4-point Likert Scale. The results were compared to evaluate the effectiveness of training and self-reported confidence in performing the skills.  

 

Results: The one day curriculum included didactic instruction and hands-on training. Sixteen (16) non-obstetric resident physicians from five specialty areas participated in the training. All resident physicians spent 30 minutes at each of the six stations while mentored by OB/GYN attending and resident physicians.  Costs associated with the curriculum were approximately $20/trainee excluding faculty time. All participants considered training either helpful (45%) or very helpful (55%).  At the completion of the session, most trainees felt very comfortable (top quartile of the Likert scale) performing vaginal deliveries (76.9%), assessing cervical dilation (84.6%) and estimating blood loss/postpartum hemorrhage (69.2%). Only 46 percent of the participants surveyed felt very confident repairing vaginal lacerations.

 

Discussions: Low cost simulation for non-obstetric resident trainees anticipating a global health experience is feasible and easily implemented. Participants felt very comfortable assessing cervical dilation, performing vaginal deliveries and assessing postpartum hemorrhage. Targeting procedures and maneuvers that are considered high yield and technically less complex would help improve trainee comfort, particularly in the areas of laceration repair.

 

Keywords: Global Health, Healthcare Workforce, Interdisciplinary, Simulation

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Simulation, Global Health,

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Evaluation of a Combined Neonatal and Obstetric Resuscitation Program in a Resource-limited Setting

Background: Philippines has some of the highest NMR (14 per 1000 live births) and MMR (MMR 220 per 100,000 live births) in Asia. Prior studies in limited-resource settings have shown efficacy of simulation-based HBB initiatives in improving education and regional stillbirth rates. The HMS program similarly addresses emergency obstetric care.  

 

Methods: Training courses in HBB/HMS were conducted for N=55 midwives in Davao, Philippines as part of an interventional cohort study. Multiple choice exams and videotaped objective standardized clinical assessments were used to measure knowledge and skills pre and post intervention. Outcome measures were compared pre and post intervention using t-test comparison of means.

 

Results: Written knowledge tests revealed a 13% relative improvement in post-test scores (p < 0.001). Skill improvement in maternal resuscitation was demonstrated by decrease in average time to administration of uterotonic agent after birth from 95 to 54 seconds (p < 0.001) and in neonatal resuscitation by achievement of successful bag mask ventilation by 45% pre intervention vs. 100% post intervention (p < 0.001).

 

Discussions: Combined training in neonatal and obstetric management resulted in increased knowledge and skills for midwives in this resource-limited setting. Next steps include assessment of skill decay curves, rate of uptake of best practices, and longitudinal analysis of regional NMR and MMR.

 

Keywords: Community Health, Curriculum Development/Evaluation, Global Health, Healthcare Workforce, Simulation

Topics: CREOG & APGO Annual Meeting, 2017, Student, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, Simulation, Global Health,

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Creating a Sustainable ObGyn Residency in a Resource-Limited Country Improves Maternal Health Outcomes

Background: The 2013 maternal mortality ratio (MMR) in Guyana was 250/100,000 live births according to the WHO, compared to a regional average of 68. Inadequate quality of care, shortage of skilled healthcare professionals, and systemic limitations are contributing factors.

 

Methods: In 2012 University Hospitals/Case Medical Center (UHCMC), Georgetown Public Hospital Corporation (GPHC) and University of Guyana collaborated to develop a four-year ObGyn training program using curriculum formalized at UHCMC, modified to suit local needs.  A multi- academic institutional partnership allowed international faculty involvement in training Guyana’s first ObGyn residents (MDG-8). Maternal morbidity and mortality outcomes (MDG-5) were prospectively maintained, analyzed and compared to rates prior to program implementation.

 

Results: Twenty-three residents were trained and five residents completed the program in 2016. Full-time staff are present in Guyana, and fifty-two faculty from partnering institutions travelled to Guyana to teach and provide patient care. Development of modified evidence-based clinical guidelines improved quality of care and patient safety outcomes.  MMR from direct causes decreased country-wide and at GPHC during the four-year period. Success was due to shared institutional vision, establishment of partner organizations, resident leadership development, and systems-based improvement.  Future challenges include trainee retention and continued sustainability.

