Introduction Short Term Experiences in Global Health (STEGHs) are a popular and well-acknowledged valuable component of medical education. Thirty-one percent of United States (US) medical students graduating in 2015 had a global health experience during medical school, up from 15% in 1998 [1]. A growing number of trainees in U.S. residency programs are interested in global health as well, prompting an increase in global health education and international opportunities during postgraduate training [2-5]. However, there are significantly fewer opportunities for trainees from low-and middle-income countries (LMICs) to travel to clinical sites other than their own compared to the opportunities for trainees from North America [6-10]. Moreover, when providers from low-and middle-income countries do have clinical experiences in the US, they are typically limited to observation, unlike the frequent hands-on learning when the situation is reversed [38]. "Global health" can be both all-encompassing and vague. Consistent with the Alma Ata declaration, we use "global health" to mean health for all, regardless of location or ethnicity [39]. Global health may or may not include aspects of international medicine, tropical medicine, and public health, but must include a focus on the wellbeing of all aspects of the human experience (physical, social, environmental, spiritual) and be concerned with how health is achieved, with an emphasis on social determinants of health, health disparities, and transnational health solutions [40]. "Global health experiences" in our academic context indicate a dedicated focus on the health of a population different from one's usual setting. For North American (NA) trainees, "global health" rotations, therefore, are typically in a low-income setting-either domestic or international. For trainees from low-and middleincome countries, "global health" electives indicate an experience either in a different low-income setting or in a higher-income setting such as NA or Europe.
Amikacin (A), gentamicin (G), and tobramycin (T) were added to eight different total nutrient admixtures (TNA) with varying concentrations of dextrose, amino acid, and fat emulsion to determine drug and emulsion stability. All TNA were prepared aseptically and stored at room temperature under normal room lighting for 12 hr before drug addition. One volume of each drug was added to an equal volume of each of the eight TNAs to simulate 1:1 piggyback contact volumes. Samples were left at room temperature for 6 hr. Drug concentrations were analyzed by fluorescence polarization immunoassay. TNA/drug admixtures were pH tested and visually inspected before and after centrifugation in microhematocrit tubes, noting signs of emulsion stability at 1 and 6 hr. Emulsion particle size was determined at 1 and 6 hr using interference contrast microscopy. All three drugs retained their immunoreactivity in all TNAs for at least 6 hr. G and T were stable in all eight TNAs for at least 6 hr with no significant effect on emulsion particle size or stability after centrifugation. A was incompatible with all eight TNAs, resulting in visual breaking of all emulsions within 1 hr. Therefore, G and T, but not A, can be administered via piggyback method with the eight TNAs tested if the infusion is completed within 6 hr.
Global health education is essential for equipping physicians to improve population health both at home and abroad. Global health is a multidisciplinary specialty with physicians who come from many backgrounds, making it important to reinforce concepts in its education that might not have been the focus of their previous training. Tropical medicine, and its focus on infectious disease, is one area of global health that many physicians may not have focused on extensively. We developed a curriculum for tropical medicine for residents in the Indiana University Interdepartmental Global Health Track, a 2-3 year co-curricular focus on global health with residents from Family Medicine, Internal Medicine, Med-Peds, Pediatrics, OBGYN, EM, and others. Research has shown that case-based learning (CBL) is effective in engaging students and faculty compared to other educational methods. It is believed that utilizing CBL in delivering a tropical medicine curriculum to these residents will develop proficiency in the subject over the 8 sessions developed. Residents will learn about a variety of infectious diseases in each session by working through a case, engaging in critical thinking in small groups, then taking a quiz. Following completion of all sessions, they will be complete a summative test and a survey subjectively assessing the curriculum. We hope this novel curriculum will prove effective in teaching the essentials of tropical medicine to Global Health Track residents and will serve as an example for the development of other tropical medicine curricula.
Burnout has become a prominent issue among healthcare providers. The demands of working long shifts, prolonged periods of stress and increased time spent charting all contribute to this phenomenon. Current research suggests that an intrinsic sense of resilience may be key in combating this epidemic. Just as our sense of empathy and compassion can be cultivated through experience, so too can our level of resilience. We propose that engaging in an international health project during medical professional education may promote a greater sense of resiliency. To analyze this, we will use the Connor-Davidson Resilience Scale© to survey 4thyear medical students and residents at the Indiana University School of Medicine (IUSM) that have participated in the AMPATH rotation at Moi University in Kenya between June 2018 and May 2019. To determine the potential change in resilience we will ask our subjects to complete the survey prior to their trip, as well as 1-months and 1-year after their trip. This study may lead to the advocacy for such projects to be integrated into medical education curricula to combat the growing problem that is physician burnout.
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