Global health competencies in postgraduate medical education: a scoping review and mapping to the CanMEDS physician competency framework
Background: Global Health opportunities are popular, with many reported benefits. There is a need however, to identify and situate Global Health competencies within postgraduate medical education. We sought to identify and map Global Health competencies to the current CanMEDS physician competency framework to assess the degree of equivalency and uniqueness between them.
Methods: JBI scoping review methodology was utilized to identify relevant papers searching MEDLINE, Embase, and Web of Science. Studies were reviewed independently by two of three researchers according to pre-determined eligibility criteria. Included studies identified competencies in Global Health training at the postgraduate medicine level, which were then mapped to the CanMEDS framework.
Results: A total of 19 articles met criteria for inclusion (17 from literature search and 2 from manual reference review). We identified 36 Global Health competencies; the majority (23) aligned with CanMEDS competencies within the framework. Ten were mapped to CanMEDS roles but lacked specific key or enabling competencies, while three did not fit within the specific CanMEDS roles.
Conclusions: We mapped the identified Global Health competencies, finding broad coverage of required CanMEDS competencies. We identified additional competencies for CanMEDS committee consideration and discuss the benefits of their inclusion in future physician competency frameworks.
Dey CC, Grabowski JG, Gebreyes K, Hsu E, VanRooyen MJ. Influence of international emergency medicine opportunities on residency program selection. Acad Emerg Med 2002;9(7):679-83.
Kaeppler C, Holmberg P, Tam RP, et al. The impact of global health opportunities on residency selection. BMC Med Educ. 2021 Dec 1;21(1).
Wilkinson KH, Bowder AN, Goldblatt MI, Olson L, Dodgion CM. General surgery applicants are interested in global surgery, but does it affect their rank list? J Surg Res. 2021 Jan 1;257:449-54.
Drain PK, Holmes KK, Skeff KM, Hall TL, Gardner P. Global health training and international clinical rotations during residency: current status, needs, and opportunities. Available from: https://journals.lww.com/academicmedicine
Thompson MJ, Huntington MK, Dan Hunt D, Pinsky LE, Brodie JJ. Educational effects of international health electives on u.s. and Canadian medical students and residents: a literature review. Vol. 78, Acad. Med. 2003. https://doi.org/10.1097/00001888-200303000-00023
Lu PM, Park EE, Rabin TL, et al. Impact of global health electives on us medical residents: a systematic review. Ann Glob Health. 2018 Nov 5;84(4):692-703. https://doi.org/10.29024/aogh.2379
Litzelman DK, Gardner A, Einterz RM, et al. Correction: on becoming a global citizen: transformative learning through global health experiences (Annals of Global Health. 2017 May-August; 83(3-4): 596-604. Vol. 87, Annals of Global Health. Ubiquity Press; 2021. https://doi.org/10.1016/j.aogh.2017.07.005
Sawatsky AP, Rosenman DJ, Merry SP, McDonald FS. Eight years of the Mayo International Health Program: what an international elective adds to resident education. Mayo Clin Proc. 2010;85(8):734-41. https://doi.org/10.4065/mcp.2010.0107
Frank JR, Snell LS, Cate O ten, et al. Competency-based medical education: theory to practice. Med Teach. 2010 Aug;32(8):638-45. https://doi.org/10.3109/0142159X.2010.501190
Frank JR, Snell L, Sherbino J, Royal College of Physicians and Surgeons of Canada. CanMEDS 2015 physician competency framework. 35 p.
