Concentration in Global Health

Concentration Directors

Timothy Empkie, MD, MPH
Email: Timothy_Empkie@brown.edu
Phone: (401) 863-2019
Box G-B222, Brown University

Jennifer Friedman, MD, MPH, PhD
Associate Professor of Pediatrics
Email: Jennifer_Friedman@brown.edu
Phone: (401) 444-7449
Center for International Health Research

Co-Directors:

Susan Cu-Uvin, MD
Professor of Obstetrics and Gynecology
Email: SCu-Uvin@lifespan.org
Phone: 401-793-4775
Box G-MH, Brown University

Stephen McGarvey, PhD, MPH
Professor of Community Health
Email: Stephen_McGarvey@brown.edu
Phone: (401) 863-1354
Box G0S121-2

Timothy P. Flanigan, MD
Email: Timothy_Flanigan@lifespan.org
Phone: 401-793-7152
Box G-MH, Brown University

Overview

There are two purposes of the Global Health Scholarly Concentration. First, to educate medical students about the breadth and depth of global health, with an emphasis on populations in lesser developed countries characterized as resource-poor communities who are medically underserved. These communities will have low levels of population health measured by general measures of mortality and morbidity and by specific measures of disease and risk factor prevalence and incidence.  Second, to provide and support a close mentoring relationship between medical students and Brown University faculty. This will provide a more focused way for students to conduct some scholarly activity in global health under the direction of a faculty member.
The final result of this mentored relationship and the three and one-half years of learning is a scholarly product in global health. This product may take the form of a scholarly abstract, manuscript, technical report, or another output defined by the student and faculty mentor(s), and approved by the leaders of the global health scholarly concentration. 

Curriculum

The timeline of the Scholarly Concentration in Global Health is as follows: 1) Recruitment, applications and admission in Year I; 2) Preparation for, and implementation of, summer experience between Years I and II; 3) Year II Global Health Seminars; 4) Year IV Scholarly Product

Recruitment, applications and admission

The first component pertains to annual selection of students for the Global Health Scholarly Concentration.  Early in Year I and well prior to the February application date, interested students will meet with concentration leaders to identify an area of interest and a specific faculty mentor. Together, they will develop a summer experience, investigate summer funding opportunities, and outline a plan to complete the concentration requirements in the next years.  The completed applications for entrance into the Global Health Scholarly Concentration will be due to the Scholarly Concentrations Office in February.  The faculty leaders of the Global Health Scholarly Concentration will review applications for project merit and determine program acceptance.

Summer experience between Years I and II

   A global health summer experience must be preceded by adequate preparation and close mentoring by faculty. Ideally, the summer experience would occur after intensive training in interdisciplinary aspects of global health perspectives and methods, but the realities of the regular medical school curriculum prevent that.
The period of February to June will be a very busy and critical time for Year I students in the global health concentration. In Spring semester of Year I, after entry into the global health concentration and proceeding the summer, Year I students will be required to work closely with their faculty mentor to prepare. March through early May, Year I students and faculty mentors should meet every 2 weeks. The faculty leaders of the concentration will meet with students 3-4 times from acceptance in the concentration and summer departure to review progress and share with other students their plans. These meetings will emphasize general aspects of a foreign experience and specific items related to conduct of a research or clinical project.  Using the basic plan provided by the student in the SC Program Application form as a starting point, students and faculty will more fully outline plans for the summer experience.  Students and faculty may also use this time to apply for additional funding of the summer experience if necessary.

