Consensus Competencies for Postgraduate Fellowship Training in Global Neurology

Nicoline Schiess; Violet Kulo; Pria Anand; David R Bearden; Aaron L Berkowitz; Gretchen L Birbeck; Anna Cervantes-Arslanian; Phillip Chan; Lorraine Chishimba Chishimba; Felicia C Chow; Isabel Elicer; Agnes Fleury; Aarti Kinikar; Michelle Kvalsund; Farrah J Mateen; Amir A Mbonde; Ana-Claire L Meyer; Cumara B O'Carroll; Adesola Ogunniyi; Archana A Patel; Michael Rubenstein; Omar K Siddiqi; Serena Spudich; Sean A Tackett; Kiran T Thakur; Nirali Vora; Joseph Zunt; Deanna R Saylor

doi:10.1212/WNL.0000000000207184

Consensus Competencies for Postgraduate Fellowship Training in Global Neurology

Neurology. 2023 Aug 22;101(8):357-368. doi: 10.1212/WNL.0000000000207184. Epub 2023 Mar 30.

Authors

Nicoline Schiess¹, Violet Kulo¹, Pria Anand¹, David R Bearden¹, Aaron L Berkowitz¹, Gretchen L Birbeck¹, Anna Cervantes-Arslanian¹, Phillip Chan¹, Lorraine Chishimba Chishimba¹, Felicia C Chow¹, Isabel Elicer¹, Agnes Fleury¹, Aarti Kinikar¹, Michelle Kvalsund¹, Farrah J Mateen¹, Amir A Mbonde¹, Ana-Claire L Meyer¹, Cumara B O'Carroll¹, Adesola Ogunniyi¹, Archana A Patel¹, Michael Rubenstein¹, Omar K Siddiqi¹, Serena Spudich¹, Sean A Tackett¹, Kiran T Thakur¹, Nirali Vora¹, Joseph Zunt¹, Deanna R Saylor²

Affiliations

¹ From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle.
² From the Department of Neurology (N.S., A.-C.L.M., D.R.S.), Johns Hopkins University School of Medicine; Department of Health Professions Education (V.K.), University of Maryland, Baltimore, MD; Department of Neurology (P.A., A.C.-A.), Boston University and Boston Medical Center, MA; Department of Child Neurology (D.R.B.), University of Rochester Medical Center, NY; Department of Educational Psychology (D.R.B.), University of Zambia, Lusaka; Department of Neurology (A.L.B., F.C.C.), University of California, San Francisco; Department of Neurology (G.L.B., M.K.), University of Rochester Medical Center, NY; University of Zambia School of Medicine (G.L.B., M.K., O.K.S.), Lusaka; SEARCH (P.C.), Institute of HIV Research and Innovation, Bangkok, Thailand; University Teaching Hospital (L.C.C., D.R.S.), Lusaka, Zambia; Hospital Dr. Sótero del Río (I.E.), Clínica Las Condes, Santiago, Chile; Instituto de Investigaciones Biomédicas (A.F.), Universidad Nacional Autónoma de México; Instituto Nacional de Neurología y Neurocirugía (A.F.), Secretaria de Salud, Mexico City, Mexico; Department of Paediatrics and Neonatology (A.K.), B.J. Government Medical College, Pune, India; Department of Neurology (F.J.M., A.A.M.), Massachusetts General Hospital, Boston; Department of Internal Medicine (A.A.M.), Mbarara University of Science and Technology, Uganda; Department of Neurology (C.B.O.C.), Mayo Clinic Arizona, Scottsdale; Department of Medicine (A.O.), College of Medicine, University of Ibadan, Nigeria; Department of Child Neurology (A.A.P.), Boston Children's Hospital, MA; Department of Neurology (M.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (S.S.), Yale School of Medicine, New Haven, CT; Department of Internal Medicine (S.A.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (K.T.T.), Columbia University Medical Center, New York, NY; Department of Neurology (N.V.), Stanford University Medical School, Palo Alto, CA; and Department of Neurology (J.Z.), University of Washington School of Medicine, Seattle. deanna@jhmi.edu.

Abstract

Background and objectives: Use a modified Delphi approach to develop competencies for neurologists completing ≥1 year of advanced global neurology training.

Methods: An expert panel of 19 United States-based neurologists involved in global health was recruited from the American Academy of Neurology Global Health Section and the American Neurological Association International Outreach Committee. An extensive list of global health competencies was generated from review of global health curricula and adapted for global neurology training. Using a modified Delphi method, United States-based neurologists participated in 3 rounds of voting on a survey with potential competencies rated on a 4-point Likert scale. A final group discussion was held to reach consensus. Proposed competencies were then subjected to a formal review from a group of 7 neurologists from low- and middle-income countries (LMICs) with experience working with neurology trainees from high-income countries (HICs) who commented on potential gaps, feasibility, and local implementation challenges of the proposed competencies. This feedback was used to modify and finalize competencies.

Results: Three rounds of surveys, a conference call with United States-based experts, and a semistructured questionnaire and focus group discussion with LMIC experts were used to discuss and reach consensus on the final competencies. This resulted in a competency framework consisting of 47 competencies across 8 domains: (1) cultural context, social determinants of health and access to care; (2) clinical and teaching skills and neurologic medical knowledge; (3) team-based practice; (4) developing global neurology partnerships; (5) ethics; (6) approach to clinical care; (7) community neurologic health; (8) health care systems and multinational health care organizations.

Discussion: These proposed competencies can serve as a foundation on which future global neurology training programs can be built and trainees evaluated. It may also serve as a model for global health training programs in other medical specialties as well as a framework to expand the number of neurologists from HICs trained in global neurology.

MeSH terms

Clinical Competence
Consensus
Curriculum
Delphi Technique
Fellowships and Scholarships*
Humans
Neurology* / education
Public Health
United States

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States