Journal of Internal Medicine & Primary Healthcare Category: Medical Type: Original Report
A Global Health Elective Addresses Georgetown Resident Team and Cameroon Host Expectations: A Ten Year Comparative Analysis of Evaluation Surveys, 2004-2013
- Marilee CS Cole, MD, DTMH1*
- 1 Office Of The Executive Vice President Evp, Georgetown University Medical Center, Washington DC, United States
*Corresponding Author:Marilee CS Cole, MD, DTMH
Office Of The Executive Vice President Evp, Georgetown University Medical Center, Washington DC, United States
Received Date: Apr 17, 2015 Accepted Date: May 19, 2015 Published Date: Jun 03, 2015
Objectives: The objectives were to assess strengths and weaknesses of the International Clinical Rotation (ICR) component, Georgetown Global Health Elective in Cameroon, 2004-2013, concomitantly, by Georgetown medicine resident team â€œguestsâ€ and Cameroon healthcare provider â€œhostsâ€. Georgetownâ€™s ICR had 3 key elements: gradual clinical immersion, inpatient physician-pairing, and on-site American faculty supervision.
Method: A retrospective study was conducted using self-administered evaluation surveys by 26 Georgetown and 25 Cameroon survey participants, 2004-2013, who were asked if/how they would recommend changing 8 core components (variables) of Georgetownâ€™s ICR. Cameroon survey participants were asked further questions about â€œmost positiveâ€ and â€œmost negativeâ€ aspects, to uncover additional â€œhostâ€-reported ICR strengths and weaknesses.
Results: The percentages of survey respondents in the Georgetown and in the Cameroon survey participant groups were not statistically significantly different [50% (13/26) vs 52% (13/25), p=0.99, NS].
Of 8 variables, both survey respondent groups would not recommend changing 6 variables, including Academic content, Finances, On-call schedule, Professional relationship with other teamâ€™s physicians, Special programs, and Work schedule. Georgetown and Cameroon survey respondents disagreed whether to recommend Academic format change, with significantly more Georgetown respondents recommending change [31% (4/13) vs 0% (0/13), p=0.0478, S]. Thirty five percent (35%) of Georgetown combined with Cameroon survey respondents agreed on recommending change to duration [35% (3/13 + 6/13=9/26)].
Cameroon survey respondents ranked Clinical teaching [69% (9/13)], then Clinical care [38% (5/13)], as two â€œmost positiveâ€ aspects. Unexpectedly, Professional relationship with other teamâ€™s physicians ranked third â€œmost positiveâ€ aspect [23% (3/13)]. Excess lab tests [31% (4/13)], then â€œNoneâ€ [23% (3/13)], were two â€œmost negativeâ€ aspects.
Conclusion: With strengths significantly outweighing weaknesses, Georgetownâ€™s international clinical rotation model elicited overall positive responses by Georgetown and Cameroon survey respondents. Further model optimization warrants systematic, prospective study of Academic format, Duration and Excess lab tests.
BBH : Banso Baptist Hospital
CBCHS : Cameroon Baptist Convention Health Services
GGHEC : Georgetown Global Health Elective in Cameroon
GUMC : Georgetown University Medical Center
HIV/AIDS : Human Immunodeficiency Virus Infection /Acquired Immunodeficiency Syndrome
ICR : International Clinical Rotation
IRB : Institutional Review Board
MGUH : Medstar Georgetown University Hospital
NS : Not Statistically Significant
S : Statistically Significant
A challenge facing academic medicine is how to structure, implement and assess an ethically-sound, non-exploitive International Clinical Rotation (ICR), as part of a global health elective. This longitudinal study informs the quality of graduate medical education by presenting concomitant assessments of Georgetownâ€™s three-part clinical model by Georgetown internal medicine resident team â€œguestsâ€ and by their Cameroon healthcare provider â€œhostsâ€.
Internal medicine residentsâ€™ interest in global health and international clinical experiences has increased [1-13]. Global health, animated by social justice aims to â€œimprove health and achieve equity in health for all people worldwideâ€ , resonates with physicians-in-training. Their residency directors anticipate more international clinical sites will be needed . There are few detailed descriptions of the structure and function of residentsâ€™ ICRs [3,15], and contrasting clinical rotation models [10,16]. Accordingly, there is a need to examine strengths and weaknesses evaluated by both healthcare provider â€œhostâ€ and â€œguestâ€, concomitantly [17,18], to refine productive ICRs.
