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Table 1 Review of existing recommendations for GH curricula

From: Global health education in U.S. Medical schools

A. In 1990, “A National Consensus on the Essential International-health Curriculum for Medical Schools” was developed [2]. That study, focusing on medical student education, polled twenty-two International Health Medical Education Consortium (now the Global Health Education Consortium- GHEC) members and concluded:

1.

 Curricula vary based upon the location abroad

2.

 Clinical experiences form the bulk of rotations abroad; preparation via case studies and problem-based learning is optimal

3.

 Community-based primary health care should be a core component of the preparatory curriculum

4.

 Abroad opportunities can expand the physician role to assessment and management of community health programs and to train the team’s paramedical members

5.

 Interdisciplinary faculty teams can often successfully teach global health courses.

B. Since then, GHEC has merged with the Consortium of Universities for Global Health (CUGH); the latter was created to coordinate GH efforts across institutions [12] and identified many deficiencies with GH education [13], and put forward the following recommendations:

1.

 Medicine and public health must respond to changing conditions as a result of advances and innovations in technology, an increased focus on human and civil rights, globalization, and the growing passion among students, faculty and professionals to address global health.

2.

 The emerging discipline of global health must be defined, reflecting major global health challenges with a focus on “interdependence;” including disciplines beyond health to include law, engineering, agriculture, social sciences and business.

3.

 Make the academic enterprise a transforming agent in global health, recapturing the University as part of the community, not an “ivory tower.” Ensure that academic training in global health emphasizes capacity building and the training of leaders and managers.

4.

 Expand academic exchange programs through mutually beneficial “academic twinning” between academic institutions in the developed and developing countries.

5.

 Address the “brain drain” problem and the strategic ways it might be managed.

6.

 Develop research capacity in developing countries, emphasizing the “Bench-to-Burkina Faso” principle, i.e., translate discovery to implementation.

C. The Association of Faculties of Medicine of Canada Resource Group on Global Health/GHEC joint committee partnership proposed, in 2005, seven possible areas of essential global health knowledge: 1) human rights, 2) the social determinants of health, 3) policy, trade, and health, 4) the global burden of disease, 5) health care delivery systems, 6) the environment and health and 7) migration, travel, and global interaction [14]. That has been updated to the most recent (2010) guidelines which propose that a medical graduate should have competency in the following areas:

1.

 Global Burden of Disease

2.

 Health implications of travel, migration and displacement

3.

 Social and economic determinants of health

4.

 Population, resources and environment

5.

 Globalization of health and healthcare

6.

 Healthcare in low-resource settings

7

 Human rights in global health [14, 63]

D. In 2007, Houpt et al recommended the Liaison Committee on Medical Education (LCME) establish a thirty hour standard curriculum in global health as a necessary minimum for future physicians to be competent to treat changing populations [1]. This group’s definition of Global Health was “the global commonality of health issues that transcend national borders, class, race, ethnicity, income, or culture.” Some examples of such global health issues include poverty, limited access to health care, status of women, environmental degradation, political instability, war, genetic susceptibility, and the experience of industrialization which can lead to chronic health issues. Thus, Houpt et al concluded that the distinction between domestic and international health problems is no longer useful.

E. In 2006, competency domains for medical students’ GH experiences were proposed by Eckhert et al as follows:

1)

 Medical knowledge of international diseases

2)

 Review of basic history and physical exam skills augmented by a need to apply old skills in a dissimilar setting

3)

 Cultural sensitivity

4)

 Educational preparation (objectives, responsibilities, supervision)

5)

 Quantifying success “encouraging students to think more broadly and see the patient in the context of his or her community or even the world” [8].

F. GH learning outcomes for UK medical students were developed by the UK Global Health

Learning Outcomes Working Group [15]. A similar competency-based approach was reviewed by

Battat et al [64].

1)

 Global burden of disease

2)

 Socioeconomic and environmental determinants of health

3)

 Health systems

4)

 Global health governance

5)

 Human rights and ethics

6)

 Cultural diversity and health