US medical specialty global health training and the global burden of disease

Abstract

Background: Rapid growth in global health activity among US medical specialty education programs has lead to heterogeneity in types of activities and global health training models. The breadth and scope of this activity is not well chronicled.

Methods: Using a standardized search protocol, we examined the characteristics of US medical residency global health programs by number of programs, clinical specialty, nature of activity (elective, research, extended curriculum based field training), and geographic location across seven different clinical medical residency education specialties. We tabulated programmatic activity by clinical discipline, region and country. We calculated the Spearman's rank correlation coefficient to estimate the association between programmatic activity and country-level disease burden.

Results: Of the 1856 programs assessed between January and June 2011, there were 380 global health residency training programs (20%) working in 141 countries. 529 individual programmatic activities (elective-based rotations, research programs, extended curriculum-based field training, or other) occurred at 1337 specific sites. The majority of the activities consisted of elective-based rotations. At the country level, disease burden had a statistically significant association with programmatic activity (Spearman's ρ = 0.17) but only explained 3% of the total variation between countries.

Conclusions: There were a substantial number of US medical specialty global health programs, but a relative paucity of surgical and mental health programs. Elective-based programs were more common than programs that offer longitudinal experiences. Despite heterogeneity, there was a small but statistically significant association between program location and the global burden of disease. Areas for further study include the degree to which US-based programs develop partnerships with their program sites, the significance of this activity for training, and number and breadth of programs in medical specialty global health education in other countries around the world.

Figure 1

Density of programs by country. The legend on the left refers to the number of countries indicated by color. Each color corresponds to a set range of programmatic activities. Seventy–nine countries have fewer than 5 programmatic activities, 42 countries have only one program in the country and 53 have no reported activity. Websites offered insufficient detail to reliably discern the degree of bilateral exchange between programmatic activities. All of this programmatic activity was assumed to be based in partner country sites. The United States was excluded.

Figure 2

Intensity of programmatic activity by country–level burden of disease. Points above the fitted line represent countries that have a greater number of programs than predicted by our regression model, whereas points below the line represent countries that have fewer programs than predicted.