Background
Consensus process
Goals | Outcomes | Output | Activities | Indicators | Means of Verification | Risks/Assumptions | |
---|---|---|---|---|---|---|---|
Overall | Attain proficiency in designing, implementing, and publishing GEM research | GEM Specialist prepared to conduct independent GEM research | GEM Fellowship training | Completion of GEM Fellowship activities | Certification by GEM Fellowship Director | N/A | |
Professionalism | 1 | Develop skills for stakeholder engagement | Develops stakeholder team for project during training | 1. Conduct stakeholder analysis for project | Completion of stakeholder analysis | Written stakeholder analysis submitted to fellowship director | N/A |
2 | Develop skills in organization and implementation of GEM projects | Competency in GEM project implementation | 1. Participate in existing GEM project 2. Design GEM project for implementation during or after fellowship | 1. Participation as measured by fellowship director 2. Completion of project design | 1. Certification of fellowship director 2. Submission of written project design | GEM Fellow has adequate time to complete project during training | |
3 | Develop cooperative relationships with existing medical, public health and governmental organizations | Develop professional and mentorship network for future GEM work | 1. Identify mentor in area of interest 2. Attend professional conferences/meetings 3. Engage in working groups for development of GEM | 1. Identification of mentor(s) 2. Attend at least one professional conference per year during fellowship 3. Participate in at least one GEM working group during fellowship | 1. Submit list of actual or potential mentors in area of interest to fellowship director 2. Certificate / CME from professional conference 3. Submission of working group output or summary of activities to fellowship director | Funds available for attending conferences annually | |
Communication | 4 | Develop educational skills and presentation techniques | Competence in delivering educational lectures and scientific presentations | 1. Deliver educational lectures in medical / clinical setting 2. Deliver oral presentations as part of formal degree or certificate programs 3. Deliver scientific presentation at conference or department | 1. Evaluation of educational / scientific presentations in medical settings 2. Evaluation of educational/scientific presentations in academic setting (e.g. as part of MPH or other formal degree or certificate training) 3. Letters certifying performance from GEM partners in-country or from organizations to which presentation was given | 1. Review of written evaluations of presentations given 2. Review of assessments / grades from formal degree or certificate programs 3. Review of letters of performance from partners | GEM Fellow gives educational or scientific presentations as part of training |
5 | Develop skills in communication with health authorities | Competence in written and oral communications with leadership of organizations | 1. Involve fellows in program leadership meetings with increasing level of responsibility | 1. Fellow to take lead on at least one oral and one written communication with project / program leadership | 1. Review of sample written communications between fellow and leadership team 2. Direct observation of fellow communications with partners | GEM Fellow project involves field research | |
Medical Knowledge & Patient Care | 6 | Develop skills for managing EM patients in austere settings | Competence in management of EM patients in various settings | 1. Provide direct emergency care in international setting w/ different language or resource level from home institution 2. Take part in simulation of management of common GEM cases 3. Provide direct patient care in complex emergency setting 2. Complete short-course training in management of common GEM conditions | 1. Direct observation of fellow providing patient care in GEM setting 2. Evaluation of simulation/ debrief 3. Direct observation of fellow performance in complex emergency setting 2. Evaluation/ Certificate of Completion of Short Course Training | 1. Either certification by Fellowship Director or review of evaluations submitted by faculty or partner organization 2. Review of simulation debrief 3. Either certification by Fellowship Director or review of evaluations submitted by faculty or partner organization 3. Submission of certificate of completion of short course | GEM Fellowship incorporates direct clinical care |
7 | Develop knowledge of care protocols for EM conditions in different settings | Demonstrate familiarity with published guideline for GEM care for key conditions | 1. Review of published guidelines for emergency triage (WHO, ICRC, SATS) 2. Review WHO Emergency Care checklists 3. Review of published global guidelines for management of acute illness and injury for children and adults (ETAT, IMAI, EmOC, etc.) | 1. Able to verbalize principles of triage and perform standardised EM triage 2. Able to verbalize principles of checklists and implement in patient encounter 3. Completion of in-person or virtual training courses | 1. Direct observation by faculty or member of partner organization 4. Review of grades / certificate of completion of training courses | N/A | |
8 | Acquire knowledge of major global health conditions and GEM care | Demonstrate knowledge of top 10 causes of morbidity and mortality globally and which of these are affected by emergency care | 1. Complete short-course or self-review of top causes of mortality and DALYs and review of priority setting literature (e.g. DCP3) 2. List and prioritize emergency health conditions in local setting 4. Complete formal course work in Global Health | 1. Verbalize understanding of major causes of global morbidity and mortality and how these relate to emergency care 4. Performance in formal courses | 1. Certification by Fellowship Director 5. Review of transcripts from completed courses | N/A | |
9 | Use available data for EM system evaluation | Competence in EM system evaluation | 1. Complete evaluation of single site using standard assessment tool (e.g. WHO IMEESC [6], ESRA T[7]) 5. Conduct/Participate in WHO Emergency Care Systems Analysis (local, regional or national) | 1. Produce report on emergency care capacity at single site 5. Completion of ECSA report | 6. Submission of completed reports to Fellowship Director | GEM Fellowship incorporates field experience in emergency care setting | |
