Trainee Perspectives Regarding Advanced Clinical Global Health Fellowships in North America

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  • 1 Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts;
  • 2 Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
  • 3 Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, California;
  • 4 Divisions of Global Health and Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts;
  • 5 Harvard Medical School, Boston, Massachusetts

Postgraduate clinical global health (GH) training is a rapidly evolving field. To understand and improve training opportunities, we sought the perspectives of current and former trainees related to their advanced clinical training or global health fellowships and the anticipated impact on their careers. Clinical GH fellowships across North America were identified through websites and previous studies. An e-mail was sent to program directors to invite all current and former GH fellows to complete a web-based questionnaire. We contacted 100 GH fellowship programs. Fifty-two fellows from 10 different specialties completed the survey. The median fellowship length was 23.3 months, with an annual median of 4.8 months spent in low-income and middle-income countries, which was less than their reported ideal of 6 months. The majority reported satisfaction, the anticipation of career benefits, and that they would recommend fellowship training to others. Challenges included insufficient funding, mentorship, and formal curricula. Conducting research in high-income countries was a significant negative predictor of fellowship satisfaction. Most fellows (73.1%) were not at all or only a little concerned about the absence of fellowship accreditation, with only 17.3% desiring accreditation. Survey respondents were largely satisfied with their training and valued program flexibility and educational opportunities, including advanced tropical medicine certificates or diplomas. However, to improve fellowship training, improvements are needed in mentorship, standardized curricula, institutional support, and funding. For GH fellowship training to be effective and sustainable, institutions will need to balance the needs of fellows, training programs, and the communities (low-, middle-, and high-income countries) where the fellows serve.

Author Notes

Address correspondence to Brett D. Nelson, Harvard Medical School, Boston, MA 02115. E-mail bnelson1@mgh.harvard.edu

Authors’ addresses: Adam Frange, Massachusetts General Hospital, Boston, MA, E-mail: adamfrange@gmail.com. Sean Duffy, University of Wisconsin, Department of Family Medicine and Community Health, Madison, WI, E-mail: sean.duffy@fammed.wisc.edu. Tala Al-Rousan, Herbert Wertheim School of Public Health, University of California San Diego, San Diego, CA, E-mail: talarousan@gmail.com. Ann Evensen, University of Wisconsin School of Medicine and Public Health, Verona, WI, E-mail: ann.evensen@uwmf.wisc.edu. Brett D. Nelson, Harvard Medical School and Massachusetts General Hospital, Boston, MA, E-mail: bnelson1@mgh.harvard.edu.

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