Search

Research in China has been advancing over the past decade with increasing investments from government and private entities. Collaboration with Chinese investigators and those in the United States has also increased as reflected in the growth of scientific papers with Chinese authors. Collaborations are more commonly based on faculty‐to‐faculty relationships which can be challenged by institutional or governmental policies. This paper reports on an institution‐to‐ institution collaboration, the Joint Institute for Translational and Clinical Research initiated in 2010 between the University of Michigan Medical School and Peking University Health Science Center, to enable and support collaborative faculty‐initiated research. Concomitant education and training programs have also been co‐developed. Beginning in 2011, 190 proposals from faculty‐to‐faculty partnerships have been submitted from which 59 have been selected for funding. These projects have involved over 138,000 patient subjects and resulted in 86 peer‐reviewed publications to date. Pilot data has been leveraged to secure $27.3 million dollars of extramural funding outside of China. Faculty and trainee exchanges take place regularly including an annual symposium with mechanisms to link faculty who are seeking partnerships by utilizing each other's complementary strengths and resources. As the collaboration enters its second decade, both institutions believe that the model offers a unique platform to promote faculty‐initiated collaborative research. Next steps include funding studies in prioritized scientific themes, and promoting access to high‐quality cohorts to attract industry partners and to develop sustainable financial models.

Associate's Degree in Nursing (ADN) programs rarely offer international service learning experiences. A project involving an ADN program in a southwestern U.S. border city and a care facility in a nearby city in Mexico was initiated to address cultural competence. The purpose of this study was to assess the impact of an international service learning experience on ADN students' cultural competence as measured by pre- and post-scores on the student version of the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version (IAPCC-SV). Twenty third-semester ADN students participated in a 1-day cross-border international experience. Descriptive statistics provided summaries about the participants and their IAPCC-SV scores. Results indicated a positive effect between participating in an international service learning experience and increased levels of cultural competence. Increasing ADN students' cultural competence through international service learning may help reduce health care disparities among different cultures, promote care that enhances communication between nurses and patients, and build upon therapeutic relationships. International service learning provides ADN students the opportunity to incorporate classroom learning into their care of populations living within diverse communities.

Purpose The purpose of the study was to evaluate student exchange experiences to gain insight into what students perceived as benefits, challenges, and overall areas for improvement that might inform and enhance future exchange projects. Methods A general program evaluation survey, adapted to address the project objectives, was conducted. Eight students from Norway, Canada, and South Africa participating in an international exchange project completed an online survey. The responses were coded and organized in themes such as pre-exchange preparation, home/host country support, challenges, and new learning. Results & Conclusions Despite the challenges the students experienced, students indicated advantages such as new learning, personal development, and expanded professional knowledge. Students gained an international perspective and deeper understanding of their profession and insight into the similarities and differences in clinical practice emphasizing the importance of creating global citizens through internationalization in radiography education. These student experiences confirmed their agency in disposition, motivation, self-efficacy, and position.

The COVID-19 global pandemic has disrupted research and restricted travel, threatening valuable research opportunities for early-career researchers. Support networks are critical to help overcome the challenges of relocation during this time.

Aim and Background: Globally, there is movement towards the internationalisation of allied health care. Many universities across the globe are offering international student placements as part of the movement to create therapists equipped to participate in a dynamic, borderless environment. This narrative study sought to contribute to the developing body of knowledge exploring these longer-term impacts. Design and Methods: Seven occupational therapy graduates who completed an international placement as part of their studies were recruited. Narrative data were gathered via in-depth semi-structured interviews, and thematically analysed by coding and grouping similar concepts to develop themes. Results: The overarching themes were the influence of international placement on participants’ paths and practice as therapists. Sub-themes included developing relationships, representing occupational therapy, working with interpreters, cultural sensitivity and empathy, reflective practice, resourcefulness and autonomy. Conclusion: The study identifies ongoing impact of international student placement on occupational therapy practice. Participants gained a rangeof experiences during their time overseas that has influenced their practice as therapists. Future studies would provide further knowledge to inform universities and students of the benefits of undertaking international student placements. Keywords: international educational exchange, professional practice, professional competence

As an international medical student, I support the decision1 and believe it is a positive way forward. International students already face increasingly extortionate tuition fees studying medicine (around £40 000 (€46 570; $55 587) per …

Introduction Global health initiatives provide exciting opportunities for capacity-building in low- and middle-income countries but data regarding how African clinicians characterize the most effective partnerships are lacking. Methods We surveyed attendees at two “Breast Cancer in Africa” symposia sponsored through a surgeon-led global breast cancer research collaborative. Respondents ranked their preferences for needs from American global health partnerships. Results 399 African attendees responded (170 at the 2017 Ghana conference; 229 at the 2018 Ethiopia conference). Physicians comprised 41.1% of respondents; nurses 20.1% and medical students 27.6%. Ancillary hospital staff comprised the remaining 11.2%. Among clinicians, 75.7% ranked educational/training programs or donation of medical supplies as the highest-priority needs compared to only 20.4% ranking direct monetary support as the highest-priority need (P Conclusions Our survey study found that African clinicians prioritize training programs and donation of medical/hospital supplies above direct monetary support as their highest-value needs from global health initiatives.