Volsky PG, Sinacori JT. Global health initiatives of US otolaryngology residency programs: 2011 global health initiatives survey results. Laryngoscope. 2012 Nov;122(11):2422-7. https://doi.org/10.1002/lary.23533
Schleiff M, Hansoti B, Akridge A, et al. Implementation of global health competencies: a scoping review on target audiences, levels, and pedagogy and assessment strategies. PLoS One. 2020 Oct 1;15(10 October). https://doi.org/10.1371/journal.pone.0239917
Salasky VR, Saylor D. Impact of Global Health Electives on Neurology Trainees. Ann Neurol. 2021 May 1;89(5):851-5. https://doi.org/10.1002/ana.26031
Rodriguez A, Ho T, Verheyden C. International programs in the education of residents: benefits for the resident and the home program. J Craniofacial Surg. 2015;26(8):2283-6. https://doi.org/10.1097/SCS.0000000000002212
Lauden SM, Gladding S, Slusher TM, Howard CR, Pitt MB. Thematic analysis of global health trainee experiences with mapping to core competencies (research abstract). Acad Pediatr. 2017 Jul;17(5):e48-9. https://doi.org/10.1016/j.acap.2017.04.136
Dohlman L, DiMeglio M, Laudanski K. The impact of an international elective on anesthesiology residents as assessed by a longitudinal study. J Med Educ Curric Dev. 2019 Jan;6:238212051987394. https://doi.org/10.1177/2382120519873940
Posid T, Amin S, Kaufman L, et al. MP67-08 urology patient perceptions of resident cultural competency in a pilot local global health curriculum. 2021. https://doi.org/10.1097/JU.0000000000002028.08
Lanys A, Krikler G, Spitzer RF. The impact of a global health elective on CanMEDS competencies and future practice. Hum Resour Health. 2020 Jan 29;18(1). https://doi.org/10.1186/s12960-020-0447-4
Nordhues HC, Bashir MU, Merry SP, Sawatsky AP. Graduate medical education competencies for international health electives: a qualitative study. Med Teach. 2017 Nov 2;39(11):1128-37. https://doi.org/10.1080/0142159X.2017.1361518
Walpole SC, Shortall C, van Schalkwyk MC, et al. Time to go global: a consultation on global health competencies for postgraduate doctors. Int Health. 2016 Sep 1;8(5):317-23. https://doi.org/10.1093/inthealth/ihw019
Al-Shakarchi N, Obolensky L, Walpole S, Hemingway H, Banerjee A. Global health competencies in UK postgraduate medical training: a scoping review and curricular content analysis. BMJ Open. 2019 Aug 1;9(8). https://doi.org/10.1136/bmjopen-2018-027577
Consortium of Universities for Global Health (CUGH) Competency sub-committee. CUGH Global Health Education competencies tool kit (2nd edition). Washington, DC; 2018. Available from: www.cugh.org/onlne-tools/competencies-toolkit/ [Accessed on Mar 26, 2022].
World Health Organization. Global competency and outcomes framework for universal health coverage [Internet]. Geneva; 2022. Available from: https://www.who.int/publications/i/item/9789240034686 [Accessed on Jul 24, 2022].
Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020 Oct 1;18(10):2119-26. https://doi.org/10.11124/JBIES-20-00167
Aromataris E, Munn Z (editors). JBI Manual for Evidence Synthesis. 2020. https://doi.org/10.46658/JBIMES-20-01
McDonald M, Lavelle C, Wen M, Sherbino J, Hulme J. The state of health advocacy training in postgraduate medical education: a scoping review. Vol. 53, Med Ed. Blackwell Publishing Ltd; 2019. p. 1209-20. https://doi.org/10.1111/medu.13929
Bryan JM, Alavian S, Giffin D, et al. CAEP 2021 Academic symposium: recommendations for addressing racism and colonialism in emergency medicine. Can J Emerg Med. Springer Nature; 2022. p. 144-50. https://doi.org/10.1007/s43678-021-00244-2
McLane P, Bill L, Barnabe C. First Nations members' emergency department experiences in Alberta: a qualitative study. Can J Emerg Med. 2021 Jan 1;23(1):63-74. https://doi.org/10.1007/s43678-020-00009-3
Johnson K, Idzerda L, Baras R, et al. Competency-based standardized training for humanitarian providers: making humanitarian assistance a professional discipline. Disaster Med Public Health Prep. 2013;7(4):369-72. https://doi.org/10.1017/dmp.2013.10
World Health Organization. Emergency medical teams initiative: about us [Internet]. 2020. Available from: https://extranet.who.int/emt/content/about-us [Accessed on Apr 29, 2022].
Froutan Aziz. Concern is not enough: while human trafficking continues to tear lives apart, new research reveals canadians are shockingly unaware of the realities or how to make a difference. The Canadian Centre to End Human Trafficking. 2021. Available from: https://www.canadiancentretoendhumantrafficking.ca/concern-is-not-enough-while-human-trafficking-continues-to-tear-lives-apart-new-research-reveals-canadians-are-shockingly-unaware-of-the-realities-or-how-to-make-a-difference/ [Accessed on Apr 29, 2022].
