Toronto Addis Ababa Academic Collaboration: A Relational, Partnership Model for Building Educational Capacity Between a High- and Low-Income University.

Educational partnerships between academic health sciences centers in high- and low-resource settings are often formed as attempts to address health care disparities. In this Perspective, the authors describe the Toronto Addis Ababa Academic Collaboration (TAAAC), an educational partnership between the University of Toronto and Addis Ababa University. The TAAAC model was designed to help address an urgent need for increased university faculty to teach in the massive expansion of universities in Ethiopia. As TAAAC has developed and expanded, faculty at both institutions have recognized that the need to understand contextual factors and to have clarity about funding, ownership, expertise, and control are essential elements of these types of collaborative initiatives. In describing the TAAAC model, the authors aim to contribute to wider conversations and deeper theoretical understandings about these issues.

Twenty Years of Collaboration Between Belgium and Benin in Training Anesthesiologists for Africa.

Belgium has been collaborating for 20 years with Abomey-Calavi University in Cotonou, Republic of Benin, to train anesthesiologists for Sub-Saharan, French-speaking African countries. With 123 graduates from 15 countries and 46 residents still in training, this program has succeeded in reversing the trend of a decreasing anesthesiology workforce in those countries, thus improving the quality of anesthesia and patient safety. Belgian government sources, as well as hospitals and anesthesia teams, provided most of the financial resources. Reasons for success, positive outcomes, and shortcomings are discussed, as well as future perspectives and threats. Failure to enroll enough female residents (15%) and brain drain (18% of alumni) are of concern. Alumni are capable of importing and adapting modern technology and practice. Graduates increase the impact of the Cotonou program by getting involved in teaching nonphysician anesthesia providers and by supporting new anesthesiology training programs being launched in several countries. Other African countries with training programs, by following this example, could accelerate anesthesiology progress by accepting foreign residents from the region. The role of anesthesiologists as anesthesia team leaders must be better defined, and residency training programs adapted accordingly. Continuing international support remains of critical importance, especially in the form of resident rotations to high-income countries. The development of structured anesthesiology programs should be encouraged by African governments as developing anesthesia is a prerequisite for surgical development in every discipline.

Criteria for evaluating global health partnerships in colleges of pharmacy and health sciences.

BACKGROUND AND PURPOSE: The demand for international experiences as part of education and training for healthcare providers continues to increase. As schools/colleges of pharmacy increase training opportunities in global health, there is a demand for a strategic way to evaluate opportunities. Evaluation tools can be utilized to facilitate this type of assessment. EDUCATIONAL ACTIVITY AND SETTING: The purpose of this article is to highlight two different international experiential education site evaluation tools, discuss lessons learned when applying these tools in the field, and outline steps for a college of pharmacy to create their own tool to meet institution specific needs. FINDINGS: The involvement of key stakeholders is important to developing an evaluation tool. Identification and prioritization of key criteria for assessing partnerships is essential. There are many criteria and each institution may consider a unique set of criteria, the most appropriate way to evaluate these, and who should be completing this evaluation. DISCUSSION AND SUMMARY: An evaluation tool may serve as a framework of discussion for new and existing international partnerships. The use of a global partnership evaluation tool allows for a more consistent discussion when deciding if the partnership is appropriate for both parties, helps the involved faculty know what criteria are required to be evaluated and outlines what resources should be considered.

Should I stay or should I go? A systematic review of factors that influence healthcare students' decisions around study abroad programmes.

BACKGROUND: Study abroad programmes have been shown to have significant benefits for participating healthcare students such as promoting cultural awareness and understanding of different healthcare settings, policies and practices. Healthcare students are encouraged to undertake elective or Erasmus placements overseas to enhance personal and professional development and to broaden horizons through lived cultural experience. However, there is a relatively low uptake of such opportunities amongst this student group. OBJECTIVES: This systematic review aimed to explore factors that influence healthcare students' decision making around study abroad opportunities within undergraduate training programmes. REVIEW DESIGN METHODS: A systematic review was undertaken utilising a narrative synthesis approach. DATA SOURCES: A comprehensive literature search was conducted on MEDLINE, CINAHL, EMBASE, PsycINFO, ASSIA, and ERIC databases. Key institutions were contacted for grey literature. Studies that reported on factors that influence healthcare students' decisions regarding study abroad programmes were included in the review. RESULTS: Ten studies were identified for inclusion (5 qualitative studies, 5 surveys), indicating a paucity of research in this area. Data synthesis indicates that factors that influence healthcare students' decisions to participate in study abroad programmes are similar across different geographic locations and different professional groups. Factors that support decisions to study overseas include having sufficient information about study abroad programmes, especially early in an academic programme, having an interest in other cultures/countries and having academic staff and family as positive role models who motivate them to study abroad. Key barriers are cost and language issues. Language remains a significant barrier even when generous bursaries are available, as with the Erasmus scheme, when students are not proficient with the language spoken in host countries. Students tend to prefer destinations where language is not a problem or where countries have cultural or historical connections, such as being part of the Commonwealth countries. CONCLUSIONS: Promotion of study abroad opportunities needs to start early in an academic programme. It should include detailed information and provision of language support. Faculty have an important part to play as enthusiastic role models.

