students’ choices of specialty and practice location

Global Health Programs: Medical

Students’ Choices of Specialty

and

Practice Location

John Ongito, PhD, Program Analyst

Gillian Ice, PhD, Professor, Social Medicine; Director, Global Health Social Medicine

Debra McBride, MA, Coordinator, Global Health Programs

OU-HCOM

Objectives

To investigate the relationship between the status of medical students’ participation in global health programs and their decision to:

pursue or not pursue primary care as a career

settle or not settle in medically underserved populations

settle or not settle in Health Professional Shortage Areas

(HPSAs)

settle or not settle within community < 100K people for their

medical practice.

Organization of this Presentation

Review of Terminology

Designation of MUA/HPSA

Definition of Global Health (GH).

The role of GH in medical Education.

Some of the GH rotation programs offered at OU-HCOM

Analyses of data used in this study.

MUA Designation requirements

Designation of Medically Underserved Areas (MUAs)

Index of Medical Underservice (IMU)

Scale: 0 to 100

0 </= 62.0 100

Physicians

Primary medical care

physicians per 1,000

population

Completely

underservedMUA

Best served

or least

underserved

Mortality Infant mortality rate

Poverty

Percentage of the

population with incomes

below the poverty level

Senior

Population

percentage of the

population age 65 or over

HPSA Designation requirementsHealth Professional Shortage Areas (HPSAs)

1. Primary Care (Physicians)Geographic Areas Population Groups

(persons in the population

group)

Population/FTE

physician

>/= 3,500:1 >/= 3,000:1

Facilities Federal/State Correctional Institutions’ ratio of

the number of internees/year to the number of

FTE primary care physicians serving the institution

must be at least 1,000:1


2. DentistsGeographic Areas Population Groups (persons in the

population group)

Population/

FTE Dentists

>/= 5,000:1 >/= 4,000:1

Facilities Federal or State Correctional facilities must:

Have a ratio of the number of internees per year to the number of FTE dentists serving the institution of at least 1,500:1


3. Mental Health

Geographic Areas Population Groups

(persons in the population group)

Population to FTE

core mental health

professionals

>/= 6,000:1 >/= 4,500:1

Population to FTE

psychiatrist

>/= 20,000:1 >/= 15,000:1

Facilities: State and county mental health hospitals must:

Have an average daily in patient amount of at least 100;

Federal or State Correctional facilities must:

Have a ratio of the number of internees per year to the

number of FTE psychiatrists serving the institution of at

least 2,000:1

Review of Terminology

Global health:

Could be described as a term referring to as “an area for

study, research, and practice that places a priority on

improving health and achieving equity in health for all

people worldwide.

Global health emphasizes transnational health issues,

determinants, and solutions; involves many disciplines

within and beyond the health sciences and promotes

interdisciplinary collaboration; and is a synthesis of

population-based prevention with individual-level clinical

care” (Koplan, et al., 2009).

Global health Programs in

medical education

Develop greater ability to recognize disease presentations

Develop ability to conduct more comprehensive physical

exam skills with less reliance on expensive technologies

Increase in opportunities for development of cross cultural

competence and broader understanding of determinant of

health and diseases.

Promotes interdisciplinary collaboration in healthcare.

The Tropical Disease Research Program: Healthy Living Initiative

ComponentA visit to a community were a case of Chagas was reported.

The Tropical Disease Research Program has several field and laboratory-based components.

The Tropical Disease Research Program: Biomedical

ResearchA student engaged in entomological survey.

The Botswana Healthcare Program

Student at the Botswana-Baylor Center of Excellence to learn about health and healthcare in Botswana

0

10

20

30

40

50

60

Unique Participants

0

3

6

9

12

15

Countries(1999 - 2015)

0

3

6

9

12

15

Programs(1999 - 2015)

Rotations per Country (1999-2015)

Country Rotations % of All Rotations

El Salvador 80 22Ecuador 73 20Kenya 66 18Scotland 25 6.9Dominican Republic 19 5.2

8073

66

2519

157 7 6 5

0

15

30

45

60

75

90

Rotations per Country(1999 - 2015)

71

60

35

2721

16 1410 7

0

15

30

45

60

75

Participants (unique)

5

11 11

76

11

4

21

0

2

4

6

8

10

12

14

Frequency of Offering (Years)

Program RotationsYears

OfferedParticipants

CEDEINFA 71 5 80

Independent Rotation 60 11 82

TDI Research 35 11 38

SHARE Kenya 27 7 33

Kenya Grandparents Study 21 6 33

Edinburgh Geriatrics Tutorial 16 11 24

Village Mountain Mission 14 4 19

Botswana Healthcare 10 2 11

Primary Care Clinical Elective 7 1 7

TDI Research and Workshop 6 1 6

TDI Biology Workshop 5 3 5

Chinese Medicine 3 1 3

Rotations per Program (1999-2015)

