Subspecialty and Global Health Training for Tomorrow’s Pediatric Leaders
Published on in CHOP News , Global Health Update
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Published on in CHOP News , Global Health Update
Fellowship is the ideal time to acquire advanced skills that will form the foundation of a successful pediatric career. Working alongside experienced mentors enables fellows to grow a global health skillset within a chosen area of pediatrics. Children’s Hospital of Philadelphia (CHOP) offers future global health leaders a rich and nurturing learning experience in an exciting environment.
The Global Health Center and subspecialty programs at CHOP are committed to supporting trainees in pursuing their global health goals. CHOP maintains the highest training standards while allowing the flexibility needed to engage in global health research and projects. Highlighted below are the experiences of four CHOP subspecialty fellows who incorporated global health into their fellowship training.
Growing up, I was fortunate to travel with my family to many different places. By the time I went to medical school, I had already developed an interest in global health. In medical school, I completed a Spanish language immersion experience in Costa Rica, and during residency, I taught neonatal resuscitation in Peru. Toward the end of my residency training, however, I wasn’t sure I wanted to pursue any fellowship training. I looked for work opportunities abroad and ended up spending a year in Bhutan, which helped shift my perspective and ultimately led me to apply for a neonatology fellowship.
I chose CHOP because I wanted to get the most clinical experience I could. CHOP is a referral center for babies with complex medical conditions, and Neonatology fellows have the opportunity to see a breadth of clinical neonatology, making this fellowship a fantastic learning opportunity. The fellowship is three years long and includes 13 months of clinical service, as well as overnight calls during non-clinical blocks. It is therefore possible to use call-free months for global health activities. Through the fellowship, I also have access to mentors who are doing exciting work and who are open to talking about how they structured their careers to incorporate global health, even suggesting projects I should consider.
Andrew Steenhoff, MBBCh, DCH, Medical Director of the Global Health Center at CHOP, has introduced me to a variety of programs and connected me with faculty across both CHOP and the University of Pennsylvania (Penn). For example, I am currently working on a neonatal sepsis project in Botswana with Susan Coffin, MD, MPH, an internationally recognized infection prevention expert. This is my first foray into research, and it has been an invaluable learning experience. Over the summer, Dr. Coffin and I traveled to Botswana to launch a neonatal sepsis study, specifically looking into Klebsiella infections in the neonatal intensive care unit (NICU). The lab directors and faculty at the University of Botswana were excited to collaborate with us on this project.
I’ve also had the opportunity to work with John Chuo, MD, MS, Director of Telemedicine at CHOP. Dr. Chuo is leading an mHealth collaboration, in which the Division of Neonatology is facilitating telehealth conferences with the neonatology team at Laquintinie Hospital in Douala, Cameroon. On one of these telehealth conferences a few months ago, our colleagues in Cameroon took us on a video tour of their hospital and NICU and even introduced us to their Neonatology fellows. Even though I have never been to West Africa, this video conference gave me a glimpse of what it is like to practice medicine there. That was an eye-opening experience. I had not considered telemedicine before fellowship, but I’ve since learned that it provides a way to connect with colleagues in different parts of the world.
Without the support of the Division of Neonatology and the Global Health Center, I would not have been able to explore the incorporation of global health into my career in ways that play to my strengths and expertise.
My family is originally from The Gambia, West Africa. Because of my early experiences, I have been interested in working in Africa throughout my medical career. While researching fellowship programs, I was struck by the very strong collaborations that CHOP and Penn have with institutions and hospitals around the world. I was particularly excited to learn about the Botswana-UPenn partnership, which is a long-standing collaboration created to strengthen clinical care, education and research in Botswana. Through the support of the CHOP Global Health Center and the Division of Adolescent Medicine, I was able to conduct my fellowship research project in Botswana.
The Division of Adolescent Medicine is very supportive of fellows who are interested in global health. My specific interest in adolescent medicine is centered on the sexual and reproductive health of underprivileged youth. Botswana has a high teen pregnancy rate, and I am interested in understanding the barriers to and facilitators of long-acting reversible contraceptive (LARC) use by adolescent girls and young women (AGYW). Because my research interests are well-aligned with those of our partners in Botswana, I have been able to pursue this topic for my fellowship project. The Division of Adolescent Medicine was instrumental in helping me to identify mentors, both within and outside of the division, whose expertise would guide me through my global health research. My project mentors include Andrew Steenhoff, MBBCh, DCH; Aletha Akers, MD, MPH; Sarah Wood, MD, MSHP; Chelsea Morroni, MD, MPH, PhD; and Dipesalema Joel, MBBCh BAO, B Med Sc (NUI), MRCPI. As a fellow, having experienced and committed mentors is crucial to successfully conduct research in a global health setting.
Another important consideration for trainees wanting to pursue global health activities during fellowship is choosing a flexible program that will provide protected time for research. Within my division, I was given three consecutive months during my three-year fellowship to focus on my research project. This provided me with uninterrupted time to recruit subjects, conduct interviews and prepare data for analysis. I was able to successfully complete enrollment with the support of my Botswana- and United States-based research teams. The excellent working relationship between CHOP, Penn and the researchers in Botswana makes these kinds of activities possible.
Incorporating global health into my fellowship training has been a unique and fulfilling opportunity. It has influenced my approach to medicine and allowed me to understand the challenges that millions of individuals face in receiving effective, high-quality medical care. My fellowship training has also given me an appreciation for the educational opportunities and resources that exist in the United States.
