Global health competencies in UK postgraduate medical training: a scoping review and curricular content analysis.

OBJECTIVE: To assess global health (GH) training in all postgraduate medical education in the UK. DESIGN: Mixed methodology: scoping review and curricular content analysis using two GH competency frameworks. SETTING AND PARTICIPANTS: A scoping review (until December 2017) was used to develop a framework of GH competencies for doctors. National postgraduate medical training curricula were analysed against this and a prior framework for GH competencies. The number of core competencies addressed and/or appearing in each programme was recorded. OUTCOMES: The scoping review identified eight relevant publications. A 16-competency framework was developed and, with a prior 5-competency framework, used to analyse each of 71 postgraduate medical curricula. Curricula were examined by a team of researchers and relevant learning outcomes were coded as one of the 5 or 16 core competencies. The number of core competencies in each programme was recorded. RESULTS: Using the 5-competency and 16-competency frameworks, 23 and 20, respectively, out of 71 programmes contained no global health competencies, most notably the Foundation Programme (equivalent to internship), a compulsory programme for UK medical graduates. Of a possible 16 competencies, the mean number across all 71 programmes was 1.73 (95% CI 1.42 to 2.04) and the highest number were in paediatrics and infectious diseases, each with five competencies. Of the 16 core competencies, global burden of disease and socioeconomic determinants of health were the two most cited with 47 and 35 citations, respectively. 8/16 competencies were not cited in any curriculum. CONCLUSIONS: Equity of care and the challenges of practising in an increasingly globalised world necessitate GH competencies for all doctors. Across the whole of postgraduate training, the majority of UK doctors are receiving minimal or no training in GH. Our GH competency framework can be used to map and plan integration across postgraduate programmes.

Time to go global: a consultation on global health competencies for postgraduate doctors.

BACKGROUND: Globalisation is having profound impacts on health and healthcare. We solicited the views of a wide range of stakeholders in order to develop core global health competencies for postgraduate doctors. METHODS: Published literature and existing curricula informed writing of seven global health competencies for consultation. A modified policy Delphi involved an online survey and face-to-face and telephone interviews over three rounds. RESULTS: Over 250 stakeholders participated, including doctors, other health professionals, policymakers and members of the public from all continents of the world. Participants indicated that global health competence is essential for postgraduate doctors and other health professionals. Concerns were expressed about overburdening curricula and identifying what is 'essential' for whom. Conflicting perspectives emerged about the importance and relevance of different global health topics. Five core competencies were developed: (1) diversity, human rights and ethics; (2) environmental, social and economic determinants of health; (3) global epidemiology; (4) global health governance; and (5) health systems and health professionals. CONCLUSIONS: Global health can bring important perspectives to postgraduate curricula, enhancing the ability of doctors to provide quality care. These global health competencies require tailoring to meet different trainees' needs and facilitate their incorporation into curricula. Healthcare and global health are ever-changing; therefore, the competencies will need to be regularly reviewed and updated.

ORTHOSPHERE(®) interpostitional arthroplasty used in great toe interphalangeal joint arthritis-a case report.

We report the first case in which an ORTHOSPHERE(®) spherical ceramic interposition arthroplasty has been used successfully in a patient with complex great toe pathology. The ORTHOSPHERE(®) (Wright Medical Technology, Arlington, TN) is a spherical ceramic interpositional arthroplasty designed for use in CMC joint arthritis. It has also been documented for use in basal fourth and fifth metatarsal arthritis [Shawen SB, Anderson RB, Cohen BE, Hammit MD. Spherical ceramic interpositional arthroplasty for basal fourth and fifth metatarsal arthritis. Foot Ankle Int 2007;28(8):896-901].

Importance of close surveillance for Charcot arthropathy in diabetic patients presenting to the emergency department with low-energy foot injuries.

Close monitoring, regular review and early referral of diabetic patients with midfoot injuries is of paramount importance to identify and limit progression and complications of Charcot foot. The case history is presented of a 46-year-old diabetic patient who presented to the emergency department following a low-energy midfoot sprain which was treated conservatively and the patient was discharged from follow-up. She rapidly developed midfoot disruption and associated Charcot-type arthropathy requiring surgical reconstruction. This case highlights the importance of awareness of development of Charcot foot in low-energy injuries in diabetic patients despite normal index x-rays, and the necessity for close follow-up with early referral to a foot and ankle service.