The Duke Global Health Pathway for Residents and Fellows prepares trainees to bridge clinical practice with public health principles in order to reduce health disparities both locally and abroad. Participants in the program come from multiple departments across Duke University Medical Center.
The Global Health Pathway core curriculum focuses on clinical practice, research, and health policy in low resource settings. Particular attention is given to issues of cultural sensitivity and medical and research ethics. Global Health Residents and Fellows, regardless of their discipline, will obtain a profound appreciation for the determinates and consequences of health disparities in the communities where they work.
Objectives of the program are achieved through the following components of the Pathway’s curriculum:
This 6 week experience takes place at one of our global partner locations after programmatic orientation in July and prior to starting master's classes in August. The site assessment facilitates the establishment of essential relationships and the identification of the research project focus. For more information about the formal goals and objectives of the site assessment visit, click here.
Duke’s Master of Science in Global Health degree program (MSc-GH) offers Global Health Residents and Fellows opportunities to develop and refine skills in research study design, quantitative and qualitative methods, and to understand key health policy and ethical challenges confronting those engaged in global health careers.
On-site Global Health Training
Residents and fellows spend 7-12 months engaged in a collaborative research project of global public health significance at their partner site. At some sites, trainees also work up to 20% time clinically at their site. Research conducted during this time is expected to be used towards a manuscript of publishable quality.
Regarding financial support: Financial support for trainees provided by the Global Health Pathway includes salary, graduate school tuition, and limited support for research and travel related expenses. Trainees are responsible for their own living expenses while overseas.
Global Health Competencies
Regardless of specialty training, all residents and fellows will be expected to demonstrate competencies in the following areas to be effective global health physician leaders.
- Demonstrates culturally appropriate, caring, and respectful behavior in patient interactions
- Makes informed decisions about diagnostic and therapeutic interventions with an understanding of the resource limitations of the practice setting
- Performs indicated procedures as needed, adapting to the constraints of resource limited settings
- Advocates for quality of patient care
- Demonstrates ability to learn basic science and clinical knowledge about common local disease processes
- Demonstrates up-to-date knowledge
- Uses knowledge & analytical thinking to address clinical questions
Practice-based learning and improvement
- Engages in ongoing learning; hones physical examination skills.
- Facilitates the learning of others
- Demonstrates a commitment to continuing education despite limited access to educational resources
- Facilitates the education of learners within the system by serving as a teacher and role model to local medical students, residents, nurses, and faculty
- Begin a process of self-analysis that will foster an awareness of the additional stress that can be encountered when practicing in a different country and socio-cultural setting
Interpersonal and communication skills
- Demonstrates care and concern for patients and their families
- Communicates effectively with patients and their families
- Communicates effectively with other healthcare professionals
- Works effectively with other members of the healthcare team
- Accepts responsibility and follows through on tasks
- Practices within the scope of his/her abilities and parameters of the local institution
- Responds to patients' unique characteristics and needs
- Demonstrates integrity and ethical behavior
- Demonstrates receptiveness to instruction by local physicians and non-physician providers
- Develops a personal system for stress reduction and coping mechanisms for the inevitable tragic medical events one will encounter in this setting
- Provides cost-conscious medical care in a technology challenged environment
- Works to promote patient safety
- Coordinates care with other healthcare providers
- Facilitates patient care in the larger healthcare community
- Discuss the role of foreign health professionals in the medical systems of developing nations
- Demonstrate an understanding of key proximal determinates of health disparities
- Work to find a solution to health disparities
- Demonstrates an ability to discuss the ethical principles that are most important in health care delivery in under-resourced settings (e.g., the relative importance of justice vs. beneficence)
Global Public Health Research
- Completes master’s degree in global health
- Engages in a collaborative research project of global public health significance
- Develops a working understanding of the local and regional research needs of the communities in which the trainee is working
- Develops a practical understanding of the existing research programs and institutional review protocols already in place
- Understand critical sociocultural issues that may have an effect on research initiation and implementation in the relevant health care facilities and communities.
- Demonstrates practical applications of medical research ethics with special attention to issues of justice, autonomy, and beneficence
- Demonstrates an appropriate understanding of the pitfalls and challenges of medical research in underrepresented and often impoverished populations
- Leads a research project that is regionally relevant and involves one or more nationals in key investigative roles
- Discusses the challenges of the informed consent process in patients who do not speak the common medical language and in those who may be illiterate or who may not have a shared conception of respect of autonomy
- Demonstrates the appropriate application of public health knowledge and methodology when implementing patient care plans
- Demonstrates the ability to discuss medical errors in a culturally sensitive manner and willingness to learn from these errors
- Demonstrate a commitment to the culturally sensitive application of medical ethics to patient care in this setting.
