PEDIATRICS Volume 142, number 1, July 2018:e20172966 STATE-OF-THE-ART REVIEW ARTICLE

To cite: Gladding SP, McGann PT, Summer A, et al. The Collaborative Role of North American Departments of Pediatrics in Global Child Health. Pediatrics. 2018;142(1):e20172966

Departments of aMedicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota; bCincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; cDivision of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; dDivision of Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; eDepartment of Pediatrics and Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York; fHospital Maria, Especialidades Pediatricas Honduras, Tegucigalpa, Honduras; gDivision of Infectious Diseases, Department of Pediatrics, Emory University, Atlanta, Georgia; hDivision of Pediatric Inpatient Medicine, Department of Pediatrics, University of Vermont, Burlington, Vermont; iAccreditation Council for Graduate Medical Education, Chicago, Illinois; jDepartment of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda; kDivision of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; and lRyan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University of Medicine, Bloomington, Indiana

Drs Gladding and John developed the content outline for the manuscript, recruited the author team, conducted the literature review, drafted the introduction, methods, global child health clinical practice, and conclusions sections, and synthesized the first complete draft; Drs Summer, Russ, Uwemedimo, and Matamoros Aguilar contributed to the conception and design of the manuscript, assisted with literature reviews, drafted the global child health education sections, provided content expertise, and critically reviewed the manuscript; Drs McGann and Chakraborty contributed to the conception and design of the manuscript, assisted with literature reviews, drafted the global child health research sections, provided content expertise, and critically reviewed the manuscript;

The mission of departments of pediatrics is to improve child health through education, clinical practice, research, and, increasingly, advocacy. This mission is also broadening to include improving health for all children as departments respond to growing calls, both domestic and international, for health equity.1, 2

There have been improvements globally in indicators of health equity, defined as the absence of avoidable

or remediable differences in health among groups of people defined by different levels of social advantage related to wealth, power, or prestige over the past 2 decades.3 However, global disparities in access to health services and interventions and health outcomes remain. In 2015, low- and middle-income countries (LMICs) spent, on average, 6.5% of their gross domestic product on health compared with 12% of gross domestic product

The Collaborative Role of North American Departments of Pediatrics in Global Child HealthSophia P. Gladding, PhD, a Patrick T. McGann, MD, MS, b Andrea Summer, MD, c Christiana M. Russ, MD, d Omolara T. Uwemedimo, MD, MPH, e Martha Matamoros Aguilar, MD, f Rana Chakraborty, MD, PhD, g Molly Moore, MD, h Mary Lieh-Lai, MD, i Robert Opoka, MD, j Cynthia Howard, MD, k Chandy C. John, MD, k, l on behalf of the Global Health Task Force of the American Board of Pediatrics

Appeals for health equity call for departments of pediatrics to improve the health of all children including those from underserved communities in North America and around the world. Consequently, North American (NA) departments of pediatrics have a role in global child health (GCH) which focuses on providing health care to underserved children worldwide. In this review, we describe how NA departments of pediatrics can collaboratively engage in GCH education, clinical practice, research, and advocacy and summarize best practices, challenges, and next steps for engaging in GCH in each of these areas. For GCH in low- and middle-income countries (LMICs), best practices start with the establishment of ethical, equitable, and collaborative partnerships with LMIC communities, organizations, and institutions engaged in GCH who are responsible for the vast majority of work done in GCH. Other best practices include adequate preparation of trainees and clinicians for GCH experiences; alignment with local clinical and research priorities; contributions to local professional development and ongoing monitoring and evaluation. Challenges for departments include generating funding for GCH activities; recruitment and retention of GCH-focused faculty members; and challenges meeting best practices, particularly adequate preparation of trainees and clinicians and ensuring mutual benefit and reciprocity in NA–LMIC collaborations. We provide examples of how departments have overcome these challenges and suggest next steps for development of the role of NA departments of pediatrics in GCH. Collaborative implementation of best practices in GCH by LMIC–NA partnerships can contribute to reductions of child mortality and morbidity globally.

abstract

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for high-income countries (HICs).4 There is an additional inequitable global distribution of physicians, with 8.8 physicians per 10 000 population on average in LMICs compared with 28.7 in HICs reported in 2013.5 Although the mortality rate for those <5 years old has improved dramatically in LMICs over the past 2 decades, a large difference between LMICs (47 per 1000 persons in 2013) and HICs (7 per 1000 persons) persists.6 Similar disparities exist within HICs, with, for example, infant mortality rates in the United States varying by state, race, and ethnicity.7

To address health disparities, improve child health, and achieve health equity, North American (NA) departments of pediatrics have a role in global health (GH), which has been defined as “an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.” 8 In collaboration with LMIC partners, NA departments of pediatrics can contribute to achieving health equity and improving child health by training future pediatricians to provide health care to children from around the world, engaging in clinical care collaborations that can help address health system gaps in resource-constrained settings, 9 and conducting collaborative research that has the potential to reduce childhood morbidity and mortality globally.10, 11

Our purpose with this review is to (1) describe the range of current roles of NA departments of pediatrics in global child health (GCH) education, clinical practice, and research; (2) summarize recommendations from the literature for best practices in engaging in GCH in each area; (3) describe challenges departments may experience in engaging in GCH and examples of how departments have addressed these challenges; and (4) suggest next steps for the

development of departments’ of pediatrics role in GCH.

METHODS

The authors are members of the American Board of Pediatrics Global Health Task Force Academics Working Group and are GCH educators, clinicians, and researchers working in LMICs and North America. We conducted a literature review through PubMed and Google Scholar for articles related to NA departments of pediatrics and GCH education, clinical practice, and research. See Supplemental Table 4 for the specific search terms used. The resulting articles were then assessed for relevance to the manuscript. A subset of authors with expertise in each area (education, clinical practice, research) reviewed the relevant articles and, acknowledging that no set of search terms or search engines would definitively unearth all relevant articles of interest for this broad topic, included additional articles from their areas of expertise.

The best practices (Fig 1), challenges, and recommendations for NA departments of pediatrics engaging in GCH included in this review were then drawn from the literature obtained through the search described above and informed by the authors’ experiences as well as input from colleagues in the GCH community. Examples in each area were then selected from the same literature search by using the following criteria: examples were published in peer-reviewed journals, were developed and evaluated by multi-institutional collaborations or were initiatives of pediatric organizations, and demonstrated high-quality outcomes. In the few instances in which published examples were sparse, unpublished examples known to the authors in their areas of expertise were included. The included examples

are meant to be demonstrative and not intended to be comprehensive because numerous outstanding GCH programs exist.

