Rotation in Global Women’s Health - Goals and Objectives

Location: Hospital Central de Maputo

Maputo Central Hospital (HCM) is a 1400-bed public national referral hospital for the Republic of Mozambique and serves as its primary academic teaching facility. It is the largest quaternary hospital in the nation and a large majority of Mozambique’s total number of specialists are on the HCM staff. HCM has a large OBGYN department with a separate OBGYN emergency room, 4 operating rooms, and 4 inpatient wards including labor ward, antepartum ward, benign gynecology ward and gynecologic oncology ward. There are daily inpatient rounds, surgeries and outpatient clinics staffed by 17 specialists and 33 residents. Rotation at HCM will provide a unique and unparalleled educational experience.

Rotation Description

Senior Residents (PGY3 or PGY4) will spend a 6-week elective rotation primarily at Hospital Central de Maputo (HCM), Mozambique. Residents will be paired with a Mozambican resident for the duration of their rotation. The HCM resident will help guide the Stony Brook resident through-out their elective rotation. There resident will be expected to perform overnight call duties paired with a Mozambican resident. The Global Women’s Health (GWH) elective will be comprised of 2 weeks on GYN service, 2 weeks on L&D, 1 week at José Macamo Hospital and 1 week of vacation. At the discretion of the Director of GWH, the time allotted on different services may be tailored to suite individual resident interest. For example, if a resident plans on pursuing a subspeciality, they may spend the entire rotation on the subspecialty service of interest. The rotations goals and objectives, resident expectations, and core competencies that are to be achieved are listed below

Goals & Objectives of a Global Health rotation:
  • To build compassion for the underserved
  • To gain an appreciation for how cultural and socioeconomic differences impact medical care in a resource poor setting
  • To gain knowledge about the major causes of morbidity and mortality in women worldwide
  • To gain clinical and surgical experience practicing in a resource poor setting
  • To support education, capacity building and/or quality improvement efforts at Hospital Central de Maputo
  • To learn strategies for increasing resiliency and adaptability to the unfamiliar
On-site expectations:
  • Visiting residents are ambassadors for Stony Brook University and must strive to uphold and embody the values of Stony Brook as detailed here.
  • Visiting residents will be under the direction of the Director of GWH or an assigned onsite supervisor
  • Visiting residents are expected to attend onsite orientation, meetings, and activities that are assigned the onsite supervisor
  • Visiting residents are expected to complete onsite reading assignments assigned the onsite supervisor
  • Visiting residents are expected to participate in structured didactic activities set forth by the HCM.
  • A case log must be collected.
  • All residents much complete a one-page reflection paper to be returned on the last week of the elective rotation (max 1500 words)
Global Health ACGME Competencies

 

Competency: Patient Care

  • Apply WHO (or in-country/local) clinical practice guidelines to the care of patients in resource limited settings. Gain an understanding of how and why protocols might differ from US practice guidelines.

  • Compare and contrast the practice of medicine in “technology-rich” settings (such as the majority of the US) and in low resource/“technology-poor” settings (global health setting, underserved area/population in the US).

  • Compare and contrast the availability and barriers to family planning services in US and global health settings and immigrant and refugee communities.

  • Explain the role of gender inequality in the health status of women particularly in global health settings, vulnerable populations in the US and immigrant/refugee communities.

  • Demonstrate respect for unique cultures, values, and roles of patients and family members in global health settings and/or within immigrant and refugee communities in the USA.

Competency: Medical Knowledge

  • Describe how the epidemiology of maternal mortality and morbidity varies with geography, socioeconomic status, and race.

  • Describe the major causes and known effective interventions for prevention and treatment of maternal morbidity and mortality around the world.

  • Summarize the presentation, diagnosis, management, and prevention of the top causes of maternal morbidity and mortality in the international setting where you are working.

  • Compare and contrast the top causes of maternal morbidity and mortality for low and middle-income countries (LMIC) and high-income countries (HIC) and discuss why these causes may differ

  • Outline the presentation, work up, management and treatment of pregnant women with the following presentations in global health settings, and immigrant and refugee communities:

    • Routine prenatal and intrapartum care

    • Obstructed labor

    • HIV/AIDS

    • Tuberculosis

    • Malaria

    • Malnutrition

    • Anemia

    • Hypertensive disorders of pregnancy

  • Outline the presentation, work up, management and treatment of non-pregnant women with the following presentations in global health settings:

    • Ectopic pregnancy

    • Unintended pregnancy

    • Infertility

    • STDs

    • Abnormal bleeding

    • Pelvic pain

    • Vaginal discharge

    • Menopausal symptoms

    • Acute abdomen

    • Cervical dysplasia and gynecologic cancers

    • Female genital cutting

    • Obstetric fistula

  • Identify health concerns that may disproportionately affect vulnerable populations and refugee/immigrant women such as:

