COMPETENCIES FOR PEDIATRIC GLOBAL CHILD HEALTH: ALL LEVELS TERMS OF USE: Please feel free to use and adapt this information to suit the needs of your program. PATIENT CARE Competency: s will be able to provide compassionate, culturally sensitive and effective familycentered care to a diverse patient population independent of socioeconomic status, religion, nationality or citizenship. Goals Objectives Group* Demonstrate the attitude and skill set to provide family centered care with expertise in assessment of the health care needs of children from another culture or nation. Demonstrate cultural humility and sensitivity gained from an international rotation experience into work with diverse populations including recently immigrated populations. Demonstrate a sensitive and calming manner in caring for a child who has a chronic or terminal Describe the culture of one s patients All RL1 Monthly meeting Case study Hmong Somali Ethiopian Hispanic Native American LGBTQ Understand and apply the prevailing view of medicine RL2/3 Local or international Case study within a culture different from one s own elective Understand cultural practices around disease treatment RL2/3 Local or international Case study elective Explain the family structure within a culture different from one s own RL2/3 Local or international elective Case study Consider ways that the international experience informs RL2/3 Portfolio/journal your practice of medicine Translate your role in the international setting to your RL2/3 Portfolio/journal role in the U.S. setting Be cognizant of the culture and nation you lived in during RL2/3 Portfolio/journal the international experience and allow both to improve the understanding of your patient s expressed needs and Adoption clinic perception of you as the health care provider in the U.S. Apply the knowledge, skills and attitude gained during RL2/3 Direct observation the international experience to your practice of medicine OSCE Develop awareness of personal care strategies in All RL1 Primary care seminar Case scenario providing medical care for a dying child Orientation Demonstrate confidence in discussing a terminal illness All RL3 Direct observation Page 1 of 14
disease with parent and child given a diagnosis of HIV, sickle cell disease, diabetes mellitus, or malignancy Appreciate the health provider s role in discussing death across cultures Demonstrate sensitivity to parent questions about their child s condition * All = all residents/fellows, = only participants in pediatric global health track OSCE All RL1 Primary care seminar Case scenario All RL1 Direct observation OSCE MEDICAL KNOWLEDGE Competency: s will demonstrate knowledge of diseases and of social, environmental, political and economic conditions impacting the health of children in resource-poor areas of the United States and in regions outside of North America. s must demonstrate the ability to apply this knowledge to effective patient care. Goals Objectives Group* Articulate the global burden of communicable and non-communicable disease including: knowledge of the global indicators of child health and geographic distribution of disease Know the epidemiology and pathogenesis of communicable diseases: Pneumonia Diarrhea Tetanus Polio Tuberculosis HIV Bacterial Meningitis Hepatitis A & B All RL1 Noon conference Grand Rounds Cholera Typhoid fever Dengue fever Yellow fever Malaria Intestinal parasites Know the epidemiology of non-communicable diseases: Diabetes mellitus End-stage renal disease Anemia (sickle cell) RL2/3 Noon conference All RL2/3 Noon conference Page 2 of 14
Environmental toxins Rheumatic heart disease Undernutrition Know the Global Indicators: Neonatal mortality rate Maternal mortality rate Infant mortality rate Under five mortality rate # of children living in poverty # of stunted children Millennium Development Goals RL2/3 Noon conference All RL1 Noon conference Explain the major causes of child mortality worldwide and evidence-based interventions to prevent death Know Pneumonia: Epidemiology Prevention IMCI/CBHC Medical treatment The Child Survival Strategy All RL1 Noon conference Know Diarrhea: Prevention IMCI/CBHC ORS The Child Survival Strategy All RL1 Noon conference Know Malaria: Pathogenesis Prevention IMCI/CBHC Medical treatment The Child Survival Strategy RL1 Noon conference Page 3 of 14
Know Measles: Pathogenesis Prevention IMCI/CBHC Medical treatment The Child Survival Strategy Know Undernutrition: Wasting: & Stunting: - Etiology - IMCI/CBHC - Medical treatment - Complications Acute Severe Malnutrition: - Output management - Input management Micronutrient The Child Survival Strategy RL1 Noon conference RL1 Noon conference Understand the impact of maternal health on child health Explain the major causes of neonatal death worldwide and preventive evidencebased interventions Demonstrate knowledge of the etiology and prevention of maternal mortality Explain the impact of maternal mortality on infant and child mortality and developmental morbidity Know Low Birth Weight: Prevention Know Sepsis: E-B interventions Know Hypothermia: RL2 Evening seminar All RL1 Noon conference Page 4 of 14
