Thirty-seven (51%) of 72 students who had undertaken the Global Health SSC responded to the survey within the time frame. These participants had all completed the SSC between 2011–2017 and graduated between 2013–2019. Of 16 respondents who completed the SSC in 2017 during the fourth year of medical school, 10 subsequently undertook an intercalated degree year (on top of their 5-year medical degree), therefore graduated in 2019.
Table 1
Survey respondent characteristics
Characteristic
|
Previous SSC participants
(n = 37)
n (%)
|
Age range, years (mean)
|
23–31 (26)
|
Gender
|
Male: 10 (27)
Female: 27 (73)
|
Year completed SSC (mode)
|
2011–2017 (2017)
|
Year graduated (mode)
|
2013–2019 (2018/2019)
|
Employment status
|
To commence Foundation Programme August 2019: 11 (30)
Employed, working full-time: 22 (59)
Locum: 3 (8)
Not employed, not looking for work: 2 (5)
|
Stage of Career
|
To commence Foundation Programme August 2019: 11 (30)
Foundation Programme: 12 (32)
Speciality and GP training: 10 (27)
Not in training: 4 (11)
|
Speciality Choice
The speciality choices of previous SSC participants were compared with those of UK medical graduates of 2015, one year after graduation (17), an age group similar to that of the study participants. Of previous SSC participants, one (2.7%) indicated Public Health as their top choice of speciality, compared with 0.9% of UK medical graduates, showing Public Health is one of the least popular choices of speciality amongst both groups (Table 2). Despite this, 16 (45.7%) of 35 respondents reported having considered applying to Public Health speciality training. The most popular choice of speciality for previous SSC participants and UK medical graduates was General Practice with 27.0% and 27.8% selecting primary care as their top choice respectively. The study also found that 10.8% of past SSC participants versus 1.4% of UK medical graduates were not interested in pursuing speciality or general practice training at all.
Table 2
Career speciality choices of previous SSC participants compared with UK medical graduates of 2015 one year after graduation
Speciality
|
Previous SSC participants
(n = 37)
n (%)
|
UK medical graduates of 2015*
n = 3040
n (%)
|
Anaesthetics
|
2 (5.4)
|
480 (15.8)
|
Emergency Medicine
|
1 (2.7)
|
171 (5.6)
|
General Practice
|
10 (27.0)
|
844 (27.8)
|
Medicine
|
4 (10.8)
|
826 (27.2) Hospital medical specialities + Other medical specialities
|
Obstetrics and Gynaecology
|
3 (8.1)
|
164 (5.4)
|
Paediatrics and Child Health
|
5 (13.5)
|
261 (8.6)
|
Pathology
|
0
|
97 (3.2)
|
Psychiatry
|
1 (2.7)
|
165 (5.4)
|
Public Health
|
1 (2.7)
|
28 (0.9)
|
Radiology
|
2 (5.4)
|
92 (3.0)
|
Surgery
|
3 (8.1)
|
492 (16.2)
|
Other
|
1 (2.7) Tropical Medicine and Public Health
|
87 (2.9) Radiotherapy and oncology + Community health
|
Not pursuing speciality or general practice training
|
4 (10.8)
|
44 (1.4)
|
Not stated
|
0
|
105 (3.5)
|
*2015 data (17)
|
|
|
Only one participant reported undertaking a rotation in Public Health during their two-year Foundation Programme. Three participants had accepted an Academic Foundation Programme (AFP) training post, two of whom stated their research project would be related to global health.
Further Global Health Education
Twenty-two (60%) previous SSC participants had undertaken an intercalated degree programme. Table 3 highlights the degree choices of respondents, with nine (24%) reporting completing a Masters’ Programme specific to Global Health. Seven participants studied an MRes in Global Health and two undertook a Master of Science (MSc) in Global Health and Global Health and Development respectively. Additionally, four (11%) participants undertook an MRes in Epidemiology and two (5%) did an MSc in Control of Infectious Diseases, both key themes within GHE. Eleven (26%) participants reported that their intercalated degree programme involved field research abroad, seven of whom indicated they carried out research in Tanzania, the other three undertaking research in one each of the Gambia, Sudan and Zambia.
