Figure 1
Selection Process Used in the Systematic Review.
Table 1
Details of the Studies Included in the Systematic Review.
| First author | Global health program | Learning objectives, pre-departure training, post-elective debriefing | Host countries | Study and comparison groups | Assessment tool (response rate) | Major findings |
|---|---|---|---|---|---|---|
| Miller et al [34] | Duke International Health Program Established: 1987 PGY: 2 or 3 Duration (weeks): 12 Funding: airfare covered | Learning objectives: learn global health and tropical medicine, provide cross-cultural experience, appreciate health care in another country Pre-departure training: not reported Post-elective debriefing: not reported | Brazil, China, Pakistan, Taiwan, Tanzania | Study group: internal medicine and med-peds residents (total n = 57) Comparison group: internal medicine and med-peds residents (total n = 123) | Survey using 7-point Likert scale with open ended question (91%) | Participants reported improvement of medical knowledge and tropical medicine and clinical diagnostic skills Minority of participants reported reduction in lab use Participants more likely to change career plans to academic medicine, public health, and include work abroad in the future Health consequences included traveler’s diarrhea, conversion of PPD, and malaria |
| Gupta et al [33] | Yale International Health Program Established: 1981 PGY: 2 or 3 Duration (weeks): 4–8 Funding: airfare, housing, and partial living expenses covered | Learning objectives: observe primary care in diverse cultural settings, promote cost-consciousness with practice of the physical examination, engender sense of social responsibility Pre-departure training: not reported Post-elective debriefing: not reported | Fiji, Haiti, Tanzania, Zimbabwe | Study group: internal medicine residents (n = 96) Comparison group: internal medicine residents (n = 96) | Survey using 7-point Likert scale with open ended question (61%) | Participants reported improvement of the physical examination and believed it was under-used Participants more likely to plan to volunteer or work abroad in the future Participants more likely to work with patients on public assistance, immigrants, substance abusers, and HIV infected Participants more likely to work in public health and less likely in private practice; however, no difference in careers in general or subspecialty medicine |
| Nuckton et al [30] | Tulane Program in Community Medicine Established: not reported PGY: 3 or 4 Duration (weeks): 4 Funding: airfare and living expenses partially covered | Learning objectives: observe healthcare in another country, learn new pathology, develop cultural competency Pre-departure training: reviewed history and endemic conditions to host country, counseled on health precautions Post-elective debriefing: not reported | Guatemala, Belize | Study group: med-peds residents (n = 3) Comparison group: none | Log of clinical cases (100%) | Total of 803 cases logged, most common disease category was gastrointestinal, accounting for 26% of cases Intestinal parasites represented 11% of cases and included: ascariasis, chilomastix, entamoeba, endolimax, giardia, hymenolepis, plasmodium, taenia, and trichomonas Health consequences included diarrhea with two participants treated for intestinal parasites (one confirmed, one presumed) |
| Federico et al [28] | University of Colorado Department of Pediatrics Global Health Elective Established: 2000 PGY: 2 or 3 Duration (weeks): 4 Funding: housing and in-country transportation covered | Learning objectives: observe health care and common medical and public health problems in another country, learn medicine and social interactions in a second language Pre-departure training: monthly discussions on history, culture, and language of host country, tropical medicine, safety precautions Post-elective debriefing: not reported | Guatemala, Peru | Study group: pediatric residents (n = 13) Comparison group: none | Log of clinical cases (93%) | Total of 890 cases logged with 18% of cases related to a disease never seen and 6% of cases to a disease in an advanced stage never before seen Thirty-two percent of cases related to infectious diseases and included: amebiasis, ascariasis, brucellosis, cysticercosis, echinococcus, leishmaniasis, leptospirosis, strongyloidiasis, tetanus, toxocariasis, and typhoid |
| Castillo et al [27] | Cincinnati Children’s Hospital Medical Center Global Health Scholars Program Established: 2007 PGY: 2–4 Duration (weeks): 2–4 Funding: not reported | Learning objectives: not reported Pre-departure training: counseled on cross-cultural communication, safety, legal requirements Post-elective debriefing: conducted but not described | Cambodia, Dominican Republic, Haiti, Honduras, Japan, Kenya, South Africa, Swaziland, Tanzania | Study group: pediatric and med-peds residents (total n = 13) Comparison group: none | Reflective journal passages coded for qualitative analysis using the ASTMH three competency domainsa (100%) | Participants reflected on 2 of 3 ASTMH competency domains: immigrant health (100%), burden of global disease (77%), and traveler’s medicine (0%) Two additional themes noted: humanitarianism (46%) and parental sacrifice (46%) Participants described improvement of cultural awareness and reflected on the need to build deeper relationships with patients, be better listeners, and be more patient Participants reported an increased desire to volunteer and advocate for future humanitarian outreach |