Background The purpose of this qualitative study was to assess the student-reported professional and personal value of a one-week service-learning trip to a Nicaraguan community. Methods Five pharmacy students who participated in a one-week service-learning trip to Jinotepe, Nicaragua were invited to participate in this study. Individual, semi-structured interviews were conducted following the trip. Results A variety of themes and subthemes surfaced, demonstrating the student-reported professional and personal value of the short-term service-learning experience. While each pharmacy student was impacted differently, common themes demonstrated transformative pharmacy student learning. These themes included recognition that every individual has a unique story that is essential to understanding how to care properly for that individual; the benefit of establishing a relationship with a community to more effectively and compassionately serve them; the importance of determining community-specific needs to ensure that service provided is beneficial; and recognition that those who are served have wisdom to offer healthcare providers. Conclusions Short-term service-learning opportunities can provide impactful learning for pharmacy students. Established service-learning visits with a consistent host site allow for deeper and more trusting relationships, resulting in the ability to respond to the needs and requests of the partner organization in developing communities and not impose agendas. Organizers of service-learning trips must cater to the needs of the developing community to ensure that the trip is effective in providing value to the host site rather than creating unnecessary burdens and unanticipated hardship.

Motivated by interest in enhancing their clinical experience and contributing to communities in need, US medical resident physicians are increasingly keen to train abroad. Guidelines are needed to help ensure that trainee, institutional, and faculty engagement in global health is ethically appropriate and mutually beneficial for all involved. Supported by the nonprofit organization Seed Global Health, the WWAMI-University of Malawi/College of Medicine partnership leverages long-term US faculty to structure rotations for Malawian and American trainees and endorses strong onboarding, monitoring, and evaluation practices and a mutually beneficial bidirectional international partnership and exchange model.

Short-term experiences in global health (STEGHs) are common ways trainees engage in global health activities, which can be viewed by students as either altruistic or opportunistic. This article explores how STEGHs express the social contract medicine has with society, emphasizes areas of breakdown in this social contract, and calls for medical schools, licensure boards, STEGH-sponsoring organizations, and professional societies to take active roles in addressing these ethical challenges.

Much has been written about the need for participants on global health service-learning experiences to contemplate ethical features of their involvement. This literature tends to neglect the role of self-interest in global engagement, however. This article explores how awareness of one's own interests is critical to successfully engaging in global health experiences and proposes how US-based health professions students and trainees can practice critical self-exploration. Six themes beginning with the letter I (identity, ideology, ignorance, imagination, intention, and investment) are introduced as guides to nourish conscientious, collaborative global health learning and practice.

Aim This qualitative descriptive study aimed to evaluate the role of a short-term interprofessional study abroad program in Kenya on beginning awareness of cultural humility. Background Students in the health care professions, including nursing, must learn to work effectively with diverse patient populations and provide culturally safe care. Method Course assignments of 21 students were thematically analyzed to discover how students applied concepts of cultural attunement to learn cultural humility while interacting with people in rural and urban Kenya. Results Student narrations acknowledged all aspects of cultural attunement during the experience: the pain of oppression; acted with reverence; reported coming from a place of not knowing; engaged in acts of humility; engaged in mutuality; and reported attaining harmony, cooperation, and accord. Conclusion Findings suggest a short-term community-focused study abroad experience can be a valuable tool for beginning stages of becoming culturally humble and providing culturally safe health care.

Background Cultural immersion and service learning are effective pedagogical tools to support the development of cultural competence among nursing students. An international mission trip incorporates these concepts and provides an opportunity for students to broaden their understanding and skills. Problem A review of the literature demonstrates a significant gap surrounding the process used to successfully plan such a trip. Approach Within the context of a small private college, data from an exemplar project help to identify protocols for planning a successful short-term international mission trip. Conclusions An appropriately planned short-term cultural immersion mission trip allows nurse educators and participants to achieve their personal and educational goals for the trip, while providing much-needed healthcare aid to residents and staff in impoverished and underserved areas.

Background: Nurses increasingly are identified as key health care members on global health initiatives, and nursing curricula should address this competency to prepare students to work in a global environment. This article will share how processes and structures were established for an international undergraduate nursing student exchange and service-learning experience between two schools of nursing. Method: The goals of the project were to (a) implement an annual nursing student exchange of approximately 3 weeks in length; (b) select eight students from each school, accompanied by a faculty member, to participate; and (c) provide opportunities for students to participate in service-learning assessments in identified communities. Results: To date, an annual exchange is in its fourth year of existence. Conclusion: An international service-learning opportunity is one way to improve nursing students' ability to provide culturally competent health care. [ J Nurs Educ. 2019;58(4):235–239.]

