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Vanderbilt Collaborative for Global Health Equity

Please visit the updated VCGHE webpage at  https://www.vumc.org/global-health/vanderbilt-collaborative-global-health-equity

Program Overview

The Vanderbilt Collaborative for Global Health Equity (VCGHE) exists to provide high-level training for graduate medical trainees (i.e. VUMC Residents) seeking to integrate global health service, research, education and development into their professional careers.

VCGHE aims to use a combination of multidisciplinary and specialty-specific didactic teaching, small group discussion, mentorship, research and practical clinical experiences to build the knowledge, skills and attitudes expected of physicians competent in global health work. This will be accomplished through a curriculum shared among all programs with monthly modules covering global health foundations for resident participants in their first year followed by specialty-specific education for residents in the remainder of the program.

General Course Information

Program Expectations

  • Participants are expected to attend and participate in 80% of sessions.
  • Class preparation includes completing reading assignments, which should take no more than 2 hours monthly.
  • Participants are expected to post a discussion in the class discussion board at least 8 times throughout the course, and post replies to others’ discussions at least 8 times throughout the course.
  • Residents enrolled in the Global Health Equity and Access Leadership in Surgery certificate program are required to complete this course as part of their training.

Program Syllabus

Textbook and Primary Resources

  • “Reimagining Global Health: An Introduction” by Paul Farmer, Jim Yong Kim, Arthur Kleinman, Matthew Basilico. University of California Press, 2013. https://www.amazon.com/Reimagining-Global-Health-Introduction-Anthropology/dp/0520271998
  • Consortium of Universities for Global Health (CUGH) Competency Sub-Committee (2018). CUGH Global Health Education Competencies Tool Kit (2nd edition), Washington, DC.

Program Orientation PowerPoint

Discussion Board

Monthly Modules

Learning Objectives

  • Describe the major causes of morbidity and mortality around the world
  • Describe major public health efforts to reduce disparities in global health
  • Become familiar with various metrics used to measure the quality of and track improvement of a healthcare system

Milestones

  • CUGH Global Health Competencies 1a, 1b
  • ACGME Milestones: Systems-based practice, practice-based learning and improvement

Pre-reading and viewing list

Required preparation – Be prepared to discuss the following

  • Based on the readings, write a 1-2 sentence definition of global health. Be prepared to discuss how your definition reflects concerns of high and low-resource settings, can influence policy and research toward improving global health, and distinguishes global health from other related health domains (international health, public health, etc.).
  • Based on your definition of global health, what distinguishes education in global health from general medical education? What educational priorities are different? Which priorities overlap?
  • Summarize key findings from GBD 2017. What stands out to you? What are some possible factors that account for recent trends?
  • How might a focus on ‘Global Health Delivery’ change the approach to addressing problems in global health? Give examples of major public health efforts that take a health delivery or biosocial approach to reducing disparities in global health.
  • Consider this statement: “Many failures in global health can be attributed to a lack of historical reflection and biosocial analysis.” Why is this the case? What examples can you cite?

Discussion leaders

  • Merranda Holmes
  • Michael Dewan

Meeting recording

Learning Objectives

  • Describe different national models or health systems for provision of healthcare and their respective effects on health and healthcare expenditure.
  • Describe how global trends in healthcare practice, commerce and culture, multinational agreements and multinational organizations contribute to the quality and availability of health and healthcare locally and internationally.
  • Describe general trends and influences in the global availability and movement of health care workers

Milestones

  • CUGH Global Health Competencies 2a, 2b, 2d
  • ACGME Milestones: Systems-based practice, practice-based learning and improvement

Pre-reading and viewing list

Required preparation – Be prepared to discuss the following

  • Describe the building blocks of health systems. How does considering the interrelatedness of these components influence efforts to provide health systems strengthening? What are examples?
  • What are the key components of Universal Health Coverage (UHC), and what are the models of health care systems that can most effectively promote UHC
  • Using the WHO Workforce 2030 document, describe general trends and influences in the global availability and movement of healthcare workers. Choose one objective from Workforce 2030 and summarize a policy option proposed for LMICs to advance toward stated milestones.
  • Define universal healthcare and the current focus on its growth globally
  • What are they key elements of a high-quality health system? Is there a difference between high-, middle- and low-income countries?
  • Identify various stakeholders in global healthcare market. What are their interests and how do they affect operations at the country level?

