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Global Choices: International Health and Medical Student Residency Preferences

Author: Andrew Bazemore and Philip Diller

Editor – As globalisation and increasing migration blur borders, medical students are demonstrating an increasing interest in global health, a trend to which primary care graduate medical education (GME) programmes are responding.[[ 1]] Although global health programmes have been reported to have many benefits for trainees, little is known about the benefits they offer to GME programmes.[[ 2]] We performed a cross‐sectional survey of medical student attendees at the 2004 American Academy of Family Physicians (AAFP) National Conference of Family Medicine Residents and Medical Students in Kansas City, Missouri, a natural confluence of students interested in primary care from across the country, to measure the self‐reported impact on students of the offer of global health training on student recruitment to a particular residency training programme. The study protocol was approved by the University of Cincinnati Institutional Review Board.

Of 82 medical student respondents (over 80% of those approached), 91% felt that training in global health should be offered by all family medicine residency programmes and 81% noted that a residency offering international health opportunities would be more or much more appealing than one that did not.

Interest in primary care specialties among US seniors has waned since 1997, in parallel with the growth in their participation in global health.[[ 5]] To be successful, these GME programmes need to have appealing curricula that are attractive to applicants.[ 2] This work adds to growing evidence that students interested in primary care value international health opportunities during residency.

Curricula cannot and should not be judged solely on the basis of their popularity, but the provision of education in global health may offer additional appeal to policymakers and reformers of medical education. Central to the new administration's plans for major health policy reform are efforts to increase access to primary care in areas of greatest need, to which the US Congress has responded with bills to expand GME positions for primary care disciplines. Of great concern to educators and policymakers alike is the issue of how to fill existing GME positions in primary care amidst declining interest among US seniors, much less the additional slots being considered by Congress.[[ 7]]

In response to these concerns, primary care GME innovation and reform are underway. These innovations are designed to prepare graduates for new models of primary care service delivery in the patient‐centred medical home[ 9] and recognise the need to integrate novel curricula that are attractive to learners. Simultaneous expansion of opportunities for training in global health can help programmes undergoing transformation to broaden their community medicine and public health curricula, understand team‐based and low‐resource care, address service learning, and adapt to an increasingly global community.[[ 1]]

These and other demonstrated benefits, such as the fostering of idealism, improving of cultural competency and provision of career choices in underserved settings, are mostly derived from studies of medical students, but are likely to extend to the primary care GME setting.[[ 3], [10]] Our recent findings provide early evidence of their power as attractants to primary care.[ 2] They also point to the need for additional research to identify and evaluate meaningful curricula capable of reversing the decline in interest in primary care in the USA and to measure their associations with desirable policy outcomes such as service in the most vulnerable communities.


1 Preliminary findings from the survey cited here (but not the specific material reported herein) were presented at the Global Health Education Consortium Annual Meeting in San Francisco, California, 9 March 2005.


Panosian C, Coates TJ. The new medical 'missionaries'– grooming the next generation of global health workers. N Engl J Med 2006 ; 354 (17): 1771 – 3.

2 Bazemore AW, Henein M, Goldenhar LM, Szaflarski M, Lindsell CJ, Diller P. The effect of offering international health training opportunities on family medicine residency recruiting. Fam Med 2007 ; 39 (4): 255 – 60.

3 Thompson MJ, Huntington MK, Hunt DD et al. Educational effects of international health electives on US and Canadian medical students and residents: a literature review. Acad Med 2003 ; 78 (3): 342 – 7.

4 Schultz SH, Rousseau S. International health training in family practice residency programmes. Fam Med 1998 ; 30 (1): 29 – 33.

5 Pugno PA, McGaha AL, Schmittling GT et al. Results of the 2008 National Resident Matching Program: family medicine. Fam Med 2008 ; 40 (8): 563 – 73.

6 Gonzalez EH, Phillips RL, Pugno PA. A study of closure of family practice residency programmes. Fam Med 2003 ; 35 (10): 706 – 10.

7 Hauer KE, Durning SJ, Kernan WN, Fagan MJ, Mintz M, O'Sullivan PS et al. Factors associated with medical students' career choices regarding internal medicine. JAMA 2008 ; 300 (10): 1154 – 64.

8 Phillips RL, Dodoo MS, Petterson S, Xierali I, Bazemore A, Teevan B et al. Special and Geographic Distribution of the Physician Workforce: What Influences Medical Student and Resident Choices? Washington, DC: Josiah Macy Jr Foundation, Robert Graham Center 2009.

9 Robert Graham Center. The Patient‐Centered Medical Home: History, Seven Core Features, Evidence and Transformational Change. Washington, DC: Robert Graham Center 2007.

Dey CC, Grabowski JG, Gebreyes K, Hsu E, Van Rooyen MJ. Influence of international emergency medicine opportunities on residency programme selection. Acad Emerg Med 2002 ; 9 (7): 679 – 83.


By Andrew Bazemore and Philip Diller

Reported by Author; Author

DMU Timestamp: November 27, 2019 01:26

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