Shannon Bolon, MD, MPH, University of Cincinnati; Christopher Morley, PhD, State University of New York-Upstate, Scott Loeliger, MD, Contra Costa Health Services; Christy O’Dea, MD, University of Cincinnati; Diana Clemow, MD, AnMed Health Family Medicine Residency Program

The concept of training in global health during residency is catching on as a way to prepare physicians to deal with an increasingly diverse patient body locally, as well as to care for underserved populations around the world. Here, we present three programs with different but effective approaches to global health training.

The Christ Hospital/University of Cincinnati Family Medicine Residency Global Health Program

The Global Health program at The Christ Hospital/University of Cincinnati Family Medicine Residency Program was established in the early 1990s. Two residency faculty have protected administrative and teaching time, and additional faculty members teach and precept during field experiences. Through regular trips, the residency formed a strong relationship with the remote town of Santa Lucia, Intibucá, Honduras, leading to the formation of Shoulder to Shoulder, Inc. Shoulder to Shoulder partners with 14 residencies and is a model for how residency programs can make sustained, meaningful impact in resource-poor settings.^1,2 This partnership provides learners with organized clinical, public health, and research experience.

First-year participants in the Global Health track attend a Global Health Course and spend 2 weeks at a Shoulder to Shoulder site or in local community health centers and homeless clinics. Second-year residents help organize and run brigades to Honduras or Ecuador. Third-year residents create their own field experience. First- and second-year activities are fully funded, while third-year residents receive $2,000 in support. The Global Health Course and field experiences are open to residents and medical students from outside programs.

AnMed Health Family Medicine Global Health Track

The AnMed Health Family Medicine Global Health Track began in 2008 to provide a structured curriculum for residents with global health interests. Previously, travel was encouraged but without formal preparatory teaching. The program has seen early success due to a dedicated faculty coordinator, engaged faculty members, and a supportive program director. This unopposed community-based residency overcame struggles to create and teach the curriculum by using online resources and written materials. To ensure sustainability, AnMed is starting a 501(c)3.

Since implementing the Global Health Track, AnMed has had more residency applicants. Resident feedback is positive. A second-year resident wrote, “It is difficult to communicate the value of a trip like this… I do hope that Africa has made a dent in me—in my first-world, endless resource perspective on medicine and life—and that as a result I’ll be better prepared to effectively serve abroad.”

A Socially Responsible Residency in Contra Costa County Goes Global

The Contra Costa Family Medicine Residency Program’s goal is to produce physicians with comprehensive clinical skills who can practice in any underserved locale. The residency program has a rich tradition of work and study in and out of the United States, strengthening learners’ dedication to serve those most vulnerable. A newly realized global health track was created by the initiative of current residents, who built a Web site and established field experiences with local preceptors in Uganda and Tanzania.

The Mark Stinson Fellowship in Underserved and Global Health grew out of this tradition. It was created with the ideals of “global family physicians that are driven by social justice and humanitarianism to provide medical services where medical resources are limited.” This 2-year post-residency fellowship combines an MPH from UC Berkeley with research skills and increased competency in high-level, broad-spectrum family medicine.

Conclusions

In today's world, there are observable health disparities across international borders, infectious diseases traveling along with displaced populations, and failed infrastructures in poorer nations leading to catastrophic results in the face of natural disasters. Programs like these and others across the United States and Canada are leading the way in preparing future family physicians for practice in a shrinking world.

References
1. www.shouldertoshoulder.org/partners.html
2. Heck JE, Bazemore A, Diller PM. The Shoulder to Shoulder Model—channeling medical volunteerism toward sustainable health change. Fam Med 2007;39(9):644-50.