Figure 1
Integration of knowles’ adult learning principles into the GHSP curriculum.
Source: Adapted from knowles, Holton & Swanson (1998), Androgogy in Practice.
Figure 2
Overview of the GHSP curriculum over the three years of residency.
Table 1
Characteristics of study participants.
| CHARACTERISTICS | VALUES N (%) |
|---|---|
| Gender identity Females Males Non‑binary Transgender Prefer to describe Prefer not to answer | (n = 37) 18 (48.6%) 19 (51.4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) |
| Age category 25–30 31–35 36–40 | (n = 37) 2 (5.4%) 25 (67.6%) 10 (27.0%) |
| Race American Indian/Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White Other (please specify) Prefer not to answer | (n = 37) 4 (10.8%) 0 (0) 0 (0) 0 (0) 33 (89.2%) 0 (0) 0 (0) |
| Ethnicity Hispanic/Latinx Not Hispanic/Latinx Prefer not to answer | (n = 37) 1 (2.7%) 36 (97.3%) 0 (0%) |
| Current resident/fellow Yes No | (n = 29) 7 (24.1%) 22 (75.9%) |
| Year Global Health Scholars Program completed 2016 2017 2018 2019 2020 2021 2022 2023 (Still a resident) | (n = 37) 3 (8.1%) 1 (2.7%) 9 (24.3%) 8 (21.6%) 8 (21.6%) 4 (10.8%) 3 (8.1%) 1 (2.7%) |
Table 2
Changes in knowledge before and after participating in the Global Health Scholars Program.
| ASSESSMENT VARIABLES C I UNDERSTOOD OR COULD… | MEAN (SD) BEFORE TRAINING (N = 30) | MEAN (SD) AFTER TRAINING (N = 30) | P VALUE1 | EFFECT SIZE2 | |
|---|---|---|---|---|---|
| Effects of physical and emotional health among those without housing | Range | 3.67 (0.66) 2–5 | 4.27 (0.56) 3–5 | < 0.001 | 0.750 |
| Health and access problems among immigrant populations | Range | 3.20 (0.81) 2–4 | 4.13 (0.78) 2–5 | < 0.001 | 0.828 |
| Health‑related challenges among the prison population | Range | 2.90 (0.71) 2–4 | 3.33 (0.99) 2–5 | 0.007 | 0.817 |
| Health and well‑being challenges among those with human immunodeficiency virus (HIV) | Range | 3.23 (0.73) 2–4 | 4.10 (0.85) 2–5 | < 0.001 | 0.937 |
| Health and access problems among indigenous populations | Range | 2.87 (0.78) 2–5 | 4.13 (0.82) 2–5 | < 0.001 | 0.868 |
| Effects of structural violence on those living in underserved communities | Range | 3.17 (0.99) 1–5 | 4.03 (0.97) 2–5 | < 0.001 | 0.937 |
| Effects of inequities in healthcare on underserved communities | Range | 3.50 (0.82) 2–5 | 4.40 (0.68) 3–5 | < 0.001 | 0.803 |
| Effects of systemic racism on those in underserved communities | Range | 3.20 (0.76) 2–5 | 4.00 (0.83) 2–5 | < 0.001 | 0.887 |
| Describe the context in which care is provided to Portland’s underserved communities | Range | 2.57 (1.10) 1–5 | 4.30 (0.60) 3–5 | < 0.001 | 1.230 |
| Define structural violence and social determinants of health | Range | 3.33 (0.96) 1–5 | 4.30 (0.65) 3–5 | < 0.001 | 0.999 |
| Describe how systemic racism impacts access to care and healthcare outcomes | Range | 3.10 (0.89) 1–5 | 4.07 (0.69) 3–5 | < 0.001 | 0.964 |
| Use structural analysis to examine challenges faced by underserved populations | Range | 2.43 (0.82) 1–4 | 3.17 (1.10) 1–5 | < 0.001 | 1.048 |
| Recognize the impact of historical trauma on communities today | Range | 2.93 (0.94) 2–5 | 3.97 (0.93) 2–5 | < 0.001 | 0.964 |
| Identify potential structural solutions to improve care outcomes | Range | 2.93 (0.69) 1–4 | 3.83 (0.70) 3–5 | < 0.001 | 0.845 |
| Critically reflect on clinical experiences during residency | Range | 3.67 (0.55) 3–5 | 4.30 (0.79) 1–5 | 0.001 | 0.964 |
| Engage in advocacy related to patient care | Range | 3.07 (0.74) 2–4 | 3.90 (0.92) 2–5 | < 0.001 | 0.791 |
[i] Scale: 1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = strongly agree.
[ii] 1Pre‑ versus post‑training, paired t‑test.
[iii] 2Cohen’s d (a Cohen’s d of 0.50 or greater indicates a medium or educationally meaningful difference).
Table 3
Intended or actual practice in underserved settings among global health scholar program graduates.
| UNDERSERVED PRACTICE STATUS/PLANS | VALUES |
|---|---|
| Recent graduates/residents (2021–2023) Intention to practice1 None/low Moderate High/very high | (n = 7) n (%) 2 (26.8%) 3 (42.9%) 2 (26.8%) |
| If intention is none or low, reasons why Family location decisions | (n = 2) 2 (100%) |
| Graduates in independent practice Currently practice is in underserved setting: Yes No | (n = 22) n (%) 9 (40.9%) 13 (59.1%) |
| If no, reasons why2 Family location decisions Took hospitalist/academic medical center job | (n = 11) 6 (54.5%) 5 (45.5%) |
| Graduates in independent practice2 Current practice is in: Urban underserved area Rural underserved area International underserved area | (n = 4) n (%) 3 (75.0%) 2 (50.0%) 1 (25.0%) |
| Graduates in independent practice Current practice setting Primary care (outpatient) Hospital medicine Specialty | (n = 20) n (%) 2 (10.0%) 12 (60.0%) 6 (30.0%) |
| Populations regularly worked with2 FQHC Indigenous Houseless Corrections Migrant/immigrant Limited English proficiency LGBTQ+ Medicaid Veterans | (n = 9) 1 (11.1%) 4 (44.4%) 6 (66.7%) 2 (22.2%) 4 (44.4%) 5 (55.6%) 1 (11.1%) 7 (77.8%) 1 (11.1%) |
[i] 1Scale: 1 = none; 2 = low; 3 = moderate; 4 = high; 5 = very high.
[ii] 2Categories not mutually exclusive.