 

Discussions: Guyana’s first ObGyn residency program can serve as a model for similar endeavors in global health.  Creation of sustainable training programs in ObGyn through international partnerships is essential progress towards achieving MDG’s 5 and 8.

 

Keywords: Cultural Diversity/Cultural Competency, Evidence Based Practice, Global Health, Healthcare Workforce, Underserved Communities

Topics: CREOG & APGO Annual Meeting, 2017, Resident, Faculty, Residency Director, Patient Care, Medical Knowledge, GME, CME, Global Health, Public Health, General Ob-Gyn,

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An Educational Intervention to Improve HPV and Cervical Cancer Knowledge Among African American College Students

Background: Although the overall incidence of cervical cancer in the United States is low, African American women carry a disproportionate burden of the disease. The incidence among Black women is nearly 50% higher than in Caucasians, and Black women are more likely than any other group to die from the disease. In order to eliminate such disparities and eradicate a virtually preventable cancer, education is crucial.

 

Methods: We completed a total of 5 lectures at four Historically Black Colleges. Each session included a lecture and a hands-on interactive review of HPV and cervical cancer. Participants were given a pre- and post-lecture survey that assessed knowledge and beliefs related to cervical cancer, HPV, and HPV vaccination.

 

Results: A total of 57 students completed the surveys. 96% of students reported knowledge of the HPV vaccine, however only 52% reported receiving the vaccine. About 77% of students over 21 years of age reported having a PAP smear. Of the 16 knowledge-based questions, correct response rates significantly increased (74% v. 91%, p = 0.02) with the intervention.

 

Discussions: Community outreach interventions emphasizing primary prevention and early detection are necessary to reduce racial inequalities in cervical cancer morbidity and mortality. The educational intervention utilized in this study was successful in improving knowledge about HPV and cervical cancer. Further examination of the critical components for educational intervention in this population should be explored.

 

Keywords: Community Health, Cultural Diversity/Cultural Competency, Curriculum Development/Evaluation, Residents As Teachers, Underserved Communities

Topics: CREOG & APGO Annual Meeting, 2017, Student, Resident, Medical Knowledge, Systems-Based Practice & Improvement, UME, Global Health,

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A Powerful Potion: Impact of Campus-Community Partnerships on Medical Education and Career Paths

Background: Two medical schools in separate cities partnered with community organizations to provide free gynecologic care to uninsured women.  The clinics integrate community outreach, patient care, and a peer-teaching model. Both are volunteer-run with the mission to improve the health of underserved women needing gynecologic care and enhance student learning.

 

Methods: Student volunteers completed an 18-item, open-ended survey evaluating motives for volunteering, volunteer experiences, and the impact on education and career preferences.  Surveys were sent electronically to volunteers (n=137) with a response rate of 51%. Results were thematically coded and analyzed by two separate individuals.

 

Results: Students reported their motives for volunteering were to: gain experience in gynecology or women’s health (65%), learn about and contribute to underserved medicine (55%), and increase clinical experiences (36%). All students reported achieving their self-identified goals.  Peer teaching provided a positive experience for 98%, with students valuing learning from upperclassmen and teaching underclassmen.  Volunteering sparked, increased, or confirmed an interest in a career in obstetrics and gynecology (48%) and women’s health (11%). Volunteering also sparked, increased, or confirmed interest in a career in underserved medicine (79%) and academic medicine (41%).

 

Discussions: Campus-community collaborations provide unique opportunities for students to set and achieve career goals while simultaneously influencing specialty preferences. Free clinics can be used to meet both patients’ and learners’ needs.  Peer-teaching is an effective tool that can be used across clinical settings to promote clinical skills improvement for learners and mentors alike.

 

Keywords: Ambulatory Education, Career Choice, Community Health, Cultural Diversity/Cultural Competency, Mentoring, Underserved Communities


Topics: CREOG & APGO Annual Meeting, 2017, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, UME, Global Health, Team-Based Learning, Public Health, Advocacy,

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Multicultural Educational Workshops Demonstate a Positive Impact on the Awareness and Attitudes of Health Care Providers Working with Hispanic/Latina Pregnant Women

Background: Health care providers working with patients from diverse cultural backgrounds are often unaware of how culture impacts the services they provide. Undocumented, Latina/Hispanic, pregnant women, living in low SES are a vulnerable population of women that may receive culturally-insensitive services due to the lack of multicultural education and awareness of health care providers. This may result in negative patient health outcomes.

