Lauden Stephanie M, Gladding Sophia, Slusher Tina, Howard Cynthia, Pitt Michael B
J Grad Med Educ. 2019 Aug;11(4 Suppl):91-99. doi: 10.4300/JGME-D-18-00701.
While resident participation in global health (GH) rotations has grown, little is known about trainee perceptions of the personal value of these international clinical experiences and their importance to the objectives of GH training.
We sought to better understand the clinical scenarios experienced during international rotations that residents perceived as most meaningful and the frequency of these experiences across scenarios and participating residents.
Using the conceptual framework of Schön's reflection on action, we asked University of Minnesota GH track pediatric and internal medicine-pediatric residents to describe 10 clinical scenarios they found interesting or impactful during their 2016-2017 GH elective. We conducted a qualitative analysis of the deidentified resident narratives and mapped themes to the Accreditation Council for Graduate Medical Education (ACGME) competencies.
All eligible residents (n = 13) participated, yielding 129 unique clinical scenarios from 7 countries. We identified 5 thematic groups: (1) addressing challenges in making diagnoses in resource-limited settings; (2) dealing with patient outcomes different from those expected in the United States; (3) encountering and managing diseases in a different context; (4) encountering and managing diseases in a different context; and (5) reflecting on learning and self-growth. Of the 129 unique clinical scenarios, 30% (n = 39) had not been previously experienced by participants. Across the 5 themes, all ACGME core competencies were addressed.
Residents identified meaningful scenarios of their GH experiences that are relevant to the educational and clinical objectives of GH training.
虽然住院医师参与全球健康（GH）轮转的情况有所增加，但对于实习生对这些国际临床经验的个人价值的看法以及它们对GH培训目标的重要性知之甚少。
我们试图更好地了解住院医师在国际轮转期间经历的被认为最有意义的临床场景，以及这些场景在不同场景和参与的住院医师中的出现频率。
我们运用舍恩的行动反思概念框架，要求明尼苏达大学GH项目的儿科和内科-儿科住院医师描述他们在2016 - 2017年GH选修课期间发现有趣或有影响的10个临床场景。我们对匿名的住院医师叙述进行了定性分析，并将主题映射到毕业后医学教育认证委员会（ACGME）的能力要求上。
所有符合条件的住院医师（n = 13）都参与了，共产生了来自7个国家的129个独特临床场景。我们确定了5个主题组：（1）在资源有限的环境中进行诊断时应对挑战；（2）处理与美国预期不同的患者结局；（3）在不同背景下遇到并管理疾病；（4）在不同背景下遇到并管理疾病；（5）反思学习和自我成长。在这129个独特临床场景中，30%（n = 39）是参与者之前未曾经历过的。在这5个主题中，涵盖了ACGME的所有核心能力要求。
住院医师确定了他们GH经历中与GH培训的教育和临床目标相关的有意义场景。
