Global Health Competencies in Residencies and Fellowships Natasha - - PowerPoint PPT Presentation

Global Health Competencies in Residencies and Fellowships

Natasha Anushri Anandaraja MD, MPH Mount Sinai Global Health Center

Methods

• Review of SAEM, ACEP, AAEM, AAP, AMA, AAFP websites
• Review of websites of all fellowships and residencies listed by

AMRA, SAEM, AAEM, GHSIG and AMSA as having GH Fellowships or residencies

• Personal Communication
• Pubmed and Google search for “global health residency

competencies” , “global health fellowship competencies” “global health residency “ “global health fellowship”, and “global health competency”

• Data from NYS Institution survey

Have Competencies for GH Residencies or Fellowship programs been developed?

• 1. Accreditation/Academic bodies
• 2. Individual Residency and Fellowship

Programs

Accrediting / Academic Organizations

American College of Graduate Medical Education (ACGME)

Competencies: Specific knowledge, skills, behaviors and attitudes and the appropriate educational experiences required of residents to complete GME programs Patient Care Medical Knowledge Practice-based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-based Practice

American Academy of Pediatrics – Section on International Child Health

“Competency-based goals and

• bjectives ...intended as

comprehensive guidelines for pediatric residency programs

• ffering some organized

form of training in global

• r international health”

1:Patient Care 2: Medical Knowledge 3: Interpersonal Skills and Communication 4: Practice-based Learning and Improvement 5: Professionalism 6: Systems-based Practice

Competency 1. Patient Care

Provide family-centered patient care that is development- and age-appropriate, compassionate, and effective for the treatment of health problems and the promotion

• f health.
• 1. Use a logical and appropriate clinical approach to the care of patients in a

developing country setting, utilizing locally available resources, and applying principles of evidence-based decision-making and problem-solving.

• 2. Understand the approach to pediatric patients with the following presentations in

developing countries and initiate appropriate work-up and management: – Diarrhea/dehydration – Respiratory Distress – Fever – Seizures/Altered Mental Status – Malnutrition (including Severe Acute Malnutrition)

• 3. Provide culturally sensitive care and support to patients and their families.
• 4. Participate in health promotion and injury/disease prevention activities in an

international setting, utilizing local guidelines and practices.

Competency 2: Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and social- behavioral knowledge needed by a pediatrician; demonstrate the ability to acquire, critically interpret and apply this knowledge in patient care and community health. – Epidemiology/Public Health – Malnutrition and Infectious Diseases – Specific Populations

• Become familiar with the presentation, diagnosis, management, and prevention strategies of the

following specific diseases in resource-limited settings, based on local and international guidelines: – Malaria - uncomplicated and complicated/severe (e.g. Cerebral malaria) – Pneumonia – Diarrhea and dysentery – Measles – Neonatal infections including neonatal tetanus – HIV/AIDS and related infections/complications – Tuberculosis – Typhoid Fever – Dengue Fever

Competency 4: Practice-based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one's patient care practice

• 1. Identify standardized guidelines (e.g., WHO/UNICEF) for diagnosis and treatment of conditions

common to developing countries and adapt them to the individual needs of specific patients 2. Know and/or access appropriate medical resources and apply them to the care of patients in the developing country setting 3. Understand the principles of evidence-based medicine and apply them when reviewing recent literature and considering the implications for impact on practice

• 4. Work collaboratively with health care team members to assess, coordinate, and improve patient

care practices in settings with limited resources

• 5. Apply and improve upon physical examination skills and clinical diagnosis in settings where

diagnostic studies are limited

• 8. Understand the role of the pediatrician in responding to humanitarian emergencies and disaster

relief efforts, within the context of participating local and international organizations, and become familiar with available resources to prepare for volunteering in this setting

Residencies and Fellowships

Residencies and Fellowships

• EM, IM, Peds, FP
• Curricular components either created specifically for program OR

participants take part in associated MPH program or coursework from an outside institution

• Many objectives but few competencies
• Competencies either created within framework of ACGME

competencies or GH-unique objectives/competencies

NYS GH Fellowships and Residency Tracks

GH Residency Tracks

• Columbia
• Peds
• EM
• Mount Sinai
• Interdisciplinary Peds,

IM, EM, Psych

• OBGYN

IEM Fellowships

• Columbia
• North Shore-LIJ
• SUNY Downstate
• St Luke’s Roosevelt
• University of Rochester

Mount Sinai Interdisciplinary GH Residency

GHEC Competency Domains

Global Burden of Disease

Social and Environmental Determinants of Health Healthcare in Resource Poor Settings

