Host Preceptor’s Positive Perceptions Toward Global Health Rotations: A Literature Review

Nicole Tittarelli, PA-S, Teresa Thetford, DHSc, M.S., PA-C , Eric Nemec, PharmD, MEHP, BCPS, Gerald Kayingo*, PhD Sacred Heart University Physician Assistant Studies - Fairfield, CT University of California Davis – Sacramento, CA

Masters Capstone Presentation – Stamford, Connecticut – April 27, 2018

ConclusionDiscussionv This study reveals reported benefits of GHRs from the perspective of host preceptors. v GHRs contribute valuable components toward local education, host institutions, and patient care1-8. v The gap in literature remains due to few studies identifying the value of global health rotations toward host country

institutions.v Continued research advocated so mutual benefits among partners is substantiated.

Implications for Future Researchv The available literature uses survey and interview study methods of data collection, and different study designs

should be investigated. v Future studies should research quantitative value of GHRs. Quantitative studies can include evidence of improved

cost, patient care, and institutional value. v Common themes separately researched give a more accurate understanding of how each brought value or can be

improved.

Methodology Literature Review

AbstractBackground: Health care institutions from around the globe have established relationships that provide opportunities for medical professionals to participate in Global Health Rotations (GHRs). This includes sending trainees from high- resource

institutions to learn in low-resource settings in an effort to enhance clinical training1. Low-resource settings expose trainees to clinical experiences that they may not see in their home country, including different cultures, healthcare delivery systems, and diseases1. While there are many studies to support the value of GHRs on the high-resource sending institution, there is minimal evidence to show how GHRs benefit the low-resource host institution. Purpose: This literature review

will provide evidence that host preceptors perceive GHRs to bring value to their institution. The goal is to validate current studies demonstrating that institutions participating in GHRs have mutually beneficial collaborations.

v A key word literature search was conducted using Boolean Logic to find articles from electronic databases.

Inclusion Criteria v Study designs with an approved method- survey- Likert scale, or interview

style data collection. v Participants must be hospital affiliated or medical personnel working with PA

students, medical students or residents in a low resource setting in any geographical location.

v The benefit or value of global health rotations from the perspective of the preceptor is the primary outcome measured

v GHRs within all specialties will be considered. Exclusion Criteriav Articles with study participants who are not in low resource settings v Perspective pieces that did not provide data driven outcomes. v No validated tool for ROB of Qualitative Data Qualitative Analysis and Data Extractionv Selected articles were reviewed and content pertaining to value was extracted

based on a theoretical framework (Table 1).v Data was gathered, grouped in to common themes, and analyzed (Table 2).

Three Overarching Themes Identified

Benefits Toward Educationv Motivated preceptors to enhance their medical education and training1-6. v Benefit through shared knowledge and experiences among guests, local

trainees, and local supervisors1-6. v Exchange in healthcare delivery systems, patient care, and skills1-2,4-5,7-8. v Enhanced student learning and approach to patient care1-6. v Global health rotations lead to long term partnerships which give local

students opportunities for scholarships and training experiences abroad3-8

v Local students enhance clinical skills and training1-2, 4-5, 7-8.

v Local students experience different health systems1-2, 4-5, 7-8 . Benefits Toward Institutionv A rise in prestige by the local community1,5,6.v Donated supplies and resources the institution did not previously

have1,3,4,5. v Current and future funding and research3-6.

Benefits Toward Patient Carev Filling the gap in staff shortage1,3,4,6. v Supplies and donations provide treatment that was not available2.

References1.Bozinoff N, Dorman KP, Kerr D, et al. Toward reciprocity: host supervisor perspectives on international medical electives. Medical Education. 2014;48(4):397-404. doi: 10.1111/medu.12386 2. Elobu AE, Kintu A, Galukande M, et al. Evaluating international global health collaborations: Perspectives from surgery and anesthesia trainees in Uganda. Surgery. 2014;155(4):585-592. doi:10.1016/j.surg.2013.11.007 3. Kolars JC,

Cahill K, Donkor P, et al. Perspective: Partnering for Medical Education in Sub-Saharan Africa. Academic Medicine. 2012;87(2):216-220. doi:10.1097/ACM.0b013e31823ede34. Kraeker C, Chandler C. “We Learn From Them, They Learn From Us”: Global Health Experiences and Host Perceptions of Visiting Health Care Professionals. Academic Medicine. 2013;88(4):483-487. doi:10.1097/ACM.0b013e3182857b8a 5. KumwendaB, Dowell J, Daniels K, Merrylees N. Medical electives in sub-Saharan Africa: a host perspective. Medical Education. 2015;49(6):623-633. doi:10.1111/medu.12727 6. Kung TH, Richardson ET, Mabud TS, Heaney CA, Jones E, Evert J. Host community perspectives on trainees participating in short-term experiences in global health. Medical Education. 2016;50(11):1122-1130. doi:10.1111/medu.13106 7. Lukolyo H, Rees CA,

