Low- and Middle-Income Country Host Perceptions of Short-Term Experiences in Global Health: A Systematic Review.

PURPOSE: Stakeholders have expressed concerns regarding the impact of visiting trainees and physicians from high-income countries (HICs) providing education and/or short-term clinical care in low- and middle-income countries (LMICs). This systematic review aimed to summarize LMIC host perceptions of visiting trainees and physicians from HICs during short-term experiences in global health (STEGH). METHOD: In September 2018 then again in August 2020, the authors searched 7 databases (PubMed, Embase, Scopus, Web of Science, ERIC, Cochrane Library, Global Index Medicus) for peer-reviewed studies that described LMIC host perceptions of STEGH. They extracted information pertaining to study design, participant demographics, participant perceptions, representation of LMICs and HICs, and HIC visitors' roles and used thematic synthesis to code the text, develop descriptive themes, and generate analytical themes. RESULTS: Of the 4,020 studies identified, 17 met the inclusion criteria. In total, the studies included 448 participants, of which 395 (88%) represented LMICs. The authors identified and organized 42 codes under 8 descriptive themes. They further organized these descriptive themes into 4 analytical themes related to STEGH: (1) sociocultural and contextual differences, (2) institutional and programmatic components, (3) impact on host institutions and individuals, and (4) visitor characteristics and conduct. CONCLUSIONS: STEGH can have both beneficial and detrimental effects on LMIC host institutions and individuals. The authors translated these findings into a set of evidence-based best practices for STEGH that provide specific guidance for LMIC and HIC stakeholders. Moving forward, LMIC and HIC institutions must work together to focus on the quality of their relationships and create conditions in which all stakeholders feel empowered to openly communicate to ensure equity and mutual benefit for all parties.

The Medical Mission and Modern Core Competency Training: A 10-Year Follow-Up of Resident Experiences in Global Plastic Surgery.

BACKGROUND: The emphasis on cultural competency for physicians and surgeons is increasingly important, as communication with both patients and other providers significantly affects individual and system-wide outcomes. International surgical training has been shown to improve leadership skills, cultural competency, and technical proficiency of participants in short-term follow-up. This study explores the long-term impact of international surgical mission experiences on developing participants' core competencies, professional outcomes, and commitment to global health. METHODS: All 208 plastic and reconstructive surgeons who completed the Operation Smile Regan/Stryker fellowship programs between 2006 and 2015 were surveyed electronically. RESULTS: One hundred sixty-five surveys were returned, for an overall response rate of 79.3 percent. The majority of participants reported that the fellowship positively impacted all six Accreditation Council for Graduate Medical Education core competencies. Most participants who were attending physicians at the time of the survey were practicing general plastic surgery, with 42 percent in an academic/teaching environment, 32 percent in assistant/associate professor positions, and 6 percent in either a program director or department chairman position. The majority currently volunteer on local or international missions, and all respondents would consider volunteering again. CONCLUSIONS: Carefully structured and rigorously proctored programs such as the Regan/Stryker Fellowship offer plastic surgery residents the opportunity to gain valuable professional and personal experiences that benefit them long after their service experience. Programs of this nature can not only effectively improve cultural competency of physicians, but also positively influence their attitudes toward leadership and direct that potential to meet the growing need for surgical care in low- and middle-income countries.

Adolescent health in Asia: insights from Thailand.

BACKGROUND: Adolescence in an age of opportunity in Thailand. The main health issues of this age group are related to pregnancy, injuries and poisoning, all which should be preventable. OBJECTIVE AND METHODS: This article presents the experiences of Thai physicians, who received adolescent medicine fellowship training in North America and brought their experience, knowledge, skills, and adolescent health care principles and practice back to Thailand. The anticipations and the facts faced in everyday practice, training, research, and collaboration in a place with their own culture and societal norms are described. RESULTS: Currently, there are six adolescent medicine specialists who work with experienced specialist in the subcommittee of adolescent health under the Royal College of Pediatricians of Thailand. There has been collaboration with both the public sector and health care sector, government and non-government organizations with regards to health care service and promotion. Many hospitals especially residency training institutes have increased the cut-off age of patients to be seen by pediatricians to 15 or 18 years of age. Since 2011, adolescent medicine was made one of the mandatory rotations in all pediatric resident training programs. CONCLUSION: There is still more work to be done - issues around policies for confidentiality and a lower age of consent, collaboration between other specialties to enable a large-scale youth-friendly one-stop services, and multicenter research opportunities are still awaiting.

