Getting the most out of a global health elective at UNC School of Medicine

A little bit about who we are Martha Carlough Sam Hawes Office of International Activities UNC/Chapel Hill And how we can help you…. We have a RICH environment….

Nuts and bolts of planning…. www.med.unc.edu/oia

The most important things to take with you on any trip: A flexible and adventurous spirit Appropriate expectations The ability to laugh (including at oneself) Semper gumby….be flexible You are going to have a great adventure, which means expect the unexpected.

We want to lay the foundations for GH experiences that promote: Equity Reciprocity Sustainability Quality and safety in medical care Education and supervision for students Interdisciplinary models of work Address the health of populations

What we’ll discuss today: General issues – goals, supervision, models for global health experiences Financial resources (from UNC and elsewhere) and the nuts and bolts of scheduling and planning an elective Resources and organizations that may be helpful Integrating your global health experience back into life at home

Questions to ask as you prepare...

General questions: Why do you want to do a global health elective? Learning, travel, service, other??? For you? For those you serve? For your career? For your faith? Because everyone else is? What kind of experience are you hoping for? Be realistic…. How do you hope to integrate this experience into your continuing medical education and life? My role is to talk some of you OUT OF an international elective – its not for everyone….

Interest in global health Escalated in the last decade According to the AAMC graduation questionnaire in 2011 >30% of US/Canadian med students participate in a GH elective At UNC in the last academic year, 88 medical students traveled to a total of 25 different countries Students START med school with more global experience than previously Not just in the medical education world but in public media, philanthropy, private organization involvement… Students have travelled more, volunteered more, are more savvy and willing to dive in. Medical School Graduation Questionnaire Report. 2011. Association of American Medical Colleges. Division of Medical Education. Washington DC. July 2011

Outcomes of participation in global health: Increased interest in primary health care Increased likelihood of community service Improved skills in problem solving and clinical examination Improved sensitivity to cultural issues Primary care residencies with GH tracks and opportunities have higher fill rates – cross-over between students/residents interested in global health and care of the underserved Though the unfortunate reality is that there is NOT as much hard data as we would like….. Thompson, M, Huntington, M et.al. Educational effects of international health electives on US and Canadian medical students and residents: a literature review. Academic Medicine. 2003; 78:3. 342-347

Different models of short term global health experiences: A 4-6 week pre-clinical community health oriented experience A med student rotation in an established hospital/clinic A research opportunity with one of our UNC faculty or outside faculty A combo – language and medical learning An extended experience – a year away from traditional medical school for a fellowship or MPH including an international practicum

PRACTICAL ISSUES…..

When is the best time to go? Summer after 1st year (4-6 weeks) You can only use 6 elective credits during the 1st and 2nd year toward graduation requirements As a third or fourth year elective (4 weeks) – must complete any pre-requisites for the course first Three months 4th year – 18 credits total needed for graduation (including any elective credits during 1st and 2nd year), usual time frame is mid-Jan to mid-March Longer electives/fellowships if you are considering an MPH year or a break in your med school years

When do I start to prepare? Start thinking about it one year in advance which would be NOW for next summer Remember everything takes more time than you expect

Where do I start to look into the possibilities? Office of International Activities in SOM www.med.unc.edu/oia Talk with other students/residents/faculty UNC International Health Forum UNC/SPH Office of Global Health www.sph.unc.edu/globalhealth/ UNC Global http://www.global.unc.edu/ Institute of Global Health and Infectious Disease http://globalhealth.unc.edu Other organizations – see website for ideas

How will I pay for this? As part of your financial aid package if you are receiving credit (must pay tuition) UNC SOM fellowships (deadline Feb 1st) and other UNC based scholarships (variable deadlines, but mostly in early spring) OTHER scholarships and grants, community organizations – Rotary club, churches, etc… Kind family and friends Wait tables…

How much will this cost? AMSA estimated in 2005 that the average med student spent $2000 on a 6 week overseas elective. Most of this cost is the airline ticket. Now probably closer to $2500. Hidden costs – visa, immunizations, etc… Some well organized programs now have global fees that cover everything – more expensive, but may be worth it Travel health insurance - $1.50 per day for students.

Some possibilities for UNC global health electives: Foundations in Global Health (GLBE 201/401)!!!!! Any UNC Faculty member can serve as a preceptor but credit/course arrangements made in advance FMME 225/425 – Martha Carlough/Lisa Slatt FMME 233/433 – Honduran Health Alliance (Beat Steiner) FMME 271/471 – Proyecto Puentes de Salud (Evan Ashkin) SOCM 204/404 – Alan Cross/Gail Henderson PERU 401- Marco Aleman ERMD 414 – Tanzania/Kenya (Ian Martin) MEDI 400X HIV/STD/Infectious Disease – UNC/Malawi program – Irving Hoffman

Examples of what electives students have done recently: Set electives with third party organizations: Himalayan Health Exchange in India InterHealth (Ecuador) International Health Partners (Tanzania) Child & Family Health International (South America, Africa, Asia) Mayan Medical Aid (Guatemala) Infectious Disease elective with UNC/Malawi program Independent electives with Family Health Ministries in Haiti and Shoulder to Shoulder in Honduras Independent elective with Hospitalito de Atitlan in Guatemala Group trip with Honduran Health Alliance, Proyecto Puentes de Salud (Mexico) or Sahsa (Nicaragua) Medical Spanish and Latina health elective at various schools in Costa Rica, Honduras and Guatemala Travel medicine elective in Pakistan with Global Medicine Rescue Services Fogarty fellowship (year long) in South Africa

Important issues to know…. UNC SOM students and faculty traveling abroad must comply with university wide travel policies (which are in accord with the US State Dept and CDC) You MUST purchase evacuation insurance through UNC You MUST complete the required on-line GH modules through the OIA prior to travel You MUST have a UNC faculty advisor and an identified preceptor on site who will supervise and evaluate you

A little advice…. Keep a diagnostic log or journal Take time to make friends and learn from others Don’t make promises you can’t keep Don’t get “in over your head” Take care of yourself – get reliable travel health information, finish your vaccine series and prophylactic meds and get medical care if you have unusual symptoms after returning…. Finish the evaluations for the course, as well as any paper or project as soon as possible after returning – life presses in, and procrastination is easy Allow yourself re-entry time to process and reflect Remember, you don’t have to cross an ocean to be involved in global health Its OK to blame the institution – I’m not allowed to do that….

Questions, comments???