Purpose: To train Kuwait radiologists and technologists in breast imaging to create a Kuwait national mammography screening program (KNMSP) that provides high quality safe mammography services meeting international standards for early detection of small invasive breast cancers in asymptomatic women. Materials and Methods: 5 radiologists, 6 technologists and 1 physicist/radiation protection technologist from Kuwait trained at x hospital over a 3 year period utilizing Society of Breast Imaging/American College of Radiology guidelines and Food and Drug Administration Mammography Quality Standards Act requirements for education program content. On site visits in Kuwait were provided by x hospital radiologists and technologists 3 times during the program. The KNMSP was implemented to provide asymptomatic women ages 40–69 screening mammography services. A lead Kuwaiti breast radiologist collected and analyzed mammography results and outcome data utilizing descriptive statistics. Results: 6933/164000 (4.2%) Kuwaiti women were screened with 83 cancers detected, 74 invasive and 9 ductal carcinoma in situ. Screening mammography sensitivity was 97.6%, specificity 88.2%, and PPV3 37.1%. Diagnosis was stage 0 in 9/83 (10.8%), Stage 1 in 24/83(28.9%), Stage 2 in 34/83 (41%), Stage 3 in 11/83 (13.3%) and Stage 4 in 5/83 (6.0%). 80% of women with breast cancer were diagnosed with tissue biopsy within 4 weeks of their screening mammogram. Conclusion: The KNMSP demonstrates the successful training of Kuwait radiologists and mammography technologists with implementation of a national screening mammography program in Kuwait with acceptable sensitivity and specificity and timely diagnosis of early stage breast cancers.

BACKGROUND Hand surgeons have the potential to substantially decrease the surgical disability burden in the developing world through educator trips. The Lancet Commission supports contextually driven educator trips grounded in the needs of local hosts, yet few organizations perform a comprehensive assessment of learning interests or the hosting institutions' surgical capacity before the trips. METHODS The authors adapted the Personnel, Infrastructure, Procedures, Equipment, and Supplies questionnaire, which was modified from the World Health Organization's validated Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. The authors revised each aspect of the questionnaire to reflect items pertinent to upper extremity surgery and hand trauma care. They added sections to gauge self-identified learning needs, local disease burden, operative resources, and current practices. The tool was distributed by means of Qualtrics; descriptive statistics were used to summarize data. The authors analyzed the data for all participants and performed two subgroup analyses to examine variation by regions and countries. RESULTS The authors received 338 responses from 27 countries. There was wide variability in local surgical disease burden, learning interests, and skill level of upper extremity procedures. Although learners were most interested in learning tendon transfers and microsurgical techniques, the majority did not have adequate infrastructure at their institution to sustain capacity for microvascular procedures. CONCLUSIONS Needs assessments can gauge how best to provide education during short-term visiting educator trips and optimize its impact in resource-limited settings. Understanding the needs, learning interests, and availability of resources of local learners is imperative to creating a sustainable global surgical workforce.

Medical students and radiology trainees play an integral role in serving the global community, and their opportunities to become involved in global health radiology have continued to grow.

This study aimed to explore the experiences of nursing students who have undertaken a short course in an overseas educational system to generate theoretical understanding of the experience of studying abroad. Learning in the health professions needs to considered in the context of globalization as a way of sharing knowledge and taking responsibility as world citizens. Studying abroad provides students with an opportunity to develop global health care competencies. A symbolic interactionist approach was adopted to gain insight into how the students constructed the meaning of studying abroad. The study was conducted at a university with 2 campuses in Taiwan. A purposive sampling strategy was employed to recruit 14 participants. Data were collected from August to November 2017 via individual in-depth interviews. A semi-structured interview guide was used. Qualitative content analysis was employed to analyse the data. Each interview was audiotaped and transcribed verbatim. Most students identified both positive and negative experiences related to their professional and personal development and needs. They demonstrated motivation to leave their comfort zone and enter a challenging environment as well as a high level of adaptability. The experience enabled them to see themselves as part of the world and expanded their learning in positive ways. On completion of their course, they encouraged others to experience this enjoyable once-in-a-lifetime opportunity.

Introduction: Migrants comprise a growing proportion of the dental workforce in Australia. To date, research on migrant dentists is limited, raising policy questions regarding the motivations for migration, demographic profiles and work patterns. The purpose of this paper was to present findings from the first national survey of migrant dentists in Australia. Methods: All dentists with a primary dental qualification from an overseas institution and registered with the Australian Dental Association (n = 1,872) or enrolled as a graduate student in any of the nine dental schools in Australia (n = 105) were surveyed between January and May 2013. Results: A total of 1,022 participants (response rate = 54.5%) were classifiable into three migrant dentist groups: direct recognition (n = 491); Australian Dental Council (ADC) (n = 411); and alternative pathway (n = 120). Overall, 41.8% of migrant dentists were female. More than half of the ADC group (54.1%) were from lower middle income countries. The most frequent motivation for migration according to the direct recognition group (21.1%) was ‘adventure’, whereas other groups migrated for ‘better opportunity’. The majority of ADC respondents (65%) were under 45 years of age, and a larger proportion worked in the most disadvantaged areas (12.4%), compared with other groups. Gender, marital status, years since arrival in Australia and having children varied between the groups (chi square; P < 0.05). Conclusion: Dentist groups migrate to Australia for different reasons. The large proportion of the migrant dentist workforce sourced from lower middle income countries points towards deficiencies in oral health systems both for these countries and for Australia. The feminisation of the migrant dentist profile could in future affect dentist-practice activity patterns in Australia. Further research, especially on the settlement experiences of these dentists, can provide better insights into issues faced by these dentists, the nature of support that migrant dentists receive in Australia, the probable future patterns of work and potential impact on the dental workforce and dental service provision.