Keating EM, et al. Perceptions and Expectations of Host Country Preceptors of Short-Term Learners at Four Clinical Sites in Sub-Saharan Africa. Academic Pediatrics. 2016;16(4):387-393. doi:10.1016/j.acap.2015.11.002 8. O’Donnell S, Adler DH, Inboriboon PC, Alvarado H, Acosta R, Godoy-Monzon D. Perspectives of South American physicians hosting foreign rotators in emergency medicine. International Journal of Emergency Medicine. 2014;7(1). doi:10.1186/s12245-014-0024-5 9. Pitt MB, Gladding SP, Majinge CR, Butteris SM. Making Global Health Rotations a Two-Way Street: A Model for Hosting International Residents. Global Pediatric Health. 2016;3:2333794X1663067. doi:10.1177/2333794X16630671 10.Russ CM, Ganapathi L, Marangu D, et al. Perspectives of host faculty and trainees on international visiting faculty to paediatric

academic departments in East Africa. BMJ Global Health. 2016;1(3):e000097. doi:10.1136/bmjgh-2016-000097

Strengths v Consistency in data extraction methods

Weaknessesv Heterogeneous study outcomesv Did not research disadvantagesv No statistical analysis of qualitative evidencev Small sample sizev No control group

Limitations v Limited database searchv One researcher- data analysis, extractionv No quantitative datav Poor response rate due to unavailable participants v No specific geographical location is recognized

v Host preceptors have similar perspectives regarding the value of GHRs.v The primary finding of this review is that faculty from countries with low- resource healthcare institutions perceive

global health rotations provide valuable contributions to the host faculty, students, institution, and the patients.v Distributing surveys and interviewing host preceptors is the most common study method used in current studies.

Scholarly Poster Instructions

The scholarly poster is an opportunity to present research findings to other professionals effectively and succinctly. The goal of the poster is to provide information or research that is clear and concise and that contributes or adds to what is currently known or understood in the field. Additionally, this presentation provides an opportunity to present scholarly work in a format similar to presenting at a regional or national meeting. Creating a quality poster is a valuable skill to acquire and can contribute to career advancement and promotion of the PA profession as well as the advancement of medicine, medical education, or public health policy. As a PA, there will be many opportunities to submit a scholarly poster to professional society meetings and scientific conferences and the SHU Master of Physician Assistant Studies encourages you to do so. The purpose of the Poster or Presentation is to share your work with colleagues possibly during Post-Clinical Activity Days, ConnAPA meetings, Stamford Hospital Research Day, or other regional/national meetings.

Poster Content and Organization for Clinical TrackThere are many acceptable formats for scholarly posters depending on the requirements for each organization or scientific meeting. For the Master of Physician Assistant Studies Masters Capstone Project, scholarly posters must conform to the requirements described below which are based on the AAPA poster session guidelines. Remember, the goal of the poster is to provide information or research effectively and succinctly. The poster must be easy to read and free of overly wordy text. Bullets, tables, or figures are often used in the sections of the poster to display information more clearly and concisely. A template will be provided; a sample poster layout can be found in Appendix E.

1.Title/Banner: This should include the title, author(s), and institution. The title should be brief and should clearly reflect the content of your poster. Ideally, it will capture the attention of the reader passing by. Typically, the institution logo or seal is on the left side of the banner. Do not use abbreviations. Please refer to the sample poster layout in Appendix A.

1.Abstract: This is a brief but comprehensive summary of the poster and must include the following sections: purpose or objective, methodology, results, and conclusion of the research. It is valuable to emphasize objectives that are uniquely innovative or add to what is currently known or understood in the field. Do not include references, graphs, tables, or pictures in the abstract. It should be limited to 500 words. Professional organizations and conferences base their decision for poster presentation acceptance on the submitted abstract only. This is one of the most important sections of the poster.

1.Purpose or Objective: This section introduces the topic and the importance of the poster and explains the rationale for the poster. Why did the student start this research? It should include relevant background information and describe the “problem” or gap in the literature. The “gap” in the literature will give rise to the question to be addressed in the poster. The specific question should be clearly defined in this section. The purpose of the poster and specific knowledge that will be gained from answering the question proposed should also be addressed. For example, the purpose of the poster could be to document reliability of exams or tests or to establish relationships between specific variables. Do not include the implications for clinical practice in this section as this will be included in the Conclusion section of the poster. Text and/or bullet points may be used in this section depending on the student’s preference. Resist including every possible detail on the poster. Remember the poster should be well-organized and succinct. Students may elaborate on their poster during the oral presentation.

1.Methodology: Each student will complete a comprehensive literature review on the specific topic/question for the poster. This section will be comprehensive and will align with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and format and include the PRISMA 2009 Flow Diagram (Appendix F)

1.Results: This section summarizes the current literature and should be organized to encompass themes or identified trends in the literature relative to your question. Clear, self-explanatory tables or graphs may be used to supplement the text only and should not simply duplicate data described in the text. A bullet-point format for text and/or the use of tables or graphs may make it easier to clearly display your results.

1.Conclusions: This section is a combination of discussion and conclusions. What do the results mean? Supporting evidence from published studies should be used in the explanation. Any contradictory findings or study limitations should be addressed such as bias, methodology, sample size, etc. This section should also be used to address the purpose of the poster. What does the literature suggest regarding the question addressed in the poster? Is there evidence that supports, refutes, or answers the question? How can the results of the literature review be applied to clinical practice? Describe the potential implications to clinical practice or public health/policy. Does a gap in clinical knowledge still exist and/or is there a need for additional research? Remember to be concise. The conclusion is typically the second section people scan/read after the title of a poster. It needs to capture their attention and encourage them to spend more time with the poster.

1.References: References should be listed alphabetically according to the format described in the American Medical Association Manual of Style. Proper formatting will be weighted in the final grade for the paper. A full list of references will be submitted with the final poster sections, however, only the most pertinent, essential references should be included on the poster display.