1. The Practitioner's Guide to Global Health: Online Interactive Evaluative Preparatory Modules for Students and Residents Gabrielle A. Jacquet MD, MPH 1, Janis P. Tupesis MD 2, Megan Rybarczyk MD 3, Matthew M. Fleming BS 1, Silpa Gadiraju MD 4, Alison S. Hayward MD, MPH 5, Payal Modi MD, MSc 6, Justin G. Myers DO 7, Rachel A. Umoren MB.BCh, MS 8, Scott G. Weiner MD, MP 9, Suzanne Sarfaty MD 1 1. Boston University School of Medicine 2. University of Wisconsin School of Medicine 3. Boston Medical Center 4. Baylor College of Medicine 5. Yale University School of Medicine 6. University of Massachusetts School of Medicine 7. University of North Carolina School of Medicine 8. University of Washington School of Medicine 9. Brigham and Women’s Hospital INTRODUCTIONMETHODS OBJECTIVES Medical education Global health (GH) electives and projects are on the rise at undergraduate, graduate, postgraduate levels, and across many subspecialties. A 2002 cross-institutional survey reported 86% of Emergency Medicine (EM) residents voiced interest in participating in a GH rotation. The majority of residents ranked EM programs with GH rotations higher than those without them. 1 In 2013, 80% of surveyed EM residency programs had residents completing GH rotations. 2 GH rotations place trainees in high risk situations with regard to ethics, cultural sensitivity, and personal safety. Academic institutions need to provide proper guidance and education to prepare trainees for safe and effective GH rotations. Sources such as the CDC Global Health website and the book International EM: A Guide for Clinicians in Resource-Limited Settings (EMRA 2013) provide global health rotations information, however, none of these resources provides a timeline-based, interactive, evaluative approach for preparation and reentry. 1 Dey CC, Grabowski JG, Gebreyes K, Hsu E, VanRooyen MJ. Influence of International Emergency Medicine Opportunities on Residency Program Selection. Acad Emerg Med 2002;9(7):679-683. 2 King RA, Liu KY,,Talley BE, Ginde AA. Availability and Potential Impact of International Rotations in Emergency Medicine Residency Programs. J Emerg Med 2013;44(2):499–504. To create a series of interactive courses that will prepare medical students, resident physicians, and fellows to safely and effectively participate in global health rotations and projects. To construct an online timeline-based format that permits flexible asynchronous learning. To provide an electronic evaluation tool for residency program directors and medical school deans. Teams of global health faculty experts from around the world came together to develop interactive course content. Input from fellows, residents and medical students was incorporated to maintain current day relevance. A timeline-based series of interactive online courses was developed: 1.The Big Picture 2.Preparation & On The Ground 3.Reflection These courses are available at www.edx.org.www.edx.org

2. RESULTS The 3 courses are now open at www.edx.org. Course syllabi are shown below in Tables 1-3.www.edx.org Table 1: Syllabus for COURSE 1: THE BIG PICTURE SectionMore Detailed Content Deciding to Go Purpose and Motivation; Ethics and Social Justice; Risks and Benefits Structure and Design Timing and Duration Site Selection Site Safety; Housing Conditions; Culture and Politics; Language; Sustainability Logistical Brainstorming Overview of Logistics; Security, Travel, and Communication; Personal; Academic and Professional Funding Overview of Funding; Sources of Funding; Budgeting Table 2: Syllabus for COURSE 2: PREPARATION & ON THE GROUND SectionMore Detailed Content Preparation: Logistics Overview of Logistical Preparation; Safety, Transportation, and Communication Logistics; Personal Logistics; Academic and Professional Logistics Preparation: to Serve and to Learn Cultural Competency and Differences; Professionalism and Ethics; Educational Experience Preparation: Packing Midterm Exam On the Ground: Logistics Overview of Logistics on the Ground; Safety, Transportation, and