Competency Domain: Patient Care

Interview patients and families about the particulars of the medical condition for which they seek care, with specific attention to behavioral, psychosocial, environmental, and family unit correlates of disease [IV.A.5.a).(1).(d)]:

1. Analyze the impact of environmental factors such as clean water, sanitation, air quality, pollution, climate change, overcrowding, and natural disasters on child health and apply this knowledge to the interviews of patients and families who seek care in your practice. 

2. Reflect on and describe how fragmented family units contribute to health and illness, particularly as it relates to immigrant and refugee children and adoptees that are separated from their biological parents and explore pertinent questions regarding primary caretakers and relationships among those who form the family unit.

3. Perform essential components of a history and physical for children with immigrant or refugee status (including utilization of trauma-informed care) and identify unique considerations for providing a medical home for these children.

4. Explain essential components of a comprehensive evaluation of a child/youth traveling internationally.

Develop and carry out management plans [IV.A.5.a).(1).(g)]:

1. Apply WHO guidelines to the clinical care of patients in resource-limited settings.

 

Competency Domain: Medical Knowledge

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care [IV.A.5.b)]:

1. List the top causes of neonatal, infant, and child morbidity and mortality for low and middleincome countries (LMIC) and high-income countries (HIC) and discuss why these lists may differ.

2. Describe and interpret the Global Indicators - including Neonatal Mortality Rate, Maternal Mortality Rate, Infant Mortality Rate, and Under-five Mortality Rate – and compare the differences between LMIC and HIC.

3. Summarize the presentation, diagnosis, management and prevention of global infectious (e.g., malaria, tuberculosis, HIV/AIDS, diarrheal disease) and non-infectious causes (e.g., prematurity, birth asphyxia, anemia, pneumonia, malnutrition, obesity, stunting, trauma) of child morbidity and mortality.

4. Describe the health and psychological problems of vulnerable children who are immigrants, refugees, internally displaced, or orphans. Discuss the impact of victimizing activities such as trafficking, child labor, political conflict, and warfare.
 

 

Competency Domain: Practice-based Learning and Improvement

Locate, appraise, and assimilate evidence from scientific studies related to patients’ health problems [IV.A.5.c).(6)]:

1. Identify appropriate medical resources, including references and standardized guidelines (e.g., WHO/CDC/Country guidelines) for diagnosis and treatment of conditions common to resource-limited settings, and adapt them to the individual needs of specific patients.

Locate, appraise, and assimilate evidence from scientific studies related to patients’ health problems [IV.A.5.c).(6)]:

2. Reflect on and describe how standardized guidelines developed for specific patient populations and healthcare workers (e.g., WHO, IMCI, ETAT, and Helping Babies Breathe) can improve care in resource-limited settings and understand their limitations.

3. Explain why certain evidence-based practices (NRP vs HBB, PALS vs APLS, etc.) are successful or unsuccessful in different settings (low resources vs high resource).

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Competency Domain: Interpersonal and Communication Skills

Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds [IV.A.5.d).(1)]:

1. Display effective communication skills (including both spoken language and non-verbal cues) and humility when discussing medical information with families from different cultures, particularly to those for whom English is a second language.

2. Demonstrate effective use of an interpreter.

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Work effectively as a member or leader of a health care team or other professional group [IV.A.5.d).(3)]:

1. Demonstrate cultural humility while working in an unfamiliar setting, acknowledging the local expertise and perspectives of colleagues familiar with that environment.

2. Integrate into the professional and social networks of the healthcare team and surrounding community during the global health elective (specifically, do not just spend time with other outside visitors).

 

Competency Domain: Professionalism

Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation [IV.A.5.e).(5)]:

1. Describe common ethical dilemmas that arise in the care of diverse patient populations, particularly those who may face discrimination based on race, religion, ethnicity, sexual orientation, or gender identity.

2. Identify the impact of culture-based gender roles within family and society as it applies to the physician-parent interaction, as well how the gender of a child may affect health-seeking behaviors and outlook. Develop the ability to use self-awareness of one’s own knowledge, skill, and emotional limitations that leads to appropriate help-seeking behaviors [IV.A.5.e).(6).(a)]:

3. Reflect on and describe personal biases that may affect decision-making when caring for diverse and vulnerable populations and develop strategies to avoid them.

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Develop the ability to use self-awareness of one’s own knowledge, skill, and emotional limitations that leads to appropriate help-seeking behaviors [IV.A.5.e).(6).(a)]:

1. Anticipate possible conflicts that may arise while serving in an unfamiliar clinical setting by devising strategies for managing one’s stress, well-being, security, and professional responsibility.

2. Describe signs and symptoms of ‘culture shock’ and issues surrounding clinical care with resource limitations and understand how the experience of ‘culture shock’ may affect one’s behavior and communication.

3. Identify GH elective opportunities that are under the auspices of mutually beneficial training partnerships.

4. Reflect on limitations of one’s own knowledge base when facing new, unfamiliar diseases or old, familiar diseases but with different resources, and seek appropriate help when needed.

5. Describe how coping skills and stress management may vary amongst different cultures, and amongst providers who are accustomed to resource limitations and higher rates of morbidity and mortality.

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Competency Domain: Systems-Based Practice

Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care [IV.A.5.f).(3)]:

1. Describe the differences in the health care models around the world (including public/private payers, use of community health workers, etc.), advantages and disadvantages of each system, and how each affects patient care and availability of resources.

2. Identify the multiple barriers that immigrants and refugees encounter when accessing health systems stateside. Advocate for the promotion of health and the prevention of disease and injury in populations [IV.A.5.f).(7)]:

3. Reflect on the interplay between culture and health, including reasons for the use of alternative or traditional medicine, atypical therapies, and delays in seeking care.

4. Describe traditions and practices of cultural groups in your area of practice as they relate to health practices and health outcomes. Work effectively in various health care delivery settings and systems relevant to their clinical specialty [IV.A.5.f).(1)]:

5. Identify the differences between the standardized guidelines used for the care of children around the world and the guidelines used in your own practice and explain why difference may exist and when certain guidelines may be more appropriate (e.g., rural low resource settings within the US).

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Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care [IV.A.5.f).(3)]:

1. Modify diagnostic and patient care decisions in the context of significant resource limitations domestically or abroad. Advocate for the promotion of health and the prevention of disease and injury in populations [IV.A.5.f).(7)]:

2. Participate in health promotion and prevention activities in a resource-limited setting utilizing local guidance and practices and using a diplomatic, culturally humble style. Work effectively in various health care delivery settings and systems relevant to their clinical specialty [IV.A.5.f).(1)]:

3. Perform an inventory of resources in a given clinical setting in order to understand how that setting functions and to identify possible areas of improvement while considering long-term sustainability.

4. Challenge yourself to identify how local resources could be utilized to address systems issues