Training international medical graduate clinical fellows: the challenges and opportunities for adolescent medicine programs.

Adolescent medicine achieved accreditation status first in the United States in 1994 and then in Canada in 2008 and even if it is not an accredited subspecialty in most other Western nations, it has still become firmly established as a distinct discipline. This has not necessarily been the case in some developing countries, where even the recognition of adolescence as a unique stage of human development is not always acknowledged. The program at SickKids in Toronto has prided itself in treating its international medical graduates (IMG) clinical fellows the same as their Canadian subspecialty residents by integrating them seamlessly into the training program. Although this approach has been laudable to a great extent, it may have fallen short in formally acknowledging and addressing the challenges that the IMG trainees have had to overcome. Moving forward, faculty must be trained and supports instituted that are geared specifically towards these challenges. This must be done on a formal basis to ensure both the success of the trainees as well as the overall enrichment of the fellowship training programs.

Opportunities and challenges in adolescent health training abroad: trainees' experience and perspective.

As the global adolescent population increases and as there is enhanced recognition internationally of the unique nature of the adolescent period, the need for specialized training in adolescent medicine for international physicians becomes more apparent. There are challenges in securing placement in an adolescent medicine fellowship program, as well as, on acceptance, challenges with acculturation to a new setting, socially, academically and clinically. During fellowship, international medical graduates (IMGs) are exposed to new opportunities such as learning best-practices and being mentored by experienced advocates and clinicians in the field of adolescent health and medicine. This paper considers recommendations for improving adolescent medicine fellowship programs with a focus on IMGs.

Telemedicine in education: bridging the gap.

BACKGROUND: The increasing cost and inequitable access to quality healthcare, coupled with the merger of the information technology and health service sectors, has given rise to the modern field of telemedicine. Telemedicine, meaning medicine at a distance, allows us to transcend geographic and socioeconomic boundaries to deliver high quality care to remote and/or in-need patients. As technology becomes more affordable and a physician shortage looms, telemedicine is gaining attention as a possible solution to healthcare delivery. Simultaneously, telemedicine holds great promise with regard to medical education. Several studies integrating telemedicine in medical education have shown positive outcomes, demonstrating similar or greater efficacy compared with traditional educational methods with high student-reported enthusiasm. Other domestic and international telemedicine projects, largely spearheaded by universities, have also achieved great success. DISCUSSION: In a novel approach, by pairing medical schools with in-need partner communities, utilizing similar faculty resources as traditional learning methods with standardized patients, students can gain valuable experience and skills while serving actual patients. This progressive approach to medical education fosters collaboration, communication, longitudinal care and teaches students needed skills for their future practices as 21 st Century healthcare providers.

A dozen years of American Academy of Sleep Medicine (AASM) International Mini-Fellowship: program evaluation and future directions.

UNLABELLED: Sleep medicine remains an underrepresented medical specialty worldwide, with significant geographic disparities with regard to training, number of available sleep specialists, sleep laboratory or clinic infrastructures, and evidence-based clinical practices. The American Academy of Sleep Medicine (AASM) is committed to facilitating the education of sleep medicine professionals to ensure high-quality, evidence-based clinical care and improve access to sleep centers around the world, particularly in developing countries. In 2002, the AASM launched an annual 4-week training program called Mini-Fellowship for International Scholars, designed to support the establishment of sleep medicine in developing countries. The participating fellows were generally chosen from areas that lacked a clinical infrastructure in this specialty and provided with training in AASM Accredited sleep centers. This manuscript presents an overview of the program, summarizes the outcomes, successes, and lessons learned during the first 12 years, and describes a set of programmatic changes for the near-future, as assembled and proposed by the AASM Education Committee and recently approved by the AASM Board of Directors. CITATION: Ioachimescu OC; Wickwire EM; Harrington J; Kristo D; Arnedt JT; Ramar K; Won C; Billings ME; DelRosso L; Williams S; Paruthi S; Morgenthaler TI. A dozen years of American Academy of Sleep Medicine (AASM) international mini-fellowship: program evaluation and future directions.