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.

Medical electives in sub-Saharan Africa: a host perspective.

CONTEXT: Electives are part of most Western medical school curricula. It is estimated that each year 3000-4000 undergraduate medical students from the UK alone undertake an elective in a developing country. The impact of these electives has given some cause for concern, but the views of elective hosts are largely missing from the debate. OBJECTIVES: The purpose of this study was to evaluate the organisation, outcomes and impacts of medical electives in sub-Saharan Africa from a host perspective. METHODS: A qualitative analysis of 14 semi-structured interviews with elective hosts at seven elective sites in Malawi, Zambia and Tanzania was carried out. A framework analysis approach was used to analyse 483 minutes of audio-recorded data. RESULTS: Hosts were committed to providing elective experiences but their reasons for doing so varied considerably, in particular between urban or teaching hospitals and rural or mission hospitals. Nurturing a group of professionals who will understand the provision of health care from a global perspective was the main reason reported for hosting an elective, along with generating potential future staff. Hosts argued that the quality of supervision should be judged according to local context. Typical concerns cited in the literature with reference to clinical activities, safety and ethics did not emerge as issues for these hosts. However, in under-resourced clinical contexts, the training of local students sometimes had to take priority. Electives could be improved with greater student preparation and some contribution from sending institutions to support teaching, supervision or patient care. CONCLUSIONS: The challenge to both students and their sending institutions is to progress towards giving something proportionate back in return for the learning experiences received. There is clearly room to improve electives from the hosts' perspective, but individually host institutions lack the opportunity or ability to achieve change.

Studying abroad: Exploring factors influencing nursing students' decisions to apply for clinical placements in international settings.

BACKGROUND: For over 15 years the College of Nursing at the University of Saskatchewan has facilitated study abroad clinical placements in a number of countries to enhance student learning. Nursing students often find their study abroad experience to be a defining moment in their educational program, and in their personal and professional growth. OBJECTIVES: The main objective of this research was to explore factors influencing nursing students' decisions to study abroad. DESIGN: A descriptive longitudinal design study was conducted using an online survey. SETTINGS: The Study Abroad Survey was distributed to all undergraduate and graduate nursing students, in all years of all programs, at all sites of the College of Nursing, University of Saskatchewan in Saskatchewan, Canada. PARTICIPANTS: A total of 1058 nursing students registered in the 2013-2014 academic year were surveyed. METHODS: The data were collected using an online survey administered by Campus Labs™ (2014). RESULTS: Students indicated that their interest in study abroad international experiences was high (84%), with many perceived benefits, but barriers to participation were also high for these students. Financial barriers topped the list (71%), followed by family responsibilities (30%) and job obligations (23%). CONCLUSION: The research highlights the factors behind student decision making related to international placements, and provides the basis for improvements to the College of Nursing's International Study Abroad Program (ISAP). Previous travel and international service learning, resulting in increased perceived value of a study abroad experience may prove to be the more significant factor influencing decision making, rather than financial barrier.

Analyzing international clinical education practices for Canadian rehabilitation students.

BACKGROUND: Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training ("WEIGHT Guidelines") were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master's-level rehabilitation students at a Canadian university. METHODS: In-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research. RESULTS: Five themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about "costs", (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing. CONCLUSIONS: International clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian "sending institution", including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the "receiving organizations" based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.

Electives in undergraduate medical education: AMEE Guide No. 88.

