1. Getting the Most Out of Your Global Health Elective Office of International Activities
Research
Clinical/Health Education
Clinical Observer

2. Office of International Activities (OIA) Leadership
Martha Carlough, MD, MPH, Director
Shay Slifko, MA, Program Manager
Sylvia Becker-Dreps, MD, MPH, Associate Director
Latin America focus
GLBE 204/404 (Nicaragua)
Justin Myers, DO, MPH, Associate Director
Africa focus
ERMD 409; ERMD 414 (Tanzania)
Rawley Crews, Administrative Specialist

3. SOM Office of International Activities (OIA)
Why is the OIA a resource?
The UNC School of Medicine’s Office of International Activities develops programmatic structure, support, and engagement in international medical education for UNC medical students and resident physicians interested in global health.
Engage students interested in both local and global health involvement
We are a resource to connect you with ongoing UNC faculty involvement in global health studies and sites
Provide Travel, Health, and Safety oversight for student & resident travelers
Design and offer global health curriculum
The OIA is the central hub for all activities global and our team has extensive firsthand experience working in international settings- ask us!

4. What you will learn:
Identify & describe different types of global health rotations and projects to determine which ones are the best for you
Possibilities for global medical student experiences
What types of experiences are supported (and some that are discouraged)
What is an “elective” and why you should know that term
YOUR steps to be approved for academic credit
Expectations and Ethical Considerations
Institutional Review Board (IRB) tips for conducting research
Identify funding $ources!
Open with questions

5. What is Global Health
Myth #1: You must leave the U.S. to engage in Global health
Global health is “an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide.” – CUGH, 2009
Global health is defined as “health issues that transcend national boundaries and governments and call for actions on the global forces that determine the health of people” Kickbush, 2006
Let’s consider Hans Rosling’s Swedish physician and statistician, former professor of global health at Karoliska in Sweden and founder of gapminder.org
Next slide

6. 200 years that changed the world
In 1809 all countries of the world had a life expectancy under 40 years and an income per person less than 3000 dollar per year. Since then the world has changed but it was not until after the second world war that most countries started to improve.
Hans Rosling – Swedish physician and statistician, former professor of global health at Karoliska in Sweden and founder of gapminder.org
STOP at 2 ½ min after rich/poor comparison

7. Participating in global health is a privilege
Ultimate goal of broadening global health education nurtures, at an early training stage, a committed interest in global health and in the care of medically underserved populations.
There is much to be gained from global health involvement, which can be truly worthwhile and formative experiences
How can global health prepare doctors for working in a diverse patient population?
Research has shown that GH rotations may equip medical students to be doctors adapt at providing care for diverse patient populations
Some studies have emphasized the virtues of using well-planned international medical electives as a tool for teaching about caring for disadvantaged groups
Most other studies focus primarily on self-reported outcomes, such as improvements in clinical skills and cultural awareness
Ultimate goal of broadening global health education nurture, at an early training stage, a vested interest in global health and in the care of medical underserved populations
Rassiwala, Jasmine, et al.,2013

8. What are the benefits for medical students?
Global health offers unique advantages during the formative years of medical training:
Increased awareness of the importance of public health and patient education issues
Introducing students to potential careers in underserved areas
Heightened awareness of cost issues relative to diagnostics, resources, and treatment
Increased confidence in clinical diagnostic skills
Medical learners- pre-residency- across the US have shown an exceedingly growing interest in global health opportunities. Medical student engagement in global health has grown three-fold since 1984
Also:
Recognizing socioeconomic barriers to effective patient care
Less reliance on high tech diagnostics
Larger appreciation of the barriers to communication between the physician and patient
Rassiwala, Jasmine, et al.,2013

9. According to the Association of American Medical Colleges..
Guidelines for Medical Students Providing Patient Care During Clinical Experiences Abroad
“Harm done to the patient. Everyone’s goal is to always help those in need; the first step in that direction must be to avoid doing any harm.
Physical harm to yourself. Engaging in any clinical practice without sufficient training and protection can result in direct harm to you, as well as to the patient.
Legal issues with local authorities. Even if a local health care provider is supervising your interactions with patients or says that it is acceptable for you to perform a procedure, violation of local laws may still be a punishable offense.
Putting acceptance to medical school and residency training programs at risk. Many premedical students believe that the more in depth clinical experience they have, the stronger their applications will be. However, taking on tasks that are beyond your training could make you look unethical, unknowledgeable about the health professions, irresponsible to admission committees, and may diminish or eliminate your chance for acceptance into medical school. Similarly, medical students who perform procedures beyond their training may negatively impact their chances of matching in residency programs.” –AAMC, 2011
Source: AAMC – Guidelines for Premedical and Medical Students Providing Patient Care During Clinical Experiences Abroad