In this review, we focus on NA departments of pediatrics, but the best practices and challenges are likely broadly applicable to departments of pediatrics within HICs. Best practices and ethics for individual NA-based faculty members caring for specific clinical conditions or conducting specific disease-based research studies in LMICs are beyond the scope of this review and are discussed elsewhere.12 – 14

The Role of NA Departments of Pediatrics in GCH Must Be Collaborative

Before describing the possible roles of NA departments of pediatrics within GCH (Fig 2), it is important to clarify that any role must be done in collaboration with LMIC partners because the vast majority of work in GCH is undertaken by staff and faculty at LMIC institutions. NA departments’ of pediatrics efforts should be guided by a key principle of GCH: that the work be done through bilateral, mutually beneficial, ethical collaborations with LMIC institutions.15 – 17 Any work performed within LMICs should be done with a clear understanding that NA partners are guests in the country, the LMIC partner has experience and expertise in local GCH issues the NA partner lacks, and their work together starts with an assessment by both partners of how mutual and complementary expertise may be best used to develop educational, clinical, or research programs designed to improve child health.15 – 17 The collaborative work of GCH should further be guided by the principle of cultural humility in which partners reflect on their own assumptions, biases, and values, with a focus on learning rather than knowing.15, 18 Approaching collaborations with cultural humility

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can reduce power imbalances and promote mutual respect and understanding.15, 18

Role of NA Departments of Pediatrics in GCH Education

GCH education in pediatric residency training has expanded over the past 2 decades. The earliest published survey regarding GCH training in the United States in 1995 revealed that 25.5% of responding residency programs offered GCH electives or informal GCH experiences.19 The most recently published survey of US pediatric residency programs in 2014 revealed that 58% of responding programs offered GCH international electives, with increasingly robust GCH training including more GCH curricular components (eg, electives, GCH lectures, etc).20 The survey further revealed that 66% have a GCH faculty lead, and 25% offer GCH tracks, which provide formalized, longitudinal training for a defined group of residents.19 There are many examples of well-described

guidelines for GCH core curricula, 21 – 24 GCH residency tracks, 25 –27 and GCH electives.16, 19, 28 –30 Supplemental Table 5 provides several illustrative examples as well as guidelines for and brief descriptions of GCH curricula, tracks, and electives.

In addition to providing training and mentorship to residents with specific career interests in GCH, GCH education is increasingly embedded in general pediatric residency curricula. Pediatric residency programs are increasingly providing some GCH curriculum to all residents on topics such as the global burden of disease, use of interpreters, and cultural humility21, 25 so that trainees are competent when they graduate to provide care for increasing numbers of refugee and immigrant children in the United States as well as children suffering from emerging infections such as the Zika virus, 31 travel-related diseases such as malaria, 32 and local outbreaks from imported infections such as measles.33

Finally, NA departments of pediatrics can play a role in contributing to the education of LMIC pediatric trainees when invited and in collaboration with LMIC partners. This role ranges from informal teaching by visiting faculty to more formalized educational initiatives, such as training in pediatric subspecialties, 34 – 39 joint development of core curricula, 22, 40 –42 short clinical skills training courses (eg, neonatal resuscitation), 43, 44 and telehealth collaborations.45 – 48 New and developing LMIC residency programs have been supported through academic partnerships with NA departments of pediatrics, in which guest faculty with experience in medical education contribute to the development of the program.40, 42, 49 In Supplemental Table 5, we provide several illustrative examples and brief descriptions of GCH education partnerships.

Best Practices for GCH Education

We indicate in our literature review a growing consensus in the best practices for GCH education. These include the following: (1) adequate preparation and orientation of residents before departure on GCH electives16, 19, 50 – 56; (2) adequate supervision of residents on GCH electives16, 19, 57; (3) provision of post-GCH elective debriefing58 –60; (4) establishment of ethical partnerships with host institutions, communities, and organizations that support the GCH electives and other educational opportunities, characterized by shared planning, 50, 61, 62 bidirectionality, 34, 35, 50, 51, 57, 62– 64 long-term relationships, 16, 50, 51, 65 cultural and contextual awareness, 50, 56, 65 and equitable resource allocation8, 66, 67; (5) contributing to local professional development22, 27; and (6) ongoing evaluation.16, 50, 51 In addition, the Federation of Pediatric Organizations recommended in

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FIGURE 1Best practices for engaging in GCH education, clinical practice, and research.

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2008 that US pediatric residency programs offer core curriculum in GCH for all residents.68 In Table 1, we provide a summary of specific recommendations from the literature for each best practice.

Challenges and Strategies for Addressing Them in GCH Education

NA departments of pediatrics face challenges in developing and implementing successful GCH educational programs and collaborations. A primary challenge is the need for additional financial resources to support GCH education, including the recruitment and retention of GCH-dedicated faculty with protected time because the development and management of GCH education programs requires

dedicated time and expertise. Financial resources are also essential in the formation and support of LMIC-NA educational partnerships, including support for LMIC partner faculty, infrastructure, and bidirectional opportunities as well as the provision of residents’ salaries during GCH electives.16, 70

Departments have generated funding for GCH education through the use of revenue from GCH clinical activities, such as travel, international adoption, and immigrant health clinics; leveraging research infrastructure in LMIC-NA partnerships to support education; and solicitation of philanthropic gifts.70 Smaller programs and those with limited funding can benefit from the growth in online GCH educational

resources71 –74 (see Supplemental Table 5 for examples of online resources) and from joining multi-institutional and regional consortia focused on LMIC-NA partnerships.70, 75

NA departments of pediatrics also face the challenge of ensuring their residents are adequately prepared clinically and culturally for GCH electives. Researchers describing LMIC institutions hosting US-based trainees have highlighted the problem of poor trainee preparation for situations that might lead to emotional distress, which can result in offensive or culturally insensitive behavior, and of conflicts with local practitioners that can arise when visiting trainees or faculty attempt to impose health care practices from the United States in resource-constrained settings.12, 50, 52, 54, 76 – 78 Despite the acknowledged importance of predeparture preparation, the 2014 survey revealed that only 66% of the US pediatric residency programs offering GCH electives provided predeparture preparation, 20 with larger programs (>60 residents) more likely to provide preparation (89.7%) than smaller (<30 residents) programs (50%).20 In response, many pediatric residency programs and organizations have developed online GCH curriculum and predeparture orientation materials and made them available to other pediatric residency programs.71 – 74, 79

A third challenge faced by NA departments of pediatrics is meeting their responsibility to provide mutual benefit and reciprocity with their LMIC partners, particularly the challenges in developing bidirectional exchange opportunities for the LMIC partner trainees and faculty. NA-based trainees benefit from the expert teaching of LMIC colleagues with knowledge about diseases endemic to the area, history and physical examination skills honed from the use of these skills to make diagnoses in resource-constrained

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FIGURE 2Collaborative role of NA departments of pediatrics in GCH education, clinical practice, research, and advocacy.