During this planning period, possible discussion topics include:
A. Clinical Science and Practice
1. Clinical Care challenges in LDCs
2. Ethical dilemmas in delivery of clinical care in LDCs for US medical students & faculty
3. Understanding cultural barriers to adherence
4. Clinical translational and implementation issues in communities
B. Research Concepts, Methods and Conduct:
1. Demonstrate understanding of fundamental epidemiological and clinical research concepts and methods: study designs, rates and proportions, definition of populations and sampling, bias, and confounding.    
2. Demonstrate understanding of screening and surveillance concepts and methods.
3. Understand purpose, design & conduct of experimental trials at community & individual levels.
4. Understand qualitative methods and utility in global health research.
5. Identify a medical or public health problem with a defined population deserving of further study.
6. For a specific health problem, contrast generalizability and limitations of data from different sources.
7. Discuss ethical issues related to human research participants.
8. Discuss ethical issues related to the conduct of global health research.
9. Read and critique medical and public health research literature.
10. State a global health research problem in terms of a research hypothesis.
11. Develop research methods for study of a particular public health problem.
During the summer months between Years I and II, students will engage in in-depth summer experiences (~8-10 weeks). 
Although summer experiences at foreign sites will be encouraged, experiences at domestic sites with underserved and resource poor communities are entirely suitable as well. Ideally this summer work will provide the basic direction and topical interest for the four-year concentration and the final scholarly product, but since global health research and clinical opportunities can change quickly, there will be a lot of flexibility.
Upon return to Brown in the fall, Global Health concentrators will be expected to give public presentations on their summer projects.
For tips on requirements and preparation for foreign travel, please review the Foreign Travel Guide

Year II Global Health Seminars

Substantial time has been scheduled for students in Year II to work on their mentored projects that they conducted in the preceding summer. They should be meeting also regularly with their faculty mentors to make progress on their projects and plan for the scholarly product. During Year II, the Global Health Scholarly Concentration will meet as a group with faculty leaders every two weeks from September to March.  The structure and format of the meetings will be a combination of seminars on selected global health topics, and guest lecturers.  The guest lecture series will focus on Brown faculty working in global health in the area of service, clinical research or education. They will speak in conjunction with other Brown Faculty who are involved in international projects. The format will be a 30-45 minute talk followed by 30 minutes of active discussion. These meetings will stop in March due to the 2nd years students need to prepare for the USMLE Step 1 exam. 
Additionally, the current Tropical Medicine elective course for medical students will be strongly suggested as a vital part of the scholarly concentration.

A list of Global Health activities at Brown can be found on the IHI lecture page.

Year III Activities

Although Year III will be very busy with clinical training rotations, it is essential that students maintain contact with their faculty mentors and discuss the progress on their scholarly product. In addition, most students have more optional time in Year IV, so it is wise to plan far ahead for global health activities in the last year. Below is a list of some opportunities to integrate the Global Health Scholarly Concentration into Years III and IV
Community Health Clerkship- It may be possible to integrate your scholarly concentration work into the field experience or project requirement of your Community Health Clerkship. Please be sure to pay close attention to clerkship policies and objectives.
Independent Studies- You have the opportunity to use some of those “additional” weeks (weeks in addition to the 80 weeks of required clinical coursework) to design an Independent Study related to your scholarly concentration project.  This may be the perfect opportunity to give yourself enough dedicated time to complete your scholarly product.  Please be sure to pay close attention to the requirements of Independent Study Projects.  
Longitudinal Ambulatory Clerkship- Students have the opportunity to design their own Longitudinal Ambulatory Clerkship as an independent study.  If your scholarly concentration project has a clinical component, it may be possible to design a Longitudinal Ambulatory Clerkship that also allows you to work towards your scholarly product.  However, please be sure to pay close attention to the requirements of the Longitudinal Ambulatory Clerkship, and allow yourself enough time to complete all requirements. 
Unscheduled Weeks- In addition to using some of your time off for essential things such as sleeping, reconnecting with family, and interviewing for residencies, it may also be possible to use some of your unscheduled time between blocks to reconnect with your scholarly concentration mentor, complete that manuscript, or finish putting together your portfolio of concentration work. 
Eighth Semester Program- The Eighth Semester Program allows fourth year medical students to enroll in graduate level courses at Brown.  Many of these courses are relevant to scholarly concentrations in Advocacy & Activism, Medical Ethics, Medical Humanities and others.  The Eighth Semester Program is an opportunity to once again explore your scholarly concentration area through rigorous coursework in a way that can enhance your final scholarly product.  Become reinvigorated about your concentration topic through this program! 
There is also a funding opportunity for students via International Clinical Research Scholars Program which offers overseas fellowships in Global Health and Clinical Research. This program is administered through Vanderbilt University.  Several Brown medical students have taken advantage of this program. Dr Flanigan and Kenneth Mayer can tell you about the students who have done this.
Click here for the national site.

