Global Health within U.S. Family Medical Residency Programs

International Health Activity in U.S. Family Medicine Residency Programs: Results of 2005-06 survey Stephen Schultz, M.D. Program Director, URochester FMRP Manager, AAFP International Programs Spencer Stith, MDiv Greg Tolleson Manager, AAFP Data Analysis & Collection Global Health Education Consortium Annual Meeting Santo Domingo, Dominican Republic February 2007 AAFP residency survey question:  “Does your program offer or encourage rotations in an international setting?” Why is this survey important?   AAFP survey question is sensitive, but not specific. Increasing number of medical students interested in global / international health, but do not have resources to tell them what programs specifically offer   Total number of programs surveyed by AAFP in 2005: 460 Total number of programs answered “yes” to international health question: 308 (67%) • These were the surveyed programs… • NB: In 1996, 192/442 programs responded affirmatively (43%)  Total number of programs who responded to survey: 162 (52.6% response) What are the ways programmatic support of international health can be shown?  Financial support • Salary while on IH rotations • Stipend • Travel and living expenses   Curriculum #Faculty and residents with recent IH experience Does your program continue to pay a salary to a resident who is away on an international elective? Yes = 152 (93.8%) Maximum # of months over 3 years? 70 60 50 40 # of programs 40% 35% 17% 30 20 10 0 1 2 3 No response Maximum # months paid 9% Other than salary, which types of funding support do you provide for international health electives? (check all that apply) 50 45 40 35 30 # of programs 25 20 15 10 5 0 30% 13% 8% 6% All living expenses All travel expenses Stipend Other Does your program provide international health curriculum as part of residency education? Yes = 106 (65.4%) Is the international health curriculum… (check all that apply) 70 60 50 40 # of programs 43% 42% 28% 30 20 10 0 block longitudinal occ. Lectures other Type of curricular experience 9% How many of your residents have done health care work in developing countries in the past two years? 40 35 30 25 # programs 20 23% 18% 14% 11% 9% 8% 9% 4% 15 10 5 0 0 1 2 3 4 5 6 >7 # of residents per program How many of your faculty have done health care work in developing countries in the past two years? (85% of programs have faculty w/experience in developing countries +/or “special training”) 27% 45 25% 40 20% 35 30 25 20 15 10 5 0 None 1 2 3 # of faculty 4 # of programs 11% 8% 4% 2% 5 6 to 10 Who provides in-country supervision for the residents? 90 80 70 60 # of programs 50% 50 40 30 20 10 0 Faculty from Faculty from home host country program Both Other No response 19% 14% 10% 6% Other questions we wanted to answer:    How many FMRPs offer opportunities for medical students? Do residencies have longitudinal relationships with sites in developing countries? If so, where? What do residents DO when they do these global health experiences? Are medical students/residents allowed to participate in your international opportunities? 100 90 80 70 60 50 40 30 20 10 0 No Yes, but 0 Yes No response Medical students Residents Students: 1to5 Students: 6to20 Students: >20 Does your residency program have a longitudinal relationship with an international health site in a developing country? Yes = 63 (38.9%) What region of the world? (check all that apply) 45 40 35 30 25 20 15 10 5 0 Mexico C.A. S. America Caribbean Africa 27% 12% 10% 8% 3% E. Europe Asia 9% 3% Other In which activities are your residents usually involved in during an international health elective? 160 140 120 100 80 60 40 20 0 Clinical care Comm/Public Health Teaching health care porviders Primary care research Other 92% 72% 36% 9% 9% How would you rate the following goals as a motivation for your program offering an international health experience?      Attracting residents Attracting/retaining faculty Teaching community medicine/public health Preparing physicians to practice in developing countries Preparing physicians to practice in underserved areas in US Attracting residents as motivation for program offering international health: 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Very important Somewhat important Average Not very Not important important at all Attracting/retaining faculty as motivation for program offering international health: 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Very important Somewhat important Average Not very Not important important at all Comparison of all “very important” and “somewhat important” goals: 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Attracting residents Attracting faculty teaching CM/PH Preparing for 3rd preparing for world practice U.S. underserved How would you rate the following challenges to your program’s ability to advance its international health program?       Lack of institutional support (university or hospital) Concerns of malpractice coverage Concerns of losing GME funding for away rotations Concerns of safety for residents +/or faculty Lack of experienced faculty or program experience Educational regulatory restraints Comparison of all the “major barriers” and “minor challenges:” 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Lack of Malpractice inst.support GME funding Safety Lack of Educ. experience Regulations How many of your residents have done health care work in developing countries in the past two years? 40 35 30 25 # programs 20 23% 18% 14% 11% 9% 8% 9% 4% 15 10 5 0 0 1 2 3 4 5 6 >7 # of residents per program Logistic regression: predicts the probability of a dichotomous dependent variable using, typically, a combination of continuous and categorical independent variables .    Programs with three or less residents VS. Programs with 4 or more residents Variables that have significance as predictors: • Block experience of curriculum (p=0.027); • Longitudinal relationship with site in Mexico/Central America (p=0.021); • Longitudinal relationship with site in Caribbean (p=0.015); • Attracting residents as motivator for offering IH (p=0.006) Looking at Global Health survey through lens of AAFP Residency survey data Differences by length of required rotations: Obstetrics rotation Two months or less > Two months CCU-ICU rotation One month # of programs 62 % residents done GH 15.3% 90 20.5% #of programs 83 % residents done GH 19.9% > One month 69 16.5% Differences by size of residency program and location: # of filled positions # of programs % residents done global health 6 - 18 19 - 24 >=25 56 46 50 17.8% 15.9% 21.3% global health # of programs % residents done Inner city Not inner city 23 129 24.1% 17.3% AAFP survey items that made no difference in % residents involved in global health:  Administrative structure of program (community based vs. medical school, etc.)    Presence of other residencies Length of time of pediatrics or surgery rotations Urban, suburban or rural location SUMMARY   Huge variability in what is offered by FM residency programs with regard to international/global health In terms of support: • >90% programs will pay at least one month’s salary; • Over 25% also pay travel +/or living expenses or stipend; • ~2/3 of programs offer some sort of curriculum; • Most programs had at least one experienced faculty Questions? Comments?