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settings, and an understanding of the appropriate approaches to care for children in specific resource-constrained and cultural settings. In addition, they also typically receive hands-on clinical experiences during GCH electives, although barriers exist to offering reciprocal experiences to LMIC trainees participating in bidirectional exchanges. In the United States, requisite qualifications to allow hands-on patient care can make clinical training opportunities for visiting LMIC trainees

challenging. Several institutions, particularly Canadian institutions, have succeeded in collaborating with university, hospital, and state certification agencies to allow for clinical opportunities for visiting residents under institutional agreements and with appropriate supervision.34

In the United States, residency programs have worked to create meaningful bidirectional opportunities such as the exchange

between Ann and Robert H. Lurie Children’s Hospital of Chicago and Bugando Medical Centre (BMC) in Tanzania, in which pediatric trainees from BMC are carefully integrated into a range of activities at Lurie Children’s Hospital, including broad clinical exposure and education opportunities such as conferences, teaching opportunities, and simulation training.62 The research from bidirectional opportunities reveals that LMIC trainees who participate in these exchanges

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TABLE 1 Best Practices and Recommendations From the Literature for Engaging in GCH Education

Best Practice Specific Recommendations From the Literature

Adequate preparation and orientation of residents before departure on a GCH elective

Careful selection and preparation of trainees for participation16

Effective mentorship of trainees by sending institution16, 19

Specific trainee prerequisites before approval for international rotation19

Trainee preparation to enhance medical knowledge, skills, and cultural sensitivity and/or cultural humility12, 19, 50, 51, 54

Positive attitudes and commitment of trainees52, 53

Significant investment (eg, engaging in robust predeparture preparation, self-financing travel) by trainee55

Strengthening and standardizing program curricula to provide adequate medical and sociocultural preparation for visiting rotations at LMIC institutions56

Adequate supervision of the resident while on the GCH elective

Effective mentorship and supervision of trainees at sending and hosting institutions16, 19

Collaboration with LMIC partner sites that are teaching institutions with traditional faculty supervision57, 69

Provision of post-GCH elective debriefing

Residents need support from home institution for the range of emotional responses they experience when returning from a GCH elective58

Important postelective debriefing topics include the following: evaluation of the elective, sharing of the experience, knowledge translation, health and safety issues, reentry into the residency program59, 60

Establishment of ethical partnerships with host institutions, communities, and organizations that support the GCH electives and other educational opportunities

Shared planning Initial discussion and site visits between NA and LMIC partners, with explicit and transparent discussion about mutual

benefits, costs, and financing16, 50

Written agreements (such as a Memorandum of Agreement) with clear goals, objectives, and responsibilities16, 61

Scheduled, frequent, real-time communication between partners to ensure that LMIC partner institutions have significant and frequent input throughout the program planning process16, 50

Transparency between partnering institutions16

Bidirectionality Reciprocal opportunities for residents or other trainees from partner LMIC institutions to train at NA institutions34, 57, 62

Bilateral partnerships to foster longitudinal relationships, professional development, and capacity building34, 51, 68

Bidirectional opportunities, with faculty and trainees from NA and LMIC willing to both gain and share knowledge52, 53

Share collective knowledge and resources between partners35, 50

Opportunities for professional exchanges and mentoring35, 64, 66

Peer-to-peer collaborative relationships35

Focus on long-term relationships Continuous rather than intermittent interactions between LMIC and NA partners51

Strong mutual interest from both partners to cultivate a long-term partnership16

Long-term commitments to partners12, 35, 36, 50, 64

Cultural and contextual awareness Understand local disease epidemiology, medical conditions, health care systems, and cultural and/or sociopolitical

considerations12, 50, 65

Train in ethical challenges and considerations12, 65

Equitable resource allocation Partnerships should have equity66

Direct greatest share of resources to the less-resourced partner67

Work to achieve equity in health for all8

Contribute to local professional development

Support bidirectional learning opportunities for visiting and host trainees and faculty members during GCH electives22, 27

Evaluation Evaluation for program monitoring and improvement16, 50, 51

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or obtain qualifications in North America often return to their home country and become change agents promoting diagnostic and treatment techniques and educational approaches learned within NA training programs modified to be practical and appropriate in resource-constrained settings.33, 62, 80, 81 Hosting NA institutions’ faculty and learners also benefit from LMIC trainees’ knowledge and experience in important GCH topics as well as learning from their different cultural view of medicine.62, 63 To be effective, these opportunities must undergo careful review and ongoing evaluation by both the host and the LMIC institution to ensure institutional and educational goals are being met.

Role of NA Departments of Pediatrics in GCH Clinical Practice

Clinical practice in GCH by NA pediatricians has previously often been limited to individual faculty members collaborating with LMIC sites, sometimes with the academic or financial support of their department, although more often by using the individual’s own time and resources.65, 66, 77, 78 Increasingly, NA departments of pediatrics play a larger role in GCH clinical practice through clinical partnerships. Sustainable contributions of NA departments of pediatrics to GCH clinical practice in LMICs are rooted in collaborative partnerships in which the LMIC partner has the lead role providing guidance to the NA department in ways to collaborate to improve GCH clinical practice. For example, in situations when LMIC health systems are acutely stressed, such as postconflict and postdisaster situations or during disease outbreaks, NA departments of pediatrics have partnered with LMIC institutions and ministries of health to provide clinical care while also contributing to pediatric education, faculty development, mentorship, and strengthening of

health care systems.42, 64, 66, 82 – 86 These partnerships have used different models for clinical care ranging from NA-based faculty rotating to the LMIC partner site for 1 month83 to 1 year.64 In Supplemental Table 6, we provide several illustrative examples and brief descriptions of GCH clinical care partnerships.

Best Practices in GCH Clinical Practice

In our literature review, we indicate a number of best practices for GCH clinical practice, including (1) the establishment of ethical partnerships with host institutions, communities, and GCH organizations characterized by shared planning, 50, 65 with a focus on long-term relationships12, 35, 37, 50, 64; cultural and contextual awareness12, 50, 65; and equitable resource allocation8, 66, 67; (2) alignment of clinical practice with local priorities*; (3) contributing to local professional development and pediatric care capacity35, 37, 40, 50, 67, 83; (4) adequate preparation of NA-based clinicians12, 50 – 52, 54, 67; and (5) ongoing monitoring and evaluation.50, 51, 69 In Table 2, we summarize specific recommendations from the literature for each best practice.

Challenges and Strategies for Addressing Them in GCH Clinical Practice

NA departments of pediatrics face multiple challenges in supporting clinical practice in GCH. As with GCH education, many departments face resource challenges including providing time, coverage, malpractice insurance, and salaries for faculty who pursue GCH clinical activities either through individual or departmental opportunities.70, 85 In addition to the methods for generating funding described for GCH education, some departments have successfully obtained grant funding

* Refs 12, 37, 42, 46, 50, 51, 65, 66, 69.

to support larger-scale projects and partnerships that include a clinical care component, 64 although this remains a challenge for many departments.

NA departments of pediatrics also face challenges in forming and sustaining partnerships with LMIC partners, including ensuring that in addition to providing clinical care, there are efforts to participate in local professional development. Authors of previous literature have highlighted problems related to NA-based clinicians providing clinical care not linked to developing long-term clinical capacity in LMICs, 50, 67, 69 most notably NA-based clinicians providing care that cannot be sustained after they leave (eg, treatments of chronic illnesses requiring access to medications and treatment) and clinical care projects that cannot be sustained once funding for the project has ended.12, 65, 77, 86

Departments have worked to address these challenges by incorporating an educational component as part of their partnerships. For example, in postconflict Laos, a multi-institutional partnership of the Lao University of Health Sciences, Case Western Reserve University, and Health Frontiers formed to deliver immediate postconflict pediatric care and codevelop a postgraduate pediatric training program in which most of the teaching is now provided by Lao staff.40 Additional educational models include “train the trainer, ” in which NA-based clinicians train a local faculty member or provider who in turn trains their colleagues and other providers, 69 and “twinning” models, in which an NA-based faculty member is paired with a local faculty member or provider and together they provide clinical care, each teaching the other as they work together.64 Professional development, like all things in GH, works both ways: LMIC practitioners provide substantial professional

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development to their NA faculty colleagues as well as NA trainees in how to provide clinical care in the LMIC setting.