Additional resources

Discussion leader

  • Matt Kynes

Meeting recording

Learning Objectives

  • Describe how cultural context influences perceptions of health and disease.
  • List major social and economic determinants of health and their impacts on health services and morbidity and mortality.
  • Describe the relationship between access to and quality of water, sanitation, food and air on individual and population health.

Milestones 

  • CUGH Global Health Competencies 3a, 3b, 3c
  • ACGME Milestones: Medical knowledge, Practice-based learning and improvement, Systems-based practice

Pre-reading and viewing list (Box link with hard-to-access article PDFs)

Required preparation – Be prepared to discuss the following

  • Describe a sociocultural approach to health.
  • Choose an example of a communicable or non-communicable disease and describe biosocial factors responsible for their prevalence in low/middle income countries.
  • Describe two cultural practices that promote health. Describe two cultural practices that are harmful.
  • Think about and be prepared to discuss an example.  Illustrate your ability to apply concepts of social determinants of health inequities by answering the following questions about a community of your choosing: Is this a healthy community? Are some people healthier than other people in this community? Why or why not?
  • List three different diseases or conditions that can be caused by each of the following: poor water quality; poor sanitation; lack of access to safe, healthy food; and poor air quality.  Consider how global warming affects these diseases and conditions.

Discussion leaders

  • Lindsey Zamora

Additional resources

Meeting recording and slides

Learning Objectives

  • Collaborate with a host or partner organizations to assess the organization’s operational capacity.
  • Co-create strategies with the community to strengthen community capabilities and contribute to reduction in health disparities and improvement of community health.
  • Integrate community assets and resources to improve the health of individuals and populations.

Milestones

  • CUGH Global Health Competencies 4a, 4b, 4c
  • ACGME Milestones: Systems-based practice, practice-based learning and improvement

Pre-reading and viewing list (articles can be viewed in this Box folder)

Required preparation – Be prepared to discuss the following

  • How critical is the role of the Public Sector/Government in capacity strengthening?
  • What are the factors influencing Human Capital Flight (“Brain Drain” and “Brain Gain”) What are the net costs and net benefits for the migrants and countries involved? What are some of the possible solutions to Human Capital Flight?

Bonus questions

  • Based on the readings, how would you definite Capacity Strengthening? What are some of the core indicators or measures of capacity Strengthening? How do we evaluate the outcomes or impacts of capacity strengthening efforts?
  • How would you apply concepts from readings to how you might form your own partnerships with organizations or communities?

Discussion leaders

  • Joseline Haizel-Cobbina, MBChB, MPH
  • Christopher Bonfield, MD

Additional resources

  • Wallerstein N, Muhammad M, Sanchez-Youngman S, et al. Power Dynamics in Community-Based Participatory Research: A Multiple–Case Study Analysis of Partnering Contexts, Histories, and Practices. Health Educ Behav. 2019;46(1_suppl):19S-32S. doi:10.1177/1090198119852998
  • World Health Organization, ed. Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies. World Health Organization; 2010
  • Duncan, D. H. (2012). The classic duo: Accountability and community development can help unlock an abundance of resources. Public Management Magazine, 20–23.
  • Loh LC, Cherniak W, Dreifuss BA, Dacso MM, Lin HC, Evert J. Short term global health experiences and local partnership models: a framework. Glob Health. 2015;11(1):50. doi:10.1186/s12992-015-0135-7

Meeting recording

Learning Objectives

  • Understand what it means to collaborate/partner with diverse stakeholders to establish a successful academic partnership.
  • Identify key concepts of successful academic partnerships.
  • Discuss why building trust with local community members/stakeholders is the cornerstone to successful projects, research and programs.

