Training Globally Competent Pediatricians: How and Why?
Pediatric trainees are increasingly seeking global health (GH) educational opportunities, with ∼1 in 4 participating in a GH elective during residency.1,2 Training programs have responded to this demand: surveys suggest that ∼58% of residency and 47% of fellowship training programs offer GH electives.3,4 In accordance with best practices pertaining to short-term GH electives, many programs are attempting to build GH training opportunities beyond electives, including longitudinal GH curricula at their respective institutions, predeparture preparation training, postreturn debriefing, and global training partnerships.1,2,4–11
Concomitantly, educators are recognizing that all trainees, not just those planning to work abroad, need to learn about GH-related topics. The “local global health” framework12 highlights that diseases do not respect borders, resource limitation is not unique to low- and middle-income countries (LMICs), and core skills are necessary for all trainees caring for patients and families from (and going to) diverse settings. These skills include using interpreters effectively, caring for immigrants and travelers, employing cultural humility, and integrating social determinants of health into clinical paradigms.12–17
Programs seeking to train globally competent pediatricians, both those who will practice in the United States and internationally, face predictable challenges. Allocating resources toward GH education is difficult for many pediatric departments, and not all departments have faculty with GH expertise nor an infrastructure to support global training.5,8 Notably, of the US pediatric residency programs that offered GH electives in 2013–2014, only 66% provided predeparture training and 54% had GH lectures, representing significant gaps in GH education.4 The author team sought to address these and other gaps by collaboratively developing an open-access, comprehensive GH education guide to help busy pediatric residency and fellowship program directors provide core and advanced GH training.
GH Educators Align Efforts
In 2013, the American Board of Pediatrics (ABP) convened a Global Health Task Force (GHTF) to advise its Board of Directors and staff in developing a GH agenda around its core values of training assessment, certification, quality improvement, and continued professional development. In collaboration with the American Academy of Pediatrics (AAP), they cosponsored a GH leadership stakeholder conference in 2015. The 51 attendees included representatives from 25 academic institutions and 10 organizations.*
After this conference, the GHTF made several recommendations to the ABP, including to develop a comprehensive guide to GH education for program directors. In 2016, the GHTF created a trainee workgroup that was charged with this task. It was initially composed of 11 pediatric GH educators, chosen on the basis of expressed interest during the 2015 conference, recommendations from GHTF members, or known GH education leadership experience. In 2017, the group expanded to 17 GH educators from 10 institutions to incorporate additional content experts as coauthors. A summary of the time line and development process, which includes multiple stakeholder reviews and engagement of educators from LMICs who had previous experience hosting visiting trainees, is shown in Figure 1.
Outcome: A Comprehensive Guide for GH Education
The final contents of the guide, which were informed by literature review, author experiences as GH educators, and stakeholder input, are highlighted in Figure 2. Key features include proposed core GH competencies, GH training implementation strategies, guidance surrounding GH electives, and opportunities for evaluation. Throughout the guide, there is emphasis on the importance of mutually beneficial training partnerships.
In creating the guide, we recognized that the needs of training programs are highly variable and therefore designed it to be useful for educators who have little to no GH experience, while still offering meaningful content for seasoned GH educators across all program sizes. We also acknowledged that GH education is not mandatory and therefore focused only on offering resources, strategies, and guidance as opposed to recommendations. Finally, the guide was designed to be relevant for multiple audiences, including residency and fellowship educators, program coordinators, departmental and institutional leaders, and global partners. There are many resources in the guide’s 20 appendices to assist with implementation, including modifiable checklists and templates, several of which are described in Table 1.
The guide, entitled, Global Health in Pediatric Education: An Implementation Guide for Program Directors,18 is now freely available on the ABP Web site (https://www.abp.org/ghpdguidehome), and the ABP Foundation distributed printed copies to all US pediatric department chairs and residency program directors in February 2019. As of October 2019, the landing page had been viewed 1438 times from at least 20 countries.
Because the author and reviewer groups were composed of volunteers, the primary limitations that dictated the time line were time and availability. Additionally, although we strived to engage all GH educator stakeholders in the development process, undoubtedly many were missed. Finally, opportunities for dissemination across all types of medical educators are limited, thereby limiting resource sharing capacity.
