Zeigler Claire, Jacobs Zachary G, Schwanke Khilji Sara U, Rice MaryJoe K, Frink Briana, Carney Patricia A
Associate Professor of Medicine, Division of Hospital Medicine, Director for Global Health, Oregon Health & Science University, School of Medicine, Portland, OR, USA.
Clinical Educator, Portland Veterans Affairs Healthcare System, Portland, OR, USA.
Ann Glob Health. 2024 Nov 22;90(1):70. doi: 10.5334/aogh.4501. eCollection 2024.
Global health education is important for addressing health inequities nationally and internationally. Physician shortages in underserved areas suggest more exposure during training is needed. To study the impact of a global health training program on residents' perceived preparedness and intention to care for underserved populations. Observational mixed method evaluation of the impact of an educational intervention, the Global Health Scholars Program (GHSP), on perceived knowledge and intention to practice in underserved settings. The intervention consisted of a longitudinal global health training program addressing ethics, health equity, structural determinants of health, racism, colonialism, and systems-based practice. GHSP elective clinical rotations occurred at local underserved clinics, tribal and Indian Health Services (IHS) sites (Alaska, Arizona, Oregon), and in Botswana. A 16-item survey aligned with program objectives was administered to internal medicine residents at Oregon Health & Science University who completed the GHSP. This included five groups of residents who trained before coronavirus disease 2019 (COVID-19) (2016-2020) and three groups who trained during COVID-19 (2021-2023). Qualitative content analysis was conducted on open-ended text responses. Surveys were sent to 45 participants; 37 responded (82.2%). All perceived knowledge variables increased significantly after training in the pre-COVID cohort. Among seven residents participating in GHSP during COVID, baseline scores were higher than in the pre-COVID cohort. Qualitative results indicate GHSP was a transformative educational experience and impactful on practice. Among current trainees, 42.9% reported moderate and 26.8% reported high/very high intention to practice in underserved settings. Among graduates, 40.9% reported practicing in underserved settings. GHSP provides transformative educational experiences to residents, with knowledge gains on global health topics higher post-program compared with pre-program. Given 41% of participants in practice reported working in underserved settings, this intervention may help ameliorate physician workforce shortages.
全球健康教育对于解决国内外的健康不平等问题至关重要。服务不足地区的医生短缺表明，培训期间需要更多的接触机会。为了研究全球健康培训项目对住院医师感知到的准备情况以及为服务不足人群提供护理的意愿的影响。对一项教育干预措施——全球健康学者项目（GHSP）对在服务不足环境中实践的感知知识和意愿的影响进行观察性混合方法评估。该干预措施包括一个纵向全球健康培训项目，涉及伦理、健康公平、健康的结构决定因素、种族主义、殖民主义和基于系统的实践。GHSP选修临床轮转在当地服务不足的诊所、部落和印第安卫生服务（IHS）机构（阿拉斯加、亚利桑那、俄勒冈）以及博茨瓦纳进行。对俄勒冈健康与科学大学完成GHSP的内科住院医师进行了一项与项目目标一致的16项调查。这包括五组在2019年冠状病毒病（COVID-19）之前接受培训的住院医师（2016 - 2020年）和三组在COVID-19期间接受培训的住院医师（2021 - 2023年）。对开放式文本回复进行了定性内容分析。调查发送给了45名参与者；37人回复（82.2%）。在COVID之前的队列中，所有感知知识变量在培训后均显著增加。在COVID期间参加GHSP的7名住院医师中，基线分数高于COVID之前的队列。定性结果表明，GHSP是一次变革性的教育经历，对实践有影响。在当前学员中，42.9%报告有中度意愿，26.8%报告有高/非常高的意愿在服务不足的环境中实践。在毕业生中，40.9%报告在服务不足的环境中执业。GHSP为住院医师提供了变革性的教育经历，与项目前相比，项目后在全球健康主题上的知识收获更高。鉴于41%参与实践的参与者报告在服务不足的环境中工作，这种干预措施可能有助于缓解医生劳动力短缺的问题。
