Abstract
Accumulating evidence demonstrates an increasing interest among students in global experiences, particularly among students engaged in public health professional training and scholarship. The 2-year Global Health Training Program within the Master of Public Health program at Columbia University’s Mailman School of Public Health was created with the goal of developing global health professionals equipped with skills, experience, and perspectives to address the global health challenges of today and the future. The 2-year Master of Public Health program is interdisciplinary, involving faculty and students from five departments across the School, and offering students a wide range of global health courses selected from the School and University. In addition, students are required to undertake a 6-month, continuous, mentored professional practicum experience in a low- or middle-income country. A total of over 300 students have graduated from this program over the past 10 years. Students have completed practica in 75 countries at global health agencies, academic institutions, nongovernmental organizations, and community-based organizations. The involvement of a large number of faculty in global health research and practice provides a critical asset to the program given the emphasis of the program on applied experience.
Background
Global health education in the 21st century is vitally important. Traditional global health challenges, including infectious diseases such as HIV, malaria and tuberculosis, high maternal mortality, and high morbidity and mortality among infants and children persist in low- and middle-income countries despite significant national, bilateral, and multilateral investments (Bhutta & Black, 2013; Bygbjerg, 2012). Globalization of diets with significant amounts of highly processed foods, the increase in tobacco use, urbanization, and sedentary lifestyles are leading to a rapid increase in the burden of noncommunicable chronic diseases in middle- and even low-income countries that until recently were considered public health priorities solely in high-income settings (Mendez & Popkin, 2004; Popkin, 2006). Expansion of global travel has led to a heightened risk of spread of emerging infectious diseases, such as Ebola and Zika viral infections (Bloom, Black, & Rappuoli, 2017). At the same time, the crisis of forced migration of large numbers of individuals has led to an increasing number of displaced people and unrelenting humanitarian crises (Gostin & Roberts, 2015). Finally, unfavorable environmental and unanticipated climate patterns have disproportionately affected vulnerable populations in low-resource communities (Mendelsohn, Dinar, & Williams, 2006).
Interest in the study of global health among undergraduates and nonclinical graduates at universities in the United States has been on the rise over the past two decades (Macfarlane, Jacobs, & Kaaya, 2008; Velji, 2011). Global health has also gained in popularity among medical students with a 270% increase in the number of medical students in the United States and Canada participating in an international practice experience between 1998 and 2008 (Francis et al., 2012). This growing interest is driven by greater student awareness and concern about global issues, increased public attention to the global health imperatives owing to the HIV epidemic, the threat of newly emerging and re-emerging infectious diseases, and increased private and public funding for global health initiatives (Merson & Page, 2009).
Global health programs have proliferated across the United States and other resource-rich countries to meet this demand, some situated in schools of public health or other health-related institutions and many others at colleges and universities that have not traditionally provided formal health sciences training (Adams, Wagner, Nutt, & Binagwaho, 2016; Bandara, Banerjee, Dhillon, & Rafferty, 2016). Global Health was listed by the Institute of Medicine as one of the eight critical areas to be addressed through curricular changes in public health education (Gebbie, Rosenstock, & Hernandez, 2003). Currently, about 250 universities in North America offer global health educational programs varying from doctoral programs to undergraduate curricula (Kalbarczyk et al., 2015; Merson, 2014).
Several organizations have attempted to develop competencies to guide global health training programs. In 2011, the Association of Schools and Programs in Public Health developed a set of global health competencies for students in schools of public health and related global health programs (Association of Schools and Programs of Public Health, 2011). In addition, the Consortium of Universities for Global Health also worked in support of standardization of curricula and competencies for global health (Jogerst et al., 2015). These efforts aimed to anchor global health training programs in a unifying set of competencies (Eichbaum, 2015).
We describe the design and implementation of a 2-year Global Health Training Program within the Master of Public Health (MPH) program at Columbia University’s Mailman School of Public Health to respond to this compelling need.
Overview of the Global Health Training Program
The Global Health Training Program was piloted as an interdepartmental track in 2005, formally launched in 2006, and in 2012, became an accredited certificate program that prepares students to become practitioners of global health from five departments of the school: Environmental Health Sciences, Epidemiology, Health Policy and Management, Population and Family Health, and Sociomedical Sciences. The Council on Education for Public Health is the accrediting body for the School. In 2017, the Program graduated its 10th cohort.