Milestones

  • CUGH Global Health Competencies 5a, 5b, 5f
  • ACGME Milestones: Systems-Based Practice, Professionalism, Interpersonal and Communication Skills

Pre-reading and viewing list (articles can be viewed in this Box folder)

Required preparation – Be prepared to discuss the following

  • What does it mean to establish academic partnerships?
  • What are key components in establishing and maintaining successful academic partnerships?
  • What does community based participatory research project mean? Discuss several tactics for building and maintaining trust with community from a research project standpoint?
  • Be prepared to use the knowledge gained from your required reading to participate in a panel discussion about projects that did and did not involve key community stakeholders and how this lead to the success/failure of projects. Additionally, we will be discussing the Safe Water project in more detail during small group.

Discussion leaders

  • Kristen Dettorre 
  • Panel discussion leaders:  BethAnn Yakes (Vanderbilt, Luke 9:2 Nonprofit), Guyanese EM colleagues 

Additional resources 

Meeting recording

Learning Objectives

  • Apply social justice and human rights principles in addressing global health problems.
  • Understand the unique challenges facing immigrant populations worldwide in obtaining and navigating healthcare.

Milestones

  • CUGH Global Health Competencies: 8a, 8c, 8e, 8f, 11a, 11c
  • ACGME Milestones: Patient care, Medical knowledge, Professionalism, Practice-based learning and improvement, Systems-based practice

Pre-reading and viewing list (articles can be viewed in this Box folder)

Required preparation – Be prepared to discuss the following 

  • Identify a social justice issue that faces your community and propose a strategy to enhance social justice and address this issue.
  • Identify an ethnic group in your community. What health disparities exist in this group? Reflect on what you learn with regard to their access to health services, including mental health services, what language barriers exist, what biases did you observe from others or your own? Think about what you learned and how you would apply this in a global health setting.

Discussion leaders

  • Lindsey Zamora
  • Siloam Healthcare

Additional resources 

Meeting recording

Milestones

  • CUGH domain: 7b, 7c, 11c
  • CUGH domain: 2d, 4a, 4b, 4c, 5a, 5b, 5d, 53, 5f, 9a, 9b, 11a, 11c, 11d

Pre-reading and viewing list (articles can be viewed in this Box folder)

  • Maternal Health on the Global Stage. https://my.vanderbilt.edu/globalhealth/projectdevelopment/topical-modules/
  • Wiggs H. Maternal health: An overview. VIGH Global Health Education Videos. https://www.youtube.com/watch?v=PXM1UE9uHBM&list=PLLPXs6I58e7cN3Y85o5wSJC4Oeft5sVBK&index=27 [7:57]
  • Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2:e323-33
  • TA Reynolds. The impact of trauma care systems in low-and-middle income countries. Annu Rev Public Health. 2017 Mar 20:38;507-532.
  • Hunter DJ, Reddy KS. Noncommunicable diseases. N Engl J Med. 2013;369(14):1336-1343.
  • Saving lives, spending less: A strategic response to noncommunicable diseases. Geneva, Switzerland. World Health Organization; 2018 (WHO/NMH/NVI/18.8). License: CC BY-NC-SA 3.0 IGO
  • Disease Control Priorities, Vol. 3 – Essential Surgery. Chapter 15 “Anesthesia and Perioperative Care” http://dcp-3.org/chapter/1796/anesthesia-and-perioperative-care
  • Law TJ, Lipnick M, Joshi M, Rath GP, Gelb AW. The path to safe and accessible anaesthesia care. The path to safe and accessible anaesthesia care. Indian J Anaesth 2019;63:965-71.
  • “Solving the Global Anesthesia Crisis” by Kelly McQueen. TEDx Nashville, September 2017. https://www.youtube.com/watch?v=tt8_2Qdhexg [15:00]
  • Meara J et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare and economic development. Int J Obstet Anesth 2016 Feb;25:75-8.
  • Farmer PE. Surgery and global health: a view from beyond the OR. World J Surg 2008 Apr;32(4):533-6.
  • Why did Mrs. X die? https://www.youtube.com/watch?v=Ugg-ipHnj6U

Discussion leaders

  • Ryan Belcher

Additional resources 

  • Morgan D. Global cancer: An emerging international health priority. VIGH Global Health Education videos. https://youtu.be/pIjMW-OYOBs [24:00]. 

