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

2. 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….

3. Nuts and bolts of planning….

4. 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.

5. 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

6. 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

7. Questions to ask as you prepare...

8. 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….

9. 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 Association of American Medical Colleges. Division of Medical Education. Washington DC. July 2011

10. 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:

11. 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

12. PRACTICAL ISSUES…..

13. 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

14. 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

15. Where do I start to look into the possibilities?
Office of International Activities in SOM
Talk with other students/residents/faculty
UNC International Health Forum
UNC/SPH Office of Global Health
UNC Global
Institute of Global Health and Infectious Disease
Other organizations – see website for ideas

16. 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…

17. 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.

18. 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

19. 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

20. 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

21. 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….

22. Questions, comments???