How Global Health-Specific Core Competencies Will Be Met During the Duke Global Health Fellowship Overseas Clinical Time
Patient care
Fellows will provide direct care to a variety of patients in the emergency department ("Casualty Ward"). Fellows will be trained to and then expected to provide care commensurate with need and available resources.
Medical knowledge
Fellows participating in the Duke Global Health Fellowship will acquire expanded knowledge of key biomedical and social issues relevant to the treatment of both communicable and non-communicable diseases, public health, and health systems management in resource-poor settings. Fellows will acquire this knowledge through didactic activities (e.g., independent study, journal clubs, research conferences, clinical conferences, etc.) at Duke and while overseas as well as through course work during the master's program.
Practice-based learning and improvement
Practice-based learning is a key focal point of the overall Duke Global Health Fellowship Pathway. In the context of the patient care experience, fellows will have ample opportunity to appraise and assimilate relevant scientific literature.
Interpersonal and communication skills
As in any area of medicine, interpersonal and communication skills are critically important to establishing effective therapeutic relationships. Fellows will have the opportunity to take Kiswahili language courses while in Moshi, Tanzania, to assist in their cross-cultural communication skills. Work rounds, communications among health professionals, and charts are kept in English.
Professionalism
Fellows will have added opportunity to demonstrate professionalism by demonstrating sensitivity to patients from diverse tribal backgrounds while abroad.
Systems-based practice
Sites selected for overseas training include teaching, tertiary referral hospitals that have access to many subspecialists, including full-time staffs in ophthalmology, dermatology, obstetrics/gynecology, neurology, urology, often trained in the U.S., Europe, and Australia. Fellows working in the Casualty Department will have ample opportunity to call effectively on specialists in other fields in the context of this resource-constrained, but expertise-rich environment.
Unique Curricular Goals and Objectives
| Goals | Objectives | |
|---|---|---|
| Health disparities | Describe the knowledge, skills, and attitudes necessary for culturally competent care in low resource settings. | Fellows will maintain a log of instructive patient cases in which social determinants (e.g., education, access to clean water, food, security, housing, etc.) have played a major role in their health and health care access. |
| Communicable diseases and tropical medicine | Discuss the knowledge and skills necessary to treat a number of high prevalence tropical diseases, including, but not limited to, tuberculosis, malaria, diarrheal diseases, and HIV/AIDS. | Through direct patient care, Fellows will gain an acute appreciation for the impact of communicable and tropical diseases on the lives of people throughout regions of the developing world. |
| Emergency care in resource-poor settings | Describe and demonstrate resource-appropriate delivery of emergency care. | Fellows will provide care to a variety of patients, both pediatric and adult, with a myriad of urgent and emergent complaints, including major trauma, medical, and surgical issues. Fellows will also assess emergency medical system designs in a resource-poor setting. |
| Public health | Identify the knowledge, skills, and attitudes needed to practice the basic principles of prevention. | Fellows will receive intensive didactic training in public health through completion of a master's degree program. They will demonstrate the practical implementation of this knowledge at the international clinical site. |
| Management of emergency health systems | Explain the needed knowledge and skills sets to design resource-appropriate emergency care systems. | Fellows will gain exposure to various emergency care systems in resource-limited settings. These limitations will force fellows to think in innovative ways about culturally-appropriate models for the delivery of emergency care internationally. |
Global Health Fellowship's Specific Educational Objectives
Fellows in the Duke Global Health Fellowship Program should demonstrate proficiency in the following areas:
Outcome
To diagnose and treat various infectious and tropical diseases
Plan
To expose fellows to the following topics through didactic lectures, independent study, field experiences, and Master of Science in Global Health coursework:
- Global epidemiology
- Gastrointestinal infections
- General approach and treatment
- Campylobacter and Yersinia
- Clostridium difficile colitis
- Entamoeba histolytica
- Escherichia coli
- Food poisonings
- Giardia
- Non-typhoidal salmonella
- Shigellosis
- Travelers' diarrhea
- Typhoid
- Vibrio cholera
- Viral gastroenteritis
- Parasitic infections
- Entamoeba histolytica
- Giardia
- Helminthic infections including cestodes, nematodes, and trematodes
- Leishmania
- Plasmodium and malaria
- Toxoplasmosis
- Trypanosoma
- Mycobacterial infections
- Tuberculosis (global epidemiology and clinical features)
- Non-tuberculous infections
- Human Immunodeficiency Virus
- Global epidemiology
- Clinical features
- Antiretroviral therapy
- Opportunistic infections
- Candidal infections
- Cryptococcal infections
- Histoplasmosis
- Mycobacterial infections
- Pneumocystis jeroveci
- Toxoplasmosis
- Others
- Hemorrhagic fevers
- Dengue
- Ebola
- Hanta viruses
- Lassa fever
- Yellow fever
- Others
- Liver and bile tract infections
- Hepatitis A, B, C, D, E
- Liver abscess (amebic and pyogenic)
- Genitourinary and sexually transmitted infections