Scalability Across Audiences
The contents of this guide are scalable to both undergraduate and graduate medical educators, across all medical specialties. By design, all materials are freely available to interested educators with the goal of broadly disseminating best practices and resources for GH education. The author group and collaborators have engaged in workshops, Webinars, and other strategies to promote dissemination and adaptation of this resource across specialties. Thus far, GH educators from obstetrics and gynecology, emergency medicine, and the Consortium of Universities of Global Health have already requested the materials for use with their respective trainees and stakeholder groups, extending the scope beyond pediatric audiences.
Quality Improvement Tool
To assist with implementation, several authors are collaborating with the Association of Pediatric Program Directors (APPD) Global Health Learning Community (GHLC) and the ABP Maintenance of Certification team to develop a quality improvement framework for GH education that identifies educational aims and offers tools from the guide as potential interventions. Additionally, there are many other resources developed on behalf of the GHTF of the ABP to assist providers engaging in global work.2,8,10,19,20
Pediatric Residency and Fellowship Curricula
In creating this resource, we hoped to mitigate the burden placed on educators to “reinvent the wheel” as they attempted to develop quality GH education at their respective institutions. Although there is not a way to directly measure whether the availability of the guide’s resources improve the uptake and quality of GH-related offerings in pediatric residency and fellowship programs, the hope is that the guide will promote a pendulum swing toward a more systematic focus on GH-related competencies for pediatric trainees.
The guide will be updated every 5 years in collaboration with the ABP Foundation, and users are encouraged to send feedback to firstname.lastname@example.org.
Global Health in Pediatric Education: An Implementation Guide for Program Directors18 is a product of extensive collaboration with several national stakeholder organizations, was carefully reviewed by LMIC educators, and is the first comprehensive set of resources for integrating GH into pediatric residency and fellowship training programs. It is not intended to represent a mandate for programs but instead to support training programs and to promote improvements in GH education. It can be tailored to meet the needs of individual training programs and can be adapted to nonpediatric audiences to offer a helpful framework for GH education across medical specialties. It represents a potentially replicable model of collaboration between educators, national organizations, and global partners for the creation of important educator resources.
The members of the GHTF of the ABP include the following: Linda Arnold, Maneesh Batra, Sabrina Butteris, Christopher Cunha, Jonathan D. Klein, David Nichols, Michael Pitt, Cliff O’Callahan, Nicole St Clair, and Andrew Steenhoff.
The following groups provided excellent contributions to the guide: APPD GHLC Executive and Steering Committees, AAP Section on International Child Health Executive Committee, ABP Education and Training Committee (ETC), ABP Board of Directors, ABP International and Special Initiatives Team, ABP Communications Department, and the ABP Foundation.
This article was conceptualized and produced by the Global Health Task Force of the American Board of Pediatrics. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Board of Pediatrics or the American Board of Pediatrics Foundation.
Dr St Clair led the conception and design of the guide, assisted with literature searches for the guide and the manuscript, recruited the author team, drafted the manuscript for all sections, and created Figure 2 and Table 1; Dr Pitt created Figure 1, contributed to the conception and design of the guide and the manuscript, assisted with literature searches for the guide and the manuscript, provided content expertise, and critically revised the manuscript; Drs Abdul-Mumin, Banker, Condurache, Crouse, Haq, Helphinstine, Kazembe, Marton, McQuilkin, Rus, Russ, Schubert, Schutze, Steenhoff, Uwemedimo, Watts, and Butteris contributed to the conception and design of the guide and the manuscript, assisted with literature searches for the guide and the manuscript, provided content expertise, and critically revised the manuscript; and all authors approved the final manuscript as submitted.
The following organizations were represented at the jointly sponsored GH leadership conference in 2015: AAP, ABP, Academic Pediatric Association, APPD, Canadian Pediatric Society, Consortium of Universities for Global Health, Global Pediatric Education Consortium, International Pediatric Association, Liberian College of Physicians and Surgeons, and United States Agency for International Development.
FUNDING: Supported in part by the American Board of Pediatrics Foundation.
American Academy of Pediatrics
American Board of Pediatrics
Association of Pediatric Program Directors
Education and Training Committee
Global Health Learning Community
Global Health Task Force
low- and middle-income country
Section on International Child Health
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.