269 - "Think Globally, Act Locally” (TGAL): A cross-border global health residency elective

Poster Number: 269
Publication Number: 269.420

Vanessa P. Scott, University of California, San Diego School of Medicine, San Diego, CA, United States; Shannon O'Donnell, University of California, San Diego School of Medicine, Midlothian, VA, United States; Paula Aristizabal, University of California, San Diego School of Medicine, San diego, CA, United States; Christopher Cannavino, University of California, San Diego School of Medicine, San Diego, CA, United States

Background: Global health (GH) experiences during residency have been shown to improve confidence in physical exam and communication skills,  cultural sensitivity, and better understanding of needs in underserved populations. While participation in GH electives has increased, most experiences are 1-2 months, require long-distance travel, and are costly. There are very few, if any, short-term, accessible, and low-cost pediatric residency GH electives.

Objective: To assess outcomes of a unique, local 2-week global health elective “Think Globally, Act Locally” (TGAL), which exposes residents to the diverse cross-border, immigrant and refugee populations in San Diego, California and Tijuana, Mexico (Table 1).

Design/Methods: After finishing the elective, residents completed a retrospective pre-post evaluation assessing confidence in providing care in various settings (using a 5-point Likert scale) and five open-ended questions focused on satisfaction and feedback. Frequency statistics were used to describe the characteristics of the participants and survey responses. Mean pre- and post-rotation confidence scores were compared to assess change in resident confidence. A paired sample t-test was run for each pair of mean confidence pre- and post- scores, and a significant difference was noted with p< 0.05. Resident and program cost was assessed. SAS 9.4 used for analysis.

Results: Of the 9 residents who experienced the TGAL elective, 8 completed the survey (89%). Most were in their second year of residency (78%), non-Hispanic White (89%), female (66%) and ages ranged from 28-34 years old.  Self-reported resident confidence significantly increased for almost every domain assessed (Figure 1). Areas with the most significant increase included providing outpatient care to refugee, immigrant and cross-border populations, providing routine refugee health assessments, and sending patients to hospitals in Tijuana to receive care.
 
Overall elective assessments were positive. Key themes included learning about the challenges of serving diverse cross-border populations, difficulties immigrants/refugees face, and differences between healthcare systems in the United States vs Mexico. Resident highlights included “working with Mexican physicians at the Tijuana hospitals, seeing the pathology, and refugee health assessments.” (Table 2) Participant cost was $0-$200 per resident.Conclusion(s): This unique, local GH elective improved resident confidence for providing care in resource-limited settings to a diverse cross-border and immigrant/refugee population. Resident satisfaction was overall excellent and the program cost was minimal.
Table 1. TGAL Sites, Location and Description of resident experience
Table 2. Key learning points, satisfaction and feedback by residents after the TGAL elective