INTL-4017 - Exploring Short-term Global Health Medical Missions

INTL-4017 - Exploring Short-term Global Health Medical Missions

Elective Title: Exploring Short-term Global Health Medical Missions
Course Number: INTL-4017
Elective Type: clinical Duration/Weeks: 2 Max Enrollment: No Limit
Prerequisites: Successful completion of Year 2
Additional Requirements: C-form required. Send forms to Brad Brock (ba2brock@utmb.edu). Student must be enrolled in the JSSOM & be in good standing. Students must complete an application process & undergo selection to participate in this course.
Responsible Faculty Director: Matthew Dacso, MD Periods Offered: 8 including holiday period 8 
Coordinator: Other Faculty: Ben G. Raimer, MD; Philip Keiser, MD; A. Clinton White, MD
Location to Report on First Day:
Determined by mission site

Goals
1. Improve clinical reasoning skills by participating in clinical care in resource-limited settings.
2. Identify and critique "best practices" for short-term global health experiences.
3. Discuss the role of short-term global health experiences within the context of a health system.
4. Develop cultural humility via an immersive clinical experience.
5. Appreciate the roles and responsibilities of various health professions working together as a team.
6. Enhance professional development through reflection, debrief, and feedback.

Objectives
1. Practice history-taking and physical exam skills
2. Demonstrate how to make clinical presentations to supervising faculty members
3. Use manuscripts from the medical literature to discuss and critique consensus ethical guidelines for "best practices" in short-term global health experiences
4. Analyze an existing short-term global health experience from the perspective of health systems strengthening
5. Discuss the challenges to successful implementation of a short-term global health experience, including social, economic, cultural, operational, and environmental barriers
6. Create a constructive critique that Identifies benefits, harms, and ways to ensure long-term impact from a short-term global health experience
7. Reflect upon one's own professional development based upon a short-term global health experience

Description of course activities
The past few decades have seen a profound increase in the number of health professions students that participate in global health electives. These experiences often consist of students from high-income settings participating in clinical care in healthcare settings in low and middle-income countries. This two-week elective will allow students to participate in short-term medical trips, but will demand a focus on constructive critique, health systems analysis, critical reflection, and professional development. Students will be expected to be familiar with the literature, including consensus ethical guidelines for short-term global health experiences. Participating in a closely supervised 1-week global health experience will permit students to practice history-taking and physical exam skills while observing the social, economic, cultural, and environmental determinants of population health. Small group discussions will allow students to discuss challenging clinical cases, reflect upon ethical dilemmas, and share perspectives with experts in the field of global health. All students will be expected to submit a reflection assignment by the end of the course.

Type of students who would benefit from the course
Students interested in global health, working with underserved patient populations, short-term mission work, and primary care

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:00am 5:00pm
Tuesday 8:00am 5:00pm
Wednesday 8:00am 5:00pm
Thursday 8:00am 5:00pm
Friday 8:00am 5:00pm
Saturday 8:00am 5:00pm
Sunday 8:00am 5:00pm

 Average number of patients seen per week: 50
 Call Schedule: None

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    daily
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty & other students
  B. Frequency / Duration of Presentation(s)?
    end of rotation
  C. Format - What guidelines are set for the student's presentation?
    15 minute presentation with PowerPoint
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Weekly
  B. Format - What guidelines are set for the student's written work?
    Short reports on readings, group discussions. Report on global health short-term mission experience.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
   
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student-selected, Faculty approved
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    To enhance perspective, students may interview stakeholders, organizers, and other participants from the short-term global health experience.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Grading (satisfactory/unsatisfactory) will be based on attendance and participation in assigned activities during the trip, completion of assigned task(s), evaluations/feedback from the course mentors, and submission of a final report to the course directors summarizing the experience and outcomes

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
   
 
B.
Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
   
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
   
 
D.
What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
   
 
E.
An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
   
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
   
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
   
 
H.
Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.