Mbaye R, Gebeyehu R, Hossmann S, et al. Who is telling the story? A systematic review of authorship for infectious disease research conducted in Africa, 1980-2016. BMJ Glob Health. 2019 Oct 1;4(5). https://doi.org/10.1136/bmjgh-2019-001855
Chu KM, Jayaraman S, Kyamanywa P, Ntakiyiruta G. Building research capacity in Africa: equity and global health collaborations. PLoS Med. 2014;11(3). https://doi.org/10.1371/journal.pmed.1001612
Naidu T. Southern exposure: levelling the Northern tilt in global medical and medical humanities education. Adv Health Sci Educ. 2021 May 1;26(2):739-52. https://doi.org/10.1007/s10459-020-09976-9
Edejer TTT. North-South research partnerships: the ethics of carrying out research in developing countries. BMJ. 1999 Aug 14;319(7207):438-41. https://doi.org/10.1136/bmj.319.7207.438
Eichbaum QG, Adams Lv, Evert J, Ho MJ, Semali IA, van Schalkwyk SC. Decolonizing global health education: rethinking institutional partnerships and approaches. Vol. 96, Acad Med. Lippincott Williams and Wilkins; 2021. p. 329-35. https://doi.org/10.1097/ACM.0000000000003473
Chaudhuri MM, Mkumba L, Raveendran Y, Smith RD. Decolonising global health: Beyond "reformative" roadmaps and towards decolonial thought. Vol. 6, BMJ Global Health; 2021. https://doi.org/10.1136/bmjgh-2021-006371
Sayegh H, Harden C, Khan H, et al. Global health education in high-income countries: confronting coloniality and power asymmetry. BMJ Global Health. 2022 May;7(5):e008501. https://doi.org/10.1136/bmjgh-2022-008501
Chen CCG, Dougherty A, Whetstone S, et al. Competency-based objectives in global underserved women's health for medical trainees. Obstetrics and Gynecology. 2017 Oct 1;130(4):836-42. https://doi.org/10.1097/AOG.0000000000002197
Asgary R, Smith CL, Sckell B, Paccione G. Teaching immigrant and refugee health to residents: domestic global health. Teach Learn Med. 2013 Jul;25(3):258-65. https://doi.org/10.1080/10401334.2013.801773
Arora G, Condurache T, Batra M, et al. Miles away milestones: a framework for assessment of pediatric residents during global health rotations. Acad Pediatr. 2017 Jul 1;17(5):577-9. https://doi.org/10.1016/j.acap.2016.12.018
Truth and Reconciliation Commission of Canada. Truth and Reconciliation Commission of Canada : calls to action. [Internet]. 2015. Available from: https://publications.gc.ca/site/eng/9.801236/publication.html [Accessed on Aug 12, 2022].
Shaheen-Hussain S. Fighting for a hand to hold: Confronting medical colonialism against Indigenous children in Canada. McGill-Queen's University Press; 2020.
Whitehead CR, Kuper A, Hodges B, Ellaway R. Conceptual and practical challenges in the assessment of physician competencies. Vol. 37, Med Teach. Informa Healthcare; 2015. p. 245-51. https://doi.org/10.3109/0142159X.2014.993599
Thoma B, Karwowska A, Samson L, et al. Emerging concepts in the CanMEDS physician competency framework. Can Med Educ J. 2023. https://doi.org/10.36834/cmej.75591
Ringsted C, Hansen TL, Davis D, Scherpbier A. Are some of the challenging aspects of the CanMEDS roles valid outside Canada? Med Educ. 2006 Aug;40(8):807-15. https://doi.org/10.1111/j.1365-2929.2006.02525.x
Afr Anaesth Analg SJ. Defining fitness for purpose in South African anaesthesiologists using a Delphi technique to assess the CanMEDS framework. South. African J Anaesth Analg 2019;25(2):7-16. https://doi.org/10.36303/SAJAA.2019.25.2.2193
Turner S, Seel M, Trotter T, et al. Defining a Leader Role curriculum for radiation oncology: a global Delphi consensus study. J Radiat Oncol. 2017 May 1;123(2):331-6. https://doi.org/10.1016/j.radonc.2017.04.009
Hautz SC, Hautz WE, Feufel MA, Spies CD. Comparability of outcome frameworks in medical education: implications for framework development. Med Teach. 2015 Nov 2;37(11):1051-9. https://doi.org/10.3109/0142159X.2015.1012490
How to Cite
Copyright (c) 2022 Jodie Pritchard, Sara Alavian, Anantha Soogoor, Susan Bartels, Andrew Hall
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.