Meeting recordings: Part 1 and Part 2

Learning Objectives

  • Understand and use various tools of program development, management and evaluation including the Theory of Change (TOC), SMART objectives, logical frameworks, stakeholder mapping, Gantt Charts, and budgets.
  • Apply principles of program management to a global health issue or intervention.
  • Plan, implement and evaluate an evidence-based program.
  • Apply project management techniques throughout program planning, implementation, and evaluation.

Milestones 

  • CUGH Competency 9a: Plan, implement and evaluate an evidence-based program.
  • CUGH Competency 9b: Apply project management techniques throughout program planning, implementation, and evaluation
  • ACGME Milestones: PBLI (problem based learning and improvement), SBP (systems based practice), COMM (communication and interpersonal skills) and PROF (professionalism) 

Pre-reading and viewing list (articles can be accessed in this Box folder)

  • Videos:
  • Articles:
    • W. K. Kellogg Foundation Logic Model Introduction – Retrieved from https://ag.purdue.edu/extension/pdehs/Documents/Pub3669.pdf “This three page chapter concisely “defines logic models and explains their usefulness to program stakeholders. You will learn the relevance of this state-of the-art tool to program planning, evaluation, and improvement.”
    • Hailemariam, M., Fekadu, A., Selamu, M., Alem, A., Medhin, G., Giorgis, T, Breuer, E. (2015). Developing a mental health care plan in a low resource setting: the theory of change approach. BMC Health Services Research, 15(429), 1–11. Retrieved from http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1097-4 “Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an innovative approach that has the potential to assist in the development of a comprehensive mental health care plan, which can inform the delivery of integrated care. We used the ToC approach to develop a MHCP in a rural district in Ethiopia. The work was part of a cross-country study, the Program for Improving Mental Health Care (PRIME) which focuses on developing evidence on the integration of mental health in to primary care.”
    • Loh, L. C., Cherniak, W., Dreifuss, B. A., Dacso, M. M., Lin, H. C., & Evert, J. (2015). Short term global health experiences and local partnership models: A framework. GLOBALIZATION AND HEALTH, 11(1), [50]. https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-015-0135-7
    • Fleming, M. L., Parker, E., Higgins, H., & Gould, T. (2006). A framework for evaluating health promotion programs. Health Promotion Journal of Australia, 17(1), 61–66. Retrieved from http://eprints.qut.edu.au/9440/1/9440.pdf “The focus of this paper is on the essential elements of the evaluation of health promotion programs. It provides methodical framework for the provision of evaluation guidance to health promotion practitioners and discusses the importance of including evaluation when planning any health promotion intervention.”

Required preparation – Be prepared to discuss the following 

  • What are the key principles to consider when planning a community-based or global health program?
  • Propose one SMART objective for evaluating a global health program.
  • In your own words, describe a model for planning and assessing the outcomes of a community-based program.
  • Present the specific steps involved in program planning, implementation and evaluation for a Case Study-based global health issue.
  • Who needs to be involved at the various stages?
  • What organizations will you look to for help in each stage?
  • How do you involve all stakeholders?
  • How would you engage the community in the program planning, implementation and evaluation?
  • In what ways can the development of global programs help and hurt existing national health systems?

Discussion (leaders) 

  • Marie Martin
  • Guest: Reeta Gobin, Dean of the College of Medicine, University of Guyana 

Additional resources
Program development:

  • Unite for Sight Global Health University (n.d.)  Certificate in Effective Program Development. Retrieved from http://www.uniteforsight.org/effective-program-development/certificate. “The Certificate in Effective Program Development provides a comprehensive understanding about program development, outcomes, and evidence-based program design. Participants learn about effective strategies for program development, metrics, and impact.” A majority of the certificate course content is free and open source.

Logic model frameworks:

  • Serowoky, M. L., George, N., & Yarandi, H. (2015). Using the program logic model to evaluate ¡Cuídate!: A sexual health program for Latino adolescents in a school-based health center. Worldviews on Evidence-Based Nursing, 12(5), 297–305. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26422189.  “The ¡Cuídate! program logic model was used as the systematic approach to plan, implement, and evaluate a sustainable model of sexual health group programing in a U.S. high school with a large Latino student population.”