10 | Develop skills in EM quality improvement | Competence in designing and implementing QA project | 1. Complete one quality assurance project at partner site (may involve analysis of existing data) 2. Produce report of QA analysis 6. Communicate findings to partner institution | 6. Completion of QA project report | 7. Submission of QA report to Fellowship Director | GEM Fellowship provides sufficient time to conduct QA project and to reflect changes | |
Research Skills | 11 | Develop skills to critically review GEM literature | Competence in evaluating published GEM literature | 1. Conduct peer-review for (1) GEM article per year 3. Lead (1) journal club on GEM topic | 1. Completion of peer-review report 7. Journal club activity | 1. Review of at least one peer-review report with Fellowship Director or other faculty 8. Evaluation of journal club presentation by Fellowship Director or other faculty | GEM Fellow gets assigned peer-review by journal |
12 | Develop skills to obtain funding for GEM research | Funding proposal for GEM research during / after GEM fellowship | 1. Attend funding / development proposal workshop 2. Identify potential funding agencies 3. Identify call for proposal or open-call in area of interest 4. Develop draft funding proposal | 1. Meet with Fellowship Director or other GEM faculty to review funding agencies and calls for proposals 8. Completion of draft funding proposal | 1. Submission of draft funding proposal to Fellowship Director 2. Submission of proposal to funding agency 9. Funded proposal | Sufficient funding available to attend workshop | |
13 | Acquire understanding of research methodology | Competence in selection of proper study methods for GEM research | 1. Complete course in research methodology – overview (online, self-study, or class) 5. Complete training in specific research methods (online, self-study, or class) | 9. Certificate of completion or transcript | 10. Review of transcripts / certificates by Fellowship Director | Sufficient funding for research methods training. May use free online courses | |
14 | Develop skills in data management & analysis | Competence in research data management | 1. Complete coursework in data science-collection, storage, cleaning and analysis of data. (Online, self-study, or class) 2. Complete coursework or self-study in data visualization (online, self-study or class) 6. Training in literature review | 10. Certificate of completion or transcript | 11. Review of transcripts / certificates by Fellowship Director | Sufficient funding for data science training. May use free online courses | |
15 | Develop research design skills to assess EM care/ intervention | Completed research study protocol | 1. Develop research question 2. Develop study protocol 7. Submit study protocol for ethics review | 1. Clearly-stated hypothesis 2. Completion of study protocol ready for ethics review 11. Ethics review submission completed | 12. Certification by Fellowship Director | N/A | |
16 | GEM research study implemented | Data gathered and ready for cleaning and analysis | 1. Perform local stakeholder analysis and engage partners 2. Select & train study team 3. Gather data and securely store 4. Clean data in preparation for analysis 8. Complete analysis of data | 1. Advisory group (incl. FD & partners in-country) 2. Completion of human subjects training by team members 3. Completion study protocol training (led by Fellow) 12. Secure database of study data | 1. Submission of names of advisory group and report of meeting 2. Review of human subjects research training certificates 13. Certification by Fellowship Director or partners | N/A | |
17 | Gain skills for research manuscript preparation and publication | Research manuscript prepared and ready for peer-review | 1. Conduct literature review for GEM research project 2. Analyse GEM research data 3. Complete data visualization 9. Prepare manuscript | 1. Submission of literature review 2. Completion of data tables 3. Completion of figures 13. Completion of manuscript | 1. Certification by Fellowship Director 14. Submission of manuscript | GEM Fellowship sufficient duration to allow completion of research project |
IEMFC survey results
Scoping review results
Level I: Global Citizen For all post-secondary students pursuing any field with bearing on global health. Level II: Exploratory For students at an exploratory stage considering future professional pursuits in global health or preparing for a global health field experience working with individuals from diverse cultures and/or socioeconomic groups. Level III: Basic Operational For students aiming to spend a moderate amount of time, but not necessarily an entire career, working in the field of global health. Level IIIa: Practitioner-Oriented Operational Required of students practicing 1) discipline-specific skills associated with direct application of clinical and clinically-related skills acquired in professional training in one of the traditional health disciplines; and 2) applying discipline-specific skills to global health-relevant work from fields that are outside of the traditional health disciplines (e.g., law, economics, environmental sciences, engineering, anthropology, and others). Level IIIb: Program-Oriented Operational: Required of students in the realm of global health program development, planning, coordination, implementation, training, evaluation or policy. Level IV: Advanced Level Required of students whose engagement with global health will be significant and sustained. These competencies can be framed to be more discipline-specific or tailored to the job or capacity in which one is working. This level encompasses a range of study programs, from a masters level degree program, up to a doctoral degree with a global health-relevant concentration. Students enrolling in these programs are usually committed to a career in global health-related activities. |
1) Define the purpose of the assessment 2) Select an overarching competency framework 3) Define progression from novice to expert 4) Design a blueprint of the curriculum 5) Select appropriate assessment methods 6) Decide on the stakes of the assessment 7) Involve stakeholders in the design of the assessment programme 8) Aggregation and triangulation of assessment results 9) Assessor selection and training 10) Quality improvement |
- Domain 1 – Knowledge, skills and performance.