10. Identify what broad scope of global health opportunities you are interested in:
4-8 week Clinical, research, education, and/or public health program
Rural versus an Urban setting
Individual versus group program
A combo – immersive language study and medical education
New versus well-established program/project
Are you hoping to establish a career in global health?
Are you looking to build sustainability in a project?
An extended experience – a year away from traditional medical school for a fellowship or MPH including an international practicum
Language Immersion only: While not eligible for credit, this is still a useful way to expand fluency in a language spoken by patient populations
How much supervision should be expected?
4-6 week pre-clinical community health oriented experience
A rotation in an established hospital/clinic functioning as a clinical observer
A research opportunity with UNC faculty or outside faculty
A combo – language study and medical learning
An extended experience – a year away from traditional medical school for a fellowship or MPH including an international practicum
Language Immersion: While not eligible for credit, this is still a useful way to spend your summer

11. Global Health Experiences When is the best time to go?
Summer after MS1/Foundation phase(4-8 weeks)
You can only apply 6 elective credits from MS1 & MS2 year towards the 18 elective credits necessary for graduation
During MS4/Individualization phase (4-8 weeks)
At least two clinical blocks of 4 weeks each (usually for two separate elective courses unless this is an ongoing research project)
Longer electives/fellowships if you are considering an MPH year or a break in your med school years

12. Global Health Experiences How do I begin the search?
Review OIA website:
Questions to consider
Why do you want to do a global health elective?
Are there types of experiences that are not supported (OIA award money)? YES.
Clinical, public-health related, or research?
For you? For your CV? For your faith? Because everyone else is? To develop fluency in another language to be more effective in patient care? You plan to practice as a global health provider?
Potential Outcomes
Skills in problem solving and clinical examination
Interest in primary care
Ignited interest in community service or rural health

13. International experiences fall into 3 categories
UNC Trips
Independent Organizations familiar with UNC
Independent Organizations
International trips fall into three categories: UNC-related experiences, Independent Organizations that UNC is very familiar with or have standardized opportunities for medical students, and Independent Organizations or individual experiences that do not have any affiliation with the university. Associated fees are the responsibility of the students, however some funding is available through the OIA.

14. UNC Global Health Electives for MS1s
8-week summer UNC Infectious Disease research elective with UNC/Malawi, Vietnam, Zambia, South Africa, China joining UNC and on-site teams
Deadline to apply: November 30th, 2017
Application on OIA website
Register for course number: MEDI 527 Global Health Research
Honduran Health Alliance (group trip, application closed)
Regiser for course number: FMME 233
Proyecto Puentes de Salud ( group trip, application closed)
Register for course number: FMME 271

15. IGHID Global Research in Malawi, Zambia, Nicaragua, China and Vietnam: 8 week summer scholarship for MS1s
For the past 10+ years, the UNC Institute for Global Health & Infectious Diseases has sponsored 7 first-year UNC medical students to conduct summer research at the UNC Project in Lilongwe, Malawi or the University of Zambia, Lusaka, Zambia. We are now extending this program to include our research sites in Vietnam; South Africa, and China. If chosen, UNC faculty will mentor students to apply for scholarships and grants’, however students
must procure their own funding.
Students typically receive funding from OIA
Eligibility:  ­First-year medical students who are available for eight weeks during the summer. They are looking for students with either a demonstrated or strong career interest in (global) research.

