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Access to global health-related training difficult for pulmonary, critical care fellowship programs

Lack of mentorship, dedicated fellowship time and established global partners are major roadblocks to providing global health-related training opportunities in U.S.-based pulmonary and pulmonary/critical care medicine fellowship programs.

Program leaders are interested in offering training, but certain barriers prevent incoming fellows from having access to these opportunities, according to a study published in the Annals of the American Thoracic Society.

“With increasing globalization, and as mass migration is occurring on an unprecedented scale, future leaders in pulmonary and pulmonary/critical care medicine (PCCM) require broad training and practical, hands-on experience that incorporates an in-depth understanding of health and disease around the world,” researchers wrote.

To summarize the current status of global health-related training opportunities as well as pinpoint obstacles that PCCM program leaders face, researchers conducted confidential, online surveys.

These surveys gathered data that included program demographics, currently available global health-related research and clinical training opportunities, potential hurdles in implementing these programs and perceived program interest by current and/or prospective trainees.

“We defined global health-related educational components as any of the following: didactic sessions on global health-related research or clinical care/teaching; global health-related local clinical experiences such as tuberculosis, public health or refugee clinics; clinical experiences based in another country; research in a global health setting; global health-related coursework; or a dedicated track or pathway within the PCCM fellowship,” the researchers wrote.

Researchers received 71 total survey responses, representing 63 unique PCCM fellowship programs.

Overall, 73% of programs had fewer than 35 MD and/or PhD faculty members and 51% reported having at least one faculty member involved with global health-related research.

Two individuals who sent discordant responses were excluded from further analysis.

Of the 61 unique programs, 66% offered at least one global health-related education element — the most common being local clinical experiences such as refugee clinics and global clinical experiences that include a rotation at a clinic or hospital in another country, according to the study results.

Programs with an NIH Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant were also more likely to offer global health-related coursework at a School of Public Health when compared with those without these grants, researchers wrote.

Responding program leaders stated that perceived barriers to offering global health-related programs included:

• competing priorities for lecture content;
• the absence of mentors with global health experience within the division;
• a faculty champion for global health-related training opportunities within the division;
• dedicated institutional funding to support global health-related opportunities;
• established global partnerships where fellows can participate in clinical, research or teaching opportunities; and
• protected time for fellows to pursue global health-related training opportunities.

“Many program leaders felt that the presence of global health-related training opportunities positively impacted their ability to recruit fellowship applicants, although a similar proportion felt that this neither helped nor hindered recruitment,” the researchers wrote. “Overall, 40% of respondents felt that currently offered global health-related training opportunities matched the needs and interests of their fellows.”

Researchers concluded that before resources are dedicated to expanding global health-related training in PCCM fellowships, more research should be done to characterize the interest of current and prospective fellows, analyze the significance of global health-related training when compared with other fellowship training programs and evaluate how existing global health-related programs are being utilized. – by Scott Buzby

Disclosures: The University of Washington International Respiratory and Severe Illness Center (INTERSECT) funded gift cards for survey participation. Healio Pulmonology could not confirm the authors’ relevant financial disclosures at the time of publication.