Center for Global Health, Massachusetts General Hospital, Boston, Mass, USA ; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Mass, USA ; Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, Mass, USA.
Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Mass, USA ; Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Mass, USA ; Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital, Boston, Mass, USA ; Center for AIDS Research, Harvard University, Cambridge, Mass, USA.
J Glob Health. 2013 Dec;3(2):020406. doi: 10.7189/jogh.03.020406.
Rapid growth in global health activity among US medical specialty education programs has lead to heterogeneity in types of activities and global health training models. The breadth and scope of this activity is not well chronicled.
Using a standardized search protocol, we examined the characteristics of US medical residency global health programs by number of programs, clinical specialty, nature of activity (elective, research, extended curriculum based field training), and geographic location across seven different clinical medical residency education specialties. We tabulated programmatic activity by clinical discipline, region and country. We calculated the Spearman's rank correlation coefficient to estimate the association between programmatic activity and country-level disease burden.
Of the 1856 programs assessed between January and June 2011, there were 380 global health residency training programs (20%) working in 141 countries. 529 individual programmatic activities (elective-based rotations, research programs, extended curriculum-based field training, or other) occurred at 1337 specific sites. The majority of the activities consisted of elective-based rotations. At the country level, disease burden had a statistically significant association with programmatic activity (Spearman's ρ = 0.17) but only explained 3% of the total variation between countries.
There were a substantial number of US medical specialty global health programs, but a relative paucity of surgical and mental health programs. Elective-based programs were more common than programs that offer longitudinal experiences. Despite heterogeneity, there was a small but statistically significant association between program location and the global burden of disease. Areas for further study include the degree to which US-based programs develop partnerships with their program sites, the significance of this activity for training, and number and breadth of programs in medical specialty global health education in other countries around the world.
美国医学专业教育项目的全球卫生活动迅速增长，导致活动类型和全球卫生培训模式出现差异。这种活动的广度和范围没有得到很好的记录。
我们使用标准化的搜索协议，根据参与项目的数量、临床专业、活动性质（选修、研究、基于扩展课程的实地培训）以及七个不同临床医学住院医师教育专业的地理位置，研究了美国住院医师全球卫生项目的特征。我们按临床学科、地区和国家对项目活动进行了分类。我们计算了斯皮尔曼等级相关系数，以评估项目活动与国家级疾病负担之间的关联。
在 2011 年 1 月至 6 月期间评估的 1856 个项目中，有 380 个全球卫生住院医师培训项目（20%）在 141 个国家开展工作。在 1337 个特定地点开展了 529 项具体项目活动（基于选修的轮转、研究项目、基于扩展课程的实地培训或其他）。这些活动大多为基于选修的轮转。在国家层面，疾病负担与项目活动之间存在统计学上显著的关联（斯皮尔曼 ρ=0.17），但仅解释了国家间总变异的 3%。
美国有大量的医学专业全球卫生项目，但外科和心理健康项目相对较少。基于选修的项目比提供长期经验的项目更为常见。尽管存在异质性，但项目地点与全球疾病负担之间仍存在微小但具有统计学意义的关联。进一步研究的领域包括美国项目与项目所在地建立伙伴关系的程度、这种活动对培训的意义，以及全球其他国家医学专业全球卫生教育项目的数量和广度。
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