| Hau et al [29] | Weill Cornell Medical College Global Health Elective Established: 2006 PGY: 3 Duration (weeks): 4–6 Funding: airfare, vaccines, and visa covered | Learning objectives: not reported Pre-departure training: conducted but not described Post-elective debriefing: conducted in the host country but not described | Tanzania | Study group: internal medicine (n = 21) and pediatric (n = 18) residents (total n = 39) Comparison group: internal medicine (n = 14) and pediatric (n = 13) residents (total n = 27) | Survey using 7-point Likert scale with open ended question (58%) | Participants reported improved knowledge of global health, tropical medicine, and physical examination Participants rated routine laboratory testing as overused Majority of participants reported reduction in laboratory and/or radiologic tests No difference in career plans in general or subspecialty medicine |
| Gladding et al [35] | University of Minnesota Department of Pediatrics Global Health Track Established: 2005 PGY: 2 or 3 Duration (weeks): not reported Funding: not reported | Learning objectives: not reported Pre-departure training: not reported Post-elective debriefing: not reported | Bolivia, Cambodia, Ethiopia, Lebanon, Nicaragua, Panama, Tanzania, Uganda | Study group: pediatric (n = 21) and med-peds (n = 11) residents (total n = 32) Comparison group: none | Reflective essays analyzed for themes and grouped into 6 ACGME competenciesb (78%) | Greater than 90% of participants reflected on the ACGME competencies of: patient care, medical knowledge, and systems-based practice Greater than 50% of participants reflected on: practice-based learning and improvement, professionalism, interpersonal and communication skills, and profession and personal development (extra domain) Participants described improvement in communication with patients and health care workers despite language barriers as well as in working with interpreters Participants described use of local equipment that differed compared to those used in the US |
| Shull et al [31] | UCLA Department of Medicine Global Health Elective Established: 2008 PGY: 3 or 4 Duration (weeks): 3 Funding: airfare, housing, and in-country transportation covered | Learning objectives: provide knowledge and skills needed to treat patients in a developing country Pre-departure training: reviewed history, culture, and conditions endemic to the host country, learned local antiretroviral therapy protocols, counseled on health precautions Post-elective debriefing: conducted but not described | Malawi | Study group: internal medicine (n = 24) and med-peds (n = 9) residents (total n = 33) Comparison group: internal medicine and med-peds residents (n=not reported) | Survey using 4-point Likert scale with open ended question (83%) | Participants reported improved knowledge of HIV, tropical medicine, and physical examination One-third of participants reported reduced reliance on imaging Participants reported a broadened perspective on health care delivery in resource poor settings and increased awareness of cost-effectiveness Participants more likely to work in general internal medicine than nonparticipants Health consequences reported but not described |
| Arora et al [26] | UCLA Department of Pediatrics/UCLA School of Medicine Global Health Education Program Established: 2008 PGY: 3 Duration: not reported Funding: not reported | Learning objectives: not reported Pre-departure training: conducted but not described Post-elective debriefing: conducted but not described | Not reported | Study group: pediatric residents (n = 16) Comparison group: none | Debriefing interview with open-ended questions (84%) | Participants at partner sites (i.e., sites with established relationships) more likely to recommend abroad elective than those at nonpartner sites Participants at nonpartner sites experienced increased challenges like: limited educational opportunities, inaccurate resident expectations, and gaps in supervision One participant described their first attempt at a bone marrow biopsy without supervision from a fellow or attending physician |
| Balmer et al [32] | Baylor College of Medicine/Texas Children’s Hospital Global Child Health Program Established: 2010 PGY: 2–4 Duration (weeks): 4–52 Funding: not reported | Learning objectives: not reported Pre-departure training: not reported Post-elective debriefing: conducted but not described | Botswana, Lesotho, Malawi, Swaziland | Study group: categorical pediatric residents (n = 9) who spent 1 month abroad and global health pediatric residents (n = 9) who spent 12 months abroad (total n = 18) Comparison group: none | Semistructured interview with focus on reentry transitions using closed card sorting to assess emotional responses (53%) | Participants reported emotions of appreciation and inspiration but also expressed frustration and sadness Global health residents abroad for 12 months were more likely to report emotions of disconnection and confusion than categorical residents abroad for 1 month Categorical residents abroad for 1 month reported more invigoration compared to global health residents abroad for 12 months |
[i] Abbreviations: PGY, postgraduate year; Med-peds, medicine-pediatrics; PPD, purified protein derivative; HIV, Human Immunodeficiency Virus; ASTMH, American Society for Tropical Medicine and Hygiene; ACGME, Accreditation Council for Graduate Medical Education.
a ASTMH 3 competency domains: (1) burden of global disease, (2) immigrant health, and (3) traveler’s medicine.
b ACGME 6 competencies: (1) patient care, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism, and (6) systems-based practice.