Table 3
Intercalated degree programme subject choice of previous SSC participants
Intercalated degree programme subject
|
Number
|
Global Health
|
9
|
Epidemiology
|
4
|
Control of Infectious Diseases
|
2
|
Medical Anthropology
|
2
|
Immunobiology
|
1
|
Philosophy
|
1
|
Reproductive and Sexual Health Research
|
1
|
Stem Cells and Regenerative Medicine
|
1
|
Not stated
|
1
|
When past SSC participants were asked to provide details of any further GHE undertaken elsewhere within the optional medical curriculum, responses fell mostly into two main themes. Firstly, arranging global health electives (five participants), four of whom specified travelling to low and middle-income countries (LMICs) in Sub-Saharan Africa and Southeast Asia, and secondly, attending global health conferences and presentations (three participants). Other optional GHE mentioned included undertaking an SSC in Infectious Diseases (one participant) and tailoring a critical appraisal assignment around a global health topic (one participant).
Four of 35 respondents indicated they had completed or were due to begin, postgraduate study related to global health since completion of medical school. Three alumni specified undertaking a DTM&H, one of whom had also completed the RANZCOG Diploma (Diploma of Women’s Health, Royal Australian and New Zealand College of Obstetricians and Gynaecologists), whilst one alumnus was studying an MSc in Public Health. Another 10 participants reported they were considering pursuing a further postgraduate qualification related to Global Health in the future, again with two specifying the DTM&H.
Extracurricular activity
Twenty-five (68%) study participants indicated that they were involved with a student global health organisation at a local or national level during medical school. Ten reported involvement with one organisation, 11 with two organisations and four with at least three organisations. The most common organisation students were involved with was Students for Global Health (formerly Medsin) (Table 4). This is perhaps the largest student global health network in the UK, which as of 2014–2015, was found to be established and active at 28 (85%) of 33 UK medical schools (16).
Table 4
Previous SSC participant involvement with student global health organisations during medical school
Student global health organisation
|
Number
(n = 37)
n (%)
|
Students for Global Health (formerly Medsin)
|
18 (49)
|
Homed
|
8 (22)
|
Students for Kids International Projects (SKIP)
|
7 (19)
|
Sexpression:UK
|
4 (11)
|
Marrow
|
3 (8)
|
Healthy Planet UK
|
2 (5)
|
Friends of Médecins Sans Frontières (MSF)
|
2 (5)
|
International Federation of Medical Students’ Associations
|
1 (3)
|
Kids Action Overseas (Kaos)
|
1 (3)
|
Student Action for Refugees: STAR
|
1 (3)
|
Student Stop AIDS Campaign
|
1 (3)
|
Universities Allied for Essential Medicines (UAEM)
|
1 (3)
|
Since completing medical school, 16 (46%) of 35 respondents indicated they were involved with extracurricular activities. Of the 19 participants who reported no involvement with extracurricular activities, eight had just graduated in 2019 and five had graduated in 2018 and were currently undergoing their Foundation Programme Year One. Excluding the 10 participants who had just graduated, a greater proportion of 14 out of 25 (56%) participants reported extracurricular activity since completion of medical school. Activities included teaching, delivering health-related presentations, committee members of non-profit organisations, research, mentoring youth and working in volunteer clinics (Table 6). Five participants specified details of extracurricular activities related to global health following completion of medical school. These included carrying out leadership roles such as Junior Doctor Sustainability Fellow, Improving Global Health (IGH) Fellow and co-founding the North-East Global Health Network (three participants), as well as mentoring subsequent IGH fellows and MRes Global Health students undergoing research in Tanzania (two participants). Other activities mentioned were volunteer work with refugees (two participants), participation in the Global Health Film Festival (one participant) and work in expedition medicine (one participant).
