Training Toward a Movement: Career Development Insights From the First 7 Years of a Global Health Equity Residency

Abstract

Background The Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine at Brigham and Women's Hospital provides global health training during residency, but little is known about its effect on participants' selection of a global health career. Objective We assessed the perceptions of residency graduates from the first 7 classes to better understand the outcomes of this education program, and the challenges faced by participants. Methods We interviewed 27 of 31 physicians (87%) who graduated from the program between 2003 and 2013 using a convergent mixed-methods design and a structured interview tool that included both open-ended and forced-choice questions. We independently coded and analyzed qualitative data using a case study design, and then wove together the qualitative and quantitative data at the interpretation phase using a parallel convergent mixed-methods design. Results Entering a career focused on social justice was cited as the most common motivator for selecting to train in global health. Most respondents (83%, 20 of 24) reported they were able to achieve this goal despite structural barriers, such as lower salaries compared with peers, a lack of mentors in the field, poorly structured and undersupported career pathways at their institutions, and unique work-life challenges. Conclusions A majority of graduates from 1 dedicated residency program in global health and internal medicine reported they were able to continue to engage in global health activities after graduation and, despite identified challenges, reported that they planned long-term careers in global health.

Socially Accountable Global Health Education Amidst Political Uncertainty and Reactionary Nationalism: A Value Proposition and Recommendations for Action

“…As a result, GHE increasingly became defined by experiences in “resource-different” settings [4]. For some participants, GHE led to the pursuit of careers involving the principles underlying GH [9]. …”

“…GH trainees gain insight into other models of healthcare that transform their career goals and clinical practice perspective [8915]. As a result, trainees develop a more nuanced understanding of healthcare delivery across settings, which may also sharpen their ability to perceive such differences locally.…”

“…Crucially, this has been shown to be true for all participants [578910], regardless of whether they are a Kenyan student rotating in the U.S., a Canadian student rotating in China, or a student from Delhi, India rotating in Nagpur, India. It may also be true whether their goal is to work at a nationally funded tuberculosis clinic in London, a community health center in rural Australia, or an academic cancer hospital in Los Angeles [578910].…”

“…It may also be true whether their goal is to work at a nationally funded tuberculosis clinic in London, a community health center in rural Australia, or an academic cancer hospital in Los Angeles [578910]. …”

“…They are also core principles of GHE. GHE programs foster relationships with international partners, drive advocacy, and mentor trainees to be effective change agents [58916171920]. Trainees observe role models working alongside local and national leaders on an array of issues including program implementation, health determinants, social justice, human rights, and access to equitable care.…”