 

Methods: Health care providers including medical residents, medical students, nurses, and mental health counselors from north-central Florida were included in this study. Participants received a 12-item likert scale questionnaire (Multicultural Awareness Questionnaire) before and after an educational workshop (Multiple Minority Identities and Their Effects on a Vulnerable Population). Data was assessed for evidence of increased awareness and attitudes in the post workshop questionnaire.

 

Results: Fifty-one health care providers were included in this study. There was statisical significance in 11 of the 12 questions.  Highlights include a statistically signficant increase in participant\'s knowledge of the vulnerability of patients and stressors women face, awareness of one\'s own cultural bias, and concern for treatment of patients in the healthcare system.

 

Discussions: Multicultural educational workshops show a positive statistically signficant impact in the attitudes and awareness of health care providers. It is essential for health care providers to receive multicultural education to ensure diverse populations are best served.

 

Keywords: multicutural, Hispanic, education


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Patient Care, Medical Knowledge, Professionalism, GME, CME, Global Health, Public Health, Advocacy,

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Jennifer Bercaw-Pratt, MD, Baylor College of Medicine; Jennifer Dietrich, MD, MSc

Background: Every woman in South Sudan has a 1 in 7 chance of dying in childbirth. There are no post-graduate training programs in Obstetrics and Gynecology, so that MBBS- qualified doctors remain especially underprepared in maternal and neonatal care. Due to concerns for political instability and safety, a distance learning module was needed.

 

Methods: We first identified topics most pertinent to undergraduate MBBS education in maternal health. We next developed a delivery system for the content as well as obtained funding. We sought resources for the content of the didactics themselves and a method to ensure effective interactive learning.

 

Results: From our university’s core lectures, we identified critical topics pertinent to maternal care in South Sudan. We secured funding through a nonprofit organization to obtain 84 digital tablets. 81 pre-recorded lectures were loaded onto the devices, which were then distributed to the MBBS students.  Two hours daily of small group discussion by our university’s facilitator accompanied the lectures. Written tests (n= 187) following the intervention showed substantial knowledge acquisition (mean score = 63%; SD +/- 12.8%).  Debriefing sessions revealed unanimously positive responses to the intervention, particularly to the group discussions.

 

Discussions: The use of pre-recorded lectures on tablets and facilitated discussion resulted in successful implementation of a distance-learning program for maternal health in an underserved country. Future research will assess the sustainability and effectiveness of this intervention.

 

Keywords: global, distance-learning, technology


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Clerkship Director, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, CME, UME, Global Health, Public Health,

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Does Interest in Global Health Effect Medical Specialty Choice?

Background: Choosing a specialty is one of the most significant decisions medical students face. The decision is certainly multi-factorial but may be influenced by ideas of what each field offers for their future lifestyle including the ability to travel and provide outreach during their career.

 

Methods: 4th year medical students (n=204) at SUNY Downstate in Brooklyn, NY were surveyed via the internet. Responses were collected anonymously. Data was analyzed and correlations were computed with chi-square test.

 

Results: There was a 29.9% response rate. More than half of respondents reported plans to be involved in global medicine (59.3%) at some point in their career. A lower proportion reported a causal relationship between opportunities to work abroad and their chosen specialty (22%) and chosen residency program (15.5%). There was a statistically significant difference in the number of students who selected careers in Emergency Medicine, based on the ability to practice global medicine within that field, compared to general medical specialties (p < 0.006) and surgical specialties (p < 0.035). No other specialty showed global medicine to be a statistically significant factor in specialty or program choice.

 

Discussions: Although, the number of residency programs offering international research and travel opportunities has been increasing in recent years, this does not seem to be a significant factor to medical students when choosing a field or residency program.   The main determinants of specialty and residency choice for Generation Y remain to be elucidated.

 

Keywords: Specialty global health


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Clerkship Director, Residency Director, Practice-Based Learning & Improvement, UME, Global Health, Public Health,

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Creating an Interprofessional Team to Investigate Medical Device Design in Low Income Countries: A Case Study

Background: Globalization and the MDGs have increased the interest of many in global health. Although interprofessional engagement is encouraged, evidence of implementation of diverse teams is lacking. Studies have shown that students exposed to interprofessional training have a better understanding of collaboration and better attitudes toward interprofessional teamwork.

