Make way for a new generation of global health doctors

The Learning Community in Global Health is offered by the University Medical Centre Groningen. Between 100 and 120 students join this learning community annually to actively participate for up to three years. About half of the students come from abroad, and of the Dutch students, more than half have lived abroad for some time. It truly is an international learning community. The former International Bachelor of Medicine programme in Groningen laid the foundation for the Learning Community in Global Health (LCGH). Three of the five members of the Global Health core team and around a quarter of the 60 coaches involved in small-scale education have worked abroad themselves.

Focus on developing competencies

LCGH students participate in course modules where health issues are put in a global context: infectious diseases (malaria, HIV, hepatitis C, etc.), non-communicable diseases (COPD, diabetes, anaemia, etc) and safe motherhood. Students analyse preventive programmes such as polio eradication, nutrition rehabilitation, and vitamin supplementation. They are challenged to discuss ethical, political and cultural aspects of health, for example in abortion, depression or end-of-life issues. Students are exposed to the right to health, equity issues and access to medicines. They discuss the organisation of health services, for example in relation to emergency medical care or maternal health. They play the role of an MSF doctor performing triage in emergency situations, and they compare diseases and treatment options across countries. It goes without saying that much attention is focused on public health and epidemiology in the LCGH. Students also learn how to critically analyse scientific literature and perform statistical analysis on large databases.

As we focus on competency development, students learn to write essays, produce posters, give pitch presentations, and participate in debates or role plays. They even learn how to make videos and animations. Students in the Global Health modules are assessed on how they translate theory into practice. There are no written exams.

During the last semester of the Bachelor programme, students perform a project in which they demonstrate their competencies, usually in the form of a product that has a direct relation to health service delivery such as health education materials, a work plan for health promotion, or an analysis of an ongoing nutrition project. Students are challenged to identify and propose their own project. This year around 40 of our students went abroad, mostly to low income countries, to work on nutrition, maternal health, child health, etc.

Internships abroad

In the Master phase, when students no longer participate in learning communities, they may follow the Global Health track and opt for an internship abroad, e.g. in surgery, internal medicine, tropical medicine or public health. Alternatively, they can do a research project abroad. The maximum duration of an internship abroad is 54 weeks, which comprises 40 percent of the Master programme. Students going abroad follow an extra course on tropical medicine and international health. Every year, around 150 Master students from UMCG do an internship abroad.

Lessons learned

With so much attention going to Global Health and so much time spent practicing competencies, don’t we neglect our duty of preparing students for medical practice? We don’t think so. Our students perform well in the national progress tests that are simultaneously taken in all medical schools in the Netherlands. The recent accreditation visit was very enthusiastic about our approach. We see very engaged and vocal students, who dare to present in public and dare to speak out and take initiatives in organising projects. They participate in international student organisations, go to international conferences, and maintain international relations with students and health workers abroad.

Of course, it all came at a price. It was not easy to develop competency-based education modules. We were not specialists in this type of education, so we had to learn by doing. And at times students felt they were the guinea pigs of education innovation. Even now, teaching staff sometimes find it difficult to take on the role of a coach rather than an instructor. For many students, especially those who are more familiar with traditional forms of education, self-directed learning is quite a challenge. It’s sometimes easier to be taken by the hand and be told exactly what to do. But during the first semester students are coached intensively in learning how to take responsibility for their own learning process.

Education

[Image: Live debate with WHO office in Afghanistan on polio eradication]
[Image: Students presenting their posters on global health]

Many students want to do an internship abroad in the Master phase. We are continuously looking for new partner hospitals that can offer our students learning opportunities. Meeting the quality standards for accreditation, however, remains a challenge for these partner hospitals.

Doctors with a new spirit

In a recent survey, around 60% of our Dutch students in the LCGH indicated they plan to work for some time in a low or middle income country. We expect to be preparing a good number of students for training as MDs in Global Health and Tropical Medicine. We hope that these young doctors, trained in Groningen, will stand out in leadership and interdisciplinary collaboration. But even if students decide not to go abroad and prefer to work in the Netherlands, their knowledge of migrant health and divergent cultural perceptions of health and disease will enable them to contribute to Global Health. Their ability to recognise equity or gender related health issues will make them better, future-proof professionals. Our motto is ‘You don’t necessarily have to go to exotic countries in order to get involved in Global Health. As a medical doctor, you can practice Global Health in the consultation room, wherever you are, every day.’ Global health is so much more than international medicine!