Portfolios for Global Health Residency Assessment

Dr. Christine Gibson at the University of Calgary has been developing an assessment process for the Global Health Enhanced Skills training year following Family Medicine. This involves the use of portfolios for assessment. This is a good fit for a number of reasons, and it is hoped that by completing this survey you will understand better these considerations and might be able to incorporate this form of assessment for your own Global Health training programs. The information collected will be used to evaluate the creation of this process for her Masters dissertation in Medical Education for the University of Dundee. Thank you in advance for your time!

Question Title

* 1. Please give some indication of your current role within Global Health or Medical Education under the heading "Company"

Name: *

Company: *

City/Town: *

State/Province *

Country: *

Email Address:

CHOOSING MATERIAL FOR A GLOBAL HEALTH PORTFOLIO

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* 2. Please rate the following items as you would consider their importance when assessing Global Health residents

	Not Very Important	Minimally Important	Should be Considered	Somewhat Important	Very Important
Student-Centered	Student-Centered Not Very Important	Student-Centered Minimally Important	Student-Centered Should be Considered	Student-Centered Somewhat Important	Student-Centered Very Important
Professionalism	Professionalism Not Very Important	Professionalism Minimally Important	Professionalism Should be Considered	Professionalism Somewhat Important	Professionalism Very Important
Encourages Self-Directedness	Encourages Self-Directedness Not Very Important	Encourages Self-Directedness Minimally Important	Encourages Self-Directedness Should be Considered	Encourages Self-Directedness Somewhat Important	Encourages Self-Directedness Very Important
Flexible	Flexible Not Very Important	Flexible Minimally Important	Flexible Should be Considered	Flexible Somewhat Important	Flexible Very Important
Personalized	Personalized Not Very Important	Personalized Minimally Important	Personalized Should be Considered	Personalized Somewhat Important	Personalized Very Important
Includes Core and Optional Competencies	Includes Core and Optional Competencies Not Very Important	Includes Core and Optional Competencies Minimally Important	Includes Core and Optional Competencies Should be Considered	Includes Core and Optional Competencies Somewhat Important	Includes Core and Optional Competencies Very Important

DETERMINING GLOBAL HEALTH OUTCOMES

The following is a list of the CanMEDS Learning Objectives matched to Global Health Competencies for Calgary's training program:

Medical Expert

Students will develop diagnostic and therapeutic skills in the realm of relevant infectious disease

Students will develop diagnostic and therapeutic skills in the realm of preventative global medicine

Students will learn how to access medical information in a variety of remote and under-resourced settings, and apply it to the specific context of their setting

Students will practice patient-centered, ethical care. They will develop expertise at serving under-resourced populations: inner-city, aboriginal, immigrants

Communicator

Global Health residents will build on abilities learned as family physicians, and continue to take thorough histories

Students will provide patient advice and education appropriate to the clinical setting

Students will demonstrate the ability to develop effective therapeutic relationships with patients, while actively addressing language and cultural challenges

The Global Health resident will develop communication skills that reflect cultural competence (working with interpreters, consider language training, consider patient comfort)

Collaborator

Global Health residents will learn how to establish triage and referral systems for ongoing care of complex patients in remote settings or marginalized populations

Trainees will learn how to be the patient gateway and a resource to the interdisciplinary team available in a resource-poor setting

Students will learn how to build working relationships with teams in the context of expertise on a defined population, whether that is an aboriginal community in Canada or a field experience in a resource-poor setting. They will learn to work with other experts in the field of Global Health.

Health Advocate

Students will learn about epidemiological principles and apply these to the populations they serve

The Global Health resident will understand the economic, political, social, and environmental determinants of health. They will become advocates of their patient for appropriate health care, human rights, basic needs, and poverty alleviation.

