Increasing Care for Underserved Communities Through a Global Health Residency Training Program

Abstract

Background: Global health education is important for addressing health inequities nationally and internationally. Physician shortages in underserved areas suggest more exposure during training is needed. Objective: To study the impact of a global health training program on residents' perceived preparedness and intention to care for underserved populations. Methods: Observational mixed method evaluation of the impact of an educational intervention, the Global Health Scholars Program (GHSP), on perceived knowledge and intention to practice in underserved settings. The intervention consisted of a longitudinal global health training program addressing ethics, health equity, structural determinants of health, racism, colonialism, and systems-based practice. GHSP elective clinical rotations occurred at local underserved clinics, tribal and Indian Health Services (IHS) sites (Alaska, Arizona, Oregon), and in Botswana. A 16-item survey aligned with program objectives was administered to internal medicine residents at Oregon Health & Science University who completed the GHSP. This included five groups of residents who trained before coronavirus disease 2019 (COVID-19) (2016-2020) and three groups who trained during COVID-19 (2021-2023). Qualitative content analysis was conducted on open-ended text responses. Findings: Surveys were sent to 45 participants; 37 responded (82.2%). All perceived knowledge variables increased significantly after training in the pre-COVID cohort. Among seven residents participating in GHSP during COVID, baseline scores were higher than in the pre-COVID cohort. Qualitative results indicate GHSP was a transformative educational experience and impactful on practice. Among current trainees, 42.9% reported moderate and 26.8% reported high/very high intention to practice in underserved settings. Among graduates, 40.9% reported practicing in underserved settings. Conclusions: GHSP provides transformative educational experiences to residents, with knowledge gains on global health topics higher post-program compared with pre-program. Given 41% of participants in practice reported working in underserved settings, this intervention may help ameliorate physician workforce shortages.

Keywords: Global Health; graduate medical education; physician workforce; resident training; underserved populations.

Figure 1

Integration of knowles’ adult learning principles into the GHSP curriculum. Source: Adapted from knowles, Holton & Swanson (1998), Androgogy in Practice.

Figure 2

Overview of the GHSP curriculum over the three years of residency.