The Global Health Training Program is situated within the School’s 2-year MPH program, one of the nation’s largest MPH degree programs. In 2012, the MPH curriculum underwent a transformation (Begg, Galea, Bayer, Walker, & Fried, 2014). A key innovative feature of this new MPH program was the establishment of University and New York State–approved certificate programs that provide students opportunities to specialize in an area of public health theory or practice beyond the disciplinary concentration of their home department. The largest of the 24 certificate programs at the Mailman School is the Global Health Certificate. Students in the Global Health Training Program receive such a certificate on completion of program requirements (Figure 1). This includes the completion of a minimum of 52 course credits, comprising one semester of a unified public health core curriculum that all MPH students participate in (18 credits), one semester (12-15 credits) of coursework in their home department, and one semester of global health–specific courses (12-15 credits). (One credit at the Mailman School of Public Health corresponds to 1 hour of class time and 2 hours of preparation weekly for a 14-week semester. A full course is typically 3 credits in length.) Additionally, students must complete a 6-month international practicum beginning in the summer between the first and second years of their study. Through coursework and the practicum, the Program addresses key Association of Schools and Programs in Public Health competencies for students of public health aiming to engage globally, with particular strong development of the interdisciplinary/cross-cutting competencies relating to diversity and culture, professionalism, program planning, and systems thinking (Association of Schools and Programs of Public Health, 2011). Each portion of the curriculum is discussed in detail below.
Global Health Certificate Program overview.
Coursework
All first-year MPH students, approximately 425 per year, receive an introduction to global health in the unified core curriculum through a required module titled Globalization and Global Health. This eight-session module provides students with an understanding of established and emerging public health challenges around the world, with a focus on the effects of globalization on population health. Other modules in the core curriculum with content particularly relevant to global health include Comparative Health Systems and Health and Human Rights.
In addition to the above educational offerings provided to all students, students enrolled in the Global Health Training Program—approximately 30 to 40 per year—complete two required global health courses that build on the content of the core curriculum. The first of these, Priorities in Global Health, is offered in the spring of the first year of study, before students depart for their practica (described below). In this course, students examine global health priorities, including both well-recognized priorities such as reproductive and child health and infectious diseases, and new challenges such as noncommunicable diseases, mental health, and injury prevention. Students learn about the causes and impact of these health problems, as well as strategies for addressing them at the national and global levels. In addition, students discuss the social, economic, and political factors that influence decisions about resource allocation and contribute to the rise of some global health priorities and the relative neglect of others. The course includes diverse lecturers including from researchers, policy makers, and implementers.
The second required course, Advanced Topics in Global Health, is offered in the last semester of the MPH program, after the students return from their 6-month practica. Using a multidisciplinary approach, this course systematically explores systems thinking concepts and tools and their application to global public health. Students then consider the global and regional political imperatives and local social contexts in which global health problems exist, and learn to analyze the successes and shortcomings of global public health interventions, including those they experienced in their practica, from a systems thinking perspective (Adam & de Savigny, 2012; Leischow & Milstein, 2006; Peters, 2014).
In addition to these Program-specific global health courses, students are required to complete two elective global health relevant courses that they can select from those offered at the School, based on their interests. The number of such courses throughout the School is vast—58 courses in 2017. A novel way for students to fulfill their global health course elective requirements is through participation in a distance-learning course during their practica period in the Fall semester of their second year. This innovation allows students to study topics of relevance to the countries where they are working while immersed in their practicum activities and draws on the students’ experiences from a wide range of global settings.
Global Health Practicum
An integral part of the Global Health Training Program experience is the required practicum, a continuous 6-month professional experience in a low- or middle-income country designed to place classroom concepts into context and provide students with the opportunity to apply the skills they learned in their first year in a supportive, mentored, and structured manner. Students are registered full time during the practicum which provides them continued access to University resources including online courses for credit, library services, health insurance, and financial aid. Students support themselves financially during their practicum through financial aid, personal sources, scholarships from outside the School, and, occasionally, through support from the practicum host organization (which could come in the form of a stipend, subsidized housing, or payment, depending on the institution). The School provides each student with a modest stipend to help cover their travel expenses. During their practicum experience, students are also able to gain a pragmatic view of what a career in global health requires, including working daily in a culturally different setting and with a diverse team of colleagues.
