A centralized structure for approving, tracking, and monitoring global health electives at a large academic institution

: 1.068_HRW Training the next generation of global health leaders: the interdisciplinary framework in global health at Brown

Purpose: The purpose of the Interdisciplinary Framework in Global Health Program at Brown University was to stimulate engagement in multidisciplinary global health activities to address health inequities. The goal was to become an integral part of the university's larger strategic plan. This idea came to fruition with the establishment of the Global Health Initiative (GHI) in 2009.

Method:
The objectives were to: develop new interdisciplinary curricular/educational opportunities through the global health scholars program; coordinate a foundational set of courses addressing global health topics; establish mentored global health experiences; create a sustainable community of global health scholars.
Outcome & Evaluation: Global Health Scholars: provides funding to students for scholarly projects. Sixty-nine students received scholarships (9 undergraduate, 27 MPH, 6 medical, 11 graduate, 16 residents/fellows) for travel to 29 different countries.
Faculty Curriculum Development: provides grants to incorporate global health content into new/existing courses: 10 faculty from 8 departments received this award.
Minority Health Disparities International Research Training (MHIRT): provides mentored research opportunities at international sites to students from underrepresented communities. Twenty-four students (1 medical, 3 graduate, 20 undergraduate) participated at 9 collaborating sites.
Brown International Advanced Research Institutes (BIARI): brings together junior faculty from lower/middle income countries (LMIC) to address global issues through high-level collaborations.  is particularly pronounced in medicine as several studies have highlighted its importance in multiple specialties, including Family Medicine, Emergency Medicine, and General Surgery.
[References] GH rotations may place trainees in high-risk situations and environments with regard to ethics, cultural sensitivity, and personal safety. Academic institutions need to provide proper guidance and education to prepare trainees for safe and effective GH rotations.
Structure/Method/Design: In order to better address institutional concerns, provide reasoned and consistent oversight, and prepare students for their GH rotations, we created, piloted, and refined a standardized preparation and approval process for resident physicians who sought to participate in GH electives as part of their training programs. A Global Health Advisory Committee (GHAC), consisting of key GME, legal, resident, and GH expert stakeholders was created. Three checklists, managed and administered via New Innovations (a commonly used and commercially available residency management software package), are used to provide trainees with consistent and critically important education about GH electives while also providing a mechanism for oversight, completion of relevant documents, and a debriefing tool which creates a summary of the elective that can be viewed by other residents.
Outcome & Evaluation: Several of our residents have successfully completed the checklists for GH rotations. Our GHAC will soon be meeting to gain feedback from the group on our new standardized preparation and approval method. This uniform system will also enable us to perform monitoring and evaluation of specific sites.
Going Forward: We are happy to share our checklists with other institutions. We will continue to assess our new system and make changes as needed.

Makerere University Kampala, Uganda
Background: WHO predicts 16 million new cancer cases per year in 2020. 70% of these will be in the developing world. In the developing world, 1/3 cancers potentially can be prevented another 1/3 are treatable if detected early. Evidence shows that cancer outcomes (survival) are better when care is provided by Specialists (Gynecologic Oncologists).This is lacking in East Africa and Uganda as well. Through partnership with University of California San Francisco (UCSF) (initiators) and other collaborator gynecologic oncologists, there has been on job surgical training and mentorship which has led to tremendous outcomes. The aim was to improve the care and management of women with gynaecologic cancers and to train a critical mass of specialists in this field starting with what is currently available in their setting.
Structure/Method/Design: This started with a needs assessment by a gynaecologic oncologist from UCSF. She then started coming twice a year to date doing ward rounds, radical surgeries and working with the administration to create an interdisciplinary team for cancer patient care that was not existent.
Outcomes: Since 2011 a gynaecologic oncologist from UCSF has worked with gynaecologists on the oncology ward at Mulago and has done at least 50 radical surgeries for gynaecologic cancers with them and has been joined by faculty from Duke University and University of Vermont. The surgeries were more appropriate in comparison to what used to be done especially for management of early CaCx with radical Hysterectomy and pelvic lymph node dissection. They have worked with at least 10 gynaecologist at the referral hospital and have mentored them in Cancer care. A multidisciplinary approach to cancer care has been started with radiation oncologists, palliative care and gynaecologists working together in the management of patients on the gynaecologic oncology unit.
Going Forward: One gynaecologist is being sponsored by UCSF to do a fellowship in gynaecologic oncology at Moi University a 2 year programme now in her second year. This will ensure sustainability. A curriculum development for a fellowship in gynaecologic oncology is underway with stakeholders meetings was held and the local faculty identified the need. the HEP to foster communities to be part of the health system to improve health outcomes. In 14 of the 115 districts, participatory community quality improvement (PCQI) is tested through fostering partnership between communities and service providers to create shared responsibility in the ownership of maternal MNH services provided by the HEP. With the aim to improve the quality of maternal and newborn health (MNH) services from the provider, client and the community's perspective, PCQI implements a cyclical process that first identifies barriers to quality services, then develops action plan to address barriers, implements the action plan, and finally monitors the quality of improvement solutions.
Methods: 82 and 34 communities respectively representing PCQI and non-PCQI areas were visited during baseline (Dec 2010eJan 2011) and at follow-up (Dec 2014eJan 2015). Maternal and newborn