16. Global Health Electives for MS1s
Child Family Health International (Global Sites)
Each site has specialty specific opportunities
Refer to website for program application deadlines
AMOS (Nicaragua)
Community Health Education
Students register for GLBE 204
Himalayan Health Exchange (India)
Programs vary
Students register for FMME 225 with Dr. Martha Carlough as Indep. Elective
Application Deadline: November 15th, 2017
Carolina for Kibera, Kenya (Peacock Fellowship funding), health education fellowship (Kenya)
Funding deadline: December 15th, 2017
Celas Maya/Pop Wuj: Language immersion/clinical observership
Unite for Sight
Local and visiting volunteers work with partner eye clinics to provide eye care in communities without previous access, with the goal of creating eye disease-free communities.
*Check each program website for specific program application details
See OIA website link for more student international electives

17. Language Immersion Celas Maya, Guatemala Critical Language Scholarship
One-on-one language classes learning conversational Spanish
Medical Spanish learning in clinical observership
No funding from OIA for language study only UNLESS you pair this with clinical observership at the Pop Wuj hospital
OIA Funding Deadline February 15, 2017
Critical Language Scholarship
CLS is an 8-week min. intensive overseas language and cultural immersion program
Arabic, Azerbaijani, Bangla, Chinese, Hindi, Indonesian, Japanese, Korean, Persian, and more.
Funding Deadline: Nov 15th, 2017
Contact Iyman Gaspard

18. Global Health is Local “Glocal” Opportunities
Migrant Farmworker course
GLBE 259/459 (cross listed as FMME 259/459
This elective is intended for both first and fourth year medical students who are interested in learning more about the health issues facing migrant and seasonal farmworkers in North Carolina. 
Requirements: Moderate to fluent in medical Spanish 
Faculty: Drs. Gayle Thomas and Martha Carlough
Refugee and Immigrant Health course
GLBE 202/402 
This elective is intended for all 4th year medical students interested in learning more about health issues facing refugees and immigrants who have resettled into the United States.
Faculty: Drs. Jeffrey Walden and Martha Carlough

19. Academic Credit breakdown
Summer after MS1/Foundation phase(4-8 weeks)
You can only apply 6 elective credits from MS1 & MS2 year towards the 18 elective credits necessary for graduation
A single summer elective 4 weeks in length= 6 credits=160 hours. You can only earn 6 credits in your first summer.
You are NOT required to apply for credit. You have time in your 4th yr.
To get credit, students must:
Identify your summer program/site
Scenario 1: You’ve been accepted for the 8wk ID elective at UNC Malawi
You do want academic credit but you do not want the credit and tuition cost to fall in the summer months.
You can apply the summer elective to your MS2 academic year and tuition package
Irving Hoffman is the faculty advisor for your elective MEDI 527. You collect the elective form from Leanne Shook, ask your faculty advisor to sign and POST DATE to Aug 15th for MS2 year, and YOU return to Leanne Shook by May 1st deadline.
Scenario 2: You’re going to a non-UNC site with no existing course number and you want credit
You want the academic credit, but the program is less than 4 weeks. And, you want it to apply to your MS2 yr. so you don’t have to pay summer tuition.
You can supplement this by registering for either a GLBE course with Dr. Carlough OR you work with a UNC faculty member to agree to do an independent elective with you where you both would complete the “One Time Elective Request Form” by asking Leanne Shook for this, have your UNC independent course advisor sign, POST-DATE to Aug 15th, for MS2 year, and YOU return to Leanne Shook by May 1st deadline.
Pre-Clinical Elective Request Form This form is required for medical students who are completing a credit-bearing global health elective in addition to international global health work. After you have met with the OIA Program Manager and clarified the UNC Faculty Advisor for your international elective, submit the form to Leanne Shook in the Office of Student Affairs.
Scenario 1: UNC site with ecxisting course number and faculty advisor
Scenario 2: independing/unaffiliated site but I do want academic credit
You have done your research and preparation and determined you are going to go to apply to
To get academic credit:
Steps:
Establish host-site
UNC course advisor
Contact Leanne Shook
OPTION 1: Independent elective? Pickup Elective Request Form
OPTION 2: UNC GH Elective Course: Elective request form
I’m doing ERMD415
I want academic credit and I need financial aid for the summer course =Then course elective form ends in July and they register with Leanne
I want aca credit and I want it to apply to 2nd year
I’m doing an independent elective
I don’t need financial aid or credit
End date on elective form on Aug 15
By what date do I need to submit the completed elective form and course description to Leanne Shook: by May 1st
160 hours= 6 elective credit hours

20. Academic Credit breakdown
Pre-Clinical Elective Request Form
This form is required for medical students who are completing a credit-bearing global health elective in addition to international global health work.
After you have identified the hosting site/organization, you have reviewed this presentation, reviewed the OIA website for pre-travel requirements, identified and met the UNC Faculty Advisor for your international elective, submit the Pre-Clinical Elective Request Form to Leanne Shook in the Office of Student Affairs.

