Global Health Residency Program Core Curriculum

The aim of the Duke Global Health Residency Program is to prepare trainees to bridge clinical practice with public health principles in order to reduce health disparities both locally and abroad. Participants in the program come from multiple departments across Duke University Medical Center and extend their specialty training through their work in the program. This expanded residency/fellowship provides additional opportunities for global health clinical service, research, and education.

The Global Health Residency Program core curriculum focuses on general issues related to clinical practice, research, and health policy in low resource settings. Within the curriculum, particular attention is given to issues of cultural sensitivity and medical and research ethics. Global Health Residents and Fellows, 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.

Objectives of the curriculum are achieved during three major assignments or rotations. The core rotations are:

• Site Assessment
  This six week rotation at a Duke University international partner site takes place prior to starting master’s classes in August. This rotation helps inform research ideas and guide master’s thesis topics and allows trainees to begin studying site-specific clinical and cultural issues.

• Master’s Training
  Eligible trainees enroll in the Master of Science in Global Health degree program (MSc-GH) offered by the Duke University Graduate School in conjunction with the Duke Global Health Institute. The MSc-GH program offers Global Health Residents and Fellows opportunities to develop and refine skills in research study design, quantitative and qualitative methods, and to understand some of the key health policy and ethical challenges confronting those engaged in Global Health careers.

• Long Term Global Health Training
  During the long term global health training rotation, residents and fellows conduct mentored research and clinical care their international partner site. Research conducted during this time is expected to be used towards a master’s paper of publishable quality. During the rotation, trainees attend relevant clinical and research conferences.

Regarding financial support:
Financial support for trainees provided by the Global Health Residency Program includes salary, graduate school tuition, and limited support for health clinic (immunizations), language training, and travel related expenses. Please note that trainees are responsible for their own living expenses while overseas.

Regardless of specialty training, all residents and fellows 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 trainee 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 underrepresented and often impoverished populations.

6. Engage in a research project that is regionally relevant and substantively involves local investigators.

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. Develop an awareness of additional stressors 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.