Faculty Bibliography

Background: The number of asylum seekers in the US has risen dramatically over the past 10 years. This study aimed to measure the prevalence of selected infectious, non-communicable and psychiatric illnesses within this population and to evaluate the success of a program for asylum seekers in screening for these conditions. Methods: Two hundred ten new clients from 51 countries, plus Tibet, who were accepted into an urban hospital-based program for asylum seekers from 2012-2014 were included. Screening rates and outcomes for infectious, non-communicable, and mental illnesses were evaluated based on intake data and review of the medical record. Informed written consent was obtained during the intake process. Findings: 71% percent of patients screened positive for depression (n=144 positive/204 total screened) and 55% screened positive for PTSD (n=111/193), followed by latent tuberculosis (41%, n=65/ 159), hypertension (10%, n=21/210), hepatitis B (9.4%, n=19/ 202), and HIV (0.8%, n=1/124). Rates of completed screenings were highest for PTSD, depression, hepatitis B and latent tuberculosis. Interpretation: This population is at very high risk of PTSD, depression, and latent tuberculosis, and at increased risk of hepatitis B. Screening rates for these diseases were high at this dedicated program for asylum seekers. Point of care testing was more effective than testing that required repeat visits. These findings call for special attention to the primary care needs for asylum seekers in the US

OBJECTIVE:: To compare spontaneous reporting of health complaints in a sample of refugee survivors of torture with a history of moderate/severe traumatic brain injury (TBI) with survivors of torture without TBI and analyze the contribution of posttraumatic stress disorder symptoms to health outcomes. PARTICIPANTS:: Treatment-seeking refugee survivors of torture with a moderate/severe TBI (n = 85) and a control group (n = 72) of survivors who suffered a physical injury during their persecution but had no history of a head injury. MEASURES:: Health outcomes included a self-report of general physical health (scale 1-5), number of medical visits, and a scaled score of the number of health complaints. The Harvard Trauma Questionnaire (HTQ) was used to measure posttraumatic stress disorder. RESULTS:: Moderate/severe TBI was associated with more health complaints but not higher HTQ scores. TBI and HTQ scores are independently associated with a greater number of health complaints, and an interaction between TBI and HTQ scores suggests that the relationship between moderate/severe TBI and the number of health complaints strengthened with increased posttraumatic stress disorder symptom severity. CONCLUSIONS:: Health complaints may be a common expression of psychological trauma, and service providers should be certain to explore both medical and psychological contributors when assessing refugee survivors of torture.

BACKGROUND: Among US medical schools, demand for Global Health (GH) programs continues to grow. At the same time, cultural competency training has become a priority for medical students who will care for an increasingly diverse US patient population. We describe a pilot period for a new GH Selective designed to introduce medical students to global medicine and enhance culturally-sensitive communication skills. METHODS: As a 4-week clinical clerkship, the GH Selective was offered annually over a three-year period to a total of 33 students. Activities included clinical assignments, cultural competency and clinical skills simulations, patient case discussions in tropical medicine, journal clubs, and lectures. Faculty assessments of student performance and student evaluations of course content were focused on 6 course objectives, adapted from standardized GH objectives. RESULTS: For each offering of the GH Selective, at least 40 faculty members and fellows volunteered over 200 teaching hours from 11 medical school departments. Student feedback was consistently positive through competency-based curricular evaluations. As a result of its successes, the course is now offered on a biannual basis. DISCUSSION: Experiential, student-centered teaching employed in this course proved successful as an introduction to delivery of evidence-based and culturally sensitive GH. Special emphasis on working with standardized patients in interdisciplinary and cross-cultural simulations provided students with clinical skills applicable for care provided both locally and on international rotations. CONCLUSION: With a special emphasis on cross-cultural sensitivity, this pilot elective trained future practitioners in fund of knowledge, clinical skills, and service delivery methods in GH.

