A review of local global health education in post-graduate medical education.

BACKGROUND: Global health (GH) education is offered in post-graduate medical education (PGME) programs and local experiences are desired by trainees and educators. This scoping review aimed to map the literature on local GH education in PGME, to describe curricular components, factors facilitating successes, and challenges to implementation using a validated education intervention checklist and inclusion of seven components of local GH programming. METHODS: A decolonization conceptual framework informed a 5-step scoping review. In May 2022, eight databases and MedEdPORTAL were searched using key words describing local GH education curricula. RESULTS: Sixty-eight full-text articles described local GH education programs in residencies (n = 52; 76.4%) and fellowships (n = 10; 14.7%) spanning multiple specialties, predominantly in North America (90%). Successful programs included faculty mentoring, community-based partnerships, and a multidisciplinary component. Scheduling challenges, cultural and linguistic differences, and trainee workload contributed to implementation difficulties. Only four programs included all seven local GH health equity/decolonization components. CONCLUSIONS: Local GH curricula vary widely in clinical experiences, didactic sessions, and inclusion of mentorship and partnerships. Local populations within the communities of these training programs could benefit from standardized inclusion of components for local global health education with careful consideration of health equity.

The ABCs of OTCs: A Video-Based Curriculum Regarding Over-the-Counter Pediatric Products.

Introduction: Over-the-counter (OTC) products are widely used by families with young children. To educate future pediatricians on OTC product counseling and support the health and safety of children under their care, modern, accessible, and engaging curricula are needed. Methods: We developed an OTC product curriculum consisting of seven videos and one facilitated group discussion using a flipped classroom pedagogy to educate students on counseling parents about OTC product use. Fourth-year medical students pursuing pediatric training from four institutions participated in the curriculum during their end-of-year transition-to-residency course. We measured effectiveness via a pre/post comparison using a student self-assessment with multiple-choice questions. A simulated parent call OSCE provided participants with an opportunity to apply their knowledge and receive directed formative feedback. Data were analyzed using descriptive and inferential statistics. Results: A total of 41 students participated in the curriculum and completed all assessments. The majority (93%) watched all the videos. All participants (100%) agreed the videos were useful. Knowledge improved significantly (pretest mean score = 70%, posttest mean score = 87%, p < .001). No significant differences were found when comparing institution, gender, prior experience, or electives. Discussion: We developed a feasible and effective video-based curriculum to teach OTC product guidance. Given the importance of discussing OTC medications with families and the need for convenient educational tools, this curriculum may have widespread application to medical students during clinical rotations as well as pediatric and family medicine trainees.

When Global Becomes Virtual: A Survey of Virtual Global Health Education Activities During the COVID-19 Pandemic Among Pediatric Educators.

Background: During the COVID-19 pandemic, global health education activities were disrupted. Transitioning to virtual options has allowed educators and trainees to continue global health education and partnerships, though the acceptability and implementation of this transition is unknown. Objective: To evaluate current and planned virtual global health education activities (VGHEAs) of a group of US global health educators during the COVID-19 pandemic and to assess perceived benefits and challenges of VGHEAs. Methods: A cross-sectional study of pediatric faculty and trainees involved in global health education from 8 institutions in the United States were surveyed anonymously about their global health education activities in 2021. Authors used representative convenience sampling and invited at least 1 faculty member and 2 trainees from each institution in the Midwest Consortium of Global Child Health Educators. Results: All 8 institutions responded to the survey, with 38 faculty and trainee participants. Institutional implementation of virtual education activities was variable. Respondents reported that VGHEAs allowed them to maintain partnerships with low-middle income countries, though they noted that unreliable internet connections presented challenges. One program reported funding cuts to its global health program during the pandemic. Conclusions: The COVID-19 pandemic created challenges for global health education programs. Educators and trainees are interested in using potentially cost-saving VGHEAs to maintain international collaborations, continue global health education efforts, and even increase access to equitable educational activities despite pandemic disruptions.

Antiarrhythmic drug-induced internalization of the atrial-specific k+ channel kv1.5.

Conventional antiarrhythmic drugs target the ion permeability of channels, but increasing evidence suggests that functional ion channel density can also be modified pharmacologically. Kv1.5 mediates the ultrarapid potassium current (I(Kur)) that controls atrial action potential duration. Given the atrial-specific expression of Kv1.5 and its alterations in human atrial fibrillation, significant effort has been made to identify novel channel blockers. In this study, treatment of HL-1 atrial myocytes expressing Kv1.5-GFP with the class I antiarrhythmic agent quinidine resulted in a dose- and temperature-dependent internalization of Kv1.5, concomitant with channel block. This quinidine-induced channel internalization was confirmed in acutely dissociated neonatal myocytes. Channel internalization was subunit-dependent, activity-independent, stereospecific, and blocked by pharmacological disruption of the endocytic machinery. Pore block and channel internalization partially overlap in the structural requirements for drug binding. Surprisingly, quinidine-induced endocytosis was calcium-dependent and therefore unrecognized by previous biophysical studies focused on isolating channel-drug interactions. Importantly, whereas acute quinidine-induced internalization was reversible, chronic treatment led to channel degradation. Together, these data reveal a novel mechanism of antiarrhythmic drug action and highlight the possibility for new agents that selectively modulate the stability of channel protein in the membrane as an approach for treating cardiac arrhythmias.

Rab-GTPase-dependent endocytic recycling of Kv1.5 in atrial myocytes.

The number of ion channels expressed on the cell surface shapes the complex electrical response of excitable cells. Maintaining a balance between anterograde and retrograde trafficking of channel proteins is vital in regulating steady-state cell surface expression. Kv1.5 is an important voltage-gated K(+) channel in the cardiovascular system underlying the ultra-rapid rectifying potassium current (Ik(ur)), a major repolarizing current in atrial myocytes, and regulating the resting membrane potential and excitability of smooth muscle cells. Defects in the expression of Kv1.5 are associated with pathological states such as chronic atrial fibrillation and hypoxic pulmonary hypertension. There is, thus, substantial interest in understanding the mechanisms regulating cell surface channel levels. Here, we investigated the internalization and recycling of Kv1.5 in the HL-1 immortalized mouse atrial myocytes. Kinetic studies indicate that Kv1.5 is rapidly internalized to a perinuclear region where it co-localizes with the early endosomal marker, EEA1. Importantly, we identified that a population of Kv1.5, originating on the cell surface, internalized and recycled back to the plasma membrane. Notably, Kv1.5 recycling processes are driven by specific Rab-dependent endosomal compartments. Thus, co-expression of GDP-locked Rab4S22N and Rab11S25N dominant-negative mutants decreased the steady-state Kv1.5 surface levels, whereas GTPase-deficient Rab4Q67L and Rab11Q70L mutants increased steady-state Kv1.5 surface levels. These data reveal an unexpected dynamic trafficking of Kv1.5 at the myocyte plasma membrane and demonstrate a role for recycling in the maintenance of steady-state ion channel surface levels.