The Radiological Society of North America (RSNA) Committee on International Radiology Education (CIRE) has worked for the past 25 years to create academic programs oriented to the needs of international radiologists. The CIRE develops organized and structured approaches to help build one's capabilities and increase one's capacity for professional growth, which then facilitates better patient care. The authors describe the four programs that CIRE is responsible for and introduces its newest initiative, Global Learning Centers, which is planned to start in 2021. RSNA involvement in global radiology education provides opportunities for early, mid-, and late-career radiologists to participate in these programs as students or teachers. The authors describe some of the programs' success stories and invite readers to become a part of and contribute to the growth of radiologic academic endeavors globally. ©RSNA, 2020.

Objective This study was conducted to acquire a deeper understanding of Japanese students’ motivation to study abroad and to provide baseline information for nurturing globally-minding dental students. Materials and Methods Students from the first to the sixth year (n = 332), at the Faculty of Dentistry, Tokyo Medical and Dental University, were invited to participate in the study and were asked to complete a self-administered questionnaire, written in Japanese. Self-reported English competency was assessed in four areas: reading; writing; speaking; and listening. Students were asked to score their competencies in these areas using a 10-point visual analogue scale (VAS). Of the total eligible students, 312 (94%) participated. Results The results of the study suggest that competency and confidence in the English language could be one of the biggest obstacles for students to study abroad. Students with an interest in studying abroad were highly motivated and studied English independently. Discussion and Conclusions Japanese educational authorities and dental schools may need to consider a range of incentives and motivational strategies to nurture clinicians, educators and researchers who can function confidently in an increasingly borderless world. These could include increasing exposure to English language skills through mandatory lectures and seminars in English, increasing the range of inbound international students through student exchange programmes and encouraging students to develop and communicate with international colleagues. The Faculty of Dentistry at Tokyo Medical and Dental University has begun to increase exposure of students to English through the regular curriculum. Outcomes will be followed and evaluated.

N/A

* Abbreviation: COVID-19 — : coronavirus disease 2019 It is a warm day in Kampala. I walk through the pediatric emergency center, taking stock of the day’s supplies before the shift begins. The medicine drawer holds one vial of dexamethasone and a few vials of adrenaline, atropine, furosemide, and phenytoin. The head nurse greets me as she does every morning and informs me of the somber news from the last shift; a child with generalized tetanus was admitted in the late afternoon and quickly decompensated. We shake our heads sadly, acknowledging that it was a difficult case. There are no ventilators in the emergency center. I spent one year in Uganda through my combined residency program in pediatrics and global child health, acclimating to a vibrant culture and nuanced pathology. Often I encountered the logistical challenges brought on by resource limitation and the tragedies that frequently accompanied them. On reentry to the United States in January 2020, I, like many physicians and trainees who spend significant time abroad, grappled with the vast differences between medical systems and the applicability of my international experiences to my practice here.1 At the same time, a disease was emerging that would blur the line between global and domestic health and would give my training new relevance on home soil. On January 30th, 2020, the World Health Organization … Address correspondence to Michelle Javier, MD, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. E-mail: javier{at}bcm.edu

BackgroundGlobal health experiences are an increasingly popular component of medical student curricula. There is little research on the impact of international medical electives embedded within long-standing, sustainable partnerships. Our research explores the University of Michigan medical student elective experience in Ghana within the context of the Ghana-Michigan collaborative.MethodsStudy participants are University of Michigan medical students who completed an international elective in Ghana between March 2006 and June 2017. Post-elective reports were completed by students, including a description of the experience, highlights, disappointments, and the impact of the experience on interest in future international work and future practice of medicine. A retrospective thematic analysis of reports was carried out using NVivo 12 (QSR International, Melbourne, Australia).ResultsA total of 57 reports were analyzed. Benefits of the elective experience included building cross-cultural relationships, exposure to different healthcare environments, hands-on clinical and surgical experience, and exposure to different patient populations. Ninety-five percent of students planned to engage in additional international work in the future. Students felt that the long-standing bidirectional exchange allowed them to build cross-cultural relationships and be incorporated as a trusted part of the local clinical team. The partnership modeled collaboration, and many students found inspiration for the direction of their own careers.ConclusionsEmbedding clinical rotations within a well-established, sustained partnerships provides valuable experiences for trainees by modeling reciprocity, program management by local physicians, and cultural humility—all of which can help prepare learners to ethically engage in balanced, long-term partnerships in the future.