THE GEORGETOWN INTERNATIONAL CLINICAL ROTATION MODEL
Medstar Georgetown University Hospital (MGUH) internal medicine residentsâ€™ interest in a medical mission to Cameroon compelled the structuring of a safe and meaningful international clinical model. After review of other ICR models, we put forward the Georgetown clinical model with 3 key elements: gradual clinical immersion, inpatient physician-pairing and on-site American faculty supervision.
Gradual clinical immersion would foster the Georgetown internal medicine residentâ€™s provision of culturally-sensitive , cost-conscious medical care. Secondly, inpatient physician-pairing would facilitate mutual teaching of local competencies , by the Cameroon physician and by the Georgetown medicine resident. Lastly, on-site American faculty supervision addresses a residentâ€™s educational, safety, and supervisory concerns during the international clinical experience [2,5,6,9,11,17,20-26]. On-site American faculty supervision would work to assure a safe clinical experience, as well as medical practice at the Georgetown residentâ€™s level of competence. This approach is responsive to the key component of inter-institutional arrangements for global health-the definition of a clearly structured educational program with appropriate supervision  and defined goals.
GOALS OF GEORGETOWN GLOBAL HEALTH ELECTIVE IN CAMEROON
- Learn about global health
- Teach global health as it relates to patient care
- Provide clinical care to patients
- Enhance medical infrastructure
Sub-Saharan Africa (SSA) has 13% of the worldâ€™s population and 24% of the total burden of disease , but only 1.5% of the worldâ€™s physicians . These healthcare access disparities are even worse in remote SSA regions, making access to quality, affordable healthcare most difficult . In remote Kumbo, Cameroon, West Africa, the 250 bed Banso Baptist Hospital (BBH) has a developing world clinical infrastructure. Cameroonian-run BBH incorporates â€œguestâ€ medical trainees into preventative and curative healthcare services-once an on-site clinical supervisor is identified.
PARTICIPANT SELECTION PROCESS
Participants are Georgetown â€œguestsâ€ and Cameroon â€œhostsâ€ who participated in the Georgetown Global Health Elective in Cameroon (GGHEC) international clinical rotation from 2004 and 2013 (Table 1). Georgetown participants, predominantly internal medicine residents, are selected early in internship for their senior year GGHEC program, following a 1 hour interview by the GGHEC Director. In contrast, Cameroon participants, predominantly practicing physicians, are selected by the GGHEC Director, in consultation with Cameroon Baptist Convention Health Services (CBCHS) leadership.
Georgetown Group(number, professional category)
Cameroon Group(number, professional category)
|ICR Participants||18 Internal Medicine Residents||25 Physicians|
|4 Medicine-Pediatrics Residents||5 Nurse/Nurse Practitioners|
|2 Medical Students IV||7 Healthcare Administrators|
|5 Fellow or Faculty|
|1 GGHEC Director|
|ICR Participant Exclusions||2 Medicine-Pediatrics Residents||4 Physicians|
|1 Fellow or Faculty||1 Nurse/Nurse Practitioners|
|1 GGHEC Director||7 Healthcare Administrators|
|Exclusion Reasons||3 Redundancy||4 No E-mail Address|
|1 Conflict of interest||1 Family Medical Leave (FML)|
|7 Non Healthcare Providers|
|Survey Participants||18 Internal Medicine Residents||21 Physicians|
|2 Medicine-Pediatrics Residents||4 Nurse/Nurse Practitioners|
|2 Medical Students IV|
|4 Fellow or Faculty|
# (% respondents/participants)
|9 (50%) Internal Medicine Residents||10 (48%) Physicians|
|1 (50%) Med-Peds Residents||3 (75%) Nurse/Nurse Practitioners|
|1 (50%) Medical Students IV|
|2 (50%) Fellow or Faculty|
Table 1: Professional Composition of Georgetown and Cameroon International Clinical Rotation (ICR) Participants, Survey Participants, and Survey Respondents.