 

Methods: A multidisciplinary team of students and professionals from biomedical engineering, mechanical engineering, health management, business, design science, and obstetrics and gynecology performed case studies of 4 different devices: Non-pneumatic Anti-Shock Garment, reusable Vacca Omnicup, Bakri Balloon, and Uniject with Oxytocin.  A template was created and tasks were delegated based on expertise. Information from current engineering, business, and medical journals was collected and interviews with developers, manufacturers, and distributors of devices were conducted. Information was systematically recorded and analyzed by team members. 

 

Results: Seven students with three advisors studying the devices looked at the design process, manufacturing, distribution, and efficacy. Each then shared information gathered based on their expertise. The diverse group of professsionals gave all members a greater appreciation for the complexities of getting a device from concept to market and end-user.

 

Discussions: Understanding cultural differences between professions is a first step toward effective collaboration and ultimately innovation and leadership. Our case study explores one model to expose learners to different disciplines within a large university setting and enhance education of device design and interdisciplinary communication.

 

Keywords: interprofessional, global health


Topics: CREOG & APGO Annual Meeting, 2016, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, UME, Global Health, Independent Study, Public Health, Faculty Development,

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Teaching by Teleconference: The Massachusetts General Hospital – Ugandan Experience

Background: In Uganda, an estimated 120 obstetrician/gynecologists serve a population of 30 million people demonstrating the need to train additional skilled clinician leaders in reproductive health.  In 2012, a partnership was formed with the Mbarara Regional Referral Hospital (MRRH) in southwest Uganda and the Massachusetts General Hospital (MGH) in Boston, USA in part to increase access to specialist training.  This report presents an update in the development of a teaching conference between the institutions.

 

Methods:   In June 2012, a didactic teleconference between the institutions was instituted. Various conferencing tools were tried: direct telephone connection, Ventrilo™ conferencing system and Skype™ via personal computer or smart phone. In Mbarara, internet was accessed via cellular data. In Boston, Internet was accessed via hospital network or cellular data. All lectures were HIPAA compliant. PowerPoint lectures were stored in a collective Dropbox™ that could be accessed and downloaded prior to lecture dates.

 

Results: Over 30 months, 27 lectures were given. Lecturers included faculty and fellows from maternal fetal medicine, gynecology oncology, urogynecology, family planning, psychiatry and obstetric anesthesia. A patient case pertinent to the teaching topic framed the discussion. About 20 participants attended each lecture. Internet connectivity was the biggest challenge. Ultimately audio Skype via cellular data proved the most successful modality and became the method of choice.

 

Discussions: A successful collaboration in medical education via teleconference is sustainable, low cost, and beneficial to both resource-rich and resource-poor institutions. Expertise can be shared bilaterally and internationally by individuals potentially unable travel.

 

Keywords: Uganda, teleconference


Topics: CREOG & APGO Annual Meeting, 2016, Faculty, Medical Knowledge, Professionalism, Interpersonal & Communication Skills, GME, Global Health,

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Bringing Laparoscopy to Haiti: A Pilot Program

Objective: To create a collaborative and sustained partnership between Physicians for Haiti, Stony Brook University Hospital and the gynecology department at Hôpital Universitaire de Mirebalais (HUM) in Haiti to provide continued medical education on laparoscopic surgery.

Methods: The gynecology department at HUM identified a need for learning minimally invasive surgical techniques for improved patient care. Eleven Haitian OBGYN physicians were enrolled in a one week didactic and simulation-based laparoscopy pilot workshop. Participants were given a knowledge assessment before and after the course. The learners attended eight hours of lecture, integrated with six hours of simulation training.

Results: All eleven participants stated that their knowledge of laparoscopy prior to the workshop was “poor” but were “very interested” in increased training. 82% reported having observed at least one laparoscopic case, but only 18% reported assisting in any of those procedures. The average knowledge evaluation before training was 44.6% and upon completion was 75.9%. Most providers identified diagnostic laparoscopy and tubal sterilization as the initial surgeries that would be most beneficial for clinical training.