Author(s): Carrillo, Laura A; Segarra, Borja; Sabharwal, Sanjeev | Abstract: BackgroundAlthough efforts have been made to address the inequities of surgical care globally, to our knowledge, there has been no comprehensive analysis of orthopaedic clinical observerships in North America that are available for international surgeons.MethodsTwo investigators performed a systematic online search to identify orthopaedic clinical observerships that are available in the United States and Canada for international surgeons. Variables such as host type, geographic location of host site, program type, eligibility criteria, subspecialty focus, application and participation fees, availability of funding, duration of observership, and the quality of online information that is available based on an online content (OC) score were collected.ResultsOf the 113 available observership sponsors in North America, 36 (32%) were professional-society-based, 69 (61%) were academic/institution-based, and 8 (7%) were private-practice-based. Most observerships were located in the U.S. (n = 85) and, of these, the Northeast was the most common U.S. region (n = 29, p = 0.008). Of the observerships with a focus, pediatrics was the most frequent orthopaedic subspecialty (p l 0.0001), followed by spine and trauma. Professional-society-sponsored observerships offered funding to international surgeons more often than academic/institution-based and privately sponsored programs (p l 0.0001). The average OC score for the entire cohort was 2.35 and was similar among the 3 host types (p = 0.954). The program structure and requirements such as applicant eligibility, application and participation fees, and duration of observership varied widely.ConclusionsThere are opportunities for international orthopaedic surgeons to participate in clinical observerships in North America. Given the greater funding support and lack of fees for professional-society-sponsored observerships, these observerships may pose fewer financial barriers for surgeons from low and middle-income countries (LMICs). The quality of online information was similar among the 3 different host types and can be improved.Clinical relevanceThe relevance and impact of a clinical observership experience in North America for a practicing orthopaedic surgeon from an LMIC need to be explored further.

Objective. To engage health professions students in a photo and caption sharing methodology to stimulate reflection and inculcate principles related to global health at a formative time in training. Methods. Undergraduate and graduate students from multiple colleges enrolled in a course that would prepare them for an in-country global health experience. As part of the course, participants took photos to illustrate one of three topics: global health ethics, interprofessional practice, or social determinants of health. The iterative and participatory photovoice process was used for students to analyze, discuss, and reflect on their work in country and upon return. Final photos with captions were displayed online. Researchers analyzed photos and captions using content analysis to identify unifying themes. All students were required to complete the photovoice assignment, but only those who gave informed consent were included in the qualitative analysis. Results. Twenty-six students were included in the analysis. Two overarching themes emerged: revelation and adaptation. Revelation encompassed novel elements that surprised the students, including differences and similarities between the United States and Ecuador. Coded segments related to adaptation discussed participants' resourcefulness while challenging work environments, and how they would apply this new perspective to their future practice in the United States. Conclusion. This global health photovoice project provided a unique medium for reflection for health care trainees. This project enhanced our understanding of the learners' perspectives and this new means of expression offered the learners a greater opportunity for deeper reflection. The assignment also revealed gaps in learning related to social determinants of health and areas of concern related to solidarity and privilege.

As a result of recent global health events, US health care leaders are strengthening international relationships to share best practices, health research, and support of workforce capacity. The Institute for Healthcare Improvement, the National Academies of Sciences, Engineering, and Medicine, the American Nurses Credentialing Center, and the Joint Commission International have all committed to expanding their vision and mission to improve health and health care globally. To support excellence in international health care delivery, the authors embarked on a Chief Nursing Officer (CNO) US Healthcare Immersion Program. The purpose of the program is to introduce the US nursing leadership competences to China CNO colleagues in preparation for their future role with health care reform.

As global leaders, US nurses will have an increasingly recognized role and responsibility in shaping health care in all countries. They should be at the forefront of changing and improving health systems to achieve universal health. Currently, a major health care reform is underway that requires a shift in the professional nursing footprint of China's nurse leaders. These leaders must garner knowledge capital to reinforce ethics, regulations, and standards; use current best practices; implement a comprehensive performance evaluation process; and capture the spirit of caring within their health care environments. Therefore, China is seeking US immersion opportunities for their emerging nurse leaders. Although US Immersion Programs exist, there is scant literature related to international precepting and how transformational learning occurs within this experience. This article introduces a transformational learning experience between US International Nurse Preceptors and a Chief Nursing Officer from Yinchuan, China.