Communication Logistics; Personal Logistics; Academic and Professional Logistics On the Ground: Serving and Learning Cultural Competency and Differences; Professionalism and Ethics; Educational Experience On the Ground: Unexpected Circumstances In Case of Emergency Table 3: Syllabus for COURSE 3: REFLECTION SectionMore Detailed Content Reverse Culture Shock What is Culture Shock?; Preparing to Return Home; The Honeymoon; Readjustment and Adaptation ReflectingReflecting; Reflection Exercises RelationshipsOld and New Friends Health Issues Feeling Sick Upon Your Return; Feeling Mentally Ill Upon Your Return Future Work Staying Involved; Your Future Career; Mentoring Others Preliminary demographic data from Course 1 is shown below in Table 4. Table 4: Course 1 Demographic Data Total Enrollment3,004 Countries Represented147 % from USA31% % Female52.3% Median Age30 Preliminary performance data from Course 1 shows that the mean pre-test vs. post-test score difference is 6.2 ± 10.1, (n=96) (two sample t-test, p<0.001). The Practitioner's Guide to Global Health: Online Interactive Evaluative Preparatory Modules for Students and Residents Gabrielle A. Jacquet MD, MPH 1, Janis P. Tupesis MD 2, Megan Rybarczyk MD 3, Matthew M. Fleming BS 1, Silpa Gadiraju MD 4, Alison S. Hayward MD, MPH 5, Payal Modi MD, MSc 6, Justin G. Myers DO 7, Rachel A. Umoren MB.BCh, MS 8, Scott G. Weiner MD, MP 9, Suzanne Sarfaty MD 1 1. Boston University School of Medicine 2. University of Wisconsin School of Medicine 3. Boston Medical Center 4. Baylor College of Medicine 5. Yale University School of Medicine 6. University of Massachusetts School of Medicine 7. University of North Carolina School of Medicine 8. Indiana University School of Medicine 9. Brigham and Women’s Hospital

3. CONCLUSIONS Our curriculum is open-access, permitting medical professionals, other international practitioners, and the general public to use it. To our knowledge, the timeline-based and interactive structure of our curriculum is the first of its kind. Interactive courses help prepare trainees for successful global health experiences. Our courses will provide medical training programs with a standardized curriculum for evaluating trainees. DISCLOSURES FUTURE DIRECTIONS The authors have no financial disclosures nor any financial stake in the creation of the global health courses discussed herein. Data regarding participant demographics, completion, performance, feedback, and corresponding Accreditation Council for Graduate Medical Education (ACGME) milestone levels for residents and competencies for medical students is being collected and analyzed. We will gather input from participants and program directors to monitor use, efficacy, and impact on training, and to inform future improvements. FUNDING These courses are funded by the Boston University Digital Learning Initiative and Boston University School of Medicine in collaboration with ACEP International Section. Figure 1: Interactive Scenario Figure 2: Student Video RESULTS (CONTINUED) Examples of interactive course content are shown in Figures 1 and 2. The Practitioner's Guide to Global Health: Online Interactive Evaluative Preparatory Modules for Students and Residents Gabrielle A. Jacquet MD, MPH 1, Janis P. Tupesis MD 2, Megan Rybarczyk MD 3, Matthew M. Fleming BS 1, Silpa Gadiraju MD 4, Alison S. Hayward MD, MPH 5, Payal Modi MD, MSc 6, Justin G. Myers DO 7, Rachel A. Umoren MB.BCh, MS 8, Scott G. Weiner MD, MP 9, Suzanne Sarfaty MD 1 1. Boston University School of Medicine 2. University of Wisconsin School of Medicine 3. Boston Medical Center 4. Baylor College of Medicine 5. Yale University School of Medicine 6. University of Massachusetts School of Medicine 7. University of North Carolina School of Medicine 8. Indiana University School of Medicine 9. Brigham and Women’s Hospital To access these 3 free courses, program directors, residents, and students can scan the QR code here or visit www.edx.org and type “Practitioner” in the search box.www.edx.org