E-B interventions Know Birth Asphyxia: E-B interventions Know Neonatal Jaundice: E-B interventions Explain the major causes of developmental morbidity Be able to discuss the magnitude of the problem, risk factors, impact on academic achievement, economic independence and evidence-based interventions List the four major causes of developmental morbidity: Stunting Inadequate cognitive stimulation Iodine deficiency Iron deficiency RL2 Evening seminar Directed Readings Become articulate regarding the interaction of the physical environment and health Know the effect of economic disparity and black market trade on maternal and child health Become aware of the specific health and social needs of Understand the impact of HIV on developmental morbidity Explain the impact of water, natural disasters, toxicants, overcrowding, urban migration, climate change, and loss of the ecosystem on human health Demonstrate knowledge of the impact of poverty, child labor, child trafficking on maternal and child health Know Orphan Issues: # of orphans worldwide Causes of loss of parents All RL3 Film Discussion On-line Module Grand Rounds All RL3 Noon conference All RL1/2/3 Noon conference Page 5 of 14
children who have been orphaned and know how to care for internationally adopted children within extended family, foster care, adoption and institutionalized contexts - Child-headed households - Loss of child s personal property - Loss of school/opportunities - Exploitation - Prostitution - Increased risk of child mortality - International adoption issues Interventions In-country foster care Practice pre-adoption consultation: Demographics History of international adoption Medical review RL1/2/3 Adoption clinic Direct observation Practice post-adoption health care: Hx/physical Lab screening Attachment Growth and development RL1/2/3 Adoption clinic Direct observation Explain the effect of armed conflict on health Know the risk of losing a parent, becoming a child soldier, suffering torture, acquiring a severe infection, dying Understand the impact on long-term mental health from Post-Traumatic Stress Syndrome Know the impact of forced migration on child health Demonstrate knowledge of the terms refugees, internally displaced people, immigrants Know the effect of forced migration on culture and health including the disruption of health care systems and the interruption of primary care Know how to care for children traveling internationally Know how to obtain up-to-date information on immunizations required for travel Demonstrate knowledge of assuring personal safety RL1/2/3 Local global health elective Direct observation Page 6 of 14
including road safety, pedestrian safety food safety and prevention of infections Know how to perform an adequate immigrant and refugee health screening Know how to access global health resources Demonstrate the ability to take a history, perform a detailed physical, obtain the correct labs, and articulate the essentials of providing a health care home Demonstrate the ability to know when and how to access the Red Book, CDC, UNICEF, WHO, other worldwide literature * All = all residents/fellows, = only participants in pediatric global health track All RL1/2/3 HCMC clinical experience Noon conference Local global health elective (for ) On-line module RL3 Direct observation PRACTICE-BASED LEARNING AND IMPROVEMENT Competency: s will be able to evaluate their patient care practices, appraising and assimilating medical evidence in a culture other than their own to improve patient care. Goals Objectives Group* Differentiate translatable versus non-translatable models among western, traditional, and international health delivery systems and appropriately implement where improvements in patient care can be made. Be able to explain to another about one s own health care delivery system Articulate the international standards of health care delivery for common diseases including the: Expanded Program on Immunization Integrated Management of Childhood Illnesses Explain the health care system in one international setting Be able to triage and manage utilizing local resources available in international settings Demonstrate knowledge of how to investigate local resources Adjust work-up using available diagnostic and treatment resources RL2/3 RL2/3 Page 7 of 14