Table 5
Previous SSC participant involvement with extracurricular activities since completing medical school
Extracurricular activity
|
Number
(n = 35)
n (%)
|
Number*
(n = 25)
n (%)
|
Teaching
|
10 (29)
|
10 (40)
|
Health-related presentation
|
8 (23)
|
7 (28)
|
Non-profit committee member
|
3 (9)
|
2 (8)
|
Research
|
3 (9)
|
2 (8)
|
Youth mentorship
|
2 (6)
|
2 (8)
|
Volunteer clinic
|
1 (3)
|
1 (4)
|
Other
|
2 (6)
|
2 (6)
|
*adjusted for participants who had just graduated from medical school. |
International Work
Five (14%) of 35 respondents had worked outside of the UK, whilst 19 (54%) were considering working abroad in the future. Responses regarding previous or planned international work could be categorised as humanitarian work (four participants), work in low resource setting (three participants), international GHE programmes including the IGH programme and Diploma in Tropical Medicine East African Partnership (two and one participants respectively), work with the World Health Organisation (two participants), work in Australia and New Zealand (two participants), expedition medicine (one participant) and research (one participant). Two participants also mentioned living outside the UK before attending medical school and thus returning after completing training.
Knowledge and Attitudes
Twenty-five (71%) of 35 respondents stated that the Newcastle medical school SSC in Global Health had influenced their clinical practice. Eight (23%) participants felt it did not and two (6%) were unsure. Table 6 shows common themes identified when participants were asked to describe the most significant influence on their clinical practice.
Table 6
Themes Identified From Responses to the Question “Describe the most significant influence of the Newcastle medical school SSC in Global Health on your clinical practice”
Theme
|
Number
(n = 22)
|
Quotes
|
Motivation to pursue additional global health education/training
|
4
|
“Advice from doctors in how to get into working in a global health setting”.
“…facilitated MRes with research in Tanzania / inspiration to apply for DTM&H”.
“Influenced my preferences in having one of my SHO rotations in Paediatric Infectious Diseases”.
“Played part in decision to apply to Masters”.
|
Importance of maintaining ethical and professional standards
|
2
|
“A session on ethical electives most likely influenced my clinical practice during the elective period and meant I was more cautious about not doing anything I would not be comfortable doing in the UK when abroad.”
Listening to how best to improve global health outcomes without crossing ethical or professional boundaries.
|
Sixteen (46%) of 35 respondents believed the SSC played a role in their career decisions, ten (29%) believed it did not, and nine (26%) were unsure. Table 7 shows common themes identified when participants were asked to describe the most significant influence on their career choice. Although perspectives on career influence of the Global Health SSC were largely positive, one participant remarked that the experience highlighted that despite having an interest in global health, they did not want to pursue it as a career.
TABLE 7 Themes Identified From Responses to the Question “Describe the most significant influence of the Newcastle medical school SSC in Global Health on your career choice”
Theme
|
Number
(n=16)
|
Quotes
|
Knowledge of career paths combining clinical work with engagement in global health
|
4
|
“Demonstrat[ed] it’s possible to work in GH alongside a clinical NHS job.”
“Demonstrated the different opportunities to get involved with global health as a clinician and that this is possible for multiple specialities, and at more stages in our career than I had previously realised.”
“…introduced me to ways of incorporating global health into my career that I hadn’t previously thought of.”
“Made me consider GP as a possible speciality to train in - considering the large set of skills GPs need to function in the community and how useful they can be in any setting.”
|
Motivation to pursue work abroad and in developing countries
|
4
|
“I also want to take some periods to work abroad, or in partnerships between NHS trusts and those abroad”
“Now keen to consider careers in developing countries and outside of [the] UK.”
“Reinforced my interests in tropical medicine and clinical medicine in developing countries.”
“Working abroad.”
|
Motivation to pursue research in global health
|
4
|
“Encouraged me to do an MRes in global health, which lead me to getting an AFP with research in ID/global health. In my future career, I am keen to continue a research component which I don't think I would have considered previously.”
“…GPs can be heavily involved in public health research of a particular community, and [it] made me realise that is an option.”
“…influenced my decision to undertake research in Tanzania with a Paediatric cohort”.
“Undertaking my AFP in global mental health.”
|
Awareness of ethical implications of working abroad
|
2
|
“made me more aware of the ethical implications of work abroad and factors to consider in respect to this.”
“listening to how best to improve global health outcomes without crossing ethical or professional boundaries.”
|
Commitment to pursuing work with greater public health effect
|
2
|
“[Influenced me] to try and pursue a career that will be sustainable and have large public health effect.”
“It made me question how big an impact on health being a doctor has…and has made me consider pursuing work in health policy and public health, potentially alongside clinical practice.”
|