Nicole E. St Clair

Essential Factors for the Development of a Residency Global Health Track

Objective There is increasing awareness of the importance of global health (GH) residency education but little guidance on what departmental, financial, and human resource support is required to develop a GH track. The authors aimed to identify essential factors and major obstacles to the development of a GH track. Methods A survey assessing curriculum, support, and factors considered essential to or obstacles to successful development of a GH track was sent to 24 GH education directors within pediatric residencies. Results In all, 19 programs (79%) completed the survey, and 6 factors were identified as essential for developing and sustaining a GH track by ≥95% of all GH education directors: supportive residency program director, resident commitment, supportive department chair, protected resident elective time, dedicated budget, and GH faculty with protected time. Conclusions Residency programs aiming to start a GH track should start by assessing the availability and sustainability of these identified essential factors within their program.

Global Health: Preparation for Working in Resource-Limited Settings

In this article, the authors outline the scope of provider involvement in GH, highlight specific considerations and issues, and summarize preparation recommendations from the literature. Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships.

Global Challenges, Efforts, and Controversies in Neonatal Care

Simple low-cost, evidence-based interventions such as clean delivery practices, immediate warming, umbilical cord care, and neonatal resuscitation could prevent 40% to 70% of newborn deaths globally, but many obstacles preclude the provision of those basic interventions for all newborns, particularly in low-resource regions. Global efforts have led to widespread development of neonatal clinical practice guidelines, training programs, and policies. Because of a shortage of health care resources, standards of care have been redefined to meet the needs of underserved populations. This article provides an overview of the challenges, efforts, and controversies surrounding neonatal health in low-resource settings.

Pediatricians and Global Health: Opportunities and Considerations for Meaningful Engagement

In this review, we describe opportunities, resources, and important personal and professional considerations for US-based pediatric practitioners who are engaged in GCH. Pediatric practitioners whose expertise is primarily focused on the care of children within health settings in the United States are increasingly engaged in global child health (GCH). The wide spectrum of this involvement may include incorporating short-term or longer-term GCH commitments in clinical care, teaching and training, mentoring, collaborative research, health policy, and advocacy into a pediatric career. We provide an overview of routes of engagement, identify resources, and describe important considerations for and challenges to better equipping US pediatric practitioners to participate in meaningful GCH experiences. This article is part of a series on GCH describing critical issues relevant to caring for children from an international perspective.

Hospitalization for Failure to Thrive: A Prospective Descriptive Report:

Failure to thrive (FTT) is a common symptom leading to hospitalization of children. Most literature describing this population is from 30 years ago. Since that time the hospitalized population has become more medically complex. We aimed to describe children hospitalized for FTT in a tertiary care pediatric hospital. We prospectively collected demographic, anthropometric, evaluation, and outcome data for 92 consecutive children admitted with FTT. The majority of children grew with behavioral interventions alone (primary nonorganic FTT) and had negative evaluation (n = 63). Children with primary organic FTT had longer hospital stays (7 vs 4 days; P < .001) and lower daily weight gain (35 vs 58 g/d; P < .001). Laboratory, radiological, and endoscopic evaluation rarely led to a diagnostic etiology of FTT in hospitalized children. We conclude that children hospitalized with FTT should be observed for weight gain prior to pursuing diagnostic investigation.

Landscape Analysis of Global Health Tracks in United States Pediatric Residencies: Moving Toward Standards

OBJECTIVE The number of pediatric Global Health (GH) tracks has more than doubled in less than 10 years. The goal of this study was to describe the characteristics of the pediatric GH tracks to identify commonalities and differences in track structure, funding, and education. In addition, we also identified demographic, institutional, and residency-related factors that were significantly associated with educational offerings and logistical challenges. METHODS A cross-sectional survey was electronically administered to pediatric residency programs with GH tracks. Statistical analyses included frequencies to describe GH track characteristics. Fishers exact tests were used to identify bivariate associations between track structure and funding with educational offerings and logistical challenges. RESULTS Leaders of 32 pediatric GH tracks (67%) completed the survey. The majority of GH tracks were completed within the 3 years of residency (94%) and identified a GH track director (100%); however, tracks varied in size, enrollment methods, domestic and international partnerships, funding, and evaluations. Dedicated faculty time and GH track budget amounts were associated with more robust infrastructure pertaining to resident international electives, including funding and mentorship. Many tracks did not meet American Academy of Pediatrics recommended standards for clinical international rotations. CONCLUSIONS Despite the presence of multiple similarities among pediatric GH tracks, there are large variations in track structure, education, and funding. The results from this study support the proposal of a formal definition and minimum standards for a GH track, which may provide a framework for quality, consistency, and comparison of GH tracks.