The master’s program provides trainees with the opportunity to view health from a population-level perspective. The course work will broaden their skill set as physicians by being better able to identify and evaluate the social and environmental determinants of health. They will be required to work with students from various educational backgrounds and disciplines on group projects, thereby developing their team-building and collaboration skills. They will acquire knowledge and skills in epidemiology, biostatistics, data management and global health ethics necessary to lead investigative or service projects. The health programs management training will provide trainees with skills in coalition building, program administration, cultural competency, and funding procurement. The Duke Global Health Institute also provides numerous opportunities for participation in global health lecture series.
While abroad, trainees will have exposure to the prevalent causes of morbidity and mortality encountered in resource-poor settings. Trainees will deepen their understanding of health disparities while caring for patients whose health is compromised due to social determinants. Their patient care will demonstrate the practical implementation of their public health knowledge. Because of inevitable infrastructure and resource constraints in the overseas location, trainees will have unique opportunities to improve their clinical problem solving abilities, physical examination proficiency, and foreign language communication skills. On-site faculty will supervise trainees clinical and research activities and provide mentorship as needed.
To successfully complete the GHP, trainees must complete the following minimum requirements:
- Depending on your overseas site, it may be extremely difficulty to initiate your own research project (as opposed to working on an already existing project). Individual projects must be discussed with GHP program director and your research mentorship panel.
- All research must be compliant with Duke IRB, local and national ethics committee requirements. These processes can take many months. You are advised to submit 6 months before anticipated start date; no work can begin without approval. For IRB approval from Duke, you must complete these two trainings: CITI human subjects protection certification and a human subjects research training in Duke’s Learning Management System.
- Submit a brief research proposal (1‐3 pgs.) for approval by the GHP and your research mentor upon return from your site visit.
- Meet regularly with Dr. Thielman and other research mentors according to a mutually agreed upon schedule.
- Produce one or more global health-oriented manuscripts of publishable quality. Manuscripts for publication should be approved by GHP leadership prior to submission and must cite collaborators and funding sources.
- Submit grant applications for funding with the goal of identifying a sustainable funding mechanism post GHP.
- Submit one or more grant applications for funding with the goal of identifying a sustainable funding mechanism post GHP. Suitable project funding mechanisms will be discussed with your mentor and program director upon return from the site assessment. You are required to submit to Fogarty Global Health Fellowship.
- Complete or work towards completion of Masters of Science in Global Health. GHP trainees who already have advanced degrees (e.g., MPH, MHSc, or PhD) in relevant fields will work with the Program Director to identify relevant coursework from these or other programs to further enhance global public health training.
- Actively participate in our multidisciplinary Global Health Journal Club. Our bi-weekly journal club is also open to all research mentors. GHP will work with trainees/fellows to schedule a regular meeting time around class and clinical schedules. Trainees are expected to lead journal club on a rotating basis.
- Engage in language training, either individually or with a tutor as appropriate for international context.
- Attend clinical department didactic lectures when possible.
- Work proactively with the HYC to complete all required administrative paperwork on time. This includes, but is not limited to new hire and faculty credentialing paperwork, licensing documents, IRB submission, medical licensure in country and travel documents.
- Abide by all requirements established by your primary specialty program director to establish board eligibility if you are completing a traditional post-graduate training program at the Duke Medical Center. This includes, but is not limited to engaging in clinical activities as discussed with your research mentor and the program director.
- Attend a travel clinic to receive all necessary immunizations, prophylaxis medications, and traveler’s health counseling prior to departure.
- Work full time at your overseas location. Personal vacation and travel should be cleared with your local faculty mentor or supervisor as well as the GHP and must be in compliance with the guidelines of your departmental residency program.
- Complete rotation and program evaluations as required as well as debriefs upon return from your overseas rotations.
- Create a project budget, keep track of all expenses, maintain appropriate receipts, submit timely reimbursement.
- Communicate regularly while overseas and at Duke.
Other Key Deliverables
- The research project should be completed prior to terminating the pathway, with a deliverable of one or more manuscripts for submission to a journal. Manuscripts for publication should be approved by the GHP leadership prior to submission and must cite collaborators and funding sources.
- Complete a master’s thesis.
- Present a topical or project‐related academic talk to the Duke medical and global health community at least once.
- Notify GHP of any and all scientific presentations and publications related to GH work.