Background In the United States, a shortage of general surgeons exists, primarily in rural, poor, and minority communities. Identification of strategies that increase resident interest in underserved regions provides valuable information in understanding and addressing this shortage. In particular, surgical experience abroad exposes residents to practice in low-resource and rural settings. As residency programs increasingly offer global surgery electives, we explore whether the presence of an international surgical rotation affects graduates' future practice patterns in underserved communities domestically. Methods We surveyed general surgery residency graduates at a single academic institution. Those who finished general surgery residency from 2001 to 2018 were included. Participant demographics, current practice demographics, and perceptions related to global surgery and underserved populations were collected. Respondents were stratified based on whether they did (“after”) or did not (“before”) have the opportunity to participate in the Kijabe rotation (started in 2011), defined by graduation year. Results Out of 119 eligible program graduates, 64 (53.7%) completed the survey, and 33 (51.6%) of the respondents graduated following the implementation of the Kijabe rotation. Two participants defined their primary current practice location as international. Fifteen (45.5%) in the “After” group indicated an interest in working with underserved populations following residency, compared to 5 (17.8%) of the “Before” group (P = 0.074). Furthermore, 20 (60.6%) respondents in the “After” group expressed interest in working with underserved populations even if it meant making less money. In the “Before” group, only 13 (46.4%) responded similarly (P = 0.268). Eleven (9.2%) residents rotated at Kijabe. Those who participated in the Kijabe rotation reported an uninsured rate of 36.7% for their current patient population, compared to rate of 13.9% in those who did not rotate there (P = 0.22). Conclusions At a single institution, our results suggest that participation in an international surgical rotation in a resource-constrained setting may be associated with increased care for underserved populations in future clinical practice. These results could be due to self-selection of residents who prioritize global surgery as part of their residency experience, or due to increased exposure to underserved patients through global surgery.

Introduction International placements challenge students to find the right level of participation, as local practices, language and time pressure may affect their engagement in patient-related tasks or team activities. This study sought to unpack the initiation process during international clinical placements with the ultimate aim to achieve active student participation. Methods Following a constructivist grounded theory approach, we conducted two individual interviews with 15 undergraduate healthcare students (before departure and whilst on placement). To identify emerging themes, we applied an iterative process of data collection and constant comparative analysis. Several team discussions informed further analysis, allowing us to reach a more conceptual level of theory. Results From our findings we constructed a four-phase model of healthcare students’ initiation of international clinical placements, which brings into focus how the phases of ‘orientation’, ‘adjustment’ and ‘contribution to patient care’ build up towards a ‘sense of belonging’. We identified several factors that induced active student participation in practice, such as a favourable workplace setting, opportunities for learning and a local support network. Discussion Active student participation is aimed at different goals, depending on the four phases of initiation that eventually lead to a sense of belonging and support workplace learning. Electronic supplementary material The online version of this article (10.1007/s40037-020-00561-9) contains supplementary material, which is available to authorized users.

Educational partnerships between academic health sciences centers in high- and low-resource settings are often formed as attempts to address health care disparities. In this Perspective, the authors describe the Toronto Addis Ababa Academic Collaboration (TAAAC), an educational partnership between the University of Toronto and Addis Ababa University. The TAAAC model was designed to help address an urgent need for increased university faculty to teach in the massive expansion of universities in Ethiopia. As TAAAC has developed and expanded, faculty at both institutions have recognized that the need to understand contextual factors and to have clarity about funding, ownership, expertise, and control are essential elements of these types of collaborative initiatives. In describing the TAAAC model, the authors aim to contribute to wider conversations and deeper theoretical understandings about these issues.

Background: Many medical and nursing schools offer opportunities for students to participate in global health experiences abroad, but little is known about the efficacy of pre-departure training in preparing students for these experiences. Objectives: The primary aim was to identify characteristics of pre-departure training associated with participants’ reporting a high level of preparedness for their global health experiences. Secondary objectives included identifying students’ preferred subjects of study and teaching modalities for pre-departure training. Methods: A questionnaire was distributed to all medical and nursing students at our institution from 2013 to 2015. Questions addressed prior global health experiences and pre-departure training, preferences for pre-departure training, and demographic information. Findings: Of 517 respondents, 55% reported having a prior global health experience abroad, 77% of whom felt prepared for their experience. Fifty-three percent received pre-departure training. Simply receiving pre-departure training was not associated with perceived preparedness, but pre-departure training in the following learning domains was: travel safety, personal health, clinical skills, cultural awareness, and leadership. Perceiving pre-departure training as useful was also independently associated with self-reported preparedness. Students’ preferred instruction methods included discussion, lecture, and simulation, and their most desired subjects of study were travel safety (81%), cultural skills (87%), and personal health (82%). Conclusions: Incorporating travel safety, personal health, clinical skills, cultural awareness, and/or leadership into pre-departure training may increase students’ preparedness for global health experiences. Student perceptions of the usefulness of pre-departure training is also associated with self-reported preparedness, suggesting a possible “buy-in” effect.

Background In response to the growing interest in global surgery among trainees, international surgical rotation (ISR) was approved as a formal elective of resident curriculum. To define ISR's role, we aim to identify the six core competencies of Accreditation Council for Graduate Medical Education (ACGME) in individual institution's experience. Data sources This is a systematic literature review studying general surgery resident experience in ISR as it pertains to the ACGME core competencies. Articles were searched using PubMed, Scopus, and Web of Science. Each abstract and article was reviewed, selected, and tabulated. Conclusion Fourteen articles were selected for the review after inclusion and exclusion criteria were applied. We found that ISR provided a valuable educational experience for US surgical residents by meeting the ACGME core competencies in a different environment. ISR is an important addition to the general surgery curriculum. Future direction should focus on bidirectional ISR and educational consortium development.