A related challenge is addressing the adequacy of preparation of NA-based faculty members to practice in LMICs. Clinicians practicing in LMICs face challenges, including linguistic and cultural differences, working in an unfamiliar health care system with different resources, and practicing in a different context with clinical conditions and scenarios infrequently or never seen in North America.87 Researchers have previously shown that inadequate preparation can lead to clinicians delivering inappropriate care that does not adhere to local guidelines, cultural norms, or public health initiatives12, 65, 77 and being a burden to hosts who spend time orienting and supervising them.50, 52 Individual faculty members are responsible for ensuring they are well prepared to practice in LMICs,

and there are many resources and organizations that support clinicians in their preparation.87 Departments also have a role and should provide time and resources to prepare their faculty and provide context-specific, predeparture preparation for those participating in departmental or institutional partnership programs.42

Role of NA Departments of Pediatrics in GCH Research

NA departments of pediatrics in partnership with LMIC institutions can play a role in advancing GCH research through the training of future NA and LMIC GCH researchers, developing and supporting individual NA and LMIC faculty members pursuing GCH research, and supporting the development of GCH research infrastructure. The training of NA-based GCH researchers in GCH-focused fellowships has increased over time; a review of pediatric subspecialty fellowships accredited

by the Accreditation Council for Graduate Medical Education found that the number of fellowship programs offering GCH research training opportunities increased from 11 in 2008 to 28 in 2011.88 Proposed fellowship guidelines have also been developed, 89 and the areas of GCH research training have expanded over time to include a number of subspecialties.

As with education and clinical practice, the most successful GCH research conducted by NA departments of pediatrics has been in long-standing collaborations with LMIC partner institutions and colleagues.90, 91 Many of the longest-standing international collaborations, such as the collaboration between Moi University and Teaching Hospital in Kenya and a consortium of NA universities led by Indiana University, began as a collaboration in clinical practice focused on HIV care but have expanded to support

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TABLE 2 Best Practices and Recommendations From the Literature for Engaging in GCH Clinical Practice

Best Practice Specific Recommendations From the Literature

Establishment of ethical partnerships with host institutions, communities, and GCH organizations

Shared planning Initial discussion and site visits between NA and LMIC partners with explicit and transparent discussion about mutual

benefits, costs, and financing50

Written agreements (such as a Memorandum of Agreement) with clear goals, objectives, and responsibilities65

Scheduled, frequent, real-time communication to ensure that LMIC partner institutions have significant and frequent input throughout the program planning process50

Focus on long-term relationships Continuous rather than intermittent interactions between LMIC and NA partners51

Long-term commitments to partners12, 35, 37, 50, 64

Cultural and contextual awareness Understand local disease epidemiology, medical conditions, health care systems, and cultural and/or sociopolitical

considerations12, 50, 65

Train in ethical challenges and considerations12, 65

Equitable resource allocation Partnerships should have equity66

Direct greatest share of resources to the less resourced partner67

Work to achieve equity in health for all8

Alignment of practice with local priorities

Collaboration within the local health system (ie, local governmental health bodies, nongovernmental organizations, and/or private health institutions) to identify needs within the health system as potential target areas for partnership42, 46, 69

Focus on addressing locally identified priorities37, 42, 50, 51, 66

Work with community to improve health system rather than just providing care to community69

Adapt treatments to local situations12, 37, 65

Contribute to professional development and pediatric care capacity

Investment in LMIC trainees, faculty, and staff35, 37, 40, 67, 83

Training and mentoring in LMIC35, 37, 40, 83

Develop and support LMIC medical faculty50, 67

Adequate preparation of clinicians

Enter partnerships with humility and solidarity67

Faculty preparation to enhance medical knowledge, skills, and cultural sensitivity and/or cultural humility12, 50, 51, 54

Positive attitudes and commitment of clinicians51, 52

Evaluation Evaluation for program monitoring and improvement50, 51, 69

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research programs in multiple diseases and specialties, including pediatrics.90 Numerous examples exist of research conducted within GCH academic partnerships that have led to improvements in outcomes for children worldwide.11, 92 – 95 In Supplemental Table 7, we provide several illustrative examples and brief descriptions of GCH research partnerships.

Best Practices in GCH Research

In our literature review, we indicate 4 main areas of best practices for engaging in GCH research: (1) establishment of ethical partnerships with host institutions that are characterized by mutual benefit, respect, and trust, 17, 37, 61, 90, 96 – 102 clear communication, 17, 90, 100 well-defined roles and expectations, 17, 101, 103 and the practice of cultural awareness98; (2) alignment of research priorities with local and national priorities17, 61, 65, 96 –99, 102, 103; (3) contributing to local professional development and research infrastructure17, 90, 96 – 103; and (4)

ongoing evaluation.17 In Table 3, we provide a summary of specific recommendations from the literature for each best practice.

Challenges and Strategies for Addressing Them in GCH Research

Specific challenges for NA departments of pediatrics in conducting collaborative GCH research include obtaining funding for GCH research, strengthening the research infrastructure domestically and in the LMIC, creating a supportive GCH research community, creating and maintaining LMIC-NA research partnerships, and navigating the bureaucratic, institutional, and governmental systems that govern GCH research.

There are multiple funding sources that can be used to support GCH research training for NA-based and LMIC trainees at all levels104 – 106 as well as LMIC-focused research awards that support research of importance in GCH.107 – 110 See Supplemental Table 7 for examples and brief descriptions of training

and research grants. Departments can help grow GCH research by making departmental and seed grant funding available for GCH research, providing grant writing and preparation support relevant to GCH funding opportunities, providing administrative support for GCH researchers with expertise in issues such as international institutional review board processes and international contracts and payments, considering adjustments to promotion timelines because international research may take longer to conduct than domestic research, and considering adjustments to promotion guidelines to reward mentoring and collaboration with LMIC partners.111

Faculty GCH researchers often feel isolated because they may be the only faculty member working in GCH in their division or department, particularly in smaller departments. In larger departments, GCH researchers may be scattered in different divisions and may not be aware of each other’s work and

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TABLE 3 Best Practices and Recommendations From the Literature for Engaging in GCH Research

Best Practice Specific Recommendations From the Literature

Establishment of ethical partnerships with host institutions and collaborators

Mutual benefit, respect, and trust LMIC and NA partners should be equals17, 90

LMIC and NA partners should have shared motivation, goals, and values17, 90, 100, 101

Commitment to long-term relationships between LMIC and NA partners17, 90, 100

Common agenda, transparency, and accountability between LMIC and NA partners17, 90, 98 –100, 102, 103

Shared academic credit, including joint-authored publications and presentations37, 61, 96, 102, 103

Clear communication Good communication skills between partners17, 90, 100

Scheduled site visits for LMIC and NA partners17, 90

Well-defined roles and expectations Shared mission and vision between LMIC and NA partners17

