A Centralized Structure and Process to Approve and Monitor GME Global Health Electives at a Large Academic Institution

Increasing numbers of undergraduate and graduate learners believe that having experiences in global health (GH) is a valuable aspect of their education. In medicine, several studies have highlighted its importance across multiple specialties. For example, in surgery, 63% of surveyed residents were interested in completing a GH rotation; this increased to 98% if they had had a prior GH experience.¹  Furthermore, an estimated 74% to 80% of emergency medicine programs reported at least 1 resident participating in a GH elective during the surveyed year.^2,3 

Learning experiences in GH can provide rich opportunities for service, for learning, and for sharing perspectives both for the host institution and for the visitor. These experiences have been relevant to several Accreditation Council for Graduate Medical Education milestone domains,⁴  and they have been correlated with caring for underserved US populations in clinical practice after completion of training.⁵ 

While on GH electives, residents can find themselves in high-risk situations and environments with regard to their personal safety,^6,7  ethics, or cultural sensitivity. This is in part because the quality and safety of GH rotations and the amount of mentorship vary within and among institutions. Most residency programs and their sponsoring institutions do not have a systematic and uniform method for vetting elective rotations and ensuring that proper mentorship occurs predeparture and upon return. Residents often have limited or no counseling before leaving and after they return.

To better address institutional concerns, provide reasoned and consistent oversight, and prepare residents for their GH rotations, we created a standardized preparation and approval process for resident physicians who seek to participate in GH electives as part of their training. A Global Health Advisory Committee was created, consisting of key graduate medical education (GME), legal, resident, and GH expert stakeholders. Three checklists, managed and administered via New Innovations (a commercially available residency management software package; Uniontown, OH), are used to provide trainees with consistent and critically important education about GH electives. These checklists (box) also provide a mechanism for oversight, completion of relevant documents, and a debriefing tool. This creates a data summary of the elective that can be viewed by all residents.

Institutional Review Board approval was not sought for this work because it constituted programmatic improvement.

The 3 checklists in the box are used in the New Innovations platform to track resident predeparture preparation and postreturn debriefing. Since the use of these checklists commenced in January 2016, we have had 23 physicians in training complete all 3 checklists for their GH rotations. Our committee met to review safety issues and the initial implementation of the checklists; subsequently, improvements were made to the checklists. This uniform system also enables monitoring and evaluation of specific sites, ensuring that issues encountered by a resident are shared with other programs that may use that same site.

A centralized online structure for approving and monitoring GME GH electives preparation can be used to help standardize preparation and promote a high quality of educational experience.