Global Health Medical Education What do students want

Global Health Medical Education: What do students want? A survey of medical student interest, experience, knowledge and attitudes Lauren Evans, MS IV and Dan Kent, MS IV Albany Medical College October 2, 2015

Activity Disclaimer ACTIVITY DISCLAIMER It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. Lauren Evans, MS IV, Dan Kent, MS IV, Elizabeth Dufort, MD and Michael Waxman, MD have indicated they have no relevant financial relationships to disclose. 2

Learning Objectives • To understand the experience with Global Health (GH) that students have upon entering medical school • To determine the percentage of medical students who want GH learning in medical school • To characterize the main reasons that medical students interested in GH want educational opportunities • To identify barriers to participation in GH learning during medical school 3

Background: Global Health Education So Far • Increasing demand among medical students and residents for GH education • Recognition that GH curriculum is needed to educate “ 21 st century” physicians • GH curriculum in medical education is rapidly expanding • No current standard on GH curriculum 4

Background: What are the options? • “International” opportunities – Mission trips, research projects, medical language courses, volunteering, etc. • Curriculum opportunities – – – 5 Global Health Interest Group Guest lectures Coursework, elective or required Global Health “track” Independent study/research/projects

Purpose • To understand the experience that medical students have in travel, research, volunteering, and GH prior to entering medical school • To understand the nuances of students’ perceptions about GH education • Hypothesis: – Exposure to GH prior to medical school – Desire for more GH opportunities during undergraduate medical education – Barriers to participation in GH opportunities and/or experiences 6

Methods: The Survey • Voluntary Survey through Survey. Monkey – 38 questions total, logic-based survey progression • Inclusion Criteria: AMC medical students during the 2013 -’ 14 and 2015 -’ 16 academic years • 3 Sections: – Experience prior to medical school – Desired experiences in medical school – Opinion on the effects of GH education on experience during medical education • Distributed in spring of 2013 and again in Fall of 2015 – Incentive $50 travel gift card raffle offered for participants • Results analyzed with Survey. Monkey and Microsoft Excel 7

Results: Overview • 301 total responses, 295 included in study • Spring 2014 – – 179 responses, 175 included (2 did not complete survey, 2 excluded from study for not meeting inclusion criteria) • 60 MS 1 (34%) • 53 MS 2 (30%) • 22 MS 3 (13%) • 40 MS 4 (23%) • Fall 2015 – – 122 responses, 120 included (2 did not complete survey) • 37 MS 1 (31%) • 51 MS 2 (43%) • 4 MS 3 (3%) • 28 MS 4 (23%) 8

Results: Demographics Spring 2014 • Mean and median age 25 • 86% American-born • Reasons for participating in survey: Other: -want more focus on GH -had a free moment -snow day! 9 Fall 2015 • Mean and median age 25 • 91% American-born • Reasons for participating in survey: Other: -especially important topic, want to contribute to project goals -GH at this school needs all the help it can get -combination of all of above -have a degree in GH, care about GH -you “da” man

Results: Demographics • Top 10 specialty interests of participants – – – – – 10 Internal Medicine Pediatrics Undecided Pediatric Subspecialty Emergency Medicine General Surgery Family Medicine Surgical Subspecialty Medical Subspecialty Infectious Diseases

Results: Define “Global Health” “Health of populations in a global context. ” “A universal approach to medicine in which knowledge of many different approaches to healthcare utilized to benefit a group of people in a diverse range of cultures, ethnic backgrounds and regions. ” “The combination of medicine and public health initiatives on a global scale. ” “Providing medical services in underserved areas outside of the USA. ” “Creating awareness and opportunities for healthcare globally. ” “Helping the less fortunate in developing countries. ” “Universal healthcare for all people. ” 11

Results: Experience Domestic Travel Spring 2014 12 Fall 2015

Results: Experience International Travel Spring 2014 13 Fall 2015

Results: Experience International Travel Spring 2014 14 Fall 2015

Results: Experience International Travel Spring 2014 Other: -conferences -significant other’s job -research 15 Fall 2015 Other: -none 28%: lived abroad for 4 or more months

Results: Experience Service Fall 2015 Spring 2014 • • • 16 Domestic – 90% participated – 31% initiated projects International – 49% participated – 12% initiated projects When? – 74% high school – 86% college – 45% btw college and med school – 68% in medical school • • • Domestic – 90% participated – 27% initiated projects International – 48% participated – 11% initiated projects When? – 72% high school – 85% college – 38% btw college and med school – 69% in medical school

Results: Experience Research Spring 2014 • • • 17 Domestic – 83% participated – 28% initiated projects International – 9% participated – 5% initiated projects When? – 41% college – 36% btw college and medical school – 52% in medical school Fall 2015 • • • Domestic – 86% participated – 28% initiated projects International – 10% participated – 4% initiated projects When? – 76% college – 41% btw college and medical school – 53% in medical school

Results: Experience Exposure to GH Spring 2014 Fall 2015 18

Results: Interest Current Interest Spring 2014 19 Fall 2015

Results: Interest Top priority in GH participation Fall 2015 Spring 2014 • • • 20 38% Travel on school-affiliated GH project 36% 4 th year GH elective 6% Conduct GH research 6% Travel on GH “mission” trip not affiliated with school 5% Participate with local organization involved in GH work 4% Formal GH training 4% Obtain GH distinction on diploma 2% Fundraising for GH efforts 1% Advocate formal GH education • • • 35% Travel on school-affiliated GH project 34% 4 th year GH elective 10% Conduct GH research 8% Participate with local organization involved in GH work 5% Travel on GH “mission” trip not affiliated with school 4% Formal GH training 2% Fundraising for GH efforts 1% Obtain GH distinction on diploma 1% Advocate formal GH education

Results: Interest Desired GH Resources Spring 2014 21 Fall 2015

Results: Effects Does offering GH opportunities make a medical school more competitive? Spring 2014 22 Fall 2015

Results: Effects Does training in GH make you a more competitive residency applicant? Spring 2014 23 Fall 2015

Results: Barriers to Participation in GH Spring 2014 Fall 2015 • 30% Financial constraints • 24% Other elements of education prioritized over GH • 23% Lack of opportunities or resources for partnerships • 16% Disconnect between students and educators over what is important in medical education • 4% School does not want to get involved in GH • 3% Legal constraints • 32% Financial constraints • 29% Other elements of education prioritized over GH • 16% Disconnect between students and educators over what is important in medical education • 13% Lack of opportunities or resources for partnerships • 8% Legal constraints • 2% School does not want to get involved in GH 24

Discussion: Summary • Experience with GH – Domestic and Int’l travel – Research and service – Exposure to GH • Desire for GH • Attitudes towards GH – Important or integral part of medical education – Competitiveness of medical school – Competitiveness for residency • Barriers to participation in GH – Identified 25

Discussion: Limitations and Future Studies • Limitations: – Sampling biases • Incentive designed to counteract this bias • Survey launch at different time of year may sample students at different points in education – Low percentage of total student body take the survey – Some survey results are not verifiable (e. g. travel experience, research initiatives) – Change in perceptions over time not studied • Future Studies: – Trend perceptions over time – Survey of alumni experience with global health – Survey of residency programs 26

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