Sophia P. Gladding

Development of a competency-based curriculum in global child health.

Resident interest in global health is increasing; however, a paucity of literature on competency-based curricula in global child health is available. A collaborative group including members from the University of Minnesota (UMN) Department of Pediatrics, the UMN College of Education and Human Development, and the Makerere University Department of Paediatrics and Child Health in Kampala, Uganda, developed a competency-based global child health curriculum for pediatrics residents at UMN. The group defined competencies for each of the Accreditation Council for Graduate Medical Education competency domains and developed the curriculum via six steps: (1) defining competencies specific to global child health, (2) authoring goals and objectives for each competency, (3) assigning appropriate postgraduate training levels to each competency, (4) determining intended resident groups for each competency, (5) aligning the program with the existing residency education program, and (6) developing methods to evaluate acquisition of each competency. Faculty implemented the competency-based curriculum in 2009, and the curriculum is now freely available online for adaptation and use by other residency programs. Faculty are currently introducing evaluation methods, which will allow them, for the first time, to assess a trainees competency in global child health by the end of his or her residency. The authors believe that the development of this curriculum represents an important step forward in global health education for pediatric residents and that other residency programs, including those of nonpediatric specialties, can use the process as a model to develop global health curricula.

An Entrustable Professional Activity (EPA) for Handoffs as a Model for EPA Assessment Development

Medical education is moving toward assessment of educational outcomes rather than educational processes. The American Board of Internal Medicine and American Board of Pediatrics milestones and the concept of entrustable professional activities (EPA)—skills essential to the practice of medicine that educators progressively entrust learners to perform—provide new approaches to assessing outcomes. Although some defined EPAs exist for internal medicine and pediatrics, the continued development and implementation of EPAs remains challenging. As residency programs are expected to begin reporting milestone-based performance, however, they will need examples of how to overcome these challenges. The authors describe a model for the development and implementation of an EPA using the resident handoff as an example. The model includes nine steps: selecting the EPA, determining where skills are practiced and assessed, addressing barriers to assessment, determining components of the EPA, determining needed assessment tools, developing new assessments if needed, determining criteria for advancement through entrustment levels, mapping milestones to the EPA, and faculty development. Following implementation, 78% of interns at the University of Minnesota Medical School were observed giving handoffs and provided feedback. The authors suggest that this model of EPA development—which includes engaging stakeholders, an iterative process to describing the behavioral characteristics of each domain at each level of entrustment, and the development of specific assessment tools that support both formative feedback and summative decisions about entrustment—can serve as a model for EPA development for other clinical skills and specialty areas.

Should we Google it? Resource use by internal medicine residents for point-of-care clinical decision making.

Purpose To determine which resources residents use at the point-of-care (POC) for decision making, the drivers for selection of these resources, and how residents use Google/Google Scholar to answer clinical questions at the POC. Method In January 2012, 299 residents from three internal medicine residencies were sent an electronic survey regarding resources used for POC decision making. Resource use frequency and factors influencing choice were determined using descriptive statistics. Binary logistic regression analysis was performed to determine relationships between the independent variables. Results A total of 167 residents (56%) responded; similar numbers responded at each level of training. Residents most frequently reported using UpToDate and Google at the POC at least daily (85% and 63%, respectively), with speed and trust in the quality of information being the primary drivers of selection. Google, used by 68% of residents, was used primarily to locate Web sites and general information about diseases, whereas Google Scholar, used by 30% of residents, tended to be used for treatment and management decisions or locating a journal article. Conclusions The findings suggest that internal medicine residents use UpToDate most frequently, followed by consultation with faculty and the search engines Google and Google Scholar; speed, trust, and portability are the biggest drivers for resource selection; and time and information overload appear to be the biggest barriers to resources such as Ovid MEDLINE. Residents frequently used Google and may benefit from further training in information management skills.

Simulation Use for Global Away Rotations (SUGAR): Preparing Residents for Emotional Challenges Abroad—A Multicenter Study

BACKGROUND Preparation for residents participating in global health (GH) experiences is critical. Active preparatory curricula allowing residents to experience and debrief emotional challenges they may encounter abroad are generally lacking. We sought to evaluate a novel simulation curriculum designed to prepare residents for emotions they may experience in response to challenges abroad. METHODS Pediatric GH educators from 7 institutions developed case vignettes incorporating common challenges residents experience abroad. Residents participating in a GH training track or planning to participate in a GH rotation from the 7 institutions were eligible to participate in the simulation curriculum. Participants and trained facilitators completed postsimulation evaluations that were analyzed using descriptive statistics and thematic analysis of written comments to assess the utility of the curriculum, emotions evoked, and changes residents anticipated making to their GH rotation preparation. RESULTS Fifty-one residents and 16 facilitators completed 160 and 52 evaluations, respectively. Overall, respondents found the simulations useful (mean [SD] resident score 4.49 [0.82] and facilitator score 4.85 [0.36] on a 5-point scale [1 = completely useless, 5 = very useful]). Residents reported strong emotions in 153 (98%) of 156 comments. After the sessions, 131 (96%) of 137 comments reflected anticipated changes to GH rotation preparation plans. CONCLUSIONS Active preparation for GH rotations using simulated cases appears to be a useful tool that can be implemented across a variety of sites with minimal facilitator training or simulation experience. The curriculum successfully elicited powerful emotions in residents and provided an opportunity to debrief these experiences before encountering them abroad.