During the 10 months prior to departure, Georgetown internal medicine resident team members and the GGHEC Director meet for 10-30 hours. Cameroon medical and cultural milieu is discussed. Georgetown residents are asked to identify their anticipated special contribution to BBH (Table 2). Georgetown residents submit 3 applications [CBCHS, Catholic Medical Mission Board (CMMB) for medical malpractice, travel and evacuation insurances, and US Visa], raise funds to cover travel costs and charitable donations, prepare a lecture, obtain immunizations, malaria prophylaxis, gloves/face masks, and study global health, including tropical diseases.
|Year||Special Contributions by Georgetown Team Members|
|2004||Surveyed Malaria Prophylaxis in Pregnancy|
|2005||Initiated Hematology and Pulmonary Consultancies|
|2006||Co-wrote Opportunistic Infections Management Manual for the Cameroon Baptist Convention Health Services (CBCHS)|
|2007||Compiled Internal Medicine Curriculum for New Cameroon Internal Medicine Residency Program at Mbingo Baptist Hospital|
|2008||Rewrote CBCHS Tuberculosis Training Manual Sections|
|2009||Initiated Medical Jeopardy Educational Game|
|2010||Ran Internal Medicine and Pediatrics Wards Solo for One Week|
|2011||Initiated Diabetes Mellitus, Gastroenterology, and Pediatrics Consultancies|
|2012||Established Tradition of Annual Fundraiser Events|
|2013||Developed Medical Evacuation Protocol and Cervical Cancer Screening Quality Improvement Project|
Table 2: Special Contributions by Georgetown Team Members to Banso Baptist Hospital, Kumbo, Cameroon.
After shadowing a Cameroon physician â€œhostâ€ for 1-3 days, the Georgetown internal medicine resident â€œguestâ€ gradually begins to care for a small cohort of hospitalized BBH patients, in consultation with an on-site American faculty supervisor. Evaluating and treating these patients is challenging, given the prevalence of severe unfamiliar communicable diseases, limited laboratory and pharmacy, and plethora (270) of tribal languages and cultures.
Afternoons are spent managing outpatients and attending American faculty-taught lecture/seminars on global health and the local implementation of evidence-based management of common diseases, such as HIV/AIDS, malaria and tuberculosis (Table 3). Rounding out the 6-day work week are BBH staff lectures and meetings, weekly mid-day Georgetown residentsâ€™ lectures, and call every fourth night and weekend.
|2||Arrhythmias and Reading EKGs|
|3||Management of Upper Gastrointestinal Bleeding|
|4||Global Health and Medical Management of Commonly Lethal Diseases|
|5||Overview of Diabetes Mellitus|
|8||HIV/AIDS and Cardiovascular Disease|
|9||Introduction to Medical Emergencies|
|11||Indications for Medical Transfers|
|12||Global Health and “TB or not TB”|
|13||Management of the Unconscious Patient|
|14||Global Health and Waging the War on Tropical Diseases|
Table 3: Sample Curriculum: Georgetown Global Health Elective in Cameroon Curriculum, 2013.
MATERIALS AND METHODS
In this study, we addressed 2 questions:
- Are strengths and weaknesses of â€œgradual clinical immersion, inpatient physician-pairing, on-site American faculty supervisionâ€ international clinical model comparable for Georgetown and Cameroon healthcare provider ICR participants?
- Do qualitative questions asked of Cameroon participants uncover additional, unexpected Cameroon â€œhostâ€-reported ICR strengths and weaknesses, not discovered through quantitative questions?
The Georgetown study group consisted, primarily, of former Georgetown internal medicine and medicine/pediatrics residents in graduation classes 2004-2013 , and, secondarily, of an occasional Georgetown medical student, fellow or faculty member, who acted as a healthcare provider and Georgetown team member.
The Cameroon study group consisted of healthcare provider partners, who were mostly Cameroon physicians, but also included an occasional nurse practitioner or nurse, who functioned equivalently to a Cameroon physician. Prior to exclusions, Cameroon healthcare administrators were also on the Cameroon study group list.
Lists of 30 Georgetown and of 37 Cameroon study group members were generated (Table 1). Four (4) Georgetown study group members were excluded, 3 for redundancy and 1 GGHEC Director for conflict of interest. Twelve (12) Cameroon study group members were excluded, 4 for no known e-mail address/es, 1 for family medical leave, and 7 healthcare administrators for not providing direct patient care.
Thus, 2 survey participant groups were identified, 26 Georgetown survey participants and 25 Cameroon survey participants. The Georgetown survey participants were significantly more white, American, female, physician trainees; the Cameroon survey participants were significantly more black, African, male, physician staff members (Supplementary file, Appendix III).
Active e-mail addresses were difficult to verify for both groups. At the time of the e-mailed survey, 88% (23/26) of Georgetown survey participants had departed Medstar Georgetown University Hospital; 84% (21/25) of Cameroon survey participants, Banso Baptist Hospital.
