Are we practicing what we teach? Ethical guidelines and student global health research experiences

N.E. St Clair, P.R. Fischer, S.A. Hagen, J. Kuzminski, A. Al-Nimr, M.B. Pitt, C. Schubert, L.A.-M. Umphrey, S. Warrick, J.H. Conway; Medical College of Wisconsin, Pediatrics, Milwaukee, WI/US, Mayo Clinic, Pediatric and Adolescent Medicine, Rochester, MN/US, University of Wisconsin, Pediatrics, Madison, WI/US, Rainbow Babies & Children’s Hospital, Center for Pediatric Education, Cleveland, OH/US, University of Minnesota, Division of Global Pediatrics, Minneapolis, MN/US, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH/US, University of Wisconsin-Madison, Global Health Institute, Madison, WI/US

Preparing locally to learn globally: The development of a joint UME and GME preparatory curriculum for global health electives Background: Recent studies on trends in US medical schools' global health curriculum found less than 30% of programs adequately prepare students for their overseas experience. To align with the AAMC's Guidelines for Premedical and Medical Students Providing Patient Care During Clinical Experiences Abroad (2011), the Medical College of Wisconsin (MCW) developed a joint undergraduate and graduate medical education (UME and GME) preparatory curriculum for trainees seeking to participate in global health electives. Structure/Method/Design: An interdisciplinary group of MCW faculty was formed in 2012 to determine the essentials of predeparture preparation for medical trainees. Based on a literature review, discussion with national colleagues and local expert consensus, 2.5 hours of training materials were developed with the following components: 1) two 20-minute online preparation modules ("What to consider with international travel health" and "Global health elective preparation"); 2) an MCW Guide for Global Engagement; and 3) an in-person 1.5-hour seminar on the ethics of short-term global health electives jointly for UME and GME trainees. The curriculum was piloted on MCW UME and GME trainees in spring 2013 and some modifications were made. UME and GME administrative approval was subsequently obtained to incorporate the curriculum for all MCW trainees participating in global rotations, and institutional review board approval was secured for a long-term evaluation of the curriculum. Data will be gathered through annual surveys (2013)(2014)(2015)(2016)(2017) to assess whether the curriculum enhances trainee preparation for global electives. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): Curriculum development was funded through an internal grant from the Medical College of Wisconsin. Institutional collaborative partners included faculty and administrative leaders from Bioethics, Medicine, Pediatrics, International Travel Clinic, and Global Health Program. Summary/Conclusion: The largest challenge is for trainees to attend the in-person ethics seminar due to schedule conflicts; therefore, an alternative online documentary viewing is offered. A review of the literature does not reveal similar combined UME and GME preparatory curriculum that is provided in conjunction with faculty mentorship to cater to individual training requirements. Thus, this is a potentially scalable model for other programs attempting to prepare large groups of trainees for global engagement.
Are we practicing what we teach? Ethical guidelines and student global health research experiences Background: Increasing numbers of students from high income countries (HIC) are participating in global health research in low-and middle-income countries (LMICs). Current best practices exhort students to define objectives and procedures in collaboration with LMIC partners, seek local IRB approval, receive research ethics training, and disseminate results locally, among other recommendations. However, compliance with such guidelines is not monitored or widely known.
Structure/Method/Design: We conducted a study to characterize the experiences of HIC students conducting research in LMICs. We invited current and former undergraduate and graduate/health professional students from Yale University who had conducted research in an LMIC in 2009-2013 to participate in an online questionnaire focusing on predeparture preparation, relationship with advisors and host communities, research ethics, dissemination, and impact on the student. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): Among the 89 respondents, 53.9% were undergraduate, 46.1% were graduate students, 67.4% were female and the mean age was 22 years. Less than half (40.4%) of the respondents reported that LMIC partners or community representatives had been involved in defining the research objectives; 74.2% of respondents had received some form of research ethics training prior to their trip; and 59.0% submitted their research protocol to the local IRB when one existed (compared with 70.9% who submitted to the Yale IRB). While 67.4% of respondents stated that they planned to disseminate results to their host institution, community, or in a local publication, only 27.0% had done so. In bivariate analysis, students who sought LMIC partner involvement in the definition of research objectives reported feeling that their Yale advisor was not enthusiastic about their research (41.2% vs 11.5% among those that did not involve partners in defining objectives, P ¼ 0.001), communicated less frequently with their Yale advisor before their research experiences (Mann-Whitney U test P ¼ 0.001), and felt less prepared to deal with ethical dilemmas in the conduct of their research (Mann-Whitney U test P ¼ 0.013). Those students who had disseminated results locally were more likely to have communicated with students who had previously visited the site (84.2% vs 55.6% of those who did not disseminate locally, P ¼ 0.029) and to feel that they would have benefited significantly from a post-experience debriefing with experienced faculty or students (50.0% vs 23.0%, P ¼ 0.012). Summary/Conclusion: According to student reports from a sample of undergraduate and graduate students, guidelines for global health research are not being uniformly applied. Support and mentoring by faculty advisors and peers should be further explored to ensure best practices and are being applied and that students receive appropriate training and guidance prior to undertaking research projects in LMIC settings.
Health systems service learning in ShanghaieLessons from an undergraduate experiential learning program in China T.J. Stranova 1 , L. Shi 2 , Y. Chen 3 , S. Tu 3 ; 1 Tulane University School of Public Health & Tropical Medicine, Global Health Systems and Development, New Orleans, LA/US, 2 Tulane University, New Orleans, LA/ US, 3 Fudan University, Shanghai/CN Background: After Hurricane Katrina, 80% of New Orleans, including both of Tulane's Uptown and Downtown campuses were under water. When classes resumed in January 2006, Tulane students, faculty, and staff returned to a city in ruins, but they returned to a university committed to rebuilding both the school and New Orleans.
A major focus of Tulane University's rebuilding plan became the creation of a service-learning requirement for all undergraduate students, regardless of major. As New Orleans' largest employer, Tulane University first directed students and their projects toward helping the areas and organizations within the city and the metro area. However, as the city of New Orleans emerged from the post-Katrina devastation, Tulane began to widen the reach of this program to other parts of the state, the nation, and eventually internationally. Structure/Method/Design: In 2011, Tulane partnered with Fudan University in Shanghai and Shandong University in Jinan to create one of the first international service-learning opportunities to be made available to Tulane undergraduates. Now entering its fourth year, the program continues to expand its number of students, relationships with Shanghai health care institutions, and opportunities for young scholars to make a difference in local communities. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): Fudan University, Xuhui Maternal and Child Health Center, Jaiding Anting Community Health Center, Malu Community Health Center, Ruijin Diabetes Center Summary/Conclusion: This poster presentation will discuss Tulane University's unique service-learning requirement; the Department of Global Health Systems and Development's efforts to develop and launch the program in China with our partners from Fudan and Shandong Universities; the impact of the program on teaching and learning for undergraduates in Fudan University; and finally the lessons learned by the faculty members along with the feedback from the student participants. Further, the poster will review the various projects, responsibilities, and experiences that the students had while working in various health care organizations in Shanghai. Student comments and feedback will be incorporated into the poster content and the future of the program will be discussed.