Global Health: A New Course for Medical Students

Student interest in global health has grown rapidly over the last decade. Increasing numbers of undergraduates are enrolling in global health degree programs; student groups are blooming across the country; and the percentage of medical students interested in global health–related electives has never been higher.

Here at Harvard, we have considerable resources in global health. Many faculty members are leaders in the field, conducting research in health care delivery, health systems improvement and drug design, and they have significant on-the-ground experience in a broad range of settings, including nations in Africa, the Caribbean, South America, Asia and the Balkans.

As student demand and faculty expertise converge on our campus, we have an opportunity to link students to these invaluable resources.

Two faculty members with experience in global health, Drs. Patrick Lee and Brett Nelson, designed an elective course called Clinical Topics in Global Health, which ran for the first time from January through March of this year. Its goal is to help medical students develop a clinical understanding of major issues in global health.

The course features content not typically found in global health curriculum. First, students learn practical skills necessary for clinical fieldwork. Second, the course combines teaching in clinical specialties that often have been separated, providing an integrated approach to clinical care in resource-limited settings. It joins, for example, pediatrics with adult medicine, newborn medicine with obstetrics and pathology with infectious disease. Finally, to generate mentorship opportunities, the course brings together medical students in years one through four; medical residents; practicing clinicians; and global health professionals such as women’s rights advocates, leaders of nongovernmental organizations (NGOs) and global health educators.

This year’s course introduced students to key causes of morbidity and mortality worldwide through in-depth lectures focusing on both epidemiological and clinical issues. Topics included child health, maternal and newborn health, malaria and neglected tropical diseases, HIV/AIDS, tuberculosis, malnutrition, diarrheal disease and rehydration. The course also covered non-communicable diseases and health issues in the context of humanitarian crises. Lectures were followed by relevant practical skills sessions such as tropical microscopy, basic neonatal resuscitation, mixing oral rehydration solution from common household ingredients, making asthma inhalers out of water bottles, portable bedside ultrasound and simple tooth extraction.

The course’s ten evening sessions were led by Drs. Lee and Nelson and featured presentations by invited experts from HMS-affiliated hospitals, the Department of Global Health and Social Medicine and the Harvard Humanitarian Initiative. The leaders also strongly encouraged student direction for the course; in fact, students contributed to course teaching. A third-year dental student led an oral-health lecture and practical teaching session, and a second-year medical student produced a report on the global burden of injuries.

The feedback from course evaluations has been extremely positive. One student noted that he had a “much better sense of priorities and trends in the field of global health,” a “much better sense of where to go to find answers,” and “a much better appreciation for how guidelines and protocols are used and how they can fall short.”

Another student commented that she “particularly liked the combination of theoretical background and clinical knowledge/skills.” A third student pointed out that “learning about the experiences of various experts in the field” and “exposure to like-minded students from other years” were key benefits of participating in the course. Finally, one student wrote that the course’s “breadth and depth were consistently impressive, and everything was presented with thoughtfulness unparalleled in my Harvard Medical School experience thus far.”

Clinical Topics in Global Health was born out of Dr. Lee’s and Dr. Nelson’s own experiences working in global health. Dr. Lee, an HMS instructor in medicine at Massachusetts General Hospital, has worked with Partners In Health in Rwanda developing systems for chronic disease care. He directs the Global Primary Care Program at MGH, launched earlier this year, which bridges the disciplines of global health and primary care in order to advance the vision of health for all and strengthen future leadership for primary health care in the U.S. and around the world. He also serves as medical director for Tiyatien Health, an NGO delivering health care to the poor in rural Liberia.

Dr. Nelson is an HMS assistant professor of pediatrics at Massachusetts General Hospital and is a core faculty member of the department’s new Division of Global Health. He helped establish the nation’s first pediatric global health fellowship and recently served as the senior pediatrician for Liberia. Dr. Nelson has worked in more than a dozen conflict-ridden countries and currently directs the Harvard Humanitarian Initiative’s program for Children in Conflict and Crisis.
Clinical Topics in Global Health will be held again in Spring 2011. Students interested in signing up for the course or getting more information may contact Dr. Patrick Lee (drpatricktlee@gmail.com) or Dr. Brett Nelson (brett.d.nelson@gmail.com).

Second-year MD student David Shulman and third-year MD–PhD student Amy Saltzman, both course participants, and course leaders Brett Nelson and Patrick Lee