Core Curriculum

The aim of the Duke Global Health Residency Program (GHRP) is to prepare resident trainees to bridge clinical practice with public health in order to reduce health disparities both locally and abroad. Participants in the GHRP come from multiple departments across Duke University Medical Center and extend their specialty training through their work in the program. This expanded residency will not conflict with ACGME requirements for accreditation, but will provide additional opportunities for global health clinical service, research, and education.

The GHRP core curriculum will focus on general issues related to clinical practice, research, and health policy in low resource settings. Within the curriculum, particular attention will be given to issues of cultural sensitivity and medical and research ethics. Global Health Residents, regardless of their discipline, will obtain a profound appreciation for the determinates and consequences of health disparities in the communities where they work, and special attention will be given to understanding key prevalent causes of morbidity and mortality encountered in resource-poor settings.

Regardless of specialty training, all residents will be expected to demonstrate competencies in the following areas to be effective global health physician leaders.

1. Patient Care

1. Demonstrate culturally appropriate, caring, and respectful behavior in all patient interactions.

2. Gather essential information from patients by performing a complete history with appropriate use of translators and progressive acquisition of skills in the local language and dialects.

3. Demonstrate culturally sensitive and efficient physical examination skills.

4. Make informed decisions about diagnostic and therapeutic interventions with an understanding of the resource limitations of the practice setting.

5. Develop culturally appropriate counseling and education methods for patients and families.

6. Demonstrate creative and effective use of information technology in patient care.

7. Perform indicated procedures as needed, adapting to the constraints of resource limited settings.

8. Serve as a model for effective inter-departmental communication and collaboration within the institution.

9. Demonstrate a commitment to the culturally sensitive application of medical ethics to patient care in this setting.

10. Demonstrate an active awareness of relevant continuous quality improvement initiatives that are achievable in this setting.

11. Demonstrate a commitment to patient safety and autonomy in all endeavors.

12. Advocate for quality of patient care at all times.

13. Demonstrate the appropriate application of public health knowledge and methodology when implementing patient care plans.

2. Research

1. Develop a working understanding of the local and regional research needs of the communities in which the resident is working.

2. Develop a practical understanding of the existing research programs and institutional review protocols already in place.

3. Understand the historical, economic, and cultural issues that may have an effect on research initiation and implementation in the relevant health care facilities and communities.

4. Demonstrate practical applications of medical research ethics with special attention to issues of distributive justice and autonomy.

5. Demonstrate an appropriate understanding of the pitfalls and challenges of medical research in under represented and often impoverished populations.

6. Lead a research project that is regionally relevant and involves one or more nationals in key investigative roles.

3. Personal

1. Demonstrate a commitment to continuing education despite limited access to educational resources.

2. Identify areas for personal and practice improvement.

3. Demonstrate receptiveness to instruction by local physicians and non-physician providers.

4. Facilitate the education of learners within the system by serving as a teacher and role model to local medical students, residents, nurses, and faculty.

5. Demonstrate the ability to discuss medical errors in a culturally sensitive manner and a willingness to learn from these errors.

6. Begin a process of self-analysis that will foster an awareness of the additional stress that can be encountered when practicing in a different country and socio-cultural setting.

7. Develop a personal system for stress reduction and coping mechanisms for the inevitable tragic medical events one will encounter in this setting.

4. Global Health Ethics

1. Discuss the role of foreign health professionals in the medical systems of developing nations.

2. Discuss the ethical principles that are most important in health care delivery in under-resourced settings (e.g., the relative importance of justice vs. beneficence).

3. Discuss the vagaries and challenges of the informed consent process in patients who do not speak the common medical language and in those who may be illiterate or who may not have a shared conception of respect for autonomy.