Country ProgramEl Salvador CEDEINFA

China Chinese Medicine

Ecuador Ecuador Clinical

Scotland Edinburgh Geriatrics Tutorial

Kenya Kenya Grandparents Study

Kenya SHARE Kenya

Honduras Surgery Brigade

Ecuador TDI Biology Workshop

Ecuador TDI Research

Ecuador TDI Research and Workshop

Dominican Republic Village Mountain Mission

Program by Name and Country

Country Australia Jamaica

Belize Mexico

Botswana New Zealand

Bulgaria Norway

Canada Palestine

Chile Panama

China Philippines

Ecuador Poland

England Scotland

Ethiopia Senegal

Ghana Slovenia

Greece Swaziland

Guatemala Uganda

Honduras Zimbabwe

India

Country: Independent Rotation

There was a statistical significant difference between the specialty choice

of GH participants and non-participants (Chi-square(1)= 4.36, p = .037).

GH Program

Participation

Non-Primary

Care SpecialtyPrimary Care Total Count

No 443 (46.2%) 515 (53.8%) 958

Yes 70 (38.2%) 126 (61.8%) 204

Total 521 (44.8%) 641 (55.2) 1162

53.8%61.8%

0%

10%

20%

30%

40%

50%

60%

70%

Yes

Primary Care Specialty

Non-GH

GH

Program Participation and Practice

Specialty

GH Program

ParticipationNon-HPSA HPSA Total Count

No 809 (86.6%) 125 (13.4%) 934

Yes 159 (84.1%) 30 (15.9%) 189

Total 968 (86.2%) 155 (13.8%) 1123

There was no statistically significant difference between practice in a

MUA for GH program participants and non-participants.

13.4%

15.9%

0%

3%

6%

9%

12%

15%

18%

HPSA

Program Participation and Practice in HPSA

Non-GH

GH


in HPSA

GH Program

ParticipationNon-MUA MUA Total Count

No 581 (62.2%) 353 (37.8%) 934

Yes 96 (50.8%) 93 (49.2%) 189

Total 677 (86.2%) 446 (13.8%) 1123

There was a statistically and substantively significant difference between practice in a MUA for GH program participants and non-participants (Chi-square (1)= 8.55, p= .003).

37.8%

49.2%

0%

10%

20%

30%

40%

50%

MUA

Program Participation and Practice in MUA

Non-GH

GH


in MUA

GH Program

Participation

Non-HPSA/

MUAHPSA/MUA Total Count

No 548 (58.7%) 386 (41.3%) 934

Yes 85 (45.0%) 104 (55%) 189

Total 633 (56.4%) 490 (43.6%) 1123

There was a statistically and substantively significant difference between practice

in either a HPSA or MUA for GH program participants and non-participants.

41.3%

55.0%

0%

10%

20%

30%

40%

50%

HPSA/MUA

Program Participation and Practice in Either HPSA or MUA

Non-GH

GH

Program Participation and Practice in

Either HPSA or MUA

Questions?

Questions?

Are students learning any specific

competencies?

How do you measure the outcomes of global

health programs in you schools?

International

Rotations CompletedStudents

1 313

2 54

3 7

4 12

5 2

6 2

Total 390

313

54

7 12 2 20

50

100

150

200

250

300

350

1 2 3 4 5 6Number of Rotations Completed

Student Completion of 1 or More Rotations

Number of Rotations for Each Individual

Chi-Square Test

Value df Asymp. Sig. (2 sided)

Pearson Chi-Square 4.359a 1 .037

Continuity Correction 4.042 1 .044

Likelihood Ratio 4.403 1 .036

N of valid cases 1162

Practice Choice- GH vs. nonGH Stats

Chi-Square Test


Pearson Chi-Square 8.692 1 .003




Practice by Community Size- GH vs.

nonGH Stats

Chi-Square Test


Pearson Chi-Square .819a 1 .365

Continuity Correction .623 1 .430

Likelihood Ratio .794 1 .373


Practice in HPSA- GH vs. nonGH Stats

Chi-Square Test


Pearson Chi-Square 8.550 1 .003




Practice in MUA- GH vs. nonGH Stats

Chi-Square Test


Pearson Chi-Square 11.994a 1 .001




Practice in Either HPSA or MUA- GH vs.

non-GH Stats

Sources:o Institute of Medicine (U.S.), Board on International Health. America’s

Vital Interest in Global Health: Protecting Our People, Enhancing Our Economy, and Advancing Our International Interests. Washington, DC: National Academy Press; 1997.

o Health Resources and Services Administration. Health Professional Shortage Areas (HPSAs). Designation Criteria and Guidelines. Retrieved from http://bhpr.hrsa.gov/shortage/hpsas/

o Koplan JP, Bond TC, Merson MH, et al. Towards a common definition of global health. Lancet 2009;373: 1993 - 5.

o Ohio University Global Health Initiative. Global Health Experiences. https://www.ohio.edu/globalhealth/programs.cfm

http://bhpr.hrsa.gov/shortage/hpsas/

https://www.ohio.edu/globalhealth/programs.cfm

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