Know how to access the medical evidence in another country and translate to one s practice setting in the local context Demonstrate how to access the local experts, internet, textbooks, literature, research facilities in one international setting Know one or two portable resources to take from the US to an international setting RL2/3 RL2/3 orientation Know of the challenge to conducting research in an international setting Be able to describe an ethical dilemma in international research Conversation with Incountry mentor * All = all residents/fellows, = only participants in pediatric global health track INTERPERSONAL AND COMMUNICATION SKILLS Competency: s will demonstrate interpersonal and communication skills which transcend cultural, economic, religious and national barriers and result in effective exchange of information. Goals Objectives Group* Demonstrate ease in relating directly to the patient and his/her family when working with an interpreter. Understand the role of gender across intercultural patientphysician interactions Demonstrate the ability to introduce oneself through an interpreter to a patient and family Demonstrate the ability to skillfully discuss with the family the patient s diagnosis, treatment and prognosis through an interpreter Articulate an understanding of gender roles within the family and society, the power of gender in the care of a child, and the issue of gender equity in a culture other than one s own All RL1/2 Primary care seminar (Skills training) All RL1/2 Primary care seminar (Didactic) Direct observation OSCE Case scenario Understand the role of non-verbal communication between patient, family and physician with differing cultural Explain the significance of hand gestures, tone of voice and postures in a culture other than one s own All RL1/2 Primary care seminar (Skills Training) Case scenario Page 8 of 14
backgrounds. Recognize the privilege of working in a country other than one s own When doing an international elective, demonstrate the understanding of being a guest in the country and local community RL2/3 Orientation When preparing for an international elective honor the logistical requirements requested to practice medicine in that setting RL2/3 Orientation on-site mentor evaluation Recognize the value of learning the language of the patient Give one account of respect gained in learning the patient s language Give one account of the power gained in communicating in the language of your patient RL2/3 Language school (optional) Portfolio/journal Develop awareness of how one is perceived in other health care settings Articulate one s own perceptions of healing RL2/3 Portfolio/journal Demonstrate the ability to communicate in a nonhierarchical RL2/3 and non-judgmental manner faculty evaluation * All = all residents/fellows, = only participants in pediatric global health track OSCE PROFESSIONALISM Competency: s will have an attitude and manner which recognizes the dignity of every human being and promotes cross cultural and transnational patient care; and recognizes the value of colleagues trained in another cultural setting. s will have a self awareness and skills to care for themselves in stressful cross cultural and transnational situations. Goals Objectives Group* Demonstrate an interest in and engagement with the culture of your international elective. Demonstrate the following attributes by the end of the international elective: Be curious Ask questions of trusted colleagues Reflect at the end of the day Address the impact of ethnocentrism on one s own RL2/3 Portfolio/journal Page 9 of 14
perception of oneself and the other Reserve political opinions while abroad Be able to effectively develop ties to local medical and community groups of recently immigrated populations in Minnesota. Be able to assess in a culturally sensitive manner the strengths and weaknesses of different medical systems Show an attitude which enriches collaboration with colleagues from another culture or nation Demonstrate during the local elective the ability to: Participate in local medical and community events Seek advice from local leaders and colleagues in the international community Seek advice from local leaders and colleagues among communities of immigrants Demonstrate the: Ability to assess and integrate strengths in the familiar and unfamiliar medical systems Ability to assess and strengthen or discard weaknesses in the familiar and unfamiliar medical systems Ability to acknowledge and process one s own feelings when encountering a clinical practice one considers inappropriate or unethical in the context of one s own culture and practice Demonstrate the ability to: Recognize the strengths that a different system of medical training brings to the practice of medicine, research and teaching Be open to learn Acknowledge the privilege of working closely with an international colleague Understand that we have a lot to learn from one another RL1/2/3 Local Elective Local elective faculty evaluation RL2/3 Case study RL2/3 Portfolio/journal Be confident in the steps to take if personal well being is compromised Before traveling, be able to: Recognize warning signs in the environment Know how to avoid putting oneself in jeopardy Understand the support system in place in the local community Know how to register one s arrival and seek help with RL2/3 Orientation Orientation and debriefing/focus groups Page 10 of 14