Congenital heart disease is the most common birth defect worldwide, and accounts for a high proportion of the world's infant mortality. About 9 of every 10 babies born each year are born in areas without adequate access to heart surgery; overcoming this problem will necessitate addressing the worldwide shortage of an estimated 3,700 pediatric cardiac surgeons. Establishing sustainable heart surgery programs requires more than an investment of money: political, social, and cultural issues unique to each environment need to be addressed. Organizations desiring to help develop cardiac surgical centers need to focus on communication and bidirectional education, and to make a long-term commitment to each site. By identifying and addressing obstacles, success rates are high.

Background International clinical placements provide undergraduate students with a unique and complex clinical learning environment, to explore cultural awareness, experience different health care settings and achieve clinical competencies. Higher education institutions need to consider how to structure these placements to ensure appropriate and achievable aims and learning outcomes. Objectives In this study we described the structure, aims and learning outcomes associated with international clinical placement opportunities currently undertaken by Australian undergraduate nursing students in the Asia region. Participants Forty eight percent (n = 18) of the institutions invited responded. Eight institutions met the inclusion criteria, one of which offered three placements in the region, resulting in 10 international placements for which data were provided. Methods An online survey tool was used to collect data during August and September 2015 on international clinical placements conducted by the participating universities. Descriptive data on type and numbers of placements is presented, along with results from the content analysis conducted to explore data from open ended questions on learning aims and outcomes. Results One hundred students undertook 10 International Clinical Placements offered in the Asian region by eight universities. Variations across placements were found in the length of placement, the number of students participating, facilitator to student ratios and assessment techniques used. Five categories related to the aims of the programs were identified: ‘becoming culturally aware through immersion’, ‘working with the community to promote health’, ‘understanding the role of nursing within the health care setting’, ‘translating theory into professional clinical practice’, and ‘developing relationships in international learning environments’. Four categories related to learning outcomes were identified: ‘understanding healthcare and determinants of health’, ‘managing challenges’, ‘understanding the role of culture within healthcare’ and ‘demonstrating professional knowledge, skills and behaviour’. Conclusions International clinical placements in the Asia region appear to vary greatly from one education institution to the next with no clear consensus from either this study's findings or the literature on which structure, support and assessments lead to greater student learning.

Background Internationalisation of higher education involving information and communication technology such as e-learning opens opportunities for innovative learning approaches across nations and cultures. Objectives Describe a case in practice of collaborative and transformative learning in relation to ‘internationalisation on home grounds’ with the broader learning objective of ‘becoming aware and knowledgeable’. Design A mutually developed project established a virtual international collaborative exchange for faculty and students using a course management software (MOODLE) and open access technology (Adobe CONNECT). Settings Two research universities in Sweden and the United States. Participants Approximately 90 nursing students from each university per semester over several semesters. Methods A collaborative process to develop a joint learning community to construct a virtual module and learning activity involving academics and nursing students in two countries using principles of meaning construction and negotiated learning. Results Developed possibilities for dealing with the challenges and finding strategies for a future higher education system that opens dialogues worldwide. Conclusions Virtual international exchanges open innovative communication and learning contexts across nations and cultures. Internationalisation is so much more than students and teachers' mobility. ‘Internationalisation on home grounds’ (internationalisation for all) should receive more attention to support faculty and student collaboration, learning, and professional development.

Background: As global learning programs gain momentum in nursing education, a variety of models have emerged. A typical experience consists of 1-week international immersion in which faculty, nursing students, and an interprofessional team deliver direct health care to impoverished communities. Our international clinical placements have been successful in providing rich learning experiences while applying clinical credit hours toward required courses in our baccalaureate nursing program. Method: The unique attributes of these international clinical placements include full integration into the curriculum, use of formative and summative clinical evaluations, participation across specialties and life span in one experience, an interprofessional practice setting, and consistent design and standards across programs. Results: By integrating the experiences into the curriculum and maximizing credit hours applied, the international experiences fulfill clinical placements and develop the students' personal and professional goals. Conclusion: These innovative strategies of international clinical placements have been successful in meeting student, program, and community needs. [ J Nurs Educ . 2019;58(12):733–735.]

Background Multiple institutions have developed international electives and sustainable global surgery initiatives to facilitate clinical, research, and outreach opportunities with hospitals in resource-poor areas. Despite increasing interest among programs, many institutions have not successfully reached potential involvement. Objective This study evaluates the experiences of Yale residents and faculty, measures interest in the development of an international surgical elective, and enumerates barriers to developing or participating in these opportunities. This was performed to develop a formalized elective and assess interest and capacity for surgical global health initiatives, as a seemingly increasing number of trainee applicants and residents were expressing interest in working in resource-poor settings. Methods Electronic survey of Yale Surgery residents and faculty analyzed using SPSS and Graphpad Prism. Results Among residents, previous global experience correlates with current interest in international opportunities, with 100% remaining interested, and 78% of those without prior experience also expressing interest (p = 0.018). Barriers to pursuing these activities included the use of vacation time, funding, scheduling, family obligations, and concern for personal safety. Among faculty, 28% of respondents have been involved internationally, and most (86%) expressed interest in additional opportunities and all were willing to take residents. Barriers to faculty participation included funding, relative value unit target reduction, protected time, and the desire for institutional support for such activities. Conclusions A substantial proportion of residents and faculty have experience in global health and motivation to pursue additional opportunities. The main barriers to participation are not a lack of interest, but rather needs for funding support, protected time, and institutional recognition of academic contributions. These findings are being used to develop a global surgery elective and establish long-term partnerships with international colleagues.