Two (2) to 4 weeks after e-mailing the first survey, a second survey was e-mailed to non-responders, with no associated inducements or incentives.
The GGHEC Director collected and analyzed survey data from each survey respondent (Table 1). Confidentiality of responses was maintained.
A core of 36 items was the same for both survey participant groups, including 16 â€œRecommendations for ICR Changeâ€ items and 20 work practice profile items. The remaining portions of the 2 questionnaires were group specific-with Georgetown survey participants asked additional questions about on-going and future plans for global health involvement; the Cameroon survey participants, about â€œmost positiveâ€ and â€œmost negativeâ€ ICR aspects, from the â€œhostâ€ viewpoint. In total, the Georgetown survey contained 55 items; the Cameroon survey, 70 items.
The information for this study came entirely from the survey instrument, except for some sociodemographic data which came from GGHEC ICR application records.
The 8 variables included:
- Academic content
- Academic format
- On-call schedule
- Professional relationship with other teamâ€™s physicians
- Special programs
- Work schedule
|Â “Variables”||Descriptive Details about Each “Variable”|
|Professional relationship with other team’s physicians||
Table 4: International Clinical Rotation â€œVariablesâ€, List and Descriptive Details. Georgetown Global Health Elective in Cameroon, 2004-2013 at Banso Baptist Hospital (BBH), Kumbo, Cameroon.
Survey respondent population
The survey respondent groups reflected the same statistically significant differences found between the survey participant groups, except for gender differences, which were no longer statistically significant [31% (4/13) Georgetown male vs 69% (9/13) Cameroon male, p=0.1152, NS]. Thus, the Georgetown survey respondent group continued to be significantly more white [92% (12/13) vs 23% (3/13), p=0.001, S], American [85% (11/13) vs 23% (3/13), p=0.0048, S], and physician trainee [92% (12/13) vs 15% (2/13), p=0.0001, S], than the Cameroon survey respondent group, which continued to be more black, African and physician staff member.
Are the strengths and weaknesses of this Georgetown international clinical model comparable for both Georgetown and Cameroon survey respondent groups?
The percentages of â€œyes responsesâ€ for each â€œvariableâ€ were calculated for Georgetown survey respondents and for Cameroon survey respondents (Table 5). There were no statistically significant differences between Georgetown and Cameroon survey respondent groups on 7 of 8 international clinical rotation â€œvariablesâ€. These 7 â€œvariablesâ€ included Academic content, Duration, Finances, On-call schedule, Professional relationship with other teamâ€™s physicians, Special programs, and Work schedule.
|Components (“Variables”) of International Clinical Rotation||
|p value, S|
|Academic content||8% (1/13)||0% (0/13)||P=0.99, NS|
|Academic format||31% (4/13)||0% (0/13)||P=0.0478, S|
|Duration||23% (3/13)||46% (6/13)||P=0.25, NS|
|Finances||15% (2/13)||15% (2/13)||P=0.99, NS|
|On-call schedule||15% (2/13)||8% (1/13)||P=0.99, NS|
|Professional relationship with other team’s physicians||8% (1/13)||15% (2/13)||P=0.99, NS|
|Special programs||0% (0/13)||15% (2/13)||P=0.48, NS|
|Work schedule||8% (1/13)||0% (0/13)||P=0.99, NS|
Table 5: Comparison between Georgetown and Cameroon Survey Respondents in Their Recommendations for Change of the International Clinical Rotation.
However, the Georgetown and Cameroon survey respondent groups significantly differed in their assessment of Academic format. Although almost one third of Georgetown survey respondents would change Academic format, no Cameroon survey respondents would do so [31% (4/13) vs 0% (0/13), p =0.0478, S]. In the aggregate, the Georgetown survey respondents would add back various components of a traditional American academic internal medicine residency rotation, such as a preparatory course, more case-based discussions, more resident lectures, and a small research project (Supplementary file, Appendix IV). However, no specific Georgetown Academic format â€œchange recommendationâ€ differed significantly from the Cameroon â€œno change recommendationâ€ [15% (2/13) vs 0% (0/13), p=0.48, Not Significant (NS)]. Academic format, although a mild weakness for the Georgetown survey respondents, was unanimously a strength for the Cameroon survey respondents.
In summary, Georgetown and Cameroon survey respondents agreed on a majority of the strengths and weaknesses of the Georgetown international clinical rotation model.
Do qualitative questions uncover unexpected Cameroon â€œhostâ€-reported ICR strengths and weaknesses not discovered through the quantitative questions?