- Chancroid
- Chlamydia
- Gonorrhea
- Granuloma inguinale
- Herpes simplex
- Lymphogranuloma venereum
- Trachoma
- Trichomonas
- Soft tissue and skin infections
- Central nervous system infections
- Epidemiology of meningitis
- Meningitis (bacterial and viral)
- Slow virus infections
- Viral encephalitis
- Childhood infections
- Diphtheria
- Measles
- Mumps
- Pertussis
- Polio
- Rubella
- Small pox
- Tetanus
- Varicella
- Spirochete infections
- Leptospirosis
- Syphilis
- Zoonoses
- General approach to animal bites
- Anthrax
- Brucellosis
- Cat-scratch disease
- Erhlichiosis
- Plague
- Rabies
- Rickettsia
- Toxoplasmosis
- Trichinosis
- Tularemia
- Typhus
- Marine envenomations and infections
- Ciguatera
- Jelly fishes
- Scombroid
- Sting rays, sea urchins, scorpion fish
- Vibrio parahemolyticus
Evaluation
- Direct observation/written evaluation from Residency Director, key Emergency Medicine faculty, and/or on-site mentor(s)
- Tools used for Master of Science in Global Health coursework
Outcome
To apply key public health principles to the needs of developing countries
Plan
- To expose fellows to the following topics through Master of Science in Global Health coursework, independent study, and field experiences
- To implement these concepts during international field experiences:
- Diseases and the community
- Disease prevention
- Clean water and sanitization systems
- Immunization programs
- Community health provider education
- Patient education
- Family planning
- Development of sustainable programs
Evaluation
- Direct observation or written evaluation from the residency director, key faculty, and on-site mentor(s)
- Tools used for Master of Science in Global Health coursework
Outcome
To diagnose and treat a variety of patients with urgent/emergent health issues in developing countries with limited resources
Plan
To expose the fellows to the following concepts through extensive international field experiences and Master of Science in Global Health coursework:
- Organizational structure of international health care systems
- Organization of relief efforts
- Personnel management of health care team
- Project management
- Outcomes research in public health
- Legal and political challenges in public health
Evaluation
- Direct observation or written evaluation from the residency director, key Emergency Medicine faculty, and on-site mentor(s)
- Tools used for Master of Science in Global Health coursework
Outcome
To appraise local resources in a developing country in the establishment of appropriate EMS systems
Plan
To equip fellows to serve as consultants in the development of appropriate EMS systems internationally through exposure to the following concepts during field experiences (such as “ride-alongs”), independent study, and dedicated didactics with Durham County EMS Director/Duke Emergency Medicine faculty:
- EMS basics
- Local political and administrative climate for EMS development
- Assessment of appropriate level of pre-hospital care given local health care resources
- Development of training sessions for pre-hospital personnel
- Approach to the patient in cardiac arrest
- Approach to the patient with major trauma
- Approach to the pediatric patient in cardiac arrest
- Pre-hospital provider protocols
- Funding for EMS systems
- Quality assurance for EMS systems
Caveat: This portion of the Duke Global Health Residency/International Emergency Medicine Fellowship Program curriculum is not intended to replace formal EMS fellowship training, but rather exposes the fellows to basic elements of EMS design and implementation.
Evaluation
- Direct observation or written evaluation from the residency director, key Emergency Medicine faculty, and on-site mentor(s)
Outcomes
- To compare the different approaches to the delivery of emergency care around the world
- To design and implement a program promoting culturally and resource- appropriate aspects of Emergency Medicine at an international site
Plan
- To expose the fellows to the following concepts through extensive international field experiences, independent study, and didactics with Duke Emergency Medicine faculty with expertise in administration and EMS
- To implement some or all of these concepts in the development of Emergency Medicine abroad, taking into account cultural differences, resources, and needs:
- Emergency medicine system design
- EMS capabilities
- Trauma capabilities
- Emergency Center physical plant design
- Hospital design
- Databases
Evaluation
Direct observation or written evaluation from the residency director, key Emergency Medicine faculty, and on-site mentor(s)
Outcomes
- To identify the central importance of water in maintaining health
- To cite mechanisms for effective water sanitation
Plan
To introduce fellows to the following concepts through independent study, Master of Science in Global Health coursework, and domestic and international field experiences:
- Water supply
- Water-related diseases
- Water assessment
- Water treatment techniques
- Sanitation
- Vector control
- Personnel hygiene
- Hand washing
- Food supply and safety
- Universal safety precautions
Evaluation
- Direct observation or written evaluation from the residency director, key Emergency Medicine faculty, and on-site mentor(s)
- Tools used for Master of Science in Global Health coursework
Outcomes
- To identify governmental and non-governmental organizations (NGOs) involved in international relief and development
- To assemble partnerships between fellows and local relief agencies
Plan
To expose fellows to the following organizational infrastructure through independent study, public health coursework, and field experiences with relief agencies in the host country:
- United States government organizations
- United States Agency for International Development (USAID)
