In total, 25% of residents (128/505) and 28% of faculty (118/413) responded to the survey. Of note, published data on the response rate to web-based surveys shows the expected response rate is 20.7% [18
]. Resident respondents included 45 Internal Medicine residents, 40 Pediatric residents, 41 Family Medicine residents, and 2 Internal Medicine-Pediatric residents with a wide distribution of year in training (40 PGY-1, 42 PGY-2, 42 PGY-3 and 4 PGY-4 respondents). Ninety seven percent of residents surveyed were in a 3-year primary care residency. There were 5 International Medical Graduates (IMG) who participated in the survey. Faculty respondents included 45 Internal Medicine faculty, 27 Pediatric faculty, 42 Family Medicine faculty, and 4 Internal Medicine-Pediatric faculty. Among both resident and faculty respondents there was adequate representation from all query sites.
Thirty-four residents (26%) stated that they had participated in IH electives during medical school. Most of these IH electives lasted from 3 weeks to 4 months (70%).
Eleven residents (8%) responded to having participated in an IH elective during their residency. These residents visited 11 countries mostly staying for 3 weeks to 4 months (77%). Seven of these residents reported having also taken an IH elective during medical school. One resident chose to return to the same country during both medical school and residency. Six residents were from UW's Milwaukee campus, five residents were from MCW, and one resident was from UW's Madison campus.
When faculty were asked, "Have you had experience working as a physician internationally, including providing medical care, community medicine, teaching, or public health activities?," 47% (55) report having had at least one IH experience. Additionally, 49% (58) of faculty reported spending more than 25% of their clinical time caring for patients from underserved communities.
Among faculty, 16% (19) have a Master's in Public Health of whom four had special focus on IH issues. Specifically, one faculty member has a Masters in Epidemiology and PhD in Anthropology, one faculty focused on addiction, HIV prevention, and tuberculosis, another faculty focused on International Public Health, and one faculty focused on Tropical Medicine.
A majority of residents (58%) and faculty (63%) responded positively to the question "How interested are you in learning about global health issues during your residency?" (See figure ) There was more interest from faculty in the University of Wisconsin system (p = 0.04).
How interested are you in learning about global health issues during your residency?
Of the residents that had taken an IH elective rotation during their residency, 82% expressed commitment to continue working in IH and 100% expressed commitment to work with the poor and underserved domestically.
Sixty three percent of the resident respondents planned on spending professional time working abroad. Most of these (70%) stated interest on spending <20% of their professional time working abroad. Independent predictor variables for residents planning on spending professional time in international health were having participated in an international elective during medical school (p < 0.01) and commitment to work with poor and underserved communities (p < 0.01).
Thirty nine percent of responding faculty (46) stated that they would be willing to be involved with developing curriculum, lecturing and/or mentoring residents in IH.
Independent predictor variables for being willing to be involved with developing curriculum, lecturing, and/or mentoring residents in IH include interest in IH (p < 0.01) and experience in IH (p = 0.014). Further, a predictor of faculty interest in IH was spending significant amount of clinic time (>25%) caring for patients from underserved communities (p = 0.01).
Residents and faculty were asked to rank medical training programs, clinical experiences, and barriers in order of importance as they pertain to IH training (see figures , , ). In addition to the barriers in the rank list, residents and faculty cited the following barriers: family medicine outpatient requirements from the ACGME; available, trustworthy international sites for clinical experiences; family commitments; restrictions on funding of residents; and a limit of 1 month elective abroad.
Please rank the following medical training programs in order of your interest. Residents (Faculty).
Please rank the following clinical experience in order of importance. Residents (Faculty).
Rank the barriers that prevent you from pursuing international health. Residents (Faculty).
When asked if there were any additional comments or questions, 4 residents and 5 faculty emphasized that they would be interested in helping develop IH curriculum, 1 resident and 3 faculty expressed that IH training is a bad idea, and 6 residents and 3 faculty elaborated on additional barriers to IH training.
Thirty-eight residents described 41 motivating influences for seeking IH experiences. Strong desire, internal motivation, parental influence or being an IMG was cited by 19 residents. A previous IH experience or availability of an IH opportunity was cited by 14 residents. There were 5 residents motivated by concern for healthcare disparity or sense of social responsibility while 3 residents cited mentorship as an influencing factor.
Perceptions on current training
Few residents (9%) and faculty (11%) assess their residencies as preparing residents well to address topics relating to IH (see figure ). Few residents (10%) and faculty (8%) assess their residencies as preparing residents well to work internationally. However, most residents (53%) and faculty (50%) assess their residencies as preparing residents to work with poor and underserved communities. Overall, there is an increased sense of preparedness for both IH electives and working with the poor by family medicine residents (p = 0.001) and faculty (p = 0.05) when compared with their counterparts in internal medicine and pediatrics combined.
Residency preparedness: address international health topics.
In terms of modality of training for IH topics, 86% (109) of residents and 70% (83) of faculty were interested in incorporating IH curriculum into general lecture series while 48% (61) of residents and 45% (54) of faculty were interested in participating in a quarterly global health interest group. Interestingly, when divided by year of residency, there was no significant difference in the desire to incorporate IH curriculum into their residency's general lecture series; however, there was more of an interest among PGY-1's to become involved with a quarterly meeting (p < 0.01).