the U.S. Embassy Be prepared to plan and undertake an international medical experience Prior to the international elective, be able to: Take steps necessary to ensure personal safety and well being Navigate the logistical requirements Choose wisely the international setting Communicate with hosts who are preparing for his/her arrival in the country Study the medical, cultural, historical and economic environment prior to departure Plan an academically and locally relevant project Present a travel and project report on return RL2/3 Orientation Report will know the signs of culture shock Know how to manage stress in a culture, climate and professional environment different from one s own Demonstrate personal and professional responsibility in an international setting Prior to the international elective, be able to articulate the following details of culture shock: Physical signs Emotional signs How to find help When to come home Prior to departure for an international elective be able to: Review stress relievers at home Plan strategy to control stress in the international setting Prepare for potential stress before it happens Be punctual Demonstrate good time-management skills Dress in appropriate attire Demonstrate respect for colleagues, patients and families Demonstrate knowledge of the practical application of the three major ethical principles: respect for persons, beneficence and justice as established by the Belmont Report RL2/3 Orientation RL2/3 Orientation Orientation Debriefing/Focus Groups Orientation Debriefing/Focus Groups Portfolio/journal RL2/3 * All = all residents/fellows, = only participants in pediatric global health track Page 11 of 14
SYSTEMS-BASED PRACTICE Competency: s will demonstrate knowledge of health care delivery systems in other countries, the role of international agencies and interactions between them. Goals Objectives Group* Understand the relationship between basic economics and child health particularly the effect of poverty and income inequality Demonstrate a knowledge of the interaction of local, tribal, national and international politics on child health Ability to conceptualize the challenge of restoring global health equity Explain the effect of poverty on: Health care Child health Education Earning potential as adults In one case scenario be able to discuss: Local community/tribal/national and international connections Effect of political interconnectedness on health Give an example of the challenge of equity in each of the following situations: Ethical considerations of undertaking research in resource-poor areas Distribution of vaccines Distribution of medicines Distribution of knowledge All RL2/3 Noon conference Case scenario RL2/3 Evening seminar Case scenario RL3 Evening seminar Portfolio/journal Understand and be able to contribute to community based health care Explain the following: Community-based health care (CBHC), its role in the United States, and its significance in global health All RL2 Noon conference Case scenario One s own role in CBHC All RL2 Noon conference Case scenario The role and significance of CBHC in an international setting RL3 Case scenario Provide program leadership in medical care for recently immigrated populations Give an example of A unique need of recently immigrated populations Build a health care program with leaders in these communities RL2/3 Local Elective Primary care seminar Portfolio/journal One item learned in the international setting that RL2/3 Portfolio/journal Page 12 of 14
Be able to assess the effectiveness of health care delivery based on local ideas in an international setting would be useful in building a health care delivery system in the U.S. Demonstrate the ability to: Seek the input of patients families and community leaders in assessing the needs and effectiveness of the practice Work closely with local colleagues to address the local needs Work closely with local colleagues to implement health care delivery based on the needs of the community Evaluate the program based on local as well as international standards of successful outcome Know the organizations that make and influence international health policy and provide funding Understand the position of the patient within a culturally different health care system. Know the following organizations: WHO Gates Foundation UNICEF World Bank Be able to discuss the patient s access to health care in their native health care setting Recognize the perception the patient would have of the health care provider in their own culture particularly with respect to communication Demonstrate appropriate communication skills to patients of different cultural backgrounds RL3 Evening seminar All RL3 Primary care seminar Direct observation OSCE Express an appreciation of the differences in medical systems, training and practice in varying cultural and institutional settings in the developing and Identify benchmarks to compare medical systems and develop process to compare Page 13 of 14
developed world Recognize the scope of health disparities and articulate potential solutions Be able to articulate one example of a health disparity in one s own culture and another Be able to articulate a possible solution to the disparities described RL3 Evening seminar De-briefing/Focus Group * All = all residents/fellows, = only participants in pediatric global health track Page 14 of 14