Qualitative Answers by Cameroon Survey Respondents
Quantity of Responses
|Most positive aspect of elective|
|Clinical teaching||69% (9/13)|
|Clinical care||38% (5/13)|
Professional relationship with other team’s physicians
|Religious and Cultural involvement||8% (1/13)|
|Medical supplies||8% (1/13)|
|Most negative aspect of elective|
|Excess lab tests||31% (4/13)|
|Cultural adjustments||15% (2/13)|
|Limited stay||15% (2/13)|
Limited patient management Solutions
Limited long term physician Relationship
|Was elective a net benefit?||100% 13/13|
Table 6: Qualitative Answers by Cameroon Survey Respondents on â€œMost Positiveâ€ and â€œMost Negativeâ€ Aspects of the International Clinical Rotation.
Advanced planning and agreement on strengths of 6 â€œvariablesâ€
Much of the Academic content in lectures and handouts is an outgrowth of discussions between Georgetown and Cameroon ICR participants on optimum, evidence-based management of common Cameroon diseases impacted by global health issues; it significantly contributes to fulfilling Goal #1 Learn about Global Health. Professional relationship with other teamâ€™s physicians is facilitated by inpatient physician-pairing. Special programs are products of clinical challenges faced by both groups, and significantly contribute to fulfilling Goal #4 Enhance Medical Infrastructure. Work-week and night/weekend call frequency are standard for the Cameroon hospital, BBH. Finances are discussed with Georgetown ICR participants, most of whom raised funds to cover trip and charitable expenses, and with CBCHS leadership, but less so with Cameroon ICR participants. Consequent to 4 years of planning, 6 of the 8 â€œvariablesâ€ evolved as strengths for both Georgetown and Cameroon ICR participant groups.
Change the duration â€œvariableâ€
Adjust to an unfamiliar academic format or change it?
Qualitative questions uncover unexpected, additional, Cameroon â€œhostâ€-reported ICR strengths and weaknesses
Cameroon survey respondents identify Excess lab tests as the most â€œnegativeâ€ ICR aspect. A worrisome critique for resource-poor BBH, the Excess lab tests critique warrants further investigation to determine if/how/by whom that Excess lab tests are ordered. An analysis of lab test expenditures by Georgetown, compared to Cameroon, ICR participants on a few common Cameroon diseases, controlling for disease severity, is indicated. Results from such a study could help to focus on-going educational efforts to limit Excess lab tests and elucidate areas for future fiscal restraint.
In summary, qualitative questions did uncover unexpected, Cameroon â€œhostâ€-reported ICR strengths, as well as weaknesses.
Interpretation of these research findings is limited by the non-anonymous nature of the retrospective evaluation survey, small individual cohort sizes, and the multiplicity of factors. The 51% average response rate may be subject to bias in that respondents may assess the Georgetown Global Health Elective in Cameroon ICR more positively than their non-respondents. The small cohort sizes of both Georgetown and Cameroon ICR participant groups, render significant differences limited to the largest response differences among groups. Lastly, although tempting to attribute the surveyâ€™s overall positive assessment to the tripartite international clinical rotation model, other factors, including the high caliber of Georgetown  and Cameroon ICR participants and leaders, consistency and continuity in leadership, as well as strong Cameroon institutional support, may equally contribute to Georgetownâ€™s tripartite international clinical rotation modelâ€™s success.
The 10 year experience of Georgetownâ€™s international clinical model elicited comparable and overall positive quantitative responses by both Georgetown medicine resident team and Cameroon healthcare provider survey respondents.
Qualitative questions asked only of Cameroon â€œhostsâ€ did uncover unexpected additional strengths, such as Professional relationship with other teamâ€™s physicians, as well as weaknesses, such as Excess lab tests. Overall, though, the modelâ€™s strengths significantly outweighed its weaknesses and fulfilled the four GGHEC goals.
The 3 key elements of this model are gradual clinical immersion, inpatient physician-pairing, and on-site American faculty supervision. To further optimize this tripartite model, weaknesses, such as Excess lab tests, Academic format, and Duration, as well as strengths, such as Clinical teaching, Clinical care and Professional relationships with other teamâ€™s physicians, warrant additional study. A systematic prospective study of Georgetownâ€™s international clinical model could assist in further optimizing the modelâ€™s strengths and minimizing its weaknesses.