The Czech government scholarship programme for students from developing countries--evaluation findings and policy reflections.

In Czech Republic there is a long tradition of providing tertiary scholarships to students from developing countries. The government scholarship programme started in the 1950s already as a part of the Czechoslovak technical assistance to countries in the South. Even though the programme left tens of thousands of graduates all over the world, the recent programme evaluation has revealed that it is characterised by a relatively poor performance. This article brings forward the main outcomes of the programme evaluation, highlights the policy recommendations and summarises policy reflections that occurred following the evaluation. The programme evaluation was done under unfavourable circumstances and could be accordingly defined as 'shoestring evaluation'. The restrictions and their influence on evaluation outcomes are discussed in article, too.

Cross-cultural use and development of virtual patients.

Three major issues drive the cross-cultural use of virtual patients (VPs): an increased mobility of healthcare professionals, students and patients; limited resources for developing VPs; and emerging standards for the exchange of VPs across institutions. Many students are trained in countries other than where they were born. In addition, healthcare professionals often move between countries and are today meeting more and more patients from cultures different from their own. VPs can be used both for learning a new "medical" language as well as for illustrating different perspectives on illness in the new culture. Therefore, it may be important to develop cases reflecting patients from a wide variety of regions and cultures to prepare these professionals to understand both the background of these patients as well as the different medical conditions they may present. However, the benefits of using VPs may be limited at many universities by insufficient resources to develop all the VPs needed for their curricula. The option to acquire VPs from other universities may therefore be appealing, but as these may only be available in English, it is important to consider whether VPs reflecting the local illness panoramas and medical procedures are needed.

Keeping the vision: sustaining social consciousness with nursing students following international learning experiences.

In an era of globalization, increasing numbers of nursing programs are initiating international learning experiences, yet empirical data is lacking regarding long term benefits and effects of international placements. This paper presents findings from a participatory action study designed in response to this gap. Objectives were to describe student learning in international experiences, and to facilitate strategies that supported integration of this learning into personal and professional domains upon return to Canada. Seventeen students and three faculty participated over twelve months following their international experiences. Initial responses to the international experience included reports of new ways of viewing the world - often characterized by heightened social consciousness - yet in the immediate and longer-term many struggled with how to translate and sustain this learning in home settings. Considerable effort and intentionality was required to sustain social consciousness over time. Based on these findings, a preliminary framework for international experiences is presented.

Medical migration and Africa: an unwanted legacy of educational change.

The opportunities given for medical staff to travel, work and remain in countries other than that of their domicile or graduation have led to the phenomenon of medical migration. This has been supported by ease of travel, improved technology and a drive to share good examples of medical education through improved communication. Whilst these opportunities create positive advantages to the individuals and countries involved, through the transfer of knowledge and medical management, the situation does not always lead to long term benefits, and clear disadvantages begin to emerge. The gulf between the developed and developing countries becomes pronounced, leading to a general drift of resources away from the areas where they are most needed and subsequent profound effects upon the indigenous population. This paper suggests that it is a responsibility of medical educators throughout the world to recognize this effect and create opportunities whereby the specialty of medical education positively effects medical migration to the benefit of the less fortunate areas of the world.

Biologistes sans frontières.

Junior researchers are encouraged to gain experience abroad, and for senior scientists, sabbaticals remain popular. France has taken the next step in fostering international exchange, by supporting long-term collaborations with foreign laboratories and by creating research units abroad.

Challenges facing internationalisation of nursing practice, nurse education and nursing workforce in Australia.

This paper examines factors that have lead to increasing internationalisation in nursing workforce and nursing education and contends that education and support for nurse managers and nurse academics is required in order to better prepare them for the challenges they will face. There are many benefits to be gained from internationalisation of nursing, the most significant being greater cross-cultural understanding and improved practices in workplaces across countries. However, the way in which nursing and nurses contribute to the international agenda is crucial to maintaining standards of education and nursing care in Australia and in countries with whom Australians collaborate. Internationalisation poses numerous challenges that need to be carefully thought through. This paper seeks to unravel and scrutinize some of the issues central to internationalisation in nursing, particularly in the Australian context.

Returning home.

Returning to one's home country after many years abroad is a life-changing decision that brings with it many challenges, but at the same time, many rewards.