Program/Project Purpose: Inter professional education is increasingly recognized as fundamental for health education worldwide. Although effective management is essential for health care improvement, business schools have been underrepresented in global health education. Here we report the Health Innovation Fellowship (HIF), a new training program created for practicing health professionals offered by the Central American Healthcare Initiative (CAHI) and INCAE Business School, Costa Rica. The initial period for this annual program is July 2014 to February 2015. HIF aims to catalyze improvements in the quality, efficiency, and delivery of healthcare for Central Americans in greatest need. Structure/Method/Design: HIF's goal is to provide training in management and leadership for fellows, in order to carry out an innovative health care improvement project in their local region. Participants are selected based on a submitted outline for their proposed project, and why it is innovative and relevant within their current local health care system. The initial cohort of 16 fellows represent eight health-related professions in six Central American countries. HIF is supported by CAHI stakeholders. Desired outcomes for HIF include successful completion of each fellow's project, and providing a positive impact on achieving their goals. All fellows attend four one-week on-site modular training sessions, receive ongoing mentorship, and stay connected through formal and informal networks and webinars to exchange knowledge and support each other. Viability is encouraged by creating a network of increasingly sustainable projects and health professional leaders across Central America, with each successive annual training program. Outcomes & Evaluation: Preliminary data are positive. During each on-site training module, fellows present updated project profiles, which are compared to their earlier project profiles to track progress. A "check-out" process has fellows set concrete goals and timelines to accomplish by the next module, and a "check-in" process reports whether they achieved their previous goals. After the first and second modules, 100% of the fellows considered HIF and its training sessions as "very good" or "excellent" toward meeting their project's goals. More than 50% of the projects have found either financial or political support for their implementation. Upon completion of HIF, fellows complete a quantitative-qualitative exit interview to measure 1) project outcomes and 2) the fellowship's impact on their project design, implementation, quality and effectiveness. Going Forward: Strengths include that both leadership and trainees come from the Global South, and that HIF offers a Global South platform to collaborate with partners in the Global North. Across sites, common themes are defined and unique lessons are learned. The seven-month period is a challenge, which is short for health system improvement efforts. By focusing on innovation and management within a Central American school of business, HIF is a novel capacity-building effort within global health education efforts

Global health (GH) spans every scientific, clinical and social science discipline. Cultural competency/ cross-cultural sensitivity has been identified as a GH priority for U.S. medical schools (Peluso 2013). As part of Curriculum for the 21st Century (C21), the Global Health Selective is prerequisite to the new Global Health Concentration at NYU School of Medicine (SoM). With special emphasis on cultural competency/ crosscultural sensitivity, its primary aim is to teach future physicians fund of knowledge and clinical skills that strengthen GH care. As a 4-week clinical clerkship, the GH Selective was first completed by 9 medical students in 2012, and again by 12 medical students in 2013. Activities included 18 ninety-minute patient case discussions in tropical medicine; related clinical assignments at NYU; literature review and journal clubs; and 9 half-day clinical skills simulation workshops covering 1) diarrhea in Haiti and Egypt, 2) tuberculosis in Peru 3) malaria in sub-Saharan Africa 4) hypertension screening by community health workers in Ghana 5) survivors of torture from central Africa 6) humanitarian response to tsunami in Indonesia 7) obstetrical emergencies in rural Liberia 8) interpreter exercise in Tibetan, and 9) smoking cessation via interpreters. Leadership is from NYU SoM Departments of Medicine and Population Health, and Center for Healthful Behavior Change. Over two years of the GH Selective, student feedback was overwhelmingly positive. Each year, at least 37 faculty volunteered from 11 departments at SoM to log at least 225 hours of direct contact teaching hours each offering. In its first two years, the GH Selective exceeded expectations. Its interdisciplinary curriculum is a particular strength, and its special emphasis on working with standardized patients in cross-cultural settings, focused on communication skills, health literacy, and health navigation, provided students with knowledge and clinical skills applicable for any clinical care provided locally, nationally,!

Since 2009, a multidisciplinary team at Weill Cornell Medical College (WCMC) has collaborated to create a comprehensive, elective global health curriculum (GHC) for medical students. Increasing student interest sparked the development of this program, which has grown from ad hoc lectures and dispersed international electives into a comprehensive four-year elective pathway with over 100 hours of training, including three courses, two international experiences, a preceptorship with a clinician working with underserved populations in New York City, and regular lectures and seminars by visiting global health leaders. Student and administrative enthusiasm has been strong: In academic years 2009, 2010, and 2011, over half of the first-year students (173 of 311)participated in some aspect of the GHC, and 18% (55 of 311) completed all first-year program requirements.The authors cite the student-driven nature of GHC as a major factor in its success and rapid growth. Also important was the foundation previously established by WCMC global health faculty, the serendipitous timing of the GHC's development in the midst of curricular reform and review, as well as the presence of a full-time, nonclinical Global Health Fellow who served as a program coordinator. Given the enormous expansion of medical student interest in global health training throughout the United States and Canada over the past decade, the authors hope that medical schools developing similar programs will find the experience at Weill Cornell informative and helpful.