Clear expectations set out at the beginning of the partnership17, 101, 103

Early planning with principal investigators17

Cultural awareness Deliberate effort needed to understand cultural aspects that affect collaborations and research98

Willingness to advise on culturally appropriate and inappropriate behavior98

Aligning research priorities Common research agenda between LMIC and NA partners17, 61, 102, 103

Focus on local problems and locally sustainable solutions37, 65, 90, 96, 97, 99, 102, 103

Strategic alignment with national, partner, and GH priorities90, 98, 102, 103

Contribute to professional development and research capacity building

Provide access to NA institutional seed funding for LMIC partners97, 100

Equity in training opportunities for LMIC and NA collaborators17, 90, 102

Provide research training at partner site96, 98, 101, 102

Support leadership development of LMIC collaborators90, 96, 98, 102

Strengthen research infrastructure98, 102

Incorporate mentoring of LMIC collaborators and research trainees as part of partnerships97, 99, 101

Evaluation Evaluation of research partnerships for ongoing improvement17

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the potential for collaboration. Departments have addressed this challenge by creating divisions or centers of global pediatrics, which bring GCH researchers together, and by joining and supporting institution-wide centers for GH.111, 112

NA departments of pediatrics face particular challenges in meeting the best practice of engaging in GCH research that aligns with LMICs’ local and national research priorities. Funding for department-based GCH research is usually secured through NA-based principal investigators. NA investigators who are not fully engaged in a mutually beneficial partnership model of research with their LMIC collaborators may design research studies poorly aligned with local and/or national priorities, which may fail to substantially benefit local populations.† US funding agencies are increasingly providing funding to projects with primary LMIC institutions and principal investigators and initiatives with clear partnerships between NA and LMIC institutions.113

In addition to creating a shared research agenda, NA departments of pediatrics must address the challenge of making a clear commitment to supporting the professional development of LMIC researchers and research infrastructure as part of their partnerships.90, 96 – 98, 100 – 103 Failure to attend to these factors results in inequitable partnerships that hinder successful research and the development of long-term collaborations.17 Departments have promoted professional development and research infrastructure within LMICs by providing training either locally or online in core GH research competencies.114 NA partners have also offered access and support for LMIC collaborators to participate in certificate or degree programs91

† Refs 37, 65, 90, 96, 97, 99, 102, 103.

and have provided training, professional development, and networking opportunities for LMIC research partners. NA partners must also acknowledge, highlight, and emphasize the value of professional development gained by NA partner researchers through learning from their LMIC colleagues.

CONCLUSIONS AND NEXT STEPS

In this review, we feature examples of how NA departments of pediatrics have successfully overcome challenges in engaging and expanding their role in GCH; however, challenges remain. NA departments should expand and strengthen advocacy efforts to address health equity. Specifically, advocacy is needed for the health concerns of diverse underserved children globally, for overcoming barriers to bidirectionality and mutual benefit in partnerships with LMIC institutions, and for greater research funding for GCH, with a substantial proportion of this funding going to LMIC institutions and investigators.

Additional work in monitoring and evaluation is also needed to better understand the outcomes in GCH programs to inform future improvements. Specifically, evaluations are needed related to the goals of health equity and improving child health, including evaluations to measure the extent to which GCH initiatives result in greater access to health services and interventions for all children; to assess the impact on trainees and faculty members of participating in GCH education and clinical practice experiences; and to monitor GCH-trained pediatricians’ career choices to provide health care to underserved populations and to monitor the discovery and dissemination of new interventions through GCH research. Health outcomes studies are also needed to determine the impact on US health outcomes of

GCH-trained pediatricians and on health outcomes at partner sites to determine if collaborating with NA departments of pediatrics impacts local health outcomes. Finally, more evaluations of partnerships are needed with several proposed evaluation models.15, 115 If goals are not being met, programs must seek to understand the issues impeding success and modify their programs to address these obstacles.

Adoption of the GCH best practices described in this review could lead to innovations in education, clinical practice, research, and advocacy efforts that reduce health inequity and improve health for all children. Through robust training and strong partnerships, departments of pediatrics can inspire the next generation of pediatricians to contribute to the often challenging but deeply fulfilling work of improving child health globally.

ACKNOWLEDGMENTS

We thank the following contributors to this article: Valerie Haig of the American Board of Pediatrics for administrative support and Bonita Stanton, Virginia Moyer, and D. Wade Clapp for their thoughtful review of the manuscript. The following American Board of Pediatrics Global Health Task Force members are nonauthor contributors: Maneesh Batra, Sabrina Butteris, Christopher Cunha, Jonathan Klein, David Nichols, Cliff O’Callahan, Nicole St Clair, and Andrew Steenhoff.

PEDIATRICS Volume 142, number 1, July 2018 9

ABBREVIATIONS

BMC:  Bugando Medical CentreGCH:  global child healthGH:  global healthHIC:  high-income countryLMIC:  low- and middle-income

countryNA:  North American

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REFERENCES

1. American Academy of Pediatrics. AAP agenda for children: health equity. Available at: https:// www. aap. org/ en- us/ about- the- aap/ aap- facts/ AAP- Agenda- for- Children- Strategic- Plan/ pages/ AAP- Agenda- for- Children- Strategic- Plan- Health- Equity. aspx. Accessed July 20, 2017

2. Sachs JD. From millennium development goals to sustainable development goals. Lancet. 2012;379(9832):2206–2211

3. Braveman PA. Monitoring equity in health and healthcare: a conceptual framework. J Health Popul Nutr. 2003;21(3):181–192

4. World Health Organization. New perspectives on global health spending for universal health coverage. Available at: www. who. int/ health_ financing/ topics/ resource- tracking/ new_ perspectives_ on_ global_ health_ spending_ for_ uhc. pdf? ua= 1. Accessed January 30, 2018

5. UN Inter-agency Group for Child Mortality Estimation. Levels and trends in child mortality: report 2015. Available at: https:// www. unicef. org/ publications/ files/ Child_ Mortality_ Report_ 2015_ Web_ 9_ Sept_ 15. pdf. Accessed January 30, 2018

6. World Health Organization. World health statistics 2015. Available at: www. who. int/ gho/ publications/ world_ health_ statistics/ 2015/ en/ . Accessed November 28, 2017

7. Centers for Disease Control and Prevention. Infant mortality. Available at: https:// www. cdc. gov/ reproductivehealt h/ maternalinfanthea lth/ infantmortality. htm. Accessed November 28, 2017

8. Koplan JP, Bond TC, Merson MH, et al; Consortium of Universities for Global Health Executive Board. Towards a common definition of global health. Lancet. 2009;373(9679):1993–1995

9. World Health Organization. Global health workforce shortage to reach 12.9 million in coming decades. Available at: www. who. int/ mediacentre/ news/ releases/ 2013/ health- workforce- shortage/ en/ . Accessed September 10, 2016

10. Slusher TM, Olusanya BO, Vreman HJ, et al. A randomized trial of phototherapy with filtered sunlight in African neonates. N Engl J Med. 2015;373(12):1115–1124

11. Guay LA, Musoke P, Fleming T, et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet. 1999;354(9181): 795–802

12. Asgary R, Junck E. New trends of short-term humanitarian medical volunteerism: professional and ethical considerations. J Med Ethics. 2013;39(10):625–631

