1. Evaluation of a Global Health Residency Track
Therese Zink, MD, MPH
Erik Solberg, MA, MEd
Global Family Medicine Pathway
Department of Family Medicine and Community Health
University of Minnesota

2. Disclosures
Dr. Zink and Mr. Solberg declare no relevant financial affiliations nor conflicts of interest.
Neither Zink nor Solberg plan to discuss an off-label use of any prescription medication during this presentation.

3. Session Objectives
By the conclusion of this session, attendees will be able to: 1. List the steps involved in creating an overarching consent to use de-identified residents' responses for evaluation. 2. Describe opportunities for testing and capturing the knowledge gained through participation in international experiences. 3. Explain the value of international experiences in addressing the six ACGME competencies during residency training T

4. Session Agenda/Overview
Overview of DFMCH and Pathway
Consent to use Resident Data
ACGME General Competencies
International Elective Goals and Objectives
Curriculum
Pre and Post Knowledge Assessments
Reflective Writing and Qualitative Assessment
Questions and Discussion T

5. UMN DFMCH Global Health Pathway
8 residencies (5 Twin Cities + 3 greater MN)
Residency autonomy
On-line curriculum, in-person experiences, international partner sites
Partners: Departments of Internal Medicine and Pediatrics (residencies)
Enrolled residents
Improve international knowledge of all residents:
Community Health
Cultural Competence T

6. Communication Moodle site Google Calendar: UMN Global Health
E-newsletter and updates
Facebook
Blogging
considerations E

7. Consent to use Residents’ data

8. Consent IRB exemptions Residents sign when enroll in pathway
#1 Educational curriculum evaluation
#4 Existing de-identified data
Residents sign when enroll in pathway
Consent to use de-identified data for evaluation
May need additional IRB approval for specific study. T

9. Consent Form

10. Reflective Writing 32 pediatric and peds/IM GH residents’ essays
Article: International Electives for Global Pediatric Residents at the University of Minnesota: Opportunities for Education in all Accreditation Council Graduate Medical Education Competencies
(Academic Pediatrics, 2012:245–250)
32 pediatric and peds/IM GH residents’ essays
Prompt: write a one-page (or longer) summary of your international elective experience
Rich learning for “hard to teach competencies”
Reflection on personal and professional development T

11. ACGME General Competencies
Patient Care
Medical Knowledge
Practice Based Learning
Interpersonal and Communication Skills
Professionalism
System Based Practice T

12. Goals and Objectives Menu for International Electives

13. Sample Goals and Objectives

14. Sample Goal 1
Inter Com Skills Goal 1. Understand the role of gender, power differentials, uncertainty avoidance across inter-cultural patient-physician interactions.
Possible Objectives:
Articulate gender roles within the family and society in ____(country)____.
Articulate the significance of gender in the care patients in ____(country)____.
Evaluate inter and intra power differentials on physician-patient interaction in __(country)__. E

15. Sample Goal 2
Prof Goal 4. Demonstrate personal and professional responsibility in a global setting.
Possible Objectives:
Describe an experience where this was evident (managed cultural misperception, safety challenge, culture shock, etc.) E

16. Sample Goal 3
PBL Goal 2. Utilizing local resources available in international settings, be able to triage and manage patient care.
Possible objectives:
Explain how to identify and access local resources in __(city, country)___.
Explain how local diagnostic and treatment resources impact your work-up and how this may be different from what you would do in the US.
Describe how non-traditional resources in __(country)___shape health care delivery. E

17. Sample Goal 4
SBP Goal 6. Recognize the importance of population-based health (i.e. community and public health).
Possible Objectives:
Identify an example of a population-based health activity in __(name of community/community)__and discuss its success, challenges or deficiencies. E

18. Pre and post Knowledge assessment

19. Knowledge Assessment Developed by pediatrics Sample Question:
True/False (Select one):
“All immigrant children, including refugees and international adoptees, are screened for tuberculosis prior to entering the U.S., as part of a medical examination required by the U.S. Department of Homeland Security” E

20. Knowledge Assessment
Illustrates knowledge change across the domains of medical knowledge, patient care.
In lights of the diversity of the patient panels at UMN residency clinics, some questions are relevant to all residents, even those NOT doing international rotations. E

21. Online curriculum and Knowledge assessment

22. On-line curriculum CONTENT Videotaped lectures GHEC modules
Ted lectures
Open Sight
OTHERS?? T

23. KNOWLEDGE ASSESSMENT
Knowledge questions (True/False, multiple choice w/ correct answer and citation)
Short answer reflection

24. Reflective essays and other qualitative opportunities

25. Examples: End of international rotation essay
Short reflections after movie night and book club
Resident project T

26. Prompts: Global Peds Essay
Where did you work?
Describe daily responsibilities, clinical and teaching environment, expound on interesting clinical cases and patient/family interactions.
Would you recommend this site to future residents, and why? Significant non-medical experiences?
Discuss how you feel your own culture and nationality played a part
Describe and discuss a situation in which your openness and curiosity fostered a learning situation T

27. Experiential prompts
What will you take away from this evening’s discussion?
Sample response:
PGY2, Female
It’s okay to make cultural “mistakes”—everyone does—as long as you approach the situation with openness and curiosity
My favorite part of these book/movie club nights is the networking & hearing other providers stories & adventures abroad. I learn so much more when what we read/watched is then discussed in an new context with someone with a real life experience. T

28. Maintain database T

29. Resident Database UMN Alumni data Every 5 year (33% response rate)
Dedicate staff to search internet (state license, professional organization lists)
Goal: Meets RRC requirement to survey program graduates and provides capability to do longitudinal research on pathway graduates T

30. Summary Pathway has only been available since 2011
The first cohort of residents will be travelling internationally in
Curriculum is individualized—Residents complete goals and objectives
Evaluation consists of:
“Traditional” pre-post test to measure knowledge change
Qualitative assessments to address professionalism and “the seventh competency”
Future plans for longitudinal, ongoing assessment T

31. Questions & Comments