- Domain 2 – Quality Assurance.
- Domain 3 – Communications, partnership and teamwork.
1) Prior to departure 2) Complete ‘before’ section of self-assessment form 3) Preparation for volunteering 4) Volunteering experience 5) Following return to the UK 6) After appraisal |
Competency framework & progression from novice to expert
Recommendation - It is recommended that each fellowship program develop a list of core general competencies as well as specific competencies related to the focus of their specific program (e.g. research, humanitarian health, etc.) and regularly evaluate attainment of these competencies in the assessment of their trainees.
Mapping the curriculum
Recommendation – GEM fellowships should map out their curriculum to logically connected curricular elements, competencies to be achieved, and measures of attainment to demonstrate trainee progression through their training program.
Postgraduate academic qualifications
Recommendation – GEM fellowships that include formal didactic training in the form of degree programs or courses taken should review the syllabi of required courses to map how they help to fulfill training.
Assessment methods and stakes of the assessment
Recommendation: Each GEM fellowship program should use the principles outlined in these common frameworks to develop or adapt an assessment framework that is able to characterize the progress of their trainees through their program and can clarify domains in which the trainee may need additional training to achieve competency before the end of their training.
Stakeholder engagement and aggregation of assessment results
Recommendation – Integration of social accountability in GEM training may take place in many ways. GEM fellowships should consider doing so in a cross cutting fashion that integrates various stakeholders’ perspectives in design or review of curricula, prioritizing competencies as well as the evaluation of trainees in the field. An example of mapping out elements of social accountability is illustrated inTable 5.Table 5Social Accountability Framework
RESPONSIBLE RESPONSIVE ACCOUNTABLE A Project/ Activities/ Research 1 Identification of Society Needs Implicit Explicit Anticipatory 2 Community Engagement Community Orientated Community Based Community Partnership 3 Ongoing Evaluation a) Focus Process/Actions Outcomes Impact b) Data sources/Assessors Internal External Health Partners c) Governance Internal Internal and External Health Partners 4 Outcomes Development and Promotion Sustainable change Mutual Transformation B Self-Reflection 1 Core Values Responsible Responsive Accountable 2 Role/Actions Good Practitioner Professional Practitioner Health system Change Agent 3 Personal Impact Development and Promotion Sustainable change Mutual Transformation
Quality improvement
Recommendation: GEM fellowships should share their assessment frameworks and regularly compare them to identify gaps in their training programs offerings. Further, programs should consider implementing periodic surveys of prior graduates to compare their graduates’ impressions of their skills once working as GEM professionals to the results of their assessments during training. Such reality testing will provide important insights regarding the validity of their assessment frameworks over time.
Proposal for an assessment framework for GEM fellowship programs
GEM fellowships should use a structured process to define the key elements of training, identify who are their communities of concern, and identify how assessments of trainees will take place and by whom. Recommendations for what such a structured process would like are illustrated inTable 6.Table 6Recommendations for Developing GEM Fellowship Assessment
1) Articulate statement of goals and objectives for fellowship2) Define list of competencies either de novo or based on previously published competencies for GEM3) Map competencies to curricular outcomes specific for each GEM fellowship4) Identify which elements are didactic competencies and which are practical/field based5) Define your communities of concern and the health problems this GEM fellowship will address/focus on6) Identify core assessors to include members from each community of concern for that GEM fellowship7) Outline a format and interval at which fellows are assessed8) Describe mechanism by which the program itself is evaluated including evaluation by fellows and graduates of the fellowship program