The author gratefully thanks GU Health Services Executive Vice President Howard Federoff, MD, PhD, CBCHS Director of Health Services Pius Tih, JD, PhD, MPH, Catholic Medical Mission Board, Georgetown Women in Medicine, GUMC Professor of Medicine Joseph Verbalis, MD, GUMC Biostatisticians Jiji Jiang, MD, MS, and Associate Professor of Biostatistics Hongbin Fang, PhD for their excellent support.
- Barry M, Bia FJ (1986) Departments of medicine and International health. Am J Med 80: 1019-1021.
- Drain P, Holmes K, Skeff K, Hall TL, Gardner P (2009) Global health training and international clinical rotations during residency: current status, needs, and opportunities. Acad Med 84: 320-325.
- Einterz RM, Kelley CR, Mamlin JJ, Van Reken DE (1995) Partnerships in international health: the Indiana University-Moi University experience. Infect Dis Clin North Am 9: 453-455.
- Furin J, Farmer P, Wolf M, Levy B, Judd A, et al. (2006) A novel training model to address health problems in poor and underserved populations. J Health Care Poor Underserved 17: 17-24.
- Gupta AR, Wells CK, Horwitz RI, Bia FJ, Barry M (1999) The International Health Program: the fifteen-year experience with Yale Universityâ€™s internal medicine residency Program. Am J Trop Med Hyg 61: 1019-1023.
- Kolars J, Halvorsen A, McDonald F (2011) Internal medicine residency directors perspectives on global health experiences. Am J Med 124: 881-885.
- Macfarlane SB, Agabian N, Novotny TE, Rutherford GW, Stewart CC, et al. (2008) Think globally, act locally, and collaborate internationally: global health sciences at the university of California, San Francisco. Acad Med 83: 173-179.
- McKinley DW, Williams SR, Norcini JJ, Anderson MB (2008) International exchange programs and US medical schools. Acad Med 83: 53-57.
- Miller WC, Corey GR, Lallinger GJ, Durack DT (1995) International health and internal medicine residency training: the Duke University experience. Am J Med 99: 291-297.
- Ravdin JI, Peterson PK, Wing E, Ibrahim T, Sande MA (2006) Globalization: a new dimension for academic internal medicine. Am J Med 119: 805-810.
- Sawatsky A, Rosenman D, Merry S, McDonald FS (2010) Eight years of the Mayo International Health Program: what an international elective adds to resident education. Mayo Clin Proc 85: 734-741.
- Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ (2003) Educational effects of international health electives on US and Canadian medical students and residents: a literature review. Acad Med 78: 342-347.
- Velji A (2011) Global Health Education Consortium: 20 years of leadership in global health and global health education. Infect Dis Clin North Am 25: 323-335.
- Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, et al. (2009) Towards a common definition of global health. Lancet 373: 1993-1995.
- Federico SG, Zachar PA, Oravec CM, Mandler T, Goldson E, et al. (2006) A successful international child health elective, the University of Colorado, Department of Pediatricsâ€™ experience. Arch Pediatr Adolesc Med 160: 191-196.
- Rassiwala J, Vaduganathan M, Kupershtok M, Castillo FM, Evert J (2013) Global health educational engagement-a tale of two models. Acad Med 88: 1651-1657.
- Crump J, Sugarman J, Working Group on Ethics Guidelines for Global Health Training (WEIGHT) (2010) Ethics and best practices guidelines for training experiences in global health. Am J Trop Med Hyg 83: 1178-1182.
- Kraeker C, Chandler C (2013) â€œWe learn from them, they learn from usâ€: global health experiences and host perceptions of visiting health care professionals. Acad Med 88: 483-487.
- Peluso MJ, Encandela J, Hafler JP, Margolis CZ (2013) Guiding principles for the development of global health education curricula in undergraduate medical education. Med Teach 34: 653-658.
- Crump J, Sugarman J (2008) Ethical considerations for short-term experiences by trainees in global health. JAMA 300: 1456-1458.
- Dandu M (2011) Trainee safety in global health. J Gen Intern Med 26: 826-827.
- Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, et al. (2007) Global health in medical education: a call for more training and opportunities. Acad Med 82: 226-230.
- Evert J, Bazemore A, Hixon A, Withy K (2007) Going global: considerations for introducing global health into family medicine training programs. Fam Med 39: 659-665.
- Gardner A, Cohen T, Carter E (2011) Tuberculosis among participants in an academic global health medical exchange program. J Gen Intern Med 26: 841-845.
