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Ch 12. What Other Fellowships Are Out There?

Introduction

Fellowships, as defined here, are generally considered post residency subspecialty training for physicians in the United States. Within emergency medicine there are fewer fellowship options than there are for internal medicine or pediatrics. Often they do not define a clinical career like cardiology, endocrinology, gastroenterology, etc. Emergency physicians regardless of fellowship training still clinically practice as emergency physicians. Global emergency medicine has become a subspecialty in and of itself and trains physicians with a unique skill set, however other emergency medicine fellowship programs have incorporated global health into their training, as well. Additionally, there are a variety of fellowship programs that are not strictly intended for emergency medicine trained physicians, but available to different types of practitioners and offer various levels and types of training. In this chapter, we discuss emergency medicine fellowships as well as some of the ‘other’ fellowships that are out there. These ‘other’ fellowships are often available to people from different training backgrounds and education levels.

Emergency Medicine Fellowships with Global Health Opportunities

As emergency medicine fellowships mature and the types of fellowships increase more programs are integrating a global health a global health component. Some of the key emergency medicine fellowships which overlap or have introduced linkages with global health are: pediatrics, toxicology, ultrasound, education and simulation, disaster medicine, and austere or wilderness medicine. These generally do not provide core expertise on the social determinants of health or specific training to work in resource-limited settings, however they do recognize the benefit of the respective subspecialty in resource-limited settings and often include global health as value-added components to training. While not exhaustive, we discuss two specific types of programs here.

The Pediatric Emergency Medicine (PEM) Route

Of fellowships incorporating a recognized global component, global pediatric emergency medicine (PEM) is probably the best developed. That PEM practitioners are involved in providing or developing emergency care globally makes sense. In low- and middle-income countries, populations tend to be younger. The WHO continually supports initiatives to improve morbidity and mortality of children under the age of five. Some major organizations that address health and wellness globally specifically focus on this vulnerable population, for example, Save the Children, UNICEF, and Safe Kids International. Also, increased effort is being placed on responding to and understanding the unique challenges of child victims of natural and man-made disasters. While some PEM providers are engaged in work within the aforementioned public health domain, the majority of providers interested in global health currently work to expand and develop capacity for care centers and practitioners to provide emergency care for acutely ill or injured children.

In response to increased interest of global health among fellowship applicants, the majority of PEM fellowships now allow for shift-free elective time during which fellows can travel abroad to initiate relationships, assist in ongoing projects or work clinically in areas where the concept of pediatric emergency medicine is new or nonexistent. 

Several programs have also begun dedicated global pediatric emergency fellowship programs. The structures of these fellowships vary, lasting 3-5 years and may or may not include the option of an MPH. Some programs incorporate the global health experience within the traditional 3-year program as an academic area of interest for the fellow. Others extend the duration of the fellowship to allow for fieldwork, program development, and additional study to foster knowledge and skills for global pediatric emergency care. 

Baylor College of Medicine/Texas Children’s Hospital started a global pediatric emergency medicine fellowship in 2005. It aims to provide the knowledge, training, skills and mentorship for fellows to function independently in the global arena. Other academic centers have followed suit and now there are a handful of similar fellowships: Boston Children’s Hospital, Eastern Virginia Medical School, Detroit Medical Center/Children’s Hospital of Michigan to name a few.

There has also been a trend toward the creation of subdivisions of Global Health or International EM within Sections of Pediatric Emergency Medicine, mostly within the larger academic groups located at the bigger children’s hospitals. Only a few of these groups have specific training in international or global EM. The global PEM field is young and you can participate without having completed fellowship training. If you are interested in getting involved in both pediatrics and global EM, discuss with prospective fellowship directors about the ability to pursue this. Reaching out to subdivisions of global PEM is a good initial step if you are interested in collaborating with experts in the provision of pediatric emergency care abroad. They are also great resources if you are working on a more general project and are looking for collaborators with pediatric expertise.

Global Toxicology Fellowship

Medical toxicology was established as a formally recognized fellowship program in emergency medicine in 1992.1 It has a rigorous training structure with a specific board examination to ensure uniformity and attainment of unique expertise. While not new, the burden of disease due to poisonings, overdoses, medication interactions, and occupational or environmental toxin exposures is increasingly acknowledged throughout the world. In 2011, University of Illinois at Chicago created a 3-year Global Toxicology Fellowship program. It incorporates the structured curriculum of toxicology, an MPH, and international fieldwork. As opposed to concentrating solely on domestic poisoning and toxicology, it emphasizes understanding of the pathophysiology and the socio-ecological influences of poisonings on a global scale. While the program concentrates on preparing the clinician for board certification in medical toxicology, research and scholarly activity focus on and promote the exchange of knowledge and understanding of globally important issues related to medical toxicology.

Multidisciplinary Fellowships in Global Health

There is a growing movement of interdisciplinary fellowship programs drawing trainees from multiple specialties. Fellows come from a wide range of specialties including Internal Medicine, Family Medicine, Pediatrics, Women’s Health, Surgery, Anesthesiology and Emergency Medicine. These allow for cross collaboration, knowledge sharing, and increased understanding of different perspectives of medicine and health issues. Fellowships in interdisciplinary fields are increasing in number.

Some examples include:

Other types of fellowships

Outside of U.S. based medical training, there are several other types of fellowship programs that are geared towards professional development. For instance, some programs are tailored to health policy, while may be focused on research. Most of them are short term, offer a mentored learning experience, and afford opportunities to learn from leading experts in global health. A few of the more well-known programs available are identified below.

  • Professional Development Fellowships
  • Global Health Program for Fellows and Scholars NIH Fogarty International Center http://www.fic.nih.gov/Programs/pages/scholars-fellows-global-health.aspx
    • This program provides mentored research training for early investigators from the U.S. and low- and middle-income countries.
  • USAID Global Health Fellows Program II https://www.ghfp.net/
    • This program focuses on training global health professionals from a variety of backgrounds to address USAID-identified health priorities
  • ASPPH/CDC Allan Rosenfield Global Health Fellowship Program https://fellowships.aspph.org/programs/details.cfm?programID=2
    • This program trains graduates of accredited schools of public health who are interested in a career in global health and want to work on the frontlines of global public health.

References

  1. http://www.acmt.net/History_of_ACMT.html
  2. Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P. Global health in medical education: a call for more training and opportunities. Acad Med. 2007 Mar;82(3):226-30.