I have continued to appreciate the value of strong, long-term domestic and international partnerships. In the future, I plan to be involved in improving health systems in low- and middle-income countries (LMICs). I am continually learning about various career paths within the area of global health. My experience in the Adolescent Medicine Fellowship Program has strengthened my passion for global health and my desire to work in LMICs. I am fortunate and thankful to have been given such a remarkable opportunity that will undoubtedly shape my future career.
I completed all of my general pediatric training in Ireland, where I am originally from. Because Ireland is such a small country, there are no pediatric subspecialty training programs, so I had to look abroad for pediatric subspecialty training. During medical school, I had the opportunity to complete a rotation at CHOP, so I knew about the rich training environment that CHOP offers. I was also interested in global health and had taken a year during my pediatric training to work for Médecins Sans Frontières. I interviewed at several different programs in the United States, but when I talked to Dr. Steenhoff about the possibilities of incorporating global health research into my Infectious Diseases (ID) Fellowship, I knew CHOP was the right place for me. CHOP’s excellent reputation, robust ID program and global health opportunities made this an easy choice.
CHOP’s three-year ID Fellowship can be helpful for anyone interested in pursuing global health. Unlike other ID programs, the majority of clinical work at CHOP is front-loaded into the first year of the program; in years two and three, fellows have protected research time. The ID program has been supportive and flexible, allowing me to dedicate time to my research in the Dominican Republic (DR). My research focuses on defining the prevalence of Group B Streptococcus (GBS) colonization among mothers and exploring attitudes toward maternal immunization among women and providers. My mentors include Dr. Steenhoff, who is also an ID faculty member; Kristen Feemster, MD, MPH, MSHPR, a Global Health and vaccine expert; Brian Fisher, DO, MPH, MSCE, Director of the ID Fellowship Training Program during my first two years of training; Adam Ratner, MD, a pediatric ID doctor and microbiologist at NYU; and Sandra Valera, MD, an ID pediatrician at Hospital Materno-Infantil San Lorenzo de los Mina in Santo Domingo and my in-country mentor. I continue to be amazed by the sheer number of people engaged in global health research and the variety of excellent mentors.
The availability of research funding for global health projects is just as crucial as protected time to conduct the research. Fellows are eligible to apply for Global Health pilot grants from the Global Health Center. I applied, and my project was one of two chosen for a $20,000 award. This funding enabled me to hire a full-time research doctor for nine months, purchase study supplies and cover my travel expenses to the DR throughout the study. The Global Health Center provides suggestions regarding funding sources and even offers support with grant writing. Fellows are provided with the resources they need to complete a global health project successfully.
The experiences I have had through fellowship have honed my skills in planning and supervising international projects. I feel confident and equipped to return to Ireland as a pediatric infectious disease specialist with global health expertise.
When I interviewed for fellowship at CHOP, I had the chance to speak to ID fellow Leslie Enane, MD, who was at that time about to graduate. She shared that she had been able to incorporate global health research activities into her fellowship experience and that the program was flexible enough for her to spend time abroad. Dr. Enane’s experience illustrated that CHOP was supportive of fellows interested in global health. In addition to this insight, I chose CHOP because it has an excellent program for clinical research in infectious diseases and offers fellows the opportunity to pursue a Master of Science in Clinical Epidemiology (MSCE) at Penn.
While I had always been interested in global health, I felt that fellowship was the perfect time to build a research project and gain firsthand experience. During my first year, I had several conversations with Dr. Steenhoff about exploring my research interests and how they matched with the needs of CHOP’s primary partner sites, Botswana and the Dominican Republic (DR). Because I was interested in studying infections in immunocompromised patients, Dr. Steenhoff introduced me to Stephen Hunger, MD, Chief of the Division of Oncology at CHOP. Dr. Hunger has an ongoing partnership with the pediatric oncology team at Hospital Infantil Robert Reid Cabral (HIRRC) in Santo Domingo, D.R. The dedicated oncologists at HIRRC, led by Dr. Dominga Reyes Pérez, were interested in reducing infection-related morbidity and mortality in their patients. Through discussions with the HIRRC team, we designed a project to describe the epidemiology, risk factors, and outcomes of infection in pediatric leukemia patients to identify interventions that would improve survival.
During my fellowship, I also pursued an MSCE degree through Penn. The MSCE program offers an additional pathway that helps fellows conceptualize and develop their research projects. In addition to support from division/subspecialty programs and the Global Health Center, the MSCE program assigns each student a research mentor and a biostatistics advisor. The MSCE courses provide instruction in protocol development, biostatistics and epidemiology, allowing students to apply that knowledge to individual projects. My mentors included Brian Fisher, DO, MSCE; Yimei Li, PhD (Biostatistics advisor); Dominga Reyes Pérez, MD (in-country mentor); and Dr. Steenhoff.
In my first year of fellowship, I traveled twice to the DR with the Global Health team for meetings at HIRRC to conceptualize my project. I went back during my second year to launch the project and was fortunate to have assistance with data abstraction from research associate F. Jay Garcia, a Penn medical student. Garcia connected to the project through the Penn Center for Global Health, a valuable resource that links interested students to investigators in global health. In my third year, I focused on data analysis and manuscript development. I then returned to the DR to present the results to the HIRRC oncology team. My global health research experience took me out of my comfort zone, allowed me to gain a global perspective and forced me to take initiative, be adaptable and find creative solutions to problems. I’m thankful to have had the opportunity to build on a collaborative international partnership.
The Global Health Center at CHOP has active collaborations in 17 countries around the world. If you are interested in global health at CHOP, contact us via email at email@example.com or learn more below.