Students will understand basic concepts in public health and their potential role as an advocate within a defined resource-poor or marginalized community (street-associated, aboriginal, immigrant and refugee, as well as those abroad)

Students will respect diversity and difference, including but not limited to the impact of gender, religion, and cultural beliefs on decision making and health

Manager

Students will develop skills that enhance their ability to deliver appropriate care in a defined community, such as utilization of limited resources and balancing the needs of all patients where such limits exist

Global Health students will learn to work within a variety of health care organizations in diverse contexts throughout both Canada and the developing world

Students will become familiar with government, NGO, and other Global Health stakeholders’ policies and programs that affect the communities in which they serve

Global Health trainees will become familiar with the principles of development, and how vertical and horizontal programming works in building health care related projects

Scholar

Global Health residents will become adept at developing their own personal learning objectives, and at reframing these periodically according to their experience

Trainees will learn about how to maintain a portfolio for assessment purposes

Students are encouraged to develop research skills for the fieldwork component of the curriculum, and to contribute to the development of new knowledge in the field of Global Health

Global Health residents will become teachers to other students within their practice community and encourage others to consider the Global community beyond their limited scope of practice

Students are encouraged to analyze how each patient encounter reframes their own ideas about Global Health, and to reflect on these experiences with respect to their learning goals and personal ideology

Professional

Students will deliver high quality health care with compassion and integrity in each clinical setting

Residents will demonstrate professional and ethical behaviour at all times, cautioning against ethnocentric beliefs and always maintaining a cross-cultural perspective

Question Title

* 3. Please examine the learning objectives described above, and consider any additional suggestions you feel might be necessary for a Global Health training program with which you are familiar or affiliated.

Medical Expert

Communicator

Collaborator

Health Advocate

Manager

Scholar

Professional

BLUEPRINTING THE PROGRAM'S OBJECTIVES TO ASSESSMENT TOOLS

Once learning objectives have been established for an educational program, the portfolio can then be created by matching these to the components in the curriculum that best fits to measure achievement. This process occurs by "blueprinting". Please now examine how this was done for the Calgary Global Health program:

Question Title

Skills Eval is a Form of Clinical Skills Evaluation to be done by preceptors
UME is Undergraduate Medical Education at University of Calgary
ISTM exam is the International Society of Travel Medicine conference and examination
CBD is a Case-Based Discussion Form where the students review a relevent case with preceptors
The Geojournal is a product of the Introduction to Global Health course in Arizona
TAB is a Multisource Feedback form given to health care team members and patients as a measure of professional behaviours
OSCE is an objective, structured examination set up for the Travel Medicine component of their curriculum

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* 4. Please comment on whether you feel the learning objectives are being adequately sampled and assessed using this format. Include any examples of alternate assessment tools that could be included to measure achievement of their competencies.

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* 5. Portfolios are unique tools for an educational program, in that their content is dictated by the curriculum, the outcomes and competencies desired, and the students themselves. Please choose which of the following items you feel would be of benefit to include in a Global Health portfolio to be used for assessment of Residents.

* Note - MSF is an assessment that asks a range of people including members of a health care team and patients about the students' professionalism and communication abilities

Clinical Skills Evaluations

* Multisource Feedback

Presentations

Chart Audits

Journal Club Reviews

Critical Incident Reports

Fieldwork Research

Reflective Journal / Pieces

Personal Learning Objectives

Case Reviews

Video Recordings

Feedback Material

Examinations

Publishings

Other

FINAL ASSESSMENT OF RESIDENTS USING THEIR PORTFOLIOS

The last step in the process was determinining how the Global Health residents' portfolios would be assessed. We formed a Committee who agreed to oversee the procedure, whereby experts in each area would determine whether the completed assessment tools demonstrated that the students had fulfilled their learning objectives. By using 3 assessors for each section, we manage to reach reliable statistical significance with this method.

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* 6. Do you feel that this method of determining pass rates is valid? Do you have any suggestions for improvement or change? Would there be further methods you would use to demonstrate achievement of personal learning objectives?