The Global Health Training Program leadership works with a wide network of organizations—many that have successfully hosted students in the past and others that are new—to develop practicum placements for each cohort of students. A description of these opportunities with application and contact information is provided for the students to apply directly to the organizations. Support during this process is provided through the seminars, discussed below, and through individual advising. Students are also encouraged to seek opportunities themselves, especially if they have interest in a topic or country not on the list of opportunities identified by the Program. Once students secure a practicum placement, they work with the host organization to develop a detailed scope of work for their 6-month placement, with help from faculty as required. The scope of work is reviewed and approved by the student’s home department advisor and the Program leadership.
In the past 10 years, students have been placed in practicum opportunities in 75 countries worldwide. The majority of students complete their practica in sub-Saharan Africa (27 countries, to date), followed by Southeast and South Asia (15 countries), with an increasing number over the years conducting their practica in South or Central America (16 countries), the Caribbean (2 countries), the Middle East (6 countries), and Central Asia (2 countries). Occasionally students split their practicum in order to spend 2 months with an organization working in global health that may be based in a high-income country (e.g., World Health Organization headquarters in Switzerland) and the remaining 4 months in a low- or middle-income country. Some students are drawn to topical projects of interest (e.g., infectious disease or global mental health), while others aim to improve specific public health skills (e.g., program planning, monitoring and evaluation, or data collection in resource-limited settings).
A crucial aspect of the practicum experience is the extensive mentorship that the students receive. Students are mentored at the practicum organization by an on-site supervisor, a professional with public health expertise and willingness to work closely with a student for 6 months. In addition to the on-site supervisor, the student also has a faculty advisor based at the School, as well as the Global Health Training Program Director and Associate Director, both faculty members, and the Global Health Training Program Coordinator. Students maintain contact with the Global Health leadership and each other through monthly written updates on their experiences. Students are covered through the School with travel insurance that allows for emergency evacuation in case a medical or security challenge requires it.
Supporting Seminars
Supporting the practicum experience are three required seminars. In the Fall of the first year of the MPH, the Global Health Professional Development Seminar introduces students to the wide-ranging roles that global health professionals play. In the Spring semester before Program students start their practica, they attend a weekly Pre-Practicum Seminar. Students are presented with information on the Program’s established, structured practicum sites and projects, including opportunities with Columbia University faculty and Centers, but also given support to secure their own practicum placements. On an annual basis, early in the semester, a forum is organized where second-year students who have recently returned from their practica describe their own experiences and answer student questions. Discussions explore cultural competency in global health, safety and security, maintaining physical and emotional health while overseas, the ethical conduct of research in resource poor countries, and other topics designed to optimize the learning experience for the students. On the students’ return, weekly Post-Practicum Seminars are organized to allow the students to share and document their experiences and prepare for the next steps in their global health careers after graduation. Students develop a scientific poster highlighting one aspect of their practicum and present it at a schoolwide Global Health Practicum Poster Session. In addition, during this period of time, students are assisted with updating of their resumes to reflect their practicum experiences, and discuss issues related to work–life balance in the context of a global health career.
Program Evaluation and Lessons Learned
Graduating Global Health Certificate students have expressed strong satisfaction with the program in exit interviews conducted by the Mailman School for the 4 years that the program has been a certificate (see Table 1). Between 83% and 95% of responding graduates rated the overall quality of the program as very or somewhat positive, and between 82% and 94% said the program prepared them very or somewhat well to integrate knowledge and skills across disciplines to address public health problems. Finally, between 77% and 95% of the graduating students felt somewhat or very connected with others in their cohort, which is a strong goal of the program.
Certificate Evaluation.
Number and percentage (in parentheses) responding “somewhat or very” positive, well, or connected, respectively.
In conclusion, the Mailman School of Public Health’s Global Health Training Program has evolved over the years in response to increasing demand for global health training. The program has increased flexibility and student choice in the practicum placement, responding to student desire to pursue practicum options in a wide range of settings and countries. The Program’s commitment to competency-based learning has informed every aspect of the training. Close attention to support and mentorship of the students has enabled its success in preparing the next generation of global health researchers and practitioners.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
