Work & Life
What does it take to pursue a career in global health and how can you plan for it during residency? NEJM Resident 360 hosted a discussion (Medical Footprints: Opportunities in Global Health) for residents and expert faculty to explore questions about careers in global health. Highlights of the discussion are summarized below, along with additional tips and resources for residents considering a career in global health.
When it comes to preparing for a career in global health, there is no substitute for real-world field experience. Potential employers will look for work experience in different settings as a marker of your ability to adapt and thrive in challenging global circumstances.
Careers in global health can include research, medical education, clinical medicine, and population and global health. Before pursuing additional training, consider the areas you plan to work in and ask your mentors about their path and the experiences or skills they found most helpful in their global health work.
If you plan to care for patients abroad, the experts in the NEJM Resident360 discussion recommended learning skills such as bedside ultrasound (from elective rotations, CME, or conferences) as well as basic lab techniques (including gram stain, acid-fast bacillus stain, and x-ray interpretation). If you plan to work in tropical areas, consider a Diploma Course in Tropical Medicine to help fill in knowledge gaps in tropical disease diagnosis and treatment that are not covered in U.S. medical schools and residency programs. After residency, you can work abroad clinically in areas with physician shortages and in the Indian Health Service through mentored programs (e.g., the HEAL Initiative).
If you are interested in pursuing global health research, a Master of Public Health (MPH) or Master of Science (MSc) in clinical research is important. These degrees can be obtained in general internal medicine or internal medicine subspecialty fellowship programs. The most important first step in a research career is finding the right mentor; one who can guide you during training and your early career. Residents can also get started in research by applying for a 1-year fellowship through the Fogarty International Center’s Global Health Fellows Program.
Many opportunities exist for becoming a global health educator. If you are interested in teaching abroad, look for opportunities in grant-funded programs. For example, SEED Global Health has positions for physicians after residency as medical educators working with local faculty in one of three African countries.
Many internal medicine residency programs are adding global health curricula, tracks, or new programs. Students considering a career in global health should investigate whether one of these residency programs is a good fit. A career in global health and medical education can also include the role of program director for one of these programs.
If you want to start a global health curriculum in your residency program, consider including the following key components:
rotations or projects with partner sites (both global and local community) with long-term relationships with your home institution to maximize learning and mutual benefits
training in health policy, economics, health systems, and sociocultural influences
skill building in bedside ultrasound, basic microbiology, and diseases not covered traditionally in U.S. programs (e.g., tropical medicine)
time for reflection on the experience of working in resource-limited settings
If you want to work with health systems, you will need training in population health and health policy. Epidemiology and biostatistics are critical skills for public health and are the core components of MPH training. In addition to an MPH, many important skills can be learned through project work during residency, either domestically or globally.
There are many options for MPH courses (in person, on-line, etc.) or other applied epidemiology training. The Epidemiological Intelligence Service (EIS) fellowship is a 2-year training program with the CDC that focuses on field epidemiology and is a great stepping-stone to a career in global public health. Most MPH or MSc fellowship programs fund this course work. The professional networks in these programs can be as valuable as the training.
Regardless of the type of career you pursue in global health, additional skill areas to focus on during residency include quality improvement, advocacy, and cross-cultural skills (including cultural humility). These skills do not require a fellowship or degree. Further, communication skills are critical to every aspect of global health, ranging from providing health education for patients and communities to communicating with diverse stakeholders in policy, legislature, and funding. Seek out opportunities to work locally near your hospital with underserved and culturally diverse communities. Many residency programs offer clinic rotations with community health centers, Federally Qualified Health Centers (FQHCs), or clinics that serve immigrant or refugee populations.
Ideally, short-term rotations take place in settings with long-term partnerships with your institution to allow collaborative learning about the needs and strengths of each partner as they evolve and change. Partnerships should be mutually beneficial to each institution and avoid draining the capacity of the partner in the underserved site. Where possible, integration of resident trainees with local trainees builds peer relationships and shared learning experiences.
If no such programs exist at your institution, look for ways to establish one! If you speak Spanish, consider applying as a Volunteer Resident Mentor through Partners in Health’s program in Chiapas, Mexico.
Productive residency rotations require much preparation in advance. Work with your mentors to develop realistic learning goals that fit the setting. Consider projects that increase capacity; for example, when teaching abroad, use the train-the-trainer model to help build skills at the partner site.
The many players in the field of global health include non-government organizations (NGOs), donors, researchers, governments, and private organizations. This complexity can result in duplication of services, competition for resources, and conflicts in setting agendas. No matter which organization you ultimately work with, negative outcomes can be prevented if you take time to build trusting relationships with your partners, and especially the community.
Dr. Thuy Bui from University of Pittsburgh and Dr. Daniel Palazuelos from Brigham and Women’s Hospital in Boston shared the following key principles to consider when starting a global health project:
Do your homework: Research the topic, country, and region; interview key informants; learn from your partners and the community.
Learn from past mistakes: Do not assume you have the magic solution to a problem others have tried to solve.
Avoid the role or label of Consultant: Do not think you are an expert.
Be aware of power differentials: Be mindful of who controls the funding and their objectives.
Play a supportive and connector role: This role is often more important than leading a project.
As you plan your career, think about the potential future priorities in global health. Chronic diseases, such as diabetes and cardiovascular disease, are growing problems in many countries. In others countries, infectious diseases, nutritional disorders, and maternal health persist as leading causes of premature death and disability. Some areas have both — with a double burden.
Despite these differences, most countries share the problem of delivering effective prevention and treatment services. Therefore, many global health initiatives prioritize efforts to strengthen health care systems that can reach people and respond to their needs. These efforts include strong primary care and community level services with trusted providers.
For residents, this means opportunities in the coming decades in all primary care and subspecialties in global health, with a particular need for training and education programs that build health work force capacity and strengthen systems of care.
Often academic physicians can negotiate positions that allow some time working for a partner organization (e.g., global health NGO or policy organization). This experience both enhances the perspective faculty bring to teaching and training at their academic institution and technical skills to the partner organization. However, funding for global health academic positions is limited, so you will have to work hard to find opportunities that are financially supported and creatively negotiate packages that bring together different activities, such as clinical medicine, teaching, and research. Beyond academic medicine, there are many career opportunities in the NGO, public health, donor, and private sectors. You can learn about such opportunities by networking at conferences, speaking with mentors, and searching online job sites.
Residents should consider your personal situation, goals, and ability to align the logistics of global work with personal and family life when thinking about career options. Salaries in global health are usually lower than in traditional clinical positions. Residents with high medical school loan burdens might consider positions that offer loan forgiveness such as the Indian Health Service.
In residency and in your career, seek out mentors, students, and colleagues that share your passions. The global health community will provide support, advice, and encouragement as you embark on your career. Although paths in global health may not be as well trodden and straightforward as other careers in medicine, the potential rewards of working with colleagues, partners, organizations, and communities toward health equity are immeasurable.
Best of luck with your training in global health!
Overview and Guidelines
Ethics and Best Practice Guidelines for Training Experiences in Global Health. Am J Trop Med Hyg 2010.
Email Alerts and Journals
Websites with Cases
Reasoning Without Resources (case studies)
Global Health Delivery (cases and online communities)
Gorgas Course in Tropical Medicine (live clinical cases)
Ethical Challenges in Short-Term Global Health Training (a course of 10 ethics cases in global health research and service)
Reflection in Global Health: An Anthology (essays that can be used for reflection in global health experiences)
Postgraduate Training Opportunities