- Kolars JC, Cahill K, Donkor P, Kaaya E, Lawson A (2012) Perspective: partnering for medical education in Sub-Saharan Africa: seeking the evidence for effective collaborations. Acad Med 87: 216-220.
- Schultz S, Rousseau S (1998) International health training in family practice residency programs. Fam Med 30: 29-33.
- WHO (2000) Disease burden, by region, DALY estimates, 2000-2012, global summary estimates. Health statistics and information systems.
- Mullan F, Frehywot S, Chen C, Greysen R, Wassermann T, et al (2010) The Sub-Saharan African Medical Schools Study: Data, observation, and opportunity, report brief.
- Sekhri N (2006) From Funding to Action: Strengthening healthcare systems in Sub Saharan Africa. World economic forum white paper, centre for public-private partnership, Global health initiative.
- [Data not shown] A statistically significantly higher percentage of Georgetown internal medicine resident survey participants became Georgetown chief medicine residents compared to their non-Cameroon-bound classmates [50% (10/20) vs. 22% (64/290), p<0.02, Significant]. Additionally, seventy seven percent (77%) of Georgetown graduates were either academic faculty or academic trainees at the time of the survey.
- Barry M (1990) International health and general internal medicine. J Gen Intern Med 5: 454-455.
Evaluation Surveys for Georgetown International Clinical Rotation Participants
Involvement in Global Health
If yes, you have remained involved in global health:
a. Yes [ ] No [ ] have you remained involved through caring for immigrant patients or international travelers in your US-based practice?
b. Yes [ ] No [ ] have you participated in other international medical missions since Cameroon?
c. Yes [ ] No [ ] have you remained involved through charitable giving?
Involvement in Georgetown Global Health Elective in Cameroon
If yes, are you interested in performing any of the following functions/jobs:
b. Yes [ ] No [ ] On-site Consultant?
c. Yes [ ] No [ ] US-based e-Consultant?
d. Yes [ ] No [ ] US-based Coordinator?
e. Yes [ ] No [ ] Fundraiser?
f. Yes [ ] No [ ] Charitable Donor?
g. Yes [ ] No [ ] Other? ________
3. If you are interested in involvement, when would you be available? ________________
4. Yes [ ] No [ ] If you are interested in on-site involvement, and assuming $3000 in on-site expenses, do you require financial support?
Recommendations for Changes to the Georgetown Global Health Elective in Cameroon
a. Yes [ ] No [ ] Duration
b. Yes [ ] No [ ] Work Schedule
c. Yes [ ] No [ ] On-Call Schedule
d. Yes [ ] No [ ] Academic Format
e. Yes [ ] No [ ] Academic Content
f. Yes [ ] No [ ] Professional Relationship with Other Teamâ€™s Physicians
g. Yes [ ] No [ ] Finances
h. Yes [ ] No [ ] Special Programs
Please comment on how you would make those recommended changes: ________________________________________________________________________________________
Your Present Work Setting
a. Private [ ], Public [ ], Academic (trainee) [ ], Academic (faculty) [ ], other [ ]
b. Hospital [ ], Outpatient Clinic [ ], Other [ ]
c. Rural [ ], Suburban [ ], Urban [ ]
7. Are you working in the following field/s of medicine presently?
a. Yes [ ] No [ ] General Internal Medicine
b. Yes [ ] No [ ] Subspecialty Medicine
c. Yes [ ] No [ ] Public Health
d. Yes [ ] No [ ] Other
8. Are you involved in the following professional activities presently?
a. Yes [ ] No [ ] Clinical practice
b. Yes [ ] No [ ] Medical Education
c. Yes [ ] No [ ] Research
d. Yes [ ] No [ ] Administration
e. Yes [ ] No [ ] Other
Evaluation Surveys for Cameroon International Clinical Rotation Partners
Evaluation of and Recommendations for Change to the Elective
a. Yes [ ] No [ ] Preparation
b. Yes [ ] No [ ] Duration
c. Yes [ ] No [ ] Work Schedule
d. Yes [ ] No [ ] On-Call Schedule
e. Yes [ ] No [ ] Academic Format
f. Yes [ ] No [ ] Academic Content
g. Yes [ ] No [ ] Professional Relationship with Other Teamâ€™s Physicians
h. Yes [ ] No [ ] Special Programs
i. Yes [ ] No [ ] Charitable Donations
j. Yes [ ] No [ ] Finances
k. Yes [ ] No [ ] Religious/Cultural
2. How would you alter or change the following aspects of the Elective?
c. Work Schedule________________
d. On-Call Schedule____________________
e. Academic Format____________________
f. Academic Content______________________
g. Professional Relationship with Other Teamâ€™s Physicians______
h. Special Programs_________________
i. Charitable Donations________________
3. What is the most positive aspect of the Elective?____________________________
4. What is the most negative aspect of the Elective?____________________________
5. Yes [ ] No [ ] Is the Elective a net benefit to the CBCHS?
If so, how?_______________________________
6. In what capacity have you worked with the Georgetown participants in the Georgetown Global Health Elective in Cameroon between 2004-2013?
