Education Research: A framework for global health curricula for neurology trainees

Needs assessment

Goals and objectives

Program development

Program description

The UMMS neurology global health curriculum included 10 modules implemented over 16 weeks. Seven modules utilized a combination of didactics and case discussion. Two modules were video-conferenced case discussions with CAM. One module focused on theoretical problem-solving in a resource-limited setting in small groups. The video-conferenced case discussions continue on a monthly basis, and 8 modules are integrated into the didactic curriculum over a 2-year academic period.

Program evaluation

Evaluations were administered at various points throughout the UMMS program. Pre- and postassessment consisted of questions on a Likert scale. Additional evaluations in the form of the “one-minute paper” with 3 open-ended questions were administered after modules 3, 5, and 8. Twenty UMMS neurology residents participated in the curriculum, and up to 70% completed assessments. All residents agreed in the pre- and postassessment that they are “interested in global health” and “a global health curriculum is important in residency training.” In addition, 78% were “aware of the impact of neurologic diseases on the global burden of disease” in the preassessment compared to 100% in the postassessment. Fifty percent could “identify neurologic diseases specific to international populations” prior to the curriculum, which increased to 80% after the curriculum. They commented on well-organized and interesting discussions with colleagues in India, although mentioned “technical issues” needing improvement.

In response to “What did you learn from the global health curriculum?” in the postassessment, one postgraduate year (PGY)-3 noted, “The broad impact of incorporating global health initiatives into providing better health care in communities with limited resources. The big gap in health care delivery among different countries.” Another PGY-3 responded, “The impact of some diseases that I thought were more ‘Western’ on the rest of the world.” When asked about ways in which the curriculum could be improved, one PGY-2 responded, “More specific cases, possibly videos of interesting cases.” Utilizing videoconference for case discussions generated positive feedback from residents who enjoyed “the discussion at every step from both sides, especially about differentials.”

Lessons learned

As the global burden of neurologic disease is growing, educating neurology trainees about the epidemiology, management, and treatment of neurologic disease in resource-limited settings is becoming increasingly important. There are various proposed models for developing global health curricula including use of ACGME competencies as a guideline.^9,12 The UMMS neurology global health curriculum is one component of a dynamic global health program. A successful global neurology program also aims for financial sustainability, encourages multi-institutional involvement in the parent country, and builds local capacity.¹³

The role of US and Canadian academic health centers (AHCs) as centers of excellence in medical science and technology has long been recognized. Thus, as major participants in global health, AHCs are called on to take on the responsibility of reducing health disparities and implementing efficient health systems abroad. The Global Health Education Consortium, since 1989, has promoted education and research collaborations between universities to address these challenges.¹⁴ The development of a global health program can serve multiple purposes. One goal is to expose trainees to the influence of sociocultural norms on the perception of health care and guide them in developing the cultural competency skills to manage patients in resource-limited settings. Another goal may be to expand on such a program to create a defined multidimensional partnership.

Many US AHCs are committed to providing services at partner institutions abroad and fostering an international presence. A 4-stage framework for development of such partnerships includes developing educational programs and training, consulting and advisory services, management services and delivering and/or owning patient care, education and/or research abroad. Examples include Cleveland Clinic, which manages the Sheikh Khalifa Medical City in Abu Dhabi, and Duke University Medical Center, which offers joint MD degrees through the National University of Singapore Medical School. This requires significant investment by the parent institution including separate legal entities and governance structures to oversee the international activities. In terms of bidirectional educational platforms, a global program promotes specialized teaching and training of local physicians, trainees, and health care workers and research collaborations. In participating in a broad range of activities in a global setting, which may include for-profit consultations, a business approach is necessary, and institutions are using strategic planning to implement these goals with global partners.¹⁵

The UMMS neurology global health program supports a robust partnership abroad. Currently, there are multiple departmental educational and research collaborations between UMMS and CAM in the areas of quantitative health sciences, cardiology, surgery, and pediatrics. The neurology program further strengthens this existing partnership. Implementing this neurology program with other partner sites can support and expand UMMS' collaborations abroad. Moreover, helping to create a neurology residency training program at CAM, one of the broader goals of this educational collaboration, will build local capacity.

In developing the UMMS curriculum, it was important to ensure that the goals and objectives of the curriculum aligned with those of the residency program leadership and department. Identifying mentors and resources, with the help of institutional faculty development programs, provided guidance in creating curricula. In addition, identifying internal funding opportunities was helpful in obtaining pilot data prior to pursing external funding. Discussion with residency program leadership on how best to incorporate a global health program without compromising other neurologic education was important. Finally, sustainability of the program required vested interest from the trainees and administration. As organizations such as the American Academy of Neurology increase awareness of global neurology, they offer unique venues for discussion and exchange of material pertaining to global neurology education and scholarship.

The major limitations in developing new curricula were time and funding. Assuming a role within medical education may include protected time. In general, funding is limited for global health education. The UMMS global health program focused on small projects and travel grants available internally to initiate global collaboration.

Global health curricula incorporated into neurology residency training can guide residents on how to approach patients with cultural sensitivity and understand social and political influences on health. Most importantly, a well-developed global health curriculum with video-conferencing can enhance learning and foster bidirectional exchange with a global partner throughout the year. Global health education programs can also serve as a first step toward committing to a larger enterprise of delivering patient care and research services abroad. This type of educational program creates compassionate neurologists with an understanding of the effect of neurologic disease on the global population and better able to treat diverse populations at home and abroad.