- United States Office of Foreign Disaster Assistance
- Center for Disease Control and Prevention
- Non-governmental organizations
- Relief organizations
- Development organizations
- European governmental organizations
- European economic community
- United Nations organizations
- General structure
- United Nations Children’s Emergency Fund (UNCEF)
- United National High Commission for Refugees (UNHCR)
- World Food Program
- Others
Evaluation
- Direct observation or written evaluation from the residency director, key Emergency Medicine faculty, and on-site mentor(s)
- Tools used for Master of Science in Global Health coursework
Outcomes
- To identify the various sources of funding for international relief and development organizations
- To compose a successful grant proposal
Plan
To expose fellows, through the following topics and experiences, to relief and development organizational funding as well as to the essentials of funding proposals using independent study, Master of Science in Global Health coursework, and mentorship from Duke faculty:
- Sources of funding
- USAID
- Department for International Development of the United Kingdom (DFID)
- European Agency for Reconstruction (EAR)
- Various NGOs and private foundations
- Basics of grant writing
- Statement of need
- Delineation of goals
- Proposal format
- Budget design
- Identifying and responding to research funding announcements (RFAs)
- Writing unsolicited grant proposals
Evaluation
- Direct observation or written evaluation from the residency director, key Emergency Medicine faculty, and on-site mentor(s)
- Tools used for Master of Science in Global Health coursework
Outcomes
- To identify critical public health concepts, ranging from health care administration to statistical analysis and epidemiology
- To earn a Master of Science in Global Health (MSc-GH) degree
Plan
- To expose fellows to key concepts/topics in public health, as laid out by the Master of Science in Global Health curriculum at Duke University.
Evaluation
- Tools used for Master of Science in Global Health coursework
Outcomes
- To cite sources for state-of-the-art information on International Emergency Medicine and international health
- To contribute to the general body of International Emergency Medicine and international health literature
Plan
To expose the fellows to this concept in International Emergency Medicine through:
- Lectures/Grand Rounds on international topics
- Fellows to give at least two per year as part of the Duke Emergency Medicine weekly conference series
- Fellows to attend weekly Emergency Medicine resident conference
- Fellows to design and implement educational programs for the physicians and health care providers at the international site
- Teaching mentorship from Residency Director/Duke Emergency Medicine faculty
- Literature review/journal club
- Research project
- Design
- Coordination and implementation
- Presentation and publication
- Research mentorship from Residency Director and Duke faculty
- National organization involvement
- Society for Academic Emergency Medicine
- American College of Emergency Physicians
Evaluation
- Written evaluation (“teaching evaluations”) by Duke Emergency Medicine residents and faculty
- Written evaluation by the residency director, key Emergency Medicine faculty, and on-site mentor(s)
- Tools used for Master of Science in Global Health coursework
Outcome
To define proper disease prevention for international travelers
Plan
To expose fellows to the following topics through independent study, personal preparation for various field experiences (e.g., different climates, hemispheres, urban vs. rural, etc.), and didactic lectures:
- General principles of travel health and medicine
- Preparation for travel
- Vaccinations
- International health regulations
- Epidemiology of communicable diseases
- Africa
- The Americas
- Asia and the Middle East
- Europe
- Oceania
- Health risks and disease prevention
- Local disease epidemiology
- Environmental hazards (Food- and water-related illnesses)
- Sexually transmitted infections
- Medical care for the international traveler
- First aid kit
- Local health care resources
- Personal care plan/insurance
- Medical evacuation strategy
- Injury prevention special considerations
- Pregnancy
- Travelers with disabilities
Evaluation
Direct observation or written evaluation by the residency director, key Emergency Medicine faculty, or on-site mentor(s)
Timetable for Global Health Fellowship
The Duke Global Health Fellowship is a 24-month track, which includes approximately nine months of didactic course work for a master of science in global health degree as well as 7.5-12 months overseas providing clinical care and working on a master’s project at a developing world partner site.
In the event that candidates already have a comparable advanced degree upon entry into the program, they will have the option to either enroll in additional class work or spend an extended period of time overseas.
Fellows will begin their program on July 1 of each academic year. After a brief orientation, the fellows will go overseas for several weeks to become acclimated to the environment where they will be working and to lay the groundwork for their projects.
Classes for the Master of Science in global health will begin in the latter half of August and continue through May of the following year. Following the master’s level coursework, fellows will complete their projects while engaging in an additional 6-12 months of mentored clinical and research activities at one of our partner global health sites.
During both program years, fellows will serve as junior-level teaching attendings in Duke University Hospital’s emergency department during the months when they are not overseas.