Best Practices for Global Health Programs

Identifying interesting approaches to global health education

Metrics

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Identify those programs that are actively validating measurable change as a result of their efforts.

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IGOT’s “International Summit & SMART (Surgical Management & Reconstructive Training) Course” has a 5-year track record of pre/post course evaluations & 1-year self-reported clinical outcomes of skills gained by international attendees (orthopaedic surgeons from developing countries). IGOT has measured the impact of the global elective program showing significant likelihood of participants to continue international volunteer opportunities & or serve under served communities in their professional careers compared to a similar cohort that did not have an elective opportunity. (*http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780923/).

IGOT has implemented Sales Force as a pilot database for learners, research, educational programs & donors but without operational support to maintain it has proven to be inefficient. Having website support to maintain a “live map” of activities & or establish an open source database of tools, including a registry for research is a long-term goal.     

The UCSF Roatan Inter-professional Program’s pediatric clinic has had >35,000 patient-visits to date.  The resident elective has hosted >100 residents (primarily pediatric, but also emergency and family medicine) from across the US, from Boston to Miami to Seattle to San Diego.  The HEAL student internship developed out of partnership with Stanford; over 80 undergraduate/post-baccalaureate students have rotated have rotated through to date.  Attending physician volunteers have numbered >120.  With a goal of bilateral training, the Program initiated a Pediatric “fellowship” for local Honduran general practitioners. The 1-3yr “fellowship” has supported pediatric training in Roatan, with mentorship from our rotating volunteer attendings.  Of 5 fellows to date, one is Medical Director of the Public Hospital Roatan and another is director at one of the island’s other four public health clinics.  The fifth fellow, who received formal pediatric training in Honduras, is our current Roatan site director.

The Program has created a culture of continuing education.  The Program brought internet to the Public Hospital and access to best-practices through UpToDate.  Rotating residents and attendings often host case-conferences and formal lectures.  The Program has sponsored focused training (e.g., ultrasound, NRP) for local providers, biomedical maintenance training, and island-wide trauma/disaster conferences.  

An interesting and timely contribution by Dr. Eichbaum at Vanderbilt University: The Problem With Competencies in Global Health Education.    E-published ahead of print in the Acad of Med.  He seems to be calling for just this type of exercise in assessing GH training programs. 

In the GHS masters program our students are located in many different sites. This puts us at a disadvantage for measuring impact as we do not place students in the same locations years after year. I am most interested in how we can measure our impact on the ground, e.g how the work our students participate in results in better health outcomes ultimately. We track our alumni to see if they stay in global health careers or higher ed degrees, but for me the marker of success is what our sites gain for our students participation. Perhaps dissemination of work is a good metric in this case? I would be interested in what others have to say about tracking the impact of shorter term projects or how we might consider continuing in a set number of sites each year. To do this, we need to also consider the varied interests of our incoming students.

Center for Global Surgical Studies (CGSS)

Primarily focused on public health research, CGSS projects regularly track metrics on measurable change as a result of research efforts. For example, in Cameroon, the implementation of trauma surveillance includes follow-up arms examining health outcomes as well as resulting policy development. This allows for CGSS to understand the extent of the impact of the trauma surveillance system on health outcomes, disability, quality improvement interventions, and injury prevention programs as well as policy and intervention development as a result of dissemination of findings.

A similar project at Soroti Regional Referral Hospital, a rural hospital in northeastern Uganda where CGSS is designing and implementing surgical and trauma registries, will track similar follow-up metrics to evaluate the impact of ongoing surgical and trauma surveillance on the health system.

Lastly, for the Kampala Advanced Trauma Training conducted quarterly in collaboration with GPAS, pre- and post-testing as well as course surveys are administered to evaluate the impact and efficacy of the course. Knowledge and retention as well as outcome metrics are collected to contribute to ongoing development and improvement of the course for the Ugandan setting.