Best Practices for Global Health Programs

Identifying interesting approaches to global health education

Multi-Learner Capacity

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Identify programs which demonstrate an ability to accommodate UCSF learners of diverse areas of study and level of training. Reference programs that provide notable learner support (i.e.; pre- and post-travel support, student orientation and debrief, etc.).

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Researchers (Medical Students): Institute for Global Orthopaedics and Traumatology (IGOT) supports a 1-year Research Fellowship (funded) for MS3/4. Fellow is incorporated into the Orthopaedic Trauma Institute (OTI) Clinical Research Center, which includes mentorship & access to projects spanning basic, translational & clinical research.

Residents: The Orthopaedic Department supports a 4-wk global elective resident rotation (funded) for PGY-4’s across 5 international sites. A formal required reading list for learners & access to audit either the UCSF Global Health Scholar or GHS MS intro courses would be beneficial to learners.

Interns/Other learners: IGOT annually accommodates interns (undergrad-MS1/2’s) for shorter-term projects but funding/HR limitations limit the expansion of these opportunities.  

International Learners: in collaboration with national societies (AAOS & OTA) we support observerhsip scholarships (up to 1 month) where learners are weaved into our clinical didactics, research curriculum & training activites per their interests.

All of the above have informal orientations, pre/post program debrief. Adminitartive uspport to organize & catalog these opportunties, manage the logistics & measure impact is needed.

The UCSF Roatan Interprofessional 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.  

Here is correct post for Multi-Learner Capacity:

The UCSF Roatan Inter-professional Program has grown from a pediatric clinic founded in 2003 (by UCSF faculty, plus the Public Hospital Roatan and Berkeley NGO Global Healing) to touch on perinatal care, OB, EM, family medicine, and surgery, as well as nursing, dentistry, and pharmacy related educational/clinical initiatives.  The Program has hosted resident learners from multiple specialties, with >100 residents from across the US (largest groups UCSF, Children’s Hospital Oakland, Stanford).  Our Health Education and Advocacy Liaisons (HEAL) internship has hosted >80 undergraduates (primarily Stanford).   The Program has expanded to include Dentistry, Nursing, Pharmacy, and GHS, hosting in FY14 3 Pathways to Discovery students (SON), 5 Global Health Scholars (SOD/SOM/SOD/SOP), and our first GHS MS candidate.   An established housing and orientation system facilitates learner travel and acclimatization—thereby maximizing clinical/project time.  Current capacity: 3+ learners simultaneously. Non-stop air from Houston, and multiple connections to San Salvador and mainland Honduras.  On-site internet access and VOIP with Bay Area phone number, together with a 2h time difference, simplifies communication with Bay Area leadership/administration.  A designated Public Hospital Roatan faculty member works full time in the pediatric clinic as our local Program director; she serves as on-site liaison and mentor for our learners.

As a pediatric pharmacy resident last year through the SOP, I had the opportunity to collaborate with SOM & SON to complete a research project through the GHS Program at Public Hospital Roatan (PHR). The opportunity had expanded my clinical knowledge and enhanced my communication, research, and global health skills. In addition to working with the multidisciplinary team (UCSF Faculty), the PHR faculty member also provided guidance and assistance during our time conducting research at PHR. 

One of the best things about the UCSF Roatan collaboration is the interprofessional nature.  Last year's pharmacy residents were able to work with medicine and nursing; this year, the opportunity was dentistry.  Each profession has something to teach and something to learn in this environment.  

It has been a great opportunity to work in important interprofessional research and clinical interventions to improve health care service delivery for vulnerable infants and children from impoversihed families in Roatan.  This unique faculty collaboration at UCSF has also supported collaboration between many students from nursing, medicine dentistry, pharmacy both at UCSF and in Roatan.  As a School of Nursing faculty, our interprofessional faculty work in Roatan has also supported me to mentor eight Global Scholar nursing students to develop innovative nursing educational projects for nurses in Roatan.

The partnership of UCSF and Public Hospital Roatan has provided a unique experience for myself and other colleagues to work intimately with health professionals internationally. I am especially grateful for this experience in the opportunity it has provided to me to complete work for the global health scholars program in conjunction with a project planning class.  It is a wonderful opportunity to collaborate with so many different faculty and classes in order to contribute to one goal.

This partnership is working to create a working knowledge base of pediatrics and emergency care through educational projects that have far reaching implications for the future both through immediate implementation and further education and training in the long run and for future students, faculty and hospital personel in public hospital Roatan.

I feel honored and very grateful to have been the first Global Health Sciences MS candidate to complete part of my Capstone Project with the UCSF Roatan Inter-Professional Program. 

My duties with the program consisted of drafting a clinical research protocol, as well as conducting informal interviews with different medical staff members at the Public Hospital of Roatan.  The goal was to gain an improved understanding of the major challenges involving dengue diagnosis and its management in resource-poor settings. 

In addition to gaining experience with research and learning more about issues concerning global health, I also had the opportunity to shadow physicians and conduct educational talks with patients regarding HIV, dengue, and malaria prevention. 