Evidence within a portfolio-based assessment program: What do medical students select to document their performance?

Background: Decisions about performance in programs of assessment that provide an array of assessment evidence require judgments about the quality of different pieces of assessment data to determine which combination of data points best represent a trainees overall performance. Aim: In this article, we examine the nature of evidence selected by first-year medical students to include in a portfolio used to make promotion decisions. Methods: We reviewed portfolios to examine the number, type, and source of assessments selected by students (n = 32) to document their performance in seven competencies. The quality of assessment data selected for each competency was rated by promotion committee members (n = 14). Results: Findings indicate that students cited multiple types and sources of available assessments. The promotion committee rated evidence quality highest for competencies where the program provided sufficient evidence for students to cite a broad range of assessments. When assessments were not provided by the program, students cited self-generated evidence. Conclusion: We found that when student-constructed portfolios are part of an overall assessment system, students generally select evidence in proportion to the number and types of assessments available.

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.

Pediatric Global Health Education: Past, Present, and Future

Recent outbreaks of diseases erroneously thought by many to be contained by borders or eliminated by vaccines have highlighted the need for proper training of all residents in global health. Beyond infectious diseases, all pediatricians should know how to care for other conditions in global child health, ranging from malnutrition to the nuances of care for immigrant and refugee children. The call for broader education for pediatric residents in global health has been increasing over the last decade, with all major pediatric organizations underscoring its importance in statement and action. Herein, the current status of global child health education in pediatric residency training in the United States is summarized, highlighting where it has been, where it is now, and where it should go next.

Making Global Health Rotations a Two-Way Street A Model for Hosting International Residents

As US residency programs are increasingly offering global health electives for their trainees, there is a growing call for these opportunities to include bidirectional exchanges—where residents from both the US and international partner institutions rotate at the other’s site. Curricular, logistical, and funding challenges of hosting residents from an international site may be barriers to developing these programs. In this report, the authors describe an 8-year experience of a US institution hosting residents from a resource-limited international partner and provide a framework for others institutions to develop bidirectional exchanges. They also report the visiting international residents’ perceptions of the impact of the exchange on their clinical practice, teaching, career paths, and their home institution.

The development and implementation of a competency-based curriculum for training in global health research.

The Fogarty International Center (FIC) Global Health Fellows Program provides trainees with the opportunity to develop research skills through a mentored research experience, increase their content expertise, and better understand trends in global health research, funding organizations, and pathways to generate support. The Northern Pacific Global Health Fellows Research and Training Consortium, which hosts one of the FIC Global Health Programs, sought to enhance research training by developing, implementing, and evaluating a competency-based curriculum that uses a modular, asynchronous, web-based format. The curriculum has 8 core competencies, 36 learning objectives, and 58 assignments. Nineteen trainees completed their 11-month fellowship, engaged in the curriculum, and provided pre- and post-fellowship self-assessments. Self-assessed scores significantly improved for all competencies. Trainees identified the curriculum as one of the strengths of the program. This competency-based curriculum represents a first step toward creating a framework of global health research competencies on which further efforts could be based.

Using Simulation for Global Health Preparation

* Abbreviations: GH — : global health GHE — : global health education SUGAR — : Simulation Use for Global Away Rotations Participation in global health electives (GHE) by pediatric residents continues to grow. In 2013, more than half of residency programs in the United States offered international electives, and 1 in 15 residents participated in such an experience during that year.1 Pretravel preparation for these experiences has been established as a best practice and should include learning about diseases likely to be encountered, health and safety abroad, site-specific information, and strategies to address cultural differences.2 Unfortunately, of the 127 programs offering GHE in 2013, only two-thirds (66.1%) provided pretravel preparation.1 Increasingly, preparatory curricula are available ranging from online self-directed modules to standardized lectures with facilitator guides for faculty.3 Much of the focus is on medical knowledge including topics such as the management of tropical diseases. Although this knowledge is an integral part of pretravel preparation, in our experience, trainees note that the more common challenges they experience working in resource-limited settings involve emotional and ethical issues that emerge while abroad. As such, preparation that focuses solely on the acquisition of knowledge, but ignores the skills and attitudes needed to practice global child health, may be short-sighted.4 We wish to highlight the need for comprehensive preparation for GHE that goes beyond merely transfer of medical knowledge … Address correspondence to Michael B. Pitt, MD, Department of Pediatrics, M653, 2450 Riverside Ave South, Minneapolis, MN 55454. E-mail: mbpitt{at}umn.edu