13. National Institute for Health and Care Excellence. Guidance and advice list. Available at: https:// www. nice. org. uk/ guidance/ published? type= apg, csg, cg, mpg, ph , sg, sc. Accessed December 19, 2017

14. Macrae DJ. The Council for International Organizations and Medical Sciences (CIOMS) guidelines on ethics of clinical trials. Proc Am Thorac Soc. 2007;4(2):176–178; discussion 178–179

15. Steenhoff AP, Crouse HL, Lukolyo H, et al; GH Task Force of the American Board of Pediatrics. Partnerships for global child health. Pediatrics. 2017;140(4):e20163823

16. Crump JA, Sugarman J; Working Group on Ethics Guidelines for Global Health Training. Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg. 2010;83(6):1178–1182

17. John CC, Ayodo G, Musoke P. Successful global health research partnerships: what makes them work? Am J Trop Med Hyg. 2016;94(1):5–7

18. Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117–125

19. Torjesen K, Mandalakas A, Kahn R, Duncan B. International child health electives for pediatric

GLADDING et al10

Drs Moore and Lieh-Lai contributed to the conception and design of the manuscript, assisted with literature reviews, drafted the global child health clinical practice sections, provided content expertise, and critically reviewed the manuscript; Drs Opoka and Howard contributed to the conception and design of the manuscript, provided content expertise, and critically reviewed the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

This paper is one of a series of papers conceptualized and produced by the Global Health Task Force of the American Board of Pediatrics. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Board of Pediatrics or the American Board of Pediatrics Foundation.

DOI: https:// doi. org/ 10. 1542/ peds. 2017- 2966

Accepted for publication Apr 12, 2018

Address correspondence to Sophia P. Gladding, PhD, Departments of Medicine and Pediatrics, University of Minnesota, 141 VCRC, 410 E. River Parkway, Minneapolis, MN 55455. E-mail: gladd001@umn.edu

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2018 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

FUNDING: Supported in part by the American Board of Pediatrics Foundation.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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residents. Arch Pediatr Adolesc Med. 1999;153(12):1297–1302

20. Butteris SM, Schubert CJ, Batra M, et al. Global health education in US pediatric residency programs. Pediatrics. 2015;136(3):458–465

21. Howard CR, Gladding SP, Kiguli S, Andrews JS, John CC. Development of a competency-based curriculum in global child health. Acad Med. 2011;86(4):521–528

22. Monroe-Wise A, Kibore M, Kiarie J, et al. The Clinical Education Partnership Initiative: an innovative approach to global health education. BMC Med Educ. 2014;14:1043

23. Asgary R, Price J, Ripp J. Global health training starts at home: a unique US-based global health clinical elective for residents. Med Teach. 2012;34(6):e445–e451

24. Global Child Health Education Consortium. The global pediatric curriculum. Available at: www. globalpediatrics. org/ globalcurriculum. html. Accessed August 24, 2017

25. Suchdev PS, Shah A, Derby KS, et al. A proposed model curriculum in global child health for pediatric residents. Acad Pediatr. 2012;12(3):229–237

26. Campagna AM, St Clair NE, Gladding SP, Wagner SM, John CC. Essential factors for the development of a residency global health track. Clin Pediatr (Phila). 2012;51(9):862–871

27. Eneriz-Wiemer M, Nelson BD, Bruce J, Chamberlain LJ. Global health training in pediatric residency: a qualitative analysis of faculty director insights. Acad Pediatr. 2012;12(3):238–244

28. Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P. Global health in medical education: a call for more training and opportunities. Acad Med. 2007;82(3):226–230

29. Ozgediz D, Wang J, Jayaraman S, et al. Surgical training and global health: initial results of a 5-year partnership with a surgical training program in a low-income country. Arch Surg. 2008;143(9):860–865; discussion 865

30. Dacso M, Chandra A, Friedman H. Adopting an ethical approach to global health training: the evolution of the Botswana - University of

Pennsylvania partnership. Acad Med. 2013;88(11):1646–1650

31. Karwowski MP, Nelson JM, Staples JE, et al. Zika virus disease: a CDC update for pediatric health care providers. Pediatrics. 2016;137(5):e20160621

32. Schwartz KR, Vinci R. Imported pediatric malaria presenting to an urban pediatric emergency department: a case series. Pediatr Emerg Care. 2012;28(12):1385–1388

33. Hall V, Banerjee E, Kenyon C, et al. Measles outbreak - Minnesota April-May 2017. MMWR Morb Mortal Wkly Rep. 2017;66(27):713–717

34. Baird R, Poenaru D, Ganey M, Hansen E, Emil S. Partnership in fellowship: comparative analysis of pediatric surgical training and evaluation of a fellow exchange between Canada and Kenya. J Pediatr Surg. 2016;51(10):1704–1710

35. Busse H, Azazh A, Teklu S, et al. Creating change through collaboration: a twinning partnership to strengthen emergency medicine at Addis Ababa University/Tikur Anbessa Specialized Hospital–a model for international medical education partnerships. Acad Emer Med. 2013;20(12):1310–1318

36. Kaddumukasa M, Katabira E, Salata RA, et al. Global medical education partnerships to expand specialty expertise: a case report on building neurology clinical and research capacity. Hum Resour Health. 2014;12:75

37. Rodriguez-Galindo C, Friedrich P, Alcasabas P, et al. Toward the cure of all children with cancer through collaborative efforts: pediatric oncology as a global challenge. J Clin Oncol. 2015;33(27):3065–3073

38. Demise A, Gebrehiwot Y, Worku B, Spector JM. Prospective audit of avoidable factors in institutional stillbirths and early neonatal deaths at Tikur Anbessa Hospital in Addis Ababa, Ethiopia. Afr J Reprod Health. 2015;19(4):78–86

39. International Neonatal Training Program, Shanghai Children’s Hospital of Fudan University and the Canadian Neonatal Network. The International Training Program in Neonatal-Perinatal Medicine in Shanghai. Available at:

www. canadianneonataln etwork. org/ portal/ CNNHome/ TrainingProgram. aspx. Accessed January 21, 2017

40. Olness K, Torjesen H. Use of volunteers to help launch a pediatric residency program in Laos. Ambul Child Health. 2001;7(2):109–116

41. Gordon G, Vongvichit E, Hansana V, Torjesen K. A model for improving physician performance in developing countries: a three-year postgraduate training program in Laos. Acad Med. 2006;81(4):399–404

42. McQuilkin P, Marshall RE, Niescierenko M, et al. A successful US academic collaborative supporting medical education in a postconflict setting. Glob Pediatr Health. 2014;1:2333794X14 563383

43. Smith JM, de Graft-Johnson J, Zyaee P, Ricca J, Fullerton J. Scaling up high-impact interventions: how is it done? Int J Gynaecol Obstet. 2015;130(suppl 2):S4–S10

44. Wall SN, Lee AC, Carlo W, et al. Reducing intrapartum-related neonatal deaths in low- and middle-income countries-what works? Semin Perinatol. 2010;34(6):395–407

45. Adler E, Alexis C, Ali Z, et al. Bridging the distance in the Caribbean: telemedicine as a means to build capacity for care in paediatric cancer and blood disorders. Stud Health Technol Inform. 2015;209:1–8

