Participation in global health activities by U.S. medical students has grown substantially in recent decades.1 Although global health interest has grown, many schools still do not offer structured global health curricula, and there is little standardization for didactic, clinical, scholarly, and cultural components across programs.2,3 Many programs also lack well-defined competencies outlining critical skills for global health practitioners, although the past decade saw the development of essential competencies to guide global health curricular development.4-10
A current challenge in global health education is identifying methods to teach students to become successful global health practitioners. Aspects of various curricula have been published. Some describe didactic curricula focused on topics such as cultural competency and communication.11 Others describe educational formats such as e-learning or simulation-based learning to teach competencies such as ethics or professional practice in low-resource settings.12-14 Many programs involve international electives or service-learning experiences, and best practice approaches have been proposed to help students in short-term global health experiences build skills in cross-cultural effectiveness, capacity building, and collaboration while addressing the needs of host communities and partners.15-18
Part of the challenge of teaching global health is designing educational methods that address competencies that include skills building and attitude formation.4 Particularly in resource-limited settings involving different cultures, political climates, and power dynamics, competencies required of effective global practitioners extend far beyond clinical knowledge and include the effective practice of cultural humility, inter-professional collaboration, ethical conduct, and promotion of health equity. The Consortium of Universities for Global Health (CUGH) formed in 2008 to support academic institutions to improve global health. In 2013, CUGH formed a Global Health Competency Subcommittee to develop a standardized set of global health competencies to guide institutions developing curricula. An interdisciplinary expert panel published this list of 39 competencies across 11 domains in 2015; however, methods for teaching these competencies are still being developed.4
Although there are some published descriptions of global health capstones for pharmacy and bioengineering students, we are not aware of other published descriptions of global health capstones as part of an educational curriculum for medical students.19,20 This paper describes our experience with the first 35 graduates of the Global Medicine (GMED) program at the University of Illinois Chicago College of Medicine (UICOM).
The GMED program was developed in response to increased interest in global health at the UICOM. Completion of a longitudinal capstone project is required as part of the GMED program. The objective of this paper is to review student capstone projects as well as student reflection papers to identify strengths and weaknesses of the GMED capstone and examine the following:
- Is a longitudinal model of a global health capstone project feasible as part of a global health curriculum for U.S. medical students?
- What mentorship is required to assist students in developing and completing their capstone projects?
- Are global health capstone projects a suitable method for teaching CUGH-identified competencies?
Using a global health capstone project as an educational method for medical students is a novel construct. This assessment will inform future modifications to the UICOM GMED program and may be valuable to global health educators who wish to develop or strengthen their global health training programs for health professions students.
GMED Program
The UICOM GMED Program recruited its first class in 2012 and has since graduated four classes. GMED is a track for 12 selected students per year that spans the four-year medical school curriculum and is completed in addition to standard required coursework. The program’s goal is to improve the health of populations worldwide by training the next generation of global health leaders. The curriculum includes didactic instruction, colloquia, skills-building workshops, and individual longitudinal capstone projects. The initial curriculum included didactic sessions modeled after the Global Health Education Consortium’s 2010 guidelines.10 Curricular adaptations were made in 2018 to address an expanded list of global health competencies.4 Programming also includes exposure to supplementary content (e.g. cultural competency, economic perspectives of global aid, ethics of volunteerism) as well as alternative interactive learning formats including film reviews, book club discussions, and simulation-based cases. Each student in the track must develop, implement, and present a capstone project to successfully complete the program.
Capstone projects
The capstone requirement is a longitudinal scholarly work culminating in a presentation and reflection paper at the end of the final year of medical school. Although capstones are reported in other disciplines, they have not been routinely incorporated into global health medical student programs.19,20 Other fields found capstones beneficial because they allow students to:
- Become involved in sustainable impact-oriented research.21
- Build skills in scholarship and professionalism including writing, presenting, and integrating “core theoretical concepts to form a broad view of professionalism.”21-23
- Develop research mentorships and relationships with faculty.21
The capstone allows students to acquire skills through project planning and implementation. Specific deliverables are required throughout the four years of medical school. During the first year, each student identifies a specific global health issue, performs a literature review, and delivers a presentation on the topic along with a written paper. In the second year, each student identifies a specific project, defines his/her role in that project, establishes methods and a timeline for project completion, and prepares a scientific poster. In the third and fourth years, students focus on capstone project implementation and evaluation, culminating in oral presentations summarizing their work. A written scholarly paper was added as a requirement for 2019 graduates (whose work is not included in this paper). Projects should be completed under the guidance of faculty mentors who are identified by the student.
Capstone projects can vary in structure and content depending on students’ interests. Projects can focus on original global health research or on curriculum design, programmatic implementation, field practicums, or meta-analyses. Although the capstone format may vary, all students must demonstrate an understanding and integration of relevant global health core competencies. All students are also provided with formal faculty advising that gives overall guidance for capstone completion but may not provide content-specific mentorship.
Graduating students also submit a self-reflection paper. In the reflection papers, students identify lessons learned during the capstone process, potential implications of their projects, and the anticipated impact completing the program will have on their future careers. This paper encourages students to reflect on their accomplishments, articulate the challenges and successes of their projects, and internalize their experiences to translate knowledge acquired to their personal and professional growth.