Conclusion: This collaborative pilot workshop demonstrates that while baseline knowledge of laparoscopy is limited in this setting, improvement in knowledge over the one-week training was attainable. This multi-year educational collaboration will subsequently include additional teaching, simulation and subsequent mentorship for clinical integration of newly acquired skills. This pilot demonstrates foundational training for a sustained collaboration to provide fundamental knowledge and experience in laparoscopic gynecologic surgery in a tertiary care center in rural Haiti.

Topics: GME, Global Health, Minimally Invasive Surgery, General Ob-Gyn,

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One More Thing Before You Go”: Pre-departure Training for Medical Students on Global Health Rotation

Study Objective: Global health is one of the fastest growing areas of clinical and research experience for US medical students and residents. Pre-departure training (PDT) involves not only orienting trainees to a global health training site but also covering general topics such as safety and evacuation planning, travel medicine, ethics in global health and post exposure prophylaxis. At the University of Vermont College of Medicine (UVMCOM), 10-15% of students travel for global health elective rotations each year. Approximately half of those students do so through a university sponsored program with a PDT curriculum; the others either participate in extramural programs or arrange travel on their own. Those students may or may not have PDT.

Methods: Medical students at UVMCOM who recently returned from global health rotations abroad participated in focus groups to evaluate their experience with PDT. An additional session was held with those who traveled through the UVMCOM sponsored program to specifically evaluate the PDT presently in place.

Results:
All students returning from global health rotations desired PDT. Those who participated in a formal PDT curriculum reported an overall more positive experience with their elective rotation. Areas for improvement in current PDT at UVMCOM were ethics and post exposure prophylaxis.

Conclusions: PDT enhances students’ global health experiences. All UVMCOM students should have access to PDT regardless of the program in which they participate. Modifications to the current PDT curriculum will be made in response to focus group comments.

Topics: CREOG & APGO Annual Meeting, 2015, Student, Clerkship Director, Interpersonal & Communication Skills, UME, Global Health,

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A Student-Centered Approach to Curriculum Design in the University of Michigan Path of Excellence in Global Health and Disparities

Objective: In the creation of a novel, co-curricular Path of Excellence in Global Health and Disparities (PoE-GHC), we attempted to engage learners with a diverse depth and breadth of preexisting knowledge. To do this, we asked our learners to reflect on their skills related to GHD-competencies.

Study Design: A prospective study, surveyed students’ baseline level of skills related to GHD with the phrase, “At this point in my career, I can…” and their anticipated need for these skills with the phrase, “I anticipate that my future career will require me to…” The 25 competencies were developed with the participation of more senior students during earlier planning sessions. Answers were captured on a 4-point Likert scale. P-value was set at 0.05 for significance.

Results: The difference between students’ perceived competence at baseline and their need for that skill in the future was calculated using Wilcoxin’s paired T-test. On all 25 competencies, students’ perception of their need for competency exceeded their current skill level (p ≤ .05). At baseline, students felt most confident with items related to cultural competence and least confident in program design and evaluation.

Conclusion: This study takes into consideration the importance of learner self-determination in the design and implementation of a voluntary, co-curricular path in undergraduate medical education. Given the demands of standard medical education, the additional workload of a voluntary program must closely address learner need in order to remain viable.

Topics: 2013, Student, Clerkship Director, Clerkship Coordinator, Systems-Based Practice & Improvement, UME, Global Health,

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Integrating Global Health into the Ob/Gyn Residency Core Curriculum: A One-Year Experience

Chadburn B. Ray, MD
Georgia Regents University, Augusta, GA
Study Objective: The Department of Obstetrics & Gynecology at Georgia Regents University sought to integrate both global health education and international experiential learning into the core curriculum for residency training. Our objective was to determine the feasibility and resources needed to successfully integrate global health into the core curriculum.

Methods: Using the Guidebook for Global Health Training, 2nd Edition available online from the Global Health Education Consortium, the department established a global health program outline. Program objectives were determined, including concentrated learning within the discipline of global health and experiential learning in women’s health in an underserved area while utilizing available resources to reduce disease burden. A review of the anticipated residency training impact was undertaken, including improved recruitment of residents, improved quality of residency education, and effect on career choice for participants. Barriers to training were assessed and placed in the three categories: financial, educational, or personal/professional liability. The program explored opportunities for partnership within the parent institution. The program then developed an educational curriculum with competency-based goals and objectives for program participants. Timing in residency was chosen based on resident availability and flexibility within the academic program.