46. Vassallo DJ, Hoque F, Roberts MF, Patterson V, Swinfen P, Swinfen R. An evaluation of the first year’s experience with a low-cost telemedicine link in Bangladesh. J Telemed Telecare. 2001;7(3): 125–138

47. Engle X, Aird J, Tho L, et al. Combining continuing education with expert consultation via telemedicine in Cambodia. Trop Doct. 2014;44(2):62–68

48. Wootton R, Geissbuhler A, Jethwani K, et al. Long-running telemedicine networks delivering humanitarian services: experience, performance and scientific output. Bull World Health Organ. 2012;90(5):341–347D

49. Ganapathi L, Martins Y, Schumann D, Russ, C. Overcoming challenges to develop pediatric postgraduate training programs in low- and

PEDIATRICS Volume 142, number 1, July 2018 11 by guest on July 7, 2020www.aappublications.org/newsDownloaded from

middle-income countries. Educ Health (Abingdon). 2014;27(3): 277–282

50. Russ CM, Ganapathi L, Marangu M, et al. Perspectives of host faculty and trainees on international visiting faculty to paediatric academic departments in East Africa. BMJ Glob Health. 2016;1(3):e000097

51. Melby MK, Loh LC, Evert J, Prater C, Lin H, Khan OA. Beyond medical “missions” to impact-driven short-term experiences in global health (STEGHs): ethical principles to optimize community benefit and learner experience. Acad Med. 2016;91(5):633–638

52. Kraeker C, Chandler C. “We learn from them, they learn from us”: global health experiences and host perceptions of visiting health care professionals. Acad Med. 2013;88(4):483–487

53. Bozinoff N, Dorman KP, Kerr D, et al. Toward reciprocity: host supervisor perspectives on international medical electives. Med Educ. 2014;48(4):397–404

54. Archer N, Moschovis PP, Le PV, Farmer P. Perspective: postearthquake Haiti renews the call for global health training in medical education. Acad Med. 2011;86(7):889–891

55. 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. Acad Pediatr. 2016;16(4):387–393

56. Brewer TF, Saba N, Clair V. From boutique to basic: a call for standardised medical education in global health. Med Educ. 2009;43(10):930–933

57. Federico SG, Zachar PA, Oravec CM, Mandler T, Goldson E, Brown J. A successful international child health elective: the University of Colorado Department of Pediatrics’ experience. Arch Pediatr Adolesc Med. 2006;160(2):191–196

58. Balmer DF, Marton S, Gillespie SL, Schutze GE, Gill A. Reentry to pediatric residency after global health experiences. Pediatrics. 2015;136(4):680–686

59. Sivakumaran L, Ayinde T, Hamadini F, et al. Support infrastructure available to Canadian residents completing post-graduate global health electives: current state and future directions. Can Med Educ J. 2016;7(3):e41–e50

60. Purkey E, Hollaar G. Developing consensus for postgraduate global health electives: definitions, pre-departure training and post-return debriefing. BMC Med Educ. 2016;16:159

61. Butler MW, Ozgediz D, Poenaru D, et al. The Global Paediatric Surgery Network: a model of subspecialty collaboration within global surgery. World J Surg. 2015;39(2):335–342

62. Pitt MB, Gladding SP, Majinge CR, Butteris SM. Making global health rotations a two-way street: a model for hosting international residents. Glob Pediatr Health. 2016;3:2333794X16 630671

63. Bodnar BE, Claassen CW, Solomon J, Mayanja-Kizza H, Rastegar A. The effect of a bidirectional exchange on faculty and institutional development in a global health collaboration. PLoS One. 2015;10(3):e0119798

64. Binagwaho A, Kyamanywa P, Farmer PE, et al. The human resources for health program in Rwanda–new partnership. N Engl J Med. 2013;369(21): 2054–2059

65. Iserson KV, Biros MH, James Holliman C. Challenges in international medicine: ethical dilemmas, unanticipated consequences, and accepting limitations. Acad Emerg Med. 2012;19(6):683–692

66. Einterz RM, Kimalyo S, Mengech HN, et al. Responding to the HIV pandemic: the power of an academic medical partnership. Acad Med. 2007;82(8):812–818

67. Rabin TL, Mayanja-Kizza H, Rastegar A. Medical education capacity-building partnerships for health care systems development. AMA J Ethics. 2016;18(7):710–717

68. Stanton B, Huang CC, Armstrong RW, et al. Global health training for pediatric residents. Pediatr Ann. 2008;37(12):786–787, 792–796

69. Suchdev P, Ahrens K, Click E, Macklin L, Evangelista D, Graham E. A model for sustainable short-term international

medical trips. Ambul Pediatr. 2007;7(4):317–320

70. Pitt MB, Moore MA, John CC, et al; American Board of Pediatrics Global Health Task Force. Supporting global health at the pediatric department level: why and how. Pediatrics. 2017;139(6):e20163939

71. Canadian Pediatric Society. Global child health curriculum. Available at: www. cps. ca/ en/ curriculum. Accessed August 24, 2017

72. Consortium of Universities for Global Health. Global child health educational modules project. Available at: https:// www. cugh. org/ training- module- topic- area/ global- child- health- gchemp. Accessed August 24, 2017

73. University of Minnesota. Global pediatrics education series. Available at: http:// globalpeds. umn. edu/ gpeds. Accessed August 24, 2017

74. Association of Pediatric Program Directors. Global Health Learning Community Resources for Global Health Education. Available at: https:// sites. google. com/ umn. edu/ peds- global- health- ed/ home/ resources. Accessed August 24, 2017

75. St Clair NE, Fischer PR, Hagen SA, et al. Midwest consortium of global child health educators: local collaboration to strengthen global education. Ann Glob Health. 2014;80(3):178

76. Harrison JD, Logar T, Le P, Glass M. What are the ethical issues facing global-health trainees working overseas? A multi-professional qualitative study. Healthcare (Basel). 2016;4(3):E43

77. Snyder J, Dharamsi S, Crooks VA. Fly-by medical care: conceptualizing the global and local social responsibilities of medical tourists and physician voluntourists. Global Health. 2011;7:6

78. Roberts M. A piece of my mind. Duffle bag medicine. JAMA. 2006;295(13):1491–1492

79. Butteris SM, Gladding SP, Eppich W, Hagen SA, Pitt MB; SUGAR Investigators. Simulation use for global away rotations (SUGAR): preparing residents for emotional challenges abroad–a multicenter study. Acad Pediatr. 2014;14(5):533–541

80. Wilson LL, Somerall D, Theus L, Rankin S, Ngoma C, Chimwaza A. Enhancing

GLADDING et al12 by guest on July 7, 2020www.aappublications.org/newsDownloaded from

global health and education in Malawi, Zambia, and the United States through an interprofessional global health exchange program. Appl Nurs Res. 2014;27(2):97–103

81. Wilmshurst JM, Morrow B, du Preez A, Githanga D, Kennedy N, Zar HJ. The African Pediatric Fellowship Program: training in Africa for Africans. Pediatrics. 2016;137(1):e20152741

