Global Health Predeparture Boot Camp Training: Preparing Residents to be Advocates for Child Health in International Settings

Background: With the dramatic rise in residency programs offering international clinical rotations, implementation of effective pre-departure preparation is paramount. To this end, many programs have incorporated curricula to improve clinical and emotional readiness for residents pre-departure. However, very few have described curricula aimed to increase resident competence in patient advocacy, that is their ability to support ethical clinical practice and navigate ethical conundrums abroad. This study evaluated the effectiveness of an innovative global health "bootcamp" curriculum" on residents' perceived knowledge, awareness and skills in patient advocacy. Methods: All residents scheduled for international clinical rotation are required to participate in global health bootcamp training within 6 months of their rotation, either during the fall or winter bootcamp sessions. This bootcamp integrates ethical scenarios into the different components, including: Simulation Use for Global Away Rotations (SUGAR), clinical procedures labs, peer-to-peer debriefing, Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) refresher trainings, and role-play exercises on cultural humility. Residents completed both pre- and post- bootcamp evaluations, which were then coded and analyzed. Open ended responses were assessed for themes exhibiting knowledge and skills relevant to patient advocacy. Results: Twenty-eight residents participated in 3 bootcamps held in January 2017, September 2017 and January 2018), of which all completed both pre-and post evaluation forms. Overall, pre-bootcamp only 35% and 0% of residents reported feeling somewhat prepared and fully prepared, respectively. After the bootcamp, all residents felt somewhat (82%) or fully (18%) prepared. As depicted in the tables, universally, there were increases in: 1) understanding of and an ability to resolve common ethical issues and challenges; 2) awareness of local and national codes of ethics relevant to one's working environment; 3) skills in applying the fundamental principles of international standards for the protection of human subjects and 4) exhibiting integrity, regard, and respect for others in all aspects of professional practice. When asked what was the most important concepts residents learned during the bootcamp, many relevant to patient advocacy were mentioned including the importance of being cultural sensitive, addressing ethical issues with their local preceptors when they arise, becoming cognizant of their own biases and how to mitigate them as not to influence care management. Comments about the HBB and ECEC sessions commonly reported improved skills in teaching and empowering parents in skills and knowledge of newborn care. Conclusion: An innovative, ethics-informed, global health bootcamp model encompassing multiple curricular components can successfully increase residents perceived ability to perform ethical clinical practice and navigate ethical conundrums in global settings. This model may be suitable for replication by other residency programs interested in improving resident competency as patient advocates for the practice of global child health.