Additional Domains: Research in Resource Poor Settings

Clinical Tropical Medicine Public Health Programming in Resource Poor Settings

University of Minnesota GH Track

for IM and Med-Pediatrics residents Program Components

1.Tropical Medicine Seminar Series or Pediatric Global Health Lecture Series

• 2. Scholarly Project
• 3. 8 week Tropical Med Global

Health Course

• 4. International Rotation
• 5. ASTMH Exam
• 6. Educational Portfolio

ACGME Competency Domains

1. Medical Knowledge 2. Patient Care - Physical Exam 3. Patient Care - Medical Decision Making 4. Patient Care - Consultative Process 5. Interpersonal Skills/ Communication 6. System-Based Practice 7. Practice-Based Learning and Improvement

• 1. Medical Knowledge
• Demonstrates understanding and working knowledge of the

IDSA's guidelines for travelers health

• Gains sufficient medical expertise and knowledge to

successfully pass the Certificate of Knowledge in Clinical Tropical and Travelers' Health Examination offered by the American Society of Tropical Medicine and Hygeine (ASTMH). In order to pass this examination Global Health Pathway Participants must

demonstrate competence in the core curriculum as outlined by the ASTMH and presented in the 8 week Trop Med course

• 2. Patient Care – Physical Exam
• Successfully performs a comprehensive, culturally respectful physical exam.
• Recognizes normal physical exam findings in ethnically diverse patients.
• Reliably identifies physical exam findings specific to commonly encountered

diseases in mobile populations, which special attention to:

Tropical dermatology Lymphadenopathy Hepatosplenomegaly Rheumatic heart disease

• Recognizes physical signs of traditional healing techniques and understands

risks of not recognizing these

• Understands importance of the physical exam in diagnosis of life threatening

conditions (ie tourniquet test for severe Dengue).

• 3. Patient Care - Medical Decision

Making

• Tailors evaluation and management decisions according to geographic, epidemiologic, and

ethnic risk factors

• Conducts a thorough new arrival screening history & exam and order appropriate studies

and referrals

• Understands how biostatistics, such as positive and negative predictive value, impact the

accuracy of diagnostic studies used in mobile populations

• Performs thorough, individualized pre-travel consultation including the selection of

appropriate anti-malarial prophylaxis regimens with particular attention to the unique risks of the VFR traveler

• Triages mobile populations appropriately, taking into account illness risk (ie. decisions

regarding the need for hospital admission)

• Isolates patients as needed according to infectious risk (eg. droplet precautions for

suspected bacterial meningitis vs airborne precautions for suspected tuberculosis)

• Knows when and how to seek post-exposure prophylaxis for exposures to selected

infectious diseases in local and international clinical settings (eg. management of needle- stick injuries)

Fellowships

Competency Sources:

• ACGME
• Proposed Fellowship Training Program in International Emergency
• Medicine. Academic Emergency Medicine, 6: 145–149. 1999. VanRooyen,
• M. J., Clem, K. J.,Holliman, C. J., Wolfson, A. B., Green, G. and Kirsch, T. D

Skills and Measurable Objectives

• 1. Integrate training in EM with knowledge of international health, and

apply acquired skills to clinical experience abroad

• 2. Demonstrate knowledge of public health issues as they pertain to

developing countries,

• 3. Obtain training in critical topics in international health, including

tropical medicine, infectious diseases, and general principles of disaster management.

• 4. Conduct research related to international health care
• 5. Develop, coordinate, and participate in international educational

exchanges

• 6. Present lectures on topics relating to international EM

INTERNATIONAL EMERGENCY MEDICINE FELLOWSHIP New York Presbyterian Columbia

Upon completion of the International Emergency Medicine Fellowship, the fellow will be able to:

• Successfully complete the requirements for the degree of Masters in Public

Health (MPH) at MSPH

• Display knowledge of public health issues as they pertain to displaced

populations in low-income countries. This will include work abroad and domestic educational opportunities.

• Display working knowledge of critical topics in international health.
• Conduct service-based research related to international health care.
• Integrate training in emergency medicine with international public health

and apply acquired skills to clinical experience abroad.

Evaluation

Strategies for evaluation of competencies

• Pre-post knowledge
• Self-assessment:

– Portfolios (Indiana IM, Minnesota)

• “Competency-based Portfolio: written documentation of how your

residency track experience has fostered growth in each of the six ACGME competencies (Patient Care, Medical Knowledge, Interpersonal Skills and Communication, Practice-based Learning and Improvement, Professionalism, and Systems-based Practice). To be reviewed yearly with your Global Health mentor“ (IM) – Reflective practice on practical experiences

• “written reflection of your experience” IU
• Mentor / Preceptor evaluation of resident
• Scholarly Work

Thank you