21. How much will this cost you?
Students spend an average of $3,000 for a 6-8 week international elective
Site Fee: Ranges $0-$3,000 (can include transportation, room & board)
Immunizations = $75-$200
Airfare= $900-$2000
Visas/Work permit = $300
Housing = $450
Food = $300-$600
Required UNC-sanctioned emergency health/evacuation insurance= $1.42/day
Some organizations have program fees that cover everything – may be worth it

22. How will you pay for thi$?
SOM/OIA Medical Student GH Scholarship Application
Deadline: February15, 2018
Selected proposals awarded maximum of $2,000 to help offset costs of GH elective
Applications accessible on OIA website 6 weeks prior to deadline
Carolina Global Initiative Internship Award
Deadline: February 12, 2018
Funding to students $1,500-$6,000 for selected students with limited to no international travel
Preference given to students with no or limited prior travel for research, clinical, internship, etc.
James and Florence Peacock Fellowship
Deadline: December 15th, 2017
Upcoming info-sessions: Nov 15th, 12:00-1:30p Global Education Center, room 1009
Nov 30th, 4:00 - 5:30p Global Education Center, room 3033
Up to $2500 are available to cover the cost of airfare, living expenses, and incidentals in Kenya for 8-10 weeks.
Health Education: Help CFK with community health initiative focused on nutrition. Fellows will work closely with program staff, nurses at Tabitha Clinic and community healthcare workers to assess, treat, monitor, and prevent malnutrition in Kibera.
Fundraise, ask family, church, part time holiday job, etc.

23. Institutional Review Board (IRB) Tips for conducting research
Last year, over one million people took part in research studies at UNC CH.
IRB Guidance for Student Research
Federal regulations and university policies require Institutional Review Board (IRB) approval for research with human subjects. This applies whether the research is conducted by faculty or students, by individuals or a group.
Failure to obtain proper approval in advance may jeopardize your data, prevent you from publishing the results, and place you and the university in violation of federal regulations. At the same time, many class projects are conducted for educational purposes and not as research, and will
not require IRB approval.
Visit the UNC IRB and Office of Human Research Ethics

24. What is research?
A systematic investigation, designed to develop or contribute to generalizable knowledge (i.e. beyond the particular setting)
Examples of research often undertaken by students:
Informal and formal questionnaires
Data collection for local clinicians
Interviews with key personnel that include patient information
So, quality improvement activities used only within a project are not “research” but if this information is printed/published more broadly it IS.

25. Global Health Experiences How do I begin the process?
NOW
Review this presentation on the OIA website
Research- based on YOUR interests- where other MS1s have gone, look into that program, ask the OIA questions
November–December- BEFORE HOLIDAY BREAK
Decide where you are going, that it is approved, and find a UNC faculty preceptor and an international preceptor/mentor
To register for a global health elective and receive credit, you MUST have a UNC medical school faculty advisor who registers you for a specific elective course in their department.
January – February
Make a schedule of deadlines - for a project proposal (if needed), scholarship applications and applications to overseas placements, applications, letters of recommendation, and getting ready to go!

26. Before you go
Review the OIA website for the list of UNC SOM pre-travel requirements
Failure to complete SOM pre-travel requirements will result in UNC travel being prohibited, credit withdrawn, and any SOM funding being withdrawn or revoked.
Schedule your immunization appt with UNC Campus Health
Check in with the OIA Program Manager to ensure you have registered for credit, completed the pre-travel list, and are ready to go.
Attend the mandatory April/May OIA Pre-Departure Session
Consider taking a journal with you to write about your time away. You’ll appreciate this later.

27. We hope you consider:
Questions around your motivation for getting involved in global health
If there are opportunities locally working with underserved populations? YES. Ask us.
Investing some money out of pocket if you do choose to pursue an international elective. This is an investment.
Research options.
Decide & Organize.
Confirm site of interest with Shay Slifko before holiday
Start your funding applications before holiday. Some are due in November.
Return from holiday ready to prepare funding applications and forms to confirm academic credit with Leanne Shook and your course advisor no later than May 1st.

28. You submitted questions Were they answered?
How do I get partial or full funding for a language immersion program?

29. Review today’s session on the OIA website
Questions?
Review today’s session on the OIA website