Building Global EM and Its Next Generation of Leaders

The Global Emergency Medicine Student Leadership Program (GEMS LP), formerly known as the International Ambassador Mentorship Program (AMP), was established in 2018 as a joint effort of EMRA and the ACEP International Ambassador Program to provide guidance to the growing number of EM-bound medical students seeking GEM mentorship.

This program aims to expose medical students to the field of GEM through participation in global health projects, engagement in a thought-provoking journal club, mentorship from ACEP Ambassadors participating in EM programs worldwide, and networking with like-minded peers. In addition to fostering interest in GEM, the program seeks to expose students to some of the complex issues in global health and the importance of having an ethical, equitable, and sustainable approach to global health involvement.

The Need
Emergency medicine is unrecognized, or in its infancy, in the vast majority of the world. This is particularly true in low and middle-income countries (LMIC) where it is estimated that 24 million lives are lost each year due to "conditions sensitive to prehospital and emergency care" including: injuries, infections, perinatal complications, and acute exacerbations of noncommunicable diseases.¹ Recognizing this need, a recent World Health Assembly resolution emphasized the necessity of ensuring timely care for the acutely ill and injured.² To date, several studies in LMICs have shown that even small interventions in areas such as pre-hospital care and triage systems can have a significant impact on mortality. ^3,4

Building a Workforce
There is a growing interest in global health experiences among medical students and residents. Consequently, there remains an opportunity to institute programs that provide essential mentorship, education, and career guidance to the next generations of physicians in global EM, particularly early in training. A recent survey of EM residency programs revealed 75% of respondents offer short-term experiences in global health; however, only 39% offer longitudinal global health training in the form of tracks or concentrations.⁶ Global health tracts have demonstrated a positive influence on knowledge, skills, and attitudes in working with underserved populations, and increase the likelihood that participants will choose to work abroad, as well as in high-need practice environments at home, following graduation.⁷ However, one shortcoming of global health experiences in residency tends to be inadequate pre-departure preparation to teach fundamental knowledge, skills, and attitudes needed for trainees to make a positive impact while working internationally.⁶ At the medical school level, even fewer opportunities exist for GEM training at home and abroad.⁸  Building competencies in domains such as: global burden of disease, social and environmental determinants of health, capacity strengthening, and program management are essential for future careers in global health.⁹

Recognizing these needs, various resources have been created to aid in GEM career development. These include books such as “The Nuts and Bolts of Global Emergency Medicine'' and SAEM’s Resident And Medical Student (RAMS) Roadmap for GEM, as well as educational and assessment tools such as AEM’s Global Health Milestones.^5,9,10 Though these resources are invaluable to understanding key concepts and the steps necessary to pursue a career in GEM, they fall short of providing aspiring GEM leaders with the personal relationships and hands-on opportunities necessary to kickstart their careers. GEMS LP is one such program that seeks to bridge this gap.

Filling the Mentorship Gap
GEMS LP is a 1-year program, under the purview of the ACEP International Ambassador Program, that aims to expose medical students strongly interested in EM to the wide variety of opportunities in GEM through mentorship, journal club (JC), and a global health project. ACEP International Ambassadors, who represent ACEP and assist health care providers worldwide with sustainable development of emergency care, serve as mentors. Over the first two years of the program, mentorship followed the traditional dyad relationship where one medical student was paired with one Ambassador based on a shared country or region of interest. This year, the program has evolved to a multi-mentor format consisting of virtual mentorship meetings with multiple Ambassadors, along with longitudinal guidance and support from the GEMS LP leadership team. This change allowed access to a wider cohort of mentors with varied experience to fulfill students’ mentoring needs, including regional, academic, and GEM subspecialty interests.¹¹ The goal of these interactions is to enable mentees to form meaningful relationships with a network of mentors in the field of GEM and gain an understanding of the variety of career paths and subspecialties within GEM. Kaley Waring, MS4, affirmed that her primary mentor was “instrumental in helping me navigate a future in global EM. Through our discussions about partnership, I have a better appreciation for reciprocal learning opportunities and the importance of local project ownership."

Monthly virtual JC meetings are another great opportunity for students and mentors to interact and continue to build dynamic relationships. Mentees present a book chapter, journal article, and a global health project proposal all pertaining to one central topic. Prior to the JC meeting, the students meet with mentors in preparation to guide a lively and insightful conversation. Discussion topics include global health inequity and the ethics of humanitarian work. Additionally, this year’s JC sessions are supplemented with two books, An Introduction to Global Health Delivery and Reimagining Global Health: An Introduction. Jerry Oommen, MS4, felt that "the reading topics covered essential global health concepts, but the most fruitful aspect was the conversations about real-world examples with GEM colleagues around the world." These events are open to all members of the ACEP International Section, and participants do not need to be an Ambassador or to be involved in the mentorship program. Diverse perspectives and insights are vital to the success of the discussion.