This survey study investigates how local staff at a partner facility perceived the role of international visiting health care workers and the impact of hosting international workers on the facility and staff.

Background: Delayed study progress in medical school is a challenging issue for the tax paying community, the faculty and the medical students themselves. Reasons for a delay might be different from known risk factors for academic difficulties. Methods: An online survey regarding delays in the study progress and including a personality test (BFI-10) was presented to medical students from four German medical schools after completion of their 3rd year of study. Results: Of 617 students, 51.2% reported a mean delay of 2.1 ± 1.5 semesters. Frequent risk factors were secondary employment (69.5%, odds ratio (OR) 1.7, p = 0.004), female gender (69.8%, OR 1.6, p = 0.007), work or study abroad (35.9%, OR 1.5, p = 0.02), a late graduation (5.9%, OR 2.4, p = 0.02), as well as support through scholarship or mentoring (19.9%, OR 1.8, p = 0.004). “Working on doctoral thesis” (11.3%, OR 1.9, p = 0.03) and structural curricular issues (36.6%, OR 0.9, p = 0.7) were frequently identified as obstacles. “Support by friends/family” was considered helpful by 24.1% (OR 1.4, p = 0.09), as well as a high intrinsic motivation (19.1%, OR 0.5, p = 0.01). In the BFI-10, students with study delay were more prone to openness and agreeableness. Conclusions: Risk factors for delay are not identical to those for academic difficulties. To decrease the risk for delays, firm curricular structures should be identified and alleviated. Intrinsic motivation is a strong impetus of study progress and additionally might be strengthened by curricular changes.

Introduction Many doctors, across grades and specialities, supervise or advise students and juniors undertaking elective placements. Electives form part of medical curricula on a worldwide scale. The Medical Schools Council (MSC) Electives Committee in the UK identified a gap in the current literature in relation to provision of comprehensive recommendations for the design and management of undergraduate elective programmes. Electives afford many known benefits for medical and other health care students, but the context, and risks (impacting potentially on patient, public and student well-being) are usually different from those associated with ‘home’ clinical placements. Aim The aim is to share experiences and good practice within UK Medical Schools, and inform and inspire others involved with similar programmes across the globe. Method This paper reports the results of the formation of a sub-group to draft a set of recommendations, drawing on the reported experiences of academic elective leads across all UK schools, and including input from the MSC, and the student group Medsin (to capture the learner voice). The final document was the result of a national consultative process of four iterations. The end document was approved at school level, e.g. by curriculum committee, by each of the participating schools. Recommendations The recommendations consolidate the experiences of 30 participating UK medical schools. The consultation process generated 17 pre-departure recommendations, seven during elective recommendations, 11 post elective recommendations and a further four recommendations relating to infectious disease. Conclusion We believe developing elective programmes using collective recommendations will provide a basis for a safer and more structured approach to a medical elective without losing the uniqueness and creative experiences valued by participants. Issues relating to undergraduates leaving their home school to experience medicine in a new context or country replicate across sites, so many recommendations will be transferable internationally.

Objective To determine the nature and volume of surgical cases being performed by US general surgery residents during a global surgery elective. Design Retrospective review of case logs from 2012 to 2016. Setting Malamulo Mission Hospital is a rural hospital in southern Malawi. Participants Rotating residents from a US-based general surgery residency program. Results Residents performed 12 cases per week from a variety of surgical disciplines. Conclusion Global surgery rotations with dedicated faculty can provide excellent surgical variety and volume to enhance the training of residents.

This paper describes a collaboration between orthopaedic nurses in Myanmar (Burma) and Australia. It aims to explores how that collaboration began and how it can grow and has grown. The unique needs and challenges of healthcare delivery in developing nations are discussed. Understanding these unique needs and challenges is vital in tailoring strategies to provide orthopaedic nurses in those countries with resources that are suitable to assist them in providing the highest level of quality care to their patients. The authors hope that this example may inspire other orthopaedic nurses and organisations around the globe to participate in this type of activity with the understanding that it benefits all those involved, nurses from both developed and developing countries, as well as improving patient care.

Background Nursing students need to be prepared for the increasingly culturally diverse health care. Therefore, providing students with international perspectives remains the mission of higher education. However, given the logistic and financial constraints, not all students will be able to travel overseas for their international experiences. A feasible alternative to study abroad is internationalisation-at-home where intercultural dimensions are incorporated into curriculum, without students leaving their home universities. This paper presents findings from a collaboration between nursing programmes in Sweden and Hong Kong. The aim of the project was to explore how undergraduate nursing students' perceived achieved learning outcomes after participating in a web-based intercultural peer-learning intervention.