Year IV Scholarly Products

The final component of the Scholarly Concentration consists of a fourth year elective and the submission of a scholarly product. It is envisioned that well over half of the students that participate in this Scholarly Concentration will go overseas in their 4th year and participate in an international elective in a resource poor setting, although international travel is not required.  Students will also have the ability to pursue an in-depth elective on health issues in the United States that are pertinent to global health. These might include evaluation of health problems in the Dominican or Haitian communities in New England or an in-depth study on vaccine or medication availability or the benefits and weaknesses of non-governmental organization programs providing health care overseas.  The fourth year elective must include a clinical component requiring students to interact in a meaningful fashion utilizing their clinical skills. 
Students will be required to submit a scholarly product for review by their faculty mentor and the concentration leadership by April of their fourth year. Approval of this product will indicate successful completion of the global health scholarly concentration.

Project Examples

Scholarly products may take the form of a manuscript conforming to peer review standards, a curriculum contribution or a policy paper relevant to global health. Presentation at a regional or national conference will also be encouraged.
For students who have pursued foreign clinical experiences not research, the scholarly product should have a basic assessment of the community served by the institution in which the clinical services were observed or performed. It should try to describe the patient population, issues of standards of care that could be improved, and ways to help the host clinical institution improve the delivery of medical care.  As the overall concentration program matures, further guidance on the acceptable range of scholarly products will be developed.

2009 Accepted Students & Scholarly Concentration Projects:

Maximum Number of Students

We anticipate that the concentration will be able to provide adequate guidance and mentorship to 8-10 scholars per year.

Faculty Mentors

A critical goal of the scholarly concentration will be to match students with faculty mentors in the 1st year of medical school. The application for joining the concentration which is due in February of Year I requires a mentor at that time. We recognize that students’ interests change, faculty resources change and other factors will influence students to seek out new mentors as they progress through the concentration. It is crucial that faculty mentors understand the need to provide ongoing mentorship. This includes assurance of safety and adequate supervision at the field site as well as continued mentorship in creation of the scholarly product. The faculty leaders will work hard to provide guidance and counseling throughout all four years and assess the quality of the student and mentor fit. 
There is a large number of faculty who have declared their interest and others who are potentially interested. We anticipate having no problems finding good matches, as the opportunity for long-term mentoring and collaboration is very attractive to faculty.

Funding Opportunities
(alternatives to Summer Assistantships)

There are several internal sources of funds that could provide financial support for proposed foreign global health experiences. Funding for international travel may be available through the International Health Institute’s Foreign Studies Fellowship Program. The International Health Institute also provides useful information on its web site about outside funding sources.
We also believe that the training and mentoring offered by the Global Health Scholarly Concentration will prepare students to compete successfully for external funds for their proposed experiences.

In the Fall of 2008 Brown University received an education grant titled “Framework in Global Health at Brown University”, from the NIH Fogarty International Center. Dr Susan Cu-Uvin is the PI and Prof. Stephen T. McGarvey is the Co-PI.  The goal of the Framework program is to provide an academic structure and initial resources for faculty collaborations on curricular developments and mentoring of students in practical global health experiences. The Framework will take advantage of Brown’s flexible boundaries to help form new global health research collaborations, thus furthering incentives for faculty participation and opportunities for practical experiences for students and clinical trainees.  In addition to promoting the coordination of global health activities at Brown, this grant also funds the Framework Global Health Scholarship program. Please visit the Framework in Global Health page for more information and an application.

• Scholarly Concentrations Program Application
• Scholarly Concentrations Program White Paper
• Faculty Letter of Support

• Faculty Conflict of Interest Form