Results: Beginning in May 2012, the program director developed a global health program outline, consulted with stakeholders, and partnered with CerviCusco, a Peruvian registered non-profit association located in Cusco, Peru. The program director performed a site visit in September 2012 to resolve issues of travel, accommodations, personal safety, resident supervision, and hospital affiliation in Cusco. Costs were determined to be air travel, accommodations, meals, ground transports, and medical evacuation insurance. The average cost per resident for travel, insurance, and housing was $2,349, paid by the department. The supervising physician was compensated for her role in resident education. Computer-based language education was purchased by the program for resident education (Rosetta Stone, Latin American Spanish). Curricular goals and objectives were determined based on both epidemiology related to global health (Peru) and disease-specific education (pre-invasive disease of the female genital tract). The rotation was integrated into the intern year. From January to July 2013, four interns successfully completed 4 to 5 weeks at the international practice site. Each intern complied with ACGME requirements for duty hours and supervision. Evaluations were done by the direct supervising physician in Peru. Online modules were completed for didactic education while abroad. Interns also participated in departmental conferences weekly via videoconference (ie, Skype). All interns returned safely and evaluated the rotation as a positive experience.

Conclusions: It is possible to successfully integrate global health into the core curriculum for Obstetrics & Gynecology residency training with limited additional resources and no prior experience in global health education. Key words: Global Health Curriculum

Topics: CREOG & APGO Annual Meeting, 2014, Osteopathic Faculty, Residency Director, Residency Coordinator, GME, Global Health,

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Satisfying ACGME Core Competencies through a Global Women’s Health Course in Obstetrics and Gynecology

Taraneh Shirazian
Mount Sinai School of Medicine, New York, NY
Objective: In response to a growing interest, many residency programs are offering trainees opportunities to learn about Global Health. Data from the Fellowship and Residency Electronic Interactive Database (FREIDA) show that in 2012, 42% of Obstetrics and Gynecology (OB/GYN) programs provide residents and fellows the opportunity to “temporarily provide health care and/or train outside the United States,” which is increased from 35% in 2011. However, there is no published evidence examining how Global Health education in obstetrics OB/GYN residencies may fulfill Accreditation Council for Graduate Medical Education (ACGME) Core Competencies. Since 2009, the Division of Global Women’s Health in the Department of Obstetrics, Gynecology and Reproductive Sciences at the Icahn School of Medicine at Mount Sinai in New York City has offered an annual Global Women’s Health course for any interested local OB/GYN residents. This multifaceted course, which consists of 12 classes over 6 months, takes place after work hours during the week. It is offered as an elective for OB/GYN residents outside of Mount Sinai and as a mandatory pre-trip requirement for Sinai residents who wish to participate in an abroad elective. The aim of the course is to both to educate about Global Women’s Health issues and to prepare residents for work abroad. The elective includes topics such as women’s human rights, gender-based violence, family planning and contraception, female genital cutting, obstetric fistula, maternal mortality, malaria in pregnancy, prevention of mother-to-child transmission of HIV and the socioeconomic determinants of health disparities. The objective of this study is to determine how participation in this course, with or without a subsequent international experience, can fulfill ACCME core competencies.

Methods: The ACGME has outlined six general competencies which must be incorporated into the curricula of all residency programs in the United States. In 2011, the Global Health Education Consortium (GHEC) published guidelines to assist programs in developing Global Health curricula based on ACGME competencies. For each ACGME competency, general Global Health learning objectives were outlined and specialty-specific examples were given. Using these Global Health learning objectives, members of the Global Women's Health Division analyzed the lectures, films, round-table discussions and case studies given during the course. A checklist was then created to monitor for each ACGME criteria met by each resident participant.

Results: All 5 of the 6 ACGME Core Competencies were fulfilled solely by the course, with the last “patient care and clinical skill” being fulfilled by an international experience.
Conclusions: During an obstetrics and gynecology residency, structured education in Global Women’s Health, with or without an international experience, can fulfill ACGME core competencies.
Key Words: Global Health, ACGME

Topics: CREOG & APGO Annual Meeting, 2014, Resident, Residency Director, Residency Coordinator, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, Global Health,

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