My experience with the program truly amplified my knowledge and passion for global health.

What is the cacpacity of your five international sites to accommodate learners from other disciplines: pharmacy, nursing for example? 

Would it be beneficial to integrate these ortho placements with other placements? I'm thinking dental- reconstuctive? Pharm? nursing? There is an intrinsic support and team building aspect to that type of placement. There is a push amoung many at UCSF to develop supportive & rehab development placements. That seems like a great overlapping way to place trainees...

IGOT has been very successful in its international learner program and I am thrilled that you are now taking the  program to the learners. In particular, the emphasis on research for best implementation in specific settings, with a follow-thru in grant writing and submission is an outstanding model for international scholars. It strikes me as similar to Eva Harris' SSI program. Definitely a model in fostering sustained capacity in the sites we impact. 

In the 5 international sites that you most heavily impact, are you doing any combined placements? team or multi-discipline?

The UCSF Roatan project provides a unique place to graduate and predoctoral dental students to interdisplinary learning and research projects that incorporating oral health as a part of the global health of children. These projects brought a whole new field of learning opportunities and open the eyes of students and faculty for novel models to promote oral health in underserved community and countries. The oral health project in Roatan started with a close collaboration between a pediatric dental resident with pediatric resident involving crossing training and research designing and close collaboration between faculties in SOD, SOM and public health in UC Berkley. Currently, we have had 3 pediatric dental residents and 3 predoctoral dental students, 1 pediatric resident, 1 pharmacy resident, 1 global health resident and 1 premedical students involved in the oral health project with mentors from all 4 schools within UCSF and mentors from UC Berkley. These projects has provide them the opportunity to learn and work with students, faculty and local health providers and administrators on different aspects that are needed to build a sustainable interdisplinary oral health program. They work as a team and start from assessing local oral health condition needs; assessing the outcomes of the program on children’s dental caries, nutrition, and parental oral-health literacy; evaluating program feasibility, coverage, best practices, and implementation barriers; and working with other medical professions to build a sustainable interdisplinary oral health program that can be used as a model globally to improve oral health for children in underserved area or countries. As a faculty in School of Dentistry, I am very excited to be included in this group. The strong bond and trust of the Roatan project and its unique location and population can serve as a unique place to build novel interdisplinary health models that can be scaled up globally.

Helpful description - Thanks!

I'm interested in the UCSF-UCB collaborative aspect. Are your learners from Berkeley also UCSF affiliates (thru a joint program?) I am aware that you also accomadte undergrads- is that done through an independent NGO? Child Family Health International? or UC Study Abroad?  My sense is that developing tighter relationships with GH workes on the East Bay is a good thing, and that seems to be a strength in this program. What advice would you give to other UCSF GH programs about cross-bay collaborations?

The UCSF Roatan project provides a unique place to graduate and predoctoral dental students to interdisplinary learning and research projects that incorporating oral health as a part of the global health of children. These projects brought a whole new field of learning opportunities and open the eyes of students and faculty for novel models to promote oral health in underserved community and countries. The oral health project in Roatan started with a close collaboration between a pediatric dental resident with pediatric resident involving crossing training and research designing and close collaboration between faculties in SOD, SOM and public health in UC Berkley.

Up to date, we have had 3 pediatric dental residents and 3 predoctoral dental students, 1 pediatric resident, 1 pharmacy resident, 1 global health resident and 1 premedical students involved in the oral health project with mentors from all 4 schools within UCSF and mentors from UC Berkley.They have received 5 campus and regional funding for their research projects, presented their projects in 6 campus wide, 3 regeinal, 5 national conferences and 1 international conferences, and won research 8 awards from UCSF SOD Research and Clinic Excellence Day (3), California Society of Pediatric Dentistry  and American Association of Pediatric Dentistry.

These projects has provide them the opportunity to learn and work with students, faculty and local health providers and administrators on different aspects that are needed to build a sustainable interdisplinary oral health program. They work as a team and start from assessing local oral health condition needs; assessing the outcomes of the program on children’s dental caries, nutrition, and parental oral-health literacy; evaluating program feasibility, coverage, best practices, and implementation barriers; and working with other medical professions to build a sustainable interdisplinary oral health program that can be used as a model globally to improve oral health for children in underserved area or countries.

As a faculty in School of Dentistry, I am very excited to be included in this group. The strong bond and trust of the Roatan project and its unique location and population can serve as a unique place to build novel interdisplinary health models that can be scaled up globally.

Hi Ling! So excited to see dentistry represented! What other programs have you done dental placements with? I think that would help this conversation a lot- knowing where placements are happening. Are you only placing thru NGO's? Did Roatan help you with that aspect? I remember Chris stuart used to have a very robust "team placement" program. Does anyone know if that is slated to be re-surrected?

We have had an outstanding experience with both IGOT and with Roatan. Masters studens, medical students, nursing students, pharmacy students and residents in the programs with which I have been involved have universally commented on the strength of the multi-learner capacity of these programs. In addition, all of them have been struck by the interprofessional mentors.

