A Decade of Dedication: Navigating Challenges and Triumphs in Pediatric Global Health

Background

Interest in global health education (GHE) continues to rise among trainees. GHE in low-resource settings (LRSs), allows residents to expand medical knowledge, enhance physical examination skills in lieu of diagnostic tests, and increase cultural sensitivity. ¹ In 2016, 83% of residents who completed a global health (GH) elective planned to incorporate GH into their careers. ² GHE should be a priority of residency programs.

Ten years ago, the Cohen Children’s Medical Center’s (CCMC) pediatric residency program, with a complement of 100 pediatric residents, began a GH program. GLOhBAL (Global Learning Optimizing Health/Building Alliances Locally) was developed to strengthen training in global pediatrics and focus on clinical management in LRSs. GLOhBAL’s vision is to improve the well-being of children in medically underserved communities through clinical care, education, research, and advocacy.

Lessons Learned

Program

To provide exposure to GH topics to all residents, a 24-month GH Noon Conference series is held. This hybrid model includes local and international experts in the fields of GH research, policy, and clinical care. The program later added morning report discussions based on experiences during their GH elective.

Electives

The GH elective experience at our institution began as an opportunity for senior residents to travel for 4 weeks to international sites, of their choosing, throughout the world. Because of the varying experiential quality and safety concerns, the program decided to focus on 3 sites. Residents travel to North Dakota (ND), Kenya, and India where they work with local physicians who serve as mentors. This has also allowed the program to have a continuous presence at these sites which has enhanced the health of the populations. Residents provide training and educational sessions to the staff at each of our partner sites. Topics include Essential Newborn Care and diagnosis, management, and treatment of common illnesses as requested by site leadership.

The Kenya elective focuses on clinical care provision of children from disadvantaged backgrounds. Residents receive a temporary medical license to rotate at Thika Level 5 Government Hospital and a community-based clinic in a rural setting.

During the India elective, residents focus on inpatient and outpatient care of children from the Southern region of India at Dr. Mehta Children’s Hospital, a tertiary care hospital. This rotation provides observational opportunities to increase trainees’ knowledge of tropical diseases and care management.

At the ND site, residents provide culturally appropriate pediatric care to children and families of the 3 Affiliated Tribes (the Mandan, Hidatsa, and Arikara Native Americans). The residents gain experience working with underserved indigenous populations, receive exposure to the challenges of working on a reservation, and witness the challenges of living in a setting with generational historical trauma.

In early 2020, the COVID pandemic temporarily halted international travel, which forced the program to develop an enhanced global experience. This combination of hybrid in-person and virtual curriculum provides all residents an opportunity for GHE. These adaptations have become an integral part of our program.

The goals of the virtual GH elective were to help residents understand the history and evolution of pandemics, increase exposure to global and public health, discuss ethics, and explore social determinants of health as it related to the pandemic. This elective includes independent learning modules and collaborative conferences with our partner sites. This bidirectional learning model has become the core of our curriculum.

To date, 42 residents have participated in the virtual elective. Residents report that the elective has helped understand the framework for pandemic preparation and to learn about issues that arise in LRSs. While virtual learning is not a substitute for field experience, this elective successfully taught residents core principles and may serve as a model for other residency GH programs.

One of the key elements of the evolution of GHE at CCMC during the COVID pandemic was the maintenance of relationships with our partners. Staying connected, through the virtual elective, during the pandemic led to seamless reopenings of our partner sites: ND in 2021, Kenya in 2022, and India in 2023.

Global Health Pathway

After 5 years it became apparent some residents wanted additional training beyond a GH elective, so the program developed a 2-year GH pathway for trainees who wanted to pursue a career committed to GH. The pathway is focused on the acquisition of knowledge relevant to common pediatric diseases in LRSs in the US and abroad, the development of and demonstration of critical clinical skills that are effective to provide care in LRS, and the enhancement of leadership skills through mentorship. In addition to didactic lectures, the pathway incorporates journal club discussions, simulation sessions, and career development workshops. Trainees work closely with faculty mentors within the GH program to develop a scholarly project for implementation during the fieldwork experience. Given the success of our collaborative model used in the pandemic elective, we added this to our pathway. In recent years we have invited international experts in the field to network and provide career guidance.

Before the pandemic, residents in this pathway participated in well child visits at the Child Center of New York (CCNY). CCNY is a community organization which serves 55 000 children yearly in New York City’s underserved communities. During the pandemic, virtual workshops were offered and continued for caregivers on topics identified by families. The success of the program lies in the accessibility of the virtual model allowing us to educate more families.

Conclusions

Since its inception, the GH program has evolved and grown. GH interest continues to blossom across many pediatric subspecialties and we have begun to incorporate fellows in our program. GH challenges caused by the pandemic, pushed the program to recognize the importance of collaborative learning, maintaining partnerships, and leveraging technology. We aim to offer bidirectional opportunities by inviting trainees to participate in electives at our home institution. Next steps include the establishment of an accredited GH fellowship. The GH program will continue to evaluate its impact from a trainee and partner site perspective as we continue to strengthen the program. GHE paves the way for well rounded pediatricians to provide culturally inclusive care.