PC2125: Virtual Global Health in Graduate Medical Education: A Systematic Review

Background: Due to pandemic related disruptions in global health (GH) education, there is a crucial need for evidence to guide virtual global health education activities (VGHEAs). The goal of this work is to summarize the recent literature describing VGHEAs for health professional trainees.

Methods: In 2021, we conducted a systematic review of articles published between 2012-2021 in seven databases describing programs delivering virtual GH education. We included articles that described GH content that was delivered primarily virtually to health professional trainees of any level or specialty. We excluded open-access resources without the aim to reach individuals in low- to middle-income countries (LMIC), descriptions of telemedicine, and non-human GH topics. We collected and qualitatively analyzed data about the types of activities and targeted trainees, program evaluations, and drivers of or barriers to these activities.

Results: Forty articles met inclusion criteria and described 69 different VGHEAs (Figure 1). Fifty-five percent of the countries that hosted VGHEAs were high-income countries (HIC), while 45% were LMICs. Most activities were aimed at students (57%, 23/40 articles) or mixed trainee audiences of students, residents and fellows (33%, 13/40). The most common format of VGHEAs was regularly available online content or short courses (25%, 10/40). Most activities (53%, 21/40) targeted trainees in both HIC and LMIC, while fewer targeted trainees solely in LMIC (22%, 9/40) or HIC (25%, 10/40). Trainees in the USA were the most frequent participants in VGHEAs. Fifty-five percent of the included studies (22/40) listed authors from only HIC institutions, while 45% (18/40) had authors from both HIC and LMIC institutions.
The most common outcomes measured were trainee satisfaction with the course/content (60%, 24/40), followed by self-reported improvement in knowledge or skills (40%, 16/40). Frequently described activity drivers were strong course content and organization, peer interactions and relationships, and the flexibility of online activities. Common challenges included trainee engagement barriers, technology or internet problems, and challenges with time zones or course hours (Figure 2). Funding, the need for protected and convenient timing for the activities, and technological support were discussed as both drivers and barriers of VGHEAs, highlighting their importance to successful VGHEA implementation. Articles reported several unanticipated benefits of VGHEAs, including wider than anticipated reach; real-world impact; improvements to existing GH partnerships; and the identification of gaps in GH practices. Unanticipated negative results were the uncertainty of ongoing funding and the lack of foreign recognition of course credit.

Conclusion: This review describes VGHEA characteristics, synthesizes common drivers and barriers, and may inform the development and improvement of VGHEAs. Further work is needed to establish activity preferences, standardized evaluation methods, best practice recommendations, and ways activities can be created, shared, and consumed more equitably by partners from both HIC and LMIC settings.