The Student Training Education Program (STEP) is based out of the Family AIDS Care and Education Services (FACES) program in western Kenya and has hosted more than 100 UCSF learners in both clinical and research capacities since its inception nine years ago. Participants in STEP were affiliated with the following UCSF schools: School of Medicine (MS1, MS3, MS4), Nursing, Pharmacy, Global Health Masters, PhD programs, and Internal Medicine, Pediatrics and Ob/Gyn Residents. STEP also allows medical students and residents at other institutions to participate. From 2006 to 2014, staff at UCSF supported the participants by conducting pre-travel orientations, arranging for arrival and transition to Kenya, and holding feedback meetings upon return. As of June 2014, there is now a Research and Training Coordinator in Kenya assigned to coordinate STEP. The creation of this position has improved the program by providing full-time support to participants and address any issues more comprehensively.

Thanks for the description - very impressive multi-level and and multi-disciplinary capacity.  

I am aware that the FACES program addresses HIV, maternal health, and the efficiencies around integrated family care. It seems that most of your trainees work semi- independently when they are on site? This would make sense, as I believe the FACES program has 300+ clinical sites. And that makes the presence of a FACES trainee-coordinator very important. With 10 learners per year, are they typically working in parallel projects? How long are their placements? Do other UCSF trainees based in Kenya and Uganda have access to the Research and Training Coordinator in Kenya?

Trainees conducting clinical electives work under supervision (although the amount of supervision depends on their level of training), and those doing research electives have a U.S. and/or Kenyan mentor they are working with.  We actually have averaged about 25 learners per year, but many are from outside UCSF.  Placements range from a minimum of 4 weeks (resident clinical electives) to several months, depending on the trainee's program/availability/interest.  The Research and Training Coordinator position is specific to Kenya, and supports trainees that are in some way affiliated with FACES.

GPAS – Global Partners in Anesthesia & Surgery (www.globalsurgery.org)

The GPAS collaboration in Uganda has facilitated educational experiences for residents and medical students from a variety of disciplines including general surgery, anesthesia and obstetrics & gynecology. This initaitive has primarily focused on srengthening the learning capacity for our Ugandan trainees, though we have also found numerous opportunities for synergistic learning with non-Ugandan trainees. Most trainees who have participated with our program are from UCSF, though trainees from Stanford, University of British Columbia, and the University of Washington have also participated.  

UCSF current collaboration with Makerere University (MU) in Uganda started studying malaria in 1998 and today, also includes research in the areas of TB, HIV, pulmonary disease, non-communicable diseases, immunology, parasite and drug resistance with over 20 collaborating principal investigators (www.muucsf.org). The goals of this collaboration are: 1) conduct high-quality research in infectious diseases; 2) build capacity through training; and 3) strengthen infrastructure to help integrate research into policy by linking researchers and policy makers. Infectious Diseases Research Collaboration (IDRC), an NGO, formed in May 2008 with the support of MU-UCSF collaborating investigators and founder members of Ugandan health scientists from MU and Ministry of Health (www.idrc-uganda.org). A Collaboration Executive Committee was formed in 2008 with members from MU, UCSF, IDRC, and LSHTM to direct and monitor goals for the scientific direction of the research collaboration. To date the collaboration accomplishments include: malaria and TB surveillance of over 750,000 patients throughout Uganda; enrolling ~230,000 persons in research studies; contribution of 250-300 publications; carrying out annual MOH dissemination meetings on malaria and HIV findings to policy makers; maintaining 2 high functioning research laboratories in Kampala and Tororo; and support for internal and external training programs and research symposiums for U.S. and Uganda students. Trainees apply through collaboration investigator mentors and receive support for orientation in person and 20-page visitors manual, in-country logistics, and medical/emergency assistance protocols. 

Center for Global Surgical Studies (CGSS)

UCSF learners have the opportunity to play a role in any of our ongoing research projects at any given time. Because of our strong collaboration and relationships with in-country partners, we are able to accommodate the interests, needs, and schedules of learners at various levels of training, including first- to fourth-year medical students, residents, fellows, master’s candidates, and doctorate-level candidates.

For each project, our research team provides guidance and research support to our learners across the continuum of the research process, supporting proposal development, study design, data analyses, conference preparation, and manuscript preparation. In the event of travel to new sites, we provide orientation materials based on information from past experience at these locations and from local partners, concluding with a debriefing upon return. 

CGSS also logistically and administratively supports transportation and accommodation arrangements according to past experience at study sites and with the support of in-country partners. In this way, CGSS has the capacity to support a wide range of levels of training for international public health research focused on issues related to global surgery. 

GAIA, discussed in greater detail under the topic of Strength of Infrastructure has multi-learner capacity that supports all types of graduate and professional degree students. For example, a pharmacy faculty member conducted a NIH-funded project on traditional healers in Malawi,masters level nursing students have completed Clinical Scholars projects, and doctoral students in nursing have gathered data for dissertations. Some of GHS students have been health care professionals and others have been representative of other disciplines.