82. Burdick W. Challenges and issues in health professions education in Africa. Med Teach. 2007;29(9):882–886

83. Nightingale K. Laos builds specialty training system through partnerships. Lancet. 2011;378(9792):653–654

84. Vermont Oxford Network. Global health initiatives. Available at: https:// public. vtoxford. org/ about- us/ global- health- initiatives/ . Accessed January 21, 2017

85. Uejima T. Medical missions and medical malpractice: the current state of medical malpractice overseas. ASA Newsl. 2011;75(2):22–24

86. Sykes KJ. Short-term medical service trips: a systematic review of the evidence. Am J Public Health. 2014;104(7):e38–e48

87. St Clair NE, Pitt MB, Bakeera-Kitaka S, et al; Global Health Task Force of the American Board of Pediatrics. Global health: preparation for working in resource-limited settings. Pediatrics. 2017;140(5):e20163783

88. Dixon CA, Castillo J, Castillo H, Hom KA, Schubert C. Global health opportunities within pediatric subspecialty fellowship training programs: surveying the virtual landscape. BMC Med Educ. 2013; 13:88

89. Nelson BD, Herlihy JM, Burke TF. Proposal for fellowship training in pediatric global health. Pediatrics. 2008;121(6):1261–1262

90. Tierney WM, Nyandiko WN, Siika AM, et al. “These are good problems to have…”: establishing a collaborative research partnership in East Africa. J Gen Intern Med. 2013;28(suppl 3):S625–S638

91. Daniels J, Nduati R, Farquhar C. Kenyan women medical doctors and their motivations to pursue international research training. Educ Health (Abingdon). 2013;26(2):89–97

92. Nduati R, John G, Mbori-Ngacha D, et al. Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial. JAMA. 2000;283(9):1167–1174

93. Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database Syst Rev. 2002;(1):CD002847

94. Phillips-Howard PA, Nahlen BL, Kolczak MS, et al. Efficacy of permethrin-treated bed nets in the prevention of mortality in young children in an area of high perennial malaria transmission in western Kenya. Am J Trop Med Hyg. 2003;68(suppl 4):23–29

95. Munos MK, Walker CL, Black RE. The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality. Int J Epidemiol. 2010;39(suppl 1):i75–i87

96. Laabes EP, Desai R, Zawedde SM, Glew RH. How much longer will Africa have to depend on western nations for support of its capacity-building efforts for biomedical research? Trop Med Int Health. 2011;16(3):258–262

97. Zacharin M, Chanoine JP, Cassoria F, et al; l 70 Global Pediatric Endocrinology and Diabetes Active Members. Promoting excellence in the care of pediatric endocrine diseases in the developing world. Pediatrics. 2013;131(2). Available at: www. pediatrics. org/ cgi/ content/ full/ 131/ 2/ e573

98. Lau CY, Wang C, Orsega S, et al. International collaborative research partnerships: blending science with management and diplomacy. J AIDS Clin Res. 2014;5(12):385

99. Walker RJ, Campbell JA, Egede LE. Effective strategies for global health research, training and clinical care: a narrative review. Glob J Health Sci. 2014;7(2):119–139

100. de-Graft Aikins A, Arhinful DK, Pitchforth E, Ogedegbe G, Allotey P, Agyemang C. Establishing and sustaining research partnerships in Africa: a case study of the UK-Africa academic partnership on chronic disease. Global Health. 2012;8:29

101. Ramaswamy R, Kallam B, Kopic D, Pujic B, Owen MD. Global health

partnerships: building multi-national collaborations to achieve lasting improvements in maternal and neonatal health. Global Health. 2016;12(1):22

102. Beran D, Byass P, Gbakima A, et al. Research capacity building-obligations for global health partners. Lancet Glob Health. 2017;5(6):e567–e568

103. Olusanya BO, Opoka RO. Obligations under global health partnerships in LMICs should be contractual. Lancet Glob Health. 2017;5(9):e869

104. National Institutes of Health. Grants and funding. Available at: https:// grants. nih. gov/ grants/ oer. htm. Accessed October 3, 2016

105. Heimburger DC, Carothers CL, Gardner P, Primack A, Warner TL, Vermund SH. Nurturing the global workforce in clinical research: the National Institutes of Health Fogarty International Clinical Scholars and Fellows Program. Am J Trop Med Hyg. 2011;85(6):971–978

106. Doris Duke Charitable Foundation. Medical research grants. Available at: http:// www. ddcf. org/ what- we- fund/ medical- research/ . Accessed October 3, 2016

107. National Institutes of Health Fogarty International Center. Global brain disorders research grants. Available at: https:// www. fic. nih. gov/ Programs/ Pages/ brain- disorders. aspx. Accessed August 11, 2017

108. Department of Health and Human Services. PAR-13-072: International Research Scientist Development Award (IRSDA (K01). Available at: https:// grants. nih. gov/ grants/ guide/ pa- files/ PAR- 13- 072. html. Accessed August 24, 2017

109. Bill and Melinda Gates Foundation. Grant opportunities. Available at: https:// www. gatesfoundation. org/ How- We- Work. Accessed August 11, 2017

110. Thrasher Research Fund. E.W. "Al" Thrasher and Early Career awards. Available at: https:// www. thrasherresearch. org/ SitePages/ which- grant. aspx. Accessed August 11, 2017

111. Suchdev PS, Breiman RF, Stoll BJ. Global child health: a call to collaborative action for academic

PEDIATRICS Volume 142, number 1, July 2018 13 by guest on July 7, 2020www.aappublications.org/newsDownloaded from

health centers. JAMA Pediatr. 2014;168(11):983–984

112. Coalition for Centres in Global Child Health. Coalition description. Available at: https:// www. gchcoalition. com/ about. html. Accessed August 11, 2017

113. Breman JG, Bridbord K, Kupfer LE, Glass RI. Global health: the Fogarty International Center, National Institutes of Health: vision and mission, programs, and accomplishments. Infect Dis Clin North Am. 2011;25(3):511–536, vii

114. Ton TG, Gladding SP, Zunt JR, et al. The development and implementation of

a competency-based curriculum for training in global health research. Am J Trop Med Hyg. 2015;92(1): 163–171

115. Tropical Health & Education Trust. Monitoring and evaluation planning tool. Available at: https:// www. thet. org/ wp- content/ uploads/ 2017/ 09/ Monitoring- and- evaluation- plan. pdf. Accessed December 19, 2017

116. Koster MP, Williams JH, Gautier J, Alce R, Trappey BE. A sustained partnership between a Haitian children’s hospital and North American academic medical centers. Front Public Health. 2017;5:122

117. Aristizabal P, Fuller S, Rivera R, Beyda D, Ribeiro RC, Roberts W. Improving pediatric cancer care disparities across the United States-Mexico border: lessons learned from a transcultural partnership between San Diego and Tijuana. Front Public Health. 2015;3:159

118. Rojas MA, Lozano JM, Rojas MX; Colombian Neonatal Research Network. International collaborative research: a Colombian model that promotes infant health and research capacity [published correction appears in J Perinatol. 2007;27(12):808]. J Perinatol. 2007;27(12):738–743

GLADDING et al14 by guest on July 7, 2020www.aappublications.org/newsDownloaded from

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