    • Cervical cancer and need for screening

    • Unmet need for family planning

    • Sex Trafficking

    • Mental health specifically addressing trauma and PTSD

    • Gender based violence

  • Describe the indications, risks and benefits of surgical interventions for relevant ob-gyn conditions in the global health setting

Competency: Practice-based Learning and Improvement

  • Identify appropriate medical resources, including references, and standardized guidelines (e.g. WHO/CDC/country-specific 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 encountered in Mozambique

  • Complete a quality improvement project in collaboration with your on-site supervisor and a Mozambican resident

Competency: Interpersonal and Communications Skills

  • Learn basic medical Portuguese and to assist in medical English acquisition for your Mozambican co-resident

  • Identify cultural practices, values and professional dynamics unique to global health settings and/or within a specific refugee/immigrant population that influence communication and healthcare decision making, including the use of translators/interpreters

Competency: Systems-based Practice

  • Demonstrate a basic understanding of the relationship between health, human rights, and social/gender inequities.

  • List major social, economic, and environmental determinants of health and their impact on access/quality of health services, particularly maternal morbidity and mortality, in global health settings, vulnerable populations in the US and immigrant/refugee communities

  • Articulate barriers to healthcare in global health settings, vulnerable populations in the US and immigrant/refugee communities

  • Compare and contrast the roles and responsibilities of different health care providers in the USA and Mozambique. Including a discussion of different cadres that may not exist in the US. e.g, Technico’s, TBA’s, CHW’s

  • Describe how globalization contributes to the epidemiology of communicable and chronic diseases

Competency: Professionalism

  • Explain the importance of a bidirectional exchange and capacity strengthening in the practice of global health and outline potential pitfalls related to the development of global health partnerships.

  • Recognize ethical dilemmas frequently experienced during global health work and/or when working with vulnerable populations

Required Project

A capacity building or quality improvement project is required as part of the global health elective. The Stony Brook Resident will identify a quality improvement project in conjunction with a Mozambican resident or specialist and the onsite supervisor. The project may be limited in nature.

In addition, the Stony Brook visiting residents are expected to provide education/teaching in English to Mozambican co-residents or work to strengthen partnership in other ways.

Pre-Departure Requirements 

Pre-Departure Requirements and Safety While Abroad are covered in detail on the Pre-Departure Requirements webpage. 
 

Post-Return Requirements

Attend an In-person debrief

  • Consistent with CREOG recommendations, Stony Brook will have an identified person to debrief with during (Dr. Sierra Washington) and following (Dr. Chioma Ndbisi) the rotation given the significant emotional impact of clinical work abroad.
  • Resident should report on the status of QI project

Feedback and Evaluation

  • Residents will be required to write a one-page reflection paper (max 1500 words) that may be used to promote the Stonybrook Global Women’s Health Program.
  • Residents will be required to submit an evaluation the elective rotation and attending(s) performance
Resident Well-being While Abroad

The Director for GWH will meet with visiting Stony Brook residents at least once weekly to check-in and debrief about wellbeing. The GWH Director will be the key support person and should the resident need to depart early due to mental health or physical health emergency the Director of GWH will be the primary coordinator to ensure resident wellbeing is maintained at all times.

Residents may also contact Stony Brook Employee Assistance Program

Resources 

NOTE: internet access may be slower at international sites and traveling residents may want to consider downloading and saving files for reference prior to departure

Courses:

  • (REQUIRED) Association of Professors of Gynecology and Obstetrics Clinical Care in Low-Resource Settings: Preparing Providers and Fostering Leaders

    The University of California San Francisco (UCSF) has designed this multi-media, case-based curriculum to prepare clinician learners to work in under-resourced settings with appropriate preparation for the clinical challenges facing the facility and the socioeconomic and cultural challenges underlying the patient’s experience. The course is divided into four Modules, each containing videos, self-assessment, and recommended readings. Estimated duration 79 minutes.
     
  • (REQUIRED) Johns Hopkins, Berman Institute of Bioethics, Ethical Challenges in Short-Term Global Health Training

    This course consists of ten cases that introduce trainees and others involved in global health research and service to ethical issues that may arise during short-term experiences abroad. Being able to recognize and navigate these issues is critical for avoiding harm to communities as well as facilitating a long-term, productive collaboration for the betterment of global health. Trainees in global health research and practice abroad are the primary audience for these cases. Other individuals involved in these training programs - including faculty mentors and advisors at sending and host institutions, as well as program sponsors – may also find them useful.
     

  • Boston University, The Practitioner's Guide to Global Health

    3-part timeline-based course, designed by a team of global health experts, will help you prepare for successful global health learning experiences and projects. The course provides guidance for undergraduate and graduate students, medical trainees, and volunteers. In each part, you will have the opportunity to learn through interactive scenarios and discussion forums.
     

  • Jhpiego: Helping Mothers Survive

    Contains training modules designed for lower resource settings in Bleeding After Birth (PPH), Pre-eclampsia, Normal Labor and Birth, Contraception, and Obstructed Labor. Materials can be printed in other languages.
     

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