The final core component of the program is the global health project. The goal is to expose participants to real-world initiatives with mentor guidance and provide students with skills and experiences that can be applied to future work. Last year, projects sought to address needs in 11 different countries (as seen in the map) and ranged from assessing the unintended ramifications of non-governmental organizations to developing curriculum for EM training programs. Though one year is often insufficient to complete all the aims of a project or assess its impact, many students maintain a relationship with their mentors to continue their work. At the conclusion of the program, students feel inspired by their progress and are eager to continue forging their path in GEM. Dania Abu-Jubara, MS4, whose project centered on ultrasound training in low resource settings, noted that "[her] experience during this program reaffirmed [her] passion for global health and ignited a new passion – bedside ultrasound." She hopes to pursue a fellowship that combines these interests.

The world needs and deserves EM to help improve the quality of life and the state of healthcare globally. GEM strives to fulfill this need through better understanding of the current global health status and its limitations and the development of ethical and sustainable emergency care initiatives. Accomplishing such a feat is a tall task and begins with the development of robust educational and mentorship experiences at all stages of training. GEMS LP is one such opportunity on a mission to pave the way for the next cohort of outstanding GEM leaders!

Get Involved
For more information on GEMS LP and how you can get involved as a mentor, mentee, or journal club participant please visit: https://www.emra.org/be-involved/committees/international-committee/amp-program-info/ or email the program leadership at info.GEMSLP@gmail.com. The 2021/22 GEMS LP application will open for students this spring with a deadline of June 30, 2021. We are always recruiting faculty mentors!

References

1. Hsia, R. Y., Thind, A., Zakariah, A., Hicks, E. R., & Mock, C. (2015). Prehospital and emergency care: updates from the disease control priorities, version 3. World journal of surgery, 39(9), 2161-2167.
2. World Health Assembly. Resolution 72.16. Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured. https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_R16-en.pdf. Published May 28, 2019. Accessed November 29, 2020.
3. Obermeyer, Z., Abujaber, S., Makar, M., Stoll, S., Kayden, S. R., Wallis, L. A., & Reynolds, T. A. (2015). Emergency care in 59 low-and middle-income countries: a systematic review. Bulletin of the World Health Organization, 93, 577-586.
4. Razzak, J. A., & Kellermann, A. L. (2002). Emergency medical care in developing countries: is it worthwhile?. Bulletin of the World Health Organization, 80, 900-905.
5. Roberts, J., & Lin, J. The Nuts & Bolts of Global Emergency Medicine. https://www.emra.org/books/nuts-and-bolts-of-global-emergency-medicine/chapter-2-global-emergency-medicine/. Published 2016. Accessed November 29, 2020.
6. Rybarczyk MM, Muck A, Kolkowitz I, Tupesis JP, Jacquet GA. Global Health Training in U.S. Emergency Medicine Residency Programs. AEM Education and Training. 2020. doi:10.1002/aet2.10451.
7. Bazemore AW, Goldenhar LM, Lindsell CJ, Diller PM, Huntington MK. An International Health Track Is Associated With Care for Underserved US Populations in Subsequent Clinical Practice. Journal of Graduate Medical Education. 2011;3(2):130-137. doi:10.4300/jgme-d-10-00066.1.
8. Peluso, M. J., Forrestel, A. K., Hafler, J. P., & Rohrbaugh, R. M. (2013). Structured global health programs in US medical schools: a web-based review of certificates, tracks, and concentrations. Academic Medicine, 88(1), 124-130.
9. Douglass, K. A., Jacquet, G. A., Hayward, A. S., Dreifuss, B. A., Tupesis, J. P., Acerra, J., ... & Dreifuss, B. (2017). Development of a Global Health milestones tool for learners in emergency medicine: a pilot project. AEM education and training, 1(4), 269-279.
10. Newberry, J. A., Patel, S., Kayden, S., O’Laughlin, K. N., Cioè‐Peña, E., & Strehlow, M. C. (2020). Fostering a Diverse Pool of Global Health Academic Leaders Through Mentorship and Career Path Planning. AEM Education and Training, 4, S98-S105.
11. DeCastro, R., Sambuco, D., Ubel, P. A., Stewart, A., & Jagsi, R. (2013). Mentor networks in academic medicine: moving beyond a dyadic conception of mentoring for junior faculty researchers. Academic medicine: journal of the Association of American Medical Colleges, 88(4), 488.