Stakeholder mapping: 

Program evaluation:

  • International Consortium for Health Outcomes Measurement. (n.d.). Retrieved from  http://www.ichom.org/measure  “This resource discusses the journey of finding outcome measurements for a global health program by explaining the process’ stages. A video example and links to further information is also available.”
  • International Initiative for Impact Evaluation. (n.d.). Retrieved from http://www.3ieimpact.org/en/publications  “This resource works to “provide guidance and support to produce, synthesize and quality assure evidence of what works, for whom, how, why and at what cost.” Several publications are available about evaluating impact of global health programs to then use that data to inform decisions, programs and policies.”
  • U.S. Department of Health and Human Services, & Centers for Disease Control and Prevention. (2011). Introduction to program evaluation for public health programs: A self-study guide. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/eval/guide/CDCEvalManual.pdf

Session recording link

Learning Objectives

  • Demonstrate an understanding of and an ability to resolve common ethical issues and challenges that arise when working in low-resource settings to address global health issues.
  • Demonstrate an awareness of local and national codes of ethics relevant to one’s working environment.
  • Apply the fundamental principles of international standards for the protection of human subjects in diverse cultural settings.

Milestones 

  • CUGH domain: 6a, 6b, 6c 
  • ACGME: PC, MK, PRO 

Pre-reading and viewing list (articles can be accessed in this Box folder)

Required preparation – Be prepared to discuss the following 

  • What do you perceive to be the primary ethical concerns when working with healthcare professionals in an unfamiliar setting?
  • How might the educational and professional expectations at your home institution differ from those on your global health elective and how will you manage those conflicts?
  • What ethical considerations accompany global health partnerships, whether they be clinical, educational or research partnerships? What knowledge, attitudes and skills are needed to ensure that these partnerships are mutually beneficial and ethically responsive to home and host institutions?
  • Describe considerations important to the process of informed consent when working in a resource-limited or cross-cultural setting.

Discussion (leaders) 

  • Rondi Kauffmann
  • Anji Wall

Additional resources 

Meeting recording

Learning Objectives

  • Compare the aims of key stakeholders in global health experiences with a focus on areas of alignment and conflict.
  • Reflect on ethically, clinically, and educationally appropriate objectives for short-term experiences in low-resource settings based on needs of all actors involved.

Milestones

  • CUGH 10a: Describe the roles and relationships of the major entities influencing global health and development.
  • ACGME: Systems-based practice, professionalism

Pre-reading and viewing list (articles can be accessed in this Box folder)

Required preparation – Be prepared to discuss the following 

  • What are risks of professionals and trainees participating in short-term global health experiences? What are risks to hosting institutions and communities?
  • How do short-term experiences in global health by professionals from high-resource settings benefit participants? How do they benefit host institutions and communities?
  • What does “mutually beneficial” partnership for institutions engaged in global health education, research and care delivery look like?

Discussion leaders

  • Lindsey Zamora
  • Elizabeth Rose

Additional resources 

Session recording link

Learning Objectives

  • Describe what is meant by the term “structural violence” in the context of the global burden of disease.
  • Elucidate the relationship between poverty and disease, including specific past and present examples.
  • Describe ways to incorporate knowledge of the link between poverty and disease into your practice.

Milestones 

  • CUGH domain: 2c, 3c, 7b, 7c, 11a
  • ACGME Milestones: Systems-based practice, medical knowledge

Pre-reading and viewing list (articles can be accessed in this Box folder)

Required preparation – Be prepared to discuss the following 

  • What are the main factors that determine your personal health? What are the main factors that would determine the health of a poor person in a poor country?
  • If you could only pick one indicator to describe the health status of a poor country, which indicator would you use and why?
  • Summarize how travel and trade contribute to the spread of communicable and chronic diseases.
  • List three different diseases or conditions that can be caused by each of the following: poor water quality; poor sanitation; lack of access to safe, healthy food; and poor air quality.
  • How do barriers to care differ by specialty or service (for example, access to primary care versus to mental healthcare versus to sub specialty care)?

Discussion leader

  • Jon Niconchuk

Additional resources 

Session recording link