a. Yes [ ] No [ ] Teacher
b. Yes [ ] No [ ] Supervisor
c. Yes [ ] No [ ] Mentor
d. Yes [ ] No [ ] Inpatient Team Member
e. Yes [ ] No [ ] Outpatient Team Member
f. Yes [ ] No [ ] Student
g.Â¬Â¬ Yes [ ] No [ ] Administrator__________
g.Â¬Â¬ Yes [ ] No [ ] Subordinate__________
h. Yes [ ] No [ ] Other_________
Your Present Work Setting
7. In what setting do you presently work? Check all that apply.
a. Group Practice [ ] Private Practice [ ] Academic (faculty) [ ], Other [ ]________
b. Hospital [ ], Outpatient Clinic [ ], Other [ ]_________
c. Rural [ ], Suburban [ ], Urban [ ]
d. In Cameroon [ ], In Another Country [ ] which one/s? ________
8. In what field/s of medicine are you presently working? Check all that apply.
a. Yes [ ] No [ ] Internal Medicine
b. Yes [ ] No [ ] Subspecialty Medicine ____________
c. Yes [ ] No [ ] Public Health
d. Yes [ ] No [ ] Other_____________
9. In which of the following professional activities are you presently involved?
Check all that apply.
a. Yes [ ] No [ ] Clinical Practice
b. Yes [ ] No [ ] Medical Education
c. Yes [ ] No [ ] Research
d. Yes [ ] No [ ] Administration
e. Yes [ ] No [ ] Other___________
CBCHS Leadership Role/s
Describe your leadership role: ______________________________________
12. Future work plans____________________
13. Educational Degrees [ ] MD, [ ] PhD, [ ] Other doctorate______, [ ] MPH, [ ] MBA, [ ] Other masters______, [ ] RN, [ ] Bachelors______, [ ] LPN, [ ] Other Degree/s________
Thank you for completing this survey!
Georgetown Global Health Electives in Cameroon (GGHEC), 2004-2013
|Georgetown Survey Participants||
|p-value, S||Georgetown Survey Respondents||Cameroon Survey Respondents||p-value, S|
Â Â Female
9 (35%)17 (65%)
18 (72%)7 (28%)
4 (31%)9 (69%)
9 (69%)4 (31%)
23 (88%)3 (12%)
5 (20%)20 (80%)
12 (92%)1Â Â (8%)
3 (23%)10 (77%)
|0.001,Â Â S|
22 (85%)4 (15%)
5 (20%)20 (80%)
11 (85%)2 (15%)
3 (23%)10 (77%)
23 (88%)3 (12%)
5 (20%)20 (80%)
12 (92%)1Â Â Â (8%)
2 (15%)11 (85%)
26 (100%)0Â Â Â Â (0%)
21 (84%)4 (16%)
13(100%)0Â Â (0%)
10 (77%)3 (23%)
0.11,Â Â NS
Georgetown Global Health Electives in Cameroon (GGHEC), 2004-2013
|International Clinical Rotation “Variables”||
Description ofRecommended Change (Δ)
% ( # times Δ listed )(# total participants)
|Academic Content||0% (0/13)|
(a)Â Tropical medicine course prior
(a) Â Â 8% (1/13)
(b) Â Â 8% (1/13)
|Duration||Increase duration of trip||15% (2/13)|
|Finances||More financial support||8% (1/13)|
|Professional Relationship with Other Team’s Physicians||Residents function as consultant attendings; medical students, as Cameroon physician team members||
|Special Programs||0% (0/13)|
|Work Schedule||0% (0/13)|
Citation: Cole MCS (2015) A Global Health Elective Addresses Georgetown Resident Team and Cameroon Host Expectations: A Ten Year Comparative Analysis of Evaluation Surveys, 2004-2013. J intern Med Prim Healthcare 1: 002.
Copyright: © 2015 Marilee CS Cole, MD, DTMH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.