Increasing Care for Underserved Communities Through a Global Health Residency Training Program

Claire Zeigler; Zachary G Jacobs; Sara U Schwanke Khilji; MaryJoe K Rice; Briana Frink; Patricia A Carney

doi:10.5334/aogh.4501

Increasing Care for Underserved Communities Through a Global Health Residency Training Program

Ann Glob Health. 2024 Nov 22;90(1):70. doi: 10.5334/aogh.4501. eCollection 2024.

Authors

Claire Zeigler^{1

2}, Zachary G Jacobs³, Sara U Schwanke Khilji^{4

5}, MaryJoe K Rice⁶, Briana Frink⁷, Patricia A Carney⁸

Affiliations

¹ Associate Professor of Medicine, Division of Hospital Medicine, Director for Global Health, Oregon Health & Science University, School of Medicine, Portland, OR, USA.
² Clinical Educator, Portland Veterans Affairs Healthcare System, Portland, OR, USA.
³ Associate Professor of Medicine, Division of Hospital Medicine, Associate Director for Global Health, Oregon Health & Science University, School of Medicine, Portland, OR, USA.
⁴ Associate Professor of Medicine, Division of Hospital Medicine, Former Internal Medicine Site Director, Botswana Global Health Program, Oregon Health & Science University, School of Medicine, Portland, OR, USA.
⁵ Research Associate, Botswana-Harvard Health Partnership, Portland, OR, USA.
⁶ Internal Medicine Resident, Oregon Health & Science University, School of Medicine, Portland, OR, USA.
⁷ During the writing of this manuscript, Dr. Fink was a 4 Year Medical Student at Oregon Health & Science University, now an intern in internal Medicine at the University of California San Diego, California, USA.
⁸ Professor of Family Medicine and of Internal Medicine, Division of Hospital Medicine, Oregon Health & Science University, School of Medicine, Portland, OR, USA.

Abstract

Background: Global health education is important for addressing health inequities nationally and internationally. Physician shortages in underserved areas suggest more exposure during training is needed. Objective: To study the impact of a global health training program on residents' perceived preparedness and intention to care for underserved populations. Methods: 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. Findings: 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. Conclusions: 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.

Keywords: Global Health; graduate medical education; physician workforce; resident training; underserved populations.

Publication types

Observational Study

MeSH terms

Adult
COVID-19* / epidemiology
Female
Global Health* / education
Humans
Internship and Residency*
Male
Medically Underserved Area*
Oregon
SARS-CoV-2

Grants and funding

The Department of Internal Medicine, Division of Hospital Medicine at Oregon Health and Science University supported this work. The authors have no other direct source of funding for this research.