key: cord-0998036-ngryd667 authors: Long, Chao; Meyers, Natalie; Nyoni, Tingadini; Sivaraj, Dharshan; Muguti, Godfrey I; Chang, James title: A new model for educational programming in global health emerges during COVID-19 date: 2021-02-11 journal: Journal of global health DOI: 10.7189/jogh.11.03034 sha: c1a2aa73dea3cda39e74e1edaf83f3060b88f34a doc_id: 998036 cord_uid: ngryd667 nan COVID-19 has disrupted medical training and education worldwide, which is especially concerning for low-and middle-income countries where there is an existing shortage of trained medical professionals. The shift from in-person to virtual educational programming confers numerous advantages which offer a more sustainable model for education and training. We recommend the global health community to evaluate the merits of virtual training and consider its adoption, perhaps as a hybrid model, in post-COVID healthcare workforce training. Virtual education however brings a unique set of challenges. First, trainees in LMICs may not have access to a reliable internet connection. In certain countries, there are frequent power outages that interfere with connectivity. Second, internet data, oftentimes paid out-of-pocket by trainees, may be prohibitively expensive given the high bandwidth and data usage that video streaming requires. Finally, because educators and trainees are typically in different time zones, the timing of the programming may preclude certain trainees from attending in real-time. Because of these challenges, we recommend that virtual educational programs consider providing financial or technical support to create a virtual learning environment locally. We also recommend all training to be recorded, so that these lessons can be watched asynchronously at any later time. ReSurge International, an NGO dedicated to increasing access to reconstructive surgery, serves as an illustrative case example for this shift in educational programming. ReSurge provides surgical education and training via its Global Training Program [9, 10] . Before COVID-19, this program comprised of Visiting Educators, a group of reconstructive surgeons who traveled to LMICs to deliver hands-on training. Once international travel was no longer possible, ReSurge quickly pivoted to a virtual curriculum involving several different lecture series, including a "Virtual Grand Rounds." This curriculum was developed jointly with their LMIC partners. At the time of this article's submission, it has reached more than 1200 participants from 24 countries spanning four continents. Re-Surge implemented strategies to ensure useful, high quality content and close engagement from its trainees. For example, it conducts continuous needs assessments by surveying trainees and program directors. It also provides certificates of completion in order to incentivize attendance and participation. To measure its impact and track trainees' progress, ReSurge administers pre-and post-lecture tests. No global health educator would discount the value of being in-country and on-site; this allows us to perform needs assessments, build trust and goodwill with LMIC partners, understand the context of our work, and secure the buy-in that any successful global health initiative requires. Surgical education is furthermore unique from other types of medical education in that competence and mastery require not only knowledge and a command of surgical anatomy but also the technical skills for execution. For these reasons, we believe that post-COVID, educational programming in global health should reflect a hybrid curriculum including both virtual and in-person training. Before the visit, lectures can be delivered virtually, along with virtual pre-operative clinics to screen patients. This would be followed by in-person trainings that transfer diagnostic and technical skills to the trainees. Virtual training can continue after in-person trainings with additional lectures and virtual follow-up clinics. The proposed three-step hybrid program is likely to improve upon the primarily inperson models used pre-COVID because it more closely resembles existing surgical education paradigms that incorporate teaching of both technical skills and foundational knowledge. The addition of virtual training before and after in-person training allows for greater and continued emphasis on the knowledge component. This hybrid program can be repeated quarterly at host hospitals to create a continuous cycle of surgical education. COVID-19 forced us to adapt, however it has also provided an opportunity to innovate and reimagine medical and surgical training. By leveraging modern technologies, virtual training and a hybrid curriculum offer a cheaper, less time-intensive, easily accessible, and more sustainable model for education and training in global health. Funding: None. Authorship contributions: All authors were responsible for the article concept and design. CL, NM, and DS conducted the literature search. All authors contributed to the manuscript writing and editing. All authors accept responsibility to submit for publication. Competing interests: NM is an employee of ReSurge International; she reports personal fees outside the submitted work. JC is a consultant for ReSurge International; he reports personal fees outside the submitted work. The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no further conflicts of interest. Minist Heal Singapore Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2 World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard 2020 COVID-19, SARS and MERS: are they closely related