This Guide outlines the scope and potential roles an elective can contribute to undergraduate medical training and identifies ways to maximize learning opportunities, including within global health. The types of educational activity available for electives range from meeting individual educational need through to exploration of potential career pathways, with many factors influencing choice. Key areas of organization underpinning a successful elective before, during and after the placement include developing clarity of the intended educational outcomes as well as addressing practicalities such as travel and accommodation. Risk management including the implications for the participating schools as well as the student and their elective supervisors is crucial. This Guide would not be complete without some discussion around ethics and professional conduct during an elective, with consideration of the impact of elective placements, particularly in low-middle income countries.

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.

Do international rotations make surgical residents more resource-efficient? A preliminary study.

OBJECTIVE: Interest in international surgery among general surgery residents in the United States has been shown in several publications. Several general surgery residency programs have reported their experiences with international surgery rotations (ISRs). Learning to use limited resources more efficiently is often cited as a benefit of such rotations. We hypothesized that general surgery residents become more resource efficient after they have completed an ISR. STUDY DESIGN: Laboratory, radiologic, and diagnostic studies ordered on 2900 patients by 21 general surgery residents over 65 months at a single institution were analyzed retrospectively. The patient populations they wrote orders on were assessed for similarity in age, gender, and diagnoses. The outcomes in those patient populations were assessed by duration of stay and in-hospital mortality. Six (29%) of these residents (ISR residents) completed a 1-month ISR during their third year of residency. Their orders were compared with their classmates who did not participate in an ISR (NISR residents). The results were compared between the 2 cohorts from both before and after their international rotations. An analysis focused on comparing the changes from pre-ISR to post-ISR. A survey was also sent after objective data were collected to all residents and alumni involved in the study to assess their subjective perception of changes in their resource efficiency and to characterize their ISRs. RESULTS: Patient populations were similar in terms of demographics and diagnoses. ISR residents generated an average of $122 less in orders per patient per month after their ISR compared with before. NISR residents generated an average of $338 more in orders per patient per month after the ISRs compared with before (p = 0.04). Pre-ISR order charges were statistically similar. Similar results were observed when radiologic/diagnostic study orders were analyzed independently. Differences in outcomes were statistically insignificant. The survey revealed that most of the ISR residents perceived that their attitude toward ordering tests and laboratories was influenced greatly by their ISR, and all the ISR residents perceived that they became more resource efficient than their peers after their ISRs. CONCLUSION: These preliminary findings seem to indicate increased resource efficiency among general surgery residents who completed an ISR. However, the sample size of residents was small, and we could not establish conclusively a causal relationship to their ISRs. A more extensive study is needed if reliable conclusions are to be drawn regarding the effect of ISRs on the resource efficiency of residents.

Teaching "global mental health": psychiatry residency directors' attitudes and practices regarding international opportunities for psychiatry residents.

OBJECTIVE: The authors surveyed Psychiatry Residency Training Directors' (RTDs') attitudes about the role and feasibility of international rotations during residency training. METHOD: A 21-question survey was electronically distributed that explored RTDs' beliefs about the value, use, and availability of international clinical and research experiences during residency. RESULTS: Of 171 RTDs, 59 (34.5%) completed the survey; 83% of respondents rated the importance of global mental health education as 3-or-above on a scale of 1 (least important) to 5 (most important), but only 42% indicated that such opportunities were made available. The value of such opportunities was thought to lie primarily in professional development and cultural exposure, less so for enhancing core knowledge competencies. Obstacles to such opportunities included lack of accreditation, financial resources, and faculty/administrative support and supervision. CONCLUSION: RTD respondents endorsed the value of international experiences during residency, but their availability and educational impact are not fully supported.

Beyond dark and bright: towards a more holistic understanding of inter-group networks.

Networks are becoming a popular organizational form for structuring human activities. To date, scholars have addressed networks in a variety of fields, including sociology, economics, public administration, criminology, political science, and international security. However, little has been done so far to systematically examine the similarities, differences, and connections between network forms of organization across different academic disciplines. This has important implications for both theory and practice. The lack of attention paid to organizational similarities and differences prevents the exchange of knowledge developed across fields. In turn, policy-makers cannot take full advantage of existing research, and may miss opportunities to improve the work of some networks and combat that of others. To address this gap in the literature, this paper uses the combination of organizational environments and organizational goals to develop a new typology of inter-group networks, and thus improve our understanding of how human behaviour is coordinated through networks.

A new clinical training scheme for overseas dentists under Tier 5.

Since the introduction of the Points Based Immigration System to the UK the opportunities for overseas trained dentists to train in the UK have been limited. This paper describes a new opportunity which has resulted from the Tier 5 Medical Training Initiative.