Promoting Resident and Fellow Training in Global Health

In 2019 when Kaile Eison, DO, was a resident in the Department of Rehabilitation and Regenerative Medicine at NewYork-Presbyterian/Columbia University Irving Medical Center, she spent seven weeks of a global health elective in Mwanza, Tanzania, sub-Saharan Africa. In fact, the chance to expand her interest in global health was one of the reasons she pursued her residency training at Columbia.

Dr. Kaile Eison consults with a patient during her elective in Tanzania.

“I had a great experience in Tanzania, and in joining the Columbia faculty I asked if I could direct global health for the department and expand the elective into a full longitudinal curriculum and track for the residency program,” says Dr. Eison, who today is Director of Global Health, Director of HIV Rehabilitation, and Associate Director of the Inpatient Rehabilitation Unit at NewYork-Presbyterian/Columbia.

While global health educational experiences are becoming increasingly common in graduate medical education and are readily available in other specialties, there are relatively few structured global health experiences in Physical Medicine and Rehabilitation residency programs. “We wanted to provide residents with training and experience in global and public health. This opportunity, which would enable them to create projects based in sustainability, would be beneficial not only for the trainees, but also for the communities that we are working with in other countries,” says Dr. Eison.

Dr. Heakyung Kim, former Director of Pediatric Physical Medicine and Rehabilitation, NewYork-Presbyterian/Columbia, and Dr. Eison meet with staff at Bugando Medical Centre.

The new curriculum is integrated with NewYork-Presbyterian medical training programs established in Tanzania some two decades ago. Residents and fellows in multiple specialties train and provide care side-by-side with physicians and healthcare workers at the Bugando Medical Centre, where Weill Cornell Medicine established a medical school – Weill Bugando – in 2003.

“If we can start to create a global community for rehabilitation and help more people develop a skill set to address the functional needs of patients around the world, that would be very significant.” — Dr. Kaile Eison

Through the new global health curriculum in physical medicine and rehabilitation, residents and fellows are exposed to the practice of medicine in a low resource setting. Their experience is broad-based, including stroke care, treatment for spinal cord injuries, and management of musculoskeletal conditions.

Dr. Kim attends to a patient.

The Columbia global health track is now in its second year and includes 18 months of eight blocks starting in the third year of residency and going into the fourth year or the fellowship year. The curriculum emphasizes site-specific physiatry skills and cultural training. Residents focus on reducing health disparities, global health ethics, advocacy, and effecting change in health and social policy. “Each block is focused on a different area of global health or public health looking at these issues through the lens of rehabilitation,” says Dr. Eison.

The curriculum includes:

• Introduction to Global Health and the State of the World: Avoiding Medical Tourism, Decolonizing Global Health, Global Burden of Disability
• Global Health Ethics
• Comparative Health Systems
• Women’s Health and Gender Health Disparities
• Palliative Care in the Global South
• Perceptions of Disability
• Pertinent Pathologies and Project Specific Training
• Site Specific Cultural Education

Dr. Eison hopes to instill in the Columbia residents and fellows that their goal is not necessarily to bring their approach to medicine to another country, but to work within the construct of that country’s resources and belief systems. “We’re trying to open up the lines of communication and share knowledge to find out how people are addressing the same concerns that we may have here, but within the context of the societal and systemic issues they may have,” she says.

A Broader Commitment to Global Health

In addition to establishing the global health curriculum, Dr. Eison is also in the process of developing one of the first inpatient rehabilitation units in the region in collaboration with an occupational therapist at NewYork-Presbyterian/Weill Cornell Medical Center and faculty at the Bugando Medical Centre. “Physiatry as a specialty does not exist in Tanzania and oftentimes the emphasis on rehabilitation and improved quality of life is not a priority in the same way that it is in the United States,” says Dr. Eison. “Part of our role is to encourage a greater focus on the recovery and rehabilitation of hospitalized patients. We would very much like to involve occupational and physical therapy students in our curriculum, as our closest counterparts in Mwanza are physical and occupational therapists. Having the involvement of PT and OT students would be an asset for them, as well as for us.”

Dr. Eison is also working with four physiatrists in the United States to develop an ACGME accredited national global health curriculum specific to physical medicine and rehabilitation that can be accessed virtually by residents who may or may not have a global health travel experience already existing within their residency program. “There are many people who are working in global health. One of our goals in developing a national curriculum is to try and bring these people together, not just nationally, but also globally, so that we can have these conversations on a broader scale.”