- ACGME —
- Accreditation Council for Graduate Medical Education
For those whose focus is training tomorrow’s pediatric workforce, the increasing demand for opportunities in global health has been both welcomed and challenging. Because the world has become more connected through air travel, as well as through immigration and migration of populations, focusing only on issues affecting children and their families in the United States is no longer acceptable. Our world is a very small place, and as the recent Ebola outbreaks in West Africa remind us, what happens in a remote region of the world today can be in our backyard tomorrow.
Pediatric training programs have to move quickly to meet the increasing demands of their learners in offering global experiences. Butteris et al1 in this issue of Pediatrics provided wonderful information about the current landscape of global health education in our residency programs. It is fascinating to note that of the 198 US pediatric residency training programs included in their analysis, 49 (25%) have a global health track. Of the 9091 pediatric residents in these programs, 666 (7%) went abroad for some part of their training in 2013–2014. I would certainly expect those numbers to continue to increase in the coming years, but care needs to be taken as these experiences expand.
Butteris et al noted that the large programs were more likely to have established partners internationally and to have pretravel preparation compared with smaller programs. Too many rotations are set up on the basis of a casual acquaintance with someone working in a particular location that the trainee is interested in. Little vetting is done on the credentials of the supervisors or the services these clinics provide, not to mention the safety of the area, or if the clinic is actually prepared to host a visiting learner. This leads to global health experiences (both international and domestic) for which the resident is unprepared and whose safety may be in question.
Financial and administrative support, securing training sites, providing adequate preparation before travel and supervision while abroad, and sustainability of international partnerships are among the challenges that must be addressed for programs to have long-term viability. At the Texas Children’s Hospital/Baylor College of Medicine Pediatric residency program we have both short-term (1 month) and long-term (1 year) global health experiences for residents. I am confident that our global health residents who spend 1 year working in a resource-limited location get a great experience, but I worry about those that go for the short term. Programs that offer short-term rotations often require vacation to be taken from these clinical experiences while the residents are away from their home institution, and between this and travel days, weekends, and local holidays the actual clinical experience may only be 2 weeks or less. A way to get around these issues would be to stay longer, but resident salary source, call coverage, and restrictions by the Accreditation Council for Graduate Medical Education on time away from a trainee’s home institution also contribute to limiting most global health experiences to 1 month or less in most programs.
It was of interest to note that 96 (49%) of the surveyed programs offered domestic field experiences as well. There are hundreds of thousands of children in the United States who live in poverty and can be reached within a 1- to 2-hour automobile drive instead of a 24-hour air flight. These children seem to get forgotten in many of the discussions about global health, and I would encourage programs to make sure that their trainees have a robust experience with this population before attempting to tackle the rest of the globe.
Global health experiences (both domestic and international) are important for pediatric training. Most residents have wonderful experiences and make it a point to work with children living in resource-limited areas for the remainder of their career. I applaud Butteris and colleagues for outlining the current landscape on which to build. It is now up to those in charge of these global health training programs to make sure the residents are adequately supported financially, work in programs that can support a visiting learner in a safe environment, provide a great educational experience, and have adequate time to make the most of their opportunity. The programs that can do this will attract great residents, provide an outstanding global health experience, and are more likely to have graduates continue this type of work for the rest of their lives, and that would be a great win for everyone involved.
- Accepted June 2, 2015.
- Address correspondence to Gordon E. Schutze, MD, FAAP, Texas Children’s Hospital, 6621 Fannin, Suite A150, MC1150, Houston, TX 77030-2399. E-mail:
Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.
FINANCIAL DISCLOSURE: The author has indicated he has no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The author has indicated he has no potential conflicts of interest to disclose.
COMPANION PAPER: A companion to this article can be found on page 458, and online at www.pediatrics.org/cgi/doi/10.1542/peds.2015-0792.
- 1.↵Butteris SM, Schubert CJ, Batra M, et al. Global health education in US pediatric residency programs. Pediatrics. 2015;136(3):458–465
- Copyright © 2015 by the American Academy of Pediatrics