Preparing Trainees to Engage in Global Health

Guest post by Nicole E. St Clair, MD

Bottom Line: Implementation guide empowers educators to create global health training programs

When I learned about the concept of transformative learning, it reminded me of a fateful evening during my third year of pediatric residency that changed the trajectory of my career. I had just arrived at the grounds of a hospital in a rural region of Lesotho, a small, mountainous country contained within the borders of South Africa, where I would be participating in a monthlong global health elective. It was dark outside, and I was exhausted from travel, so I fell asleep quickly. I planned to orient myself to the hospital in the morning. 

I had been sent as a “scout” by my residency program to help determine whether the hospital might be appropriate for a pediatric training partnership. I had done my best to prepare for this experience — I read clinical resources from the World Health Organization, studied the history of Lesotho, and filled a medical bag that included basic resuscitation supplies. I had no prior global health training.

At 2 a.m. that first evening, there was a knock on my window. It was a hospital guard asking for the pediatrician. I quickly grabbed my medical bag and ran alongside him up the path to the hospital. The hallways were dark, and the guard explained to me that the one physician on call was in the operating room with a mother who had presented with obstructed labor. He then showed me a newborn on a table in a dimly lit room who was apneic and covered in meconium. We entered at the same time as a nurse who came with a blanket. I had no idea how long the baby had been there, but he had a pulse, so I attempted resuscitation with what I had — drying, bulb suctioning, bag mask ventilating, and intubating, made possible by an intubation kit offered by the nurse. 

What ensued thereafter were personal crash courses in ethics, culture, and health disparities. 

Only after intubation did I discover that there was not a ventilator in the hospital, nor a means of transport to the next closest hospital three hours away. The baby was never able to adequately breathe on his own and passed away after I removed his endotracheal tube. In hindsight, there were so many things that I did wrong — not knowing the resources available, not knowing the mother’s wishes, not knowing the nursing team, nor the ethics of resuscitation in resource-limited settings. There were so many things that I did not know that I should have known. 

That immersive experience — paired with myriad other lessons learned that month working with significant resource limitations and very sick children — transformed my perspective on child health and health disparities. I realized that we could (and should) do “this” better. We, as a pediatric community, should better train ourselves on the extent of health disparities globally and should better equip trainees and providers to ethically and competently engage with global partners in child health initiatives.

I was certainly not alone in this realization. 

After graduation, I moved to the Midwest, started a Pediatric Global Health Track at my institution, and found other global child health educators at regional institutions. We created the Midwest Consortium of Global Child Health Educators in 2010 with a mission to advance the science and implementation of global child health training in graduate medical education through regional multi-institutional collaboration and scholarly output, and soon thereafter developed curricula to help educators prepare trainees for global health electives ( Concomitantly, there was a national push to create a scholarly “home” for global child health educators within the Association of Pediatric Program Directors. Formed in 2011, this program now is known as the Global Health Learning Community, through which many educator resources have been created and disseminated.

And now, fast forward to the reason that I am writing this blog. I had the great honor of participating in the American Board of Pediatrics (ABP) Global Health Task Force, which will come to a close this fall. This task force was convened in 2013 with a purpose of advising the ABP Board of Directors and staff in developing a global health agenda around its core values of training assessment, certification, quality improvement, and continued professional development. The task force initially was led by Stephen Ludwig, MD, of Children’s Hospital of Philadelphia, and then transitioned to Sabrina Butteris, MD, of the University of Wisconsin, in 2015. One charge for the task force was to create a global health education guide for pediatric program directors. I had the honor of leading that project from 2016 to completion in 2018, with a committed team of educators in partnership with leadership from stakeholder organizations and international educators. 

The guide, titled Global Health in Pediatric Education: An Implementation Guide for Program Directors, is a comprehensive, practical, freely available resource for incorporating global health education into pediatric training programs. It is not intended to represent a mandate for programs, but instead to support new and long-standing global health programs. Notably, it can be easily modified for other audiences, across trainee levels and specialties, and other non-pediatric educators have already expressed interest in adapting the content for their purposes. It represents a compilation of everything that I wish I had had at my fingertips these past 15 years.

Many hours were spent developing and revising this guide, by many dedicated people. My three greatest hopes are that the guide will help to:  

  • Allow educators (across disciplines) to efficiently create global health training programs without continually “reinventing the wheel”;
  • Ensure that trainees are no longer unprepared — ethically, culturally, personally, and professionally — prior to engaging in global work; and
  • Empower training programs to build the necessary infrastructure to support mutually beneficial global partnerships prior to engaging trainees and faculty in global pursuits. 

I believe strongly in the importance of immersion in resource-limited settings to promote transformative learning and empower our trainees to address health disparities locally and globally in their careers, but only if we, as an educator community, are mindful of the impact of traveling trainees and the importance of ethical partnerships. I hope that this guide can help push our community further in that direction. 

About the Author

Nicole E. St Clair, MD

Nicole E. St Clair, MD, is an Associate Professor of Pediatrics in the Divisions of Pediatric Hospital Medicine and Global Health at the University of Wisconsin School of Medicine and Public Health, where she works as a hospitalist and the Director of the Pediatric Residency Global Health Track. As a member of the ABP Global Health Task Force, Dr. St Clair served as editor of Global Health in Pediatric Education: An Implementation Guide for Program Directors. She is board certified and maintaining certification in General Pediatrics.

Self-Assessment (MOC Part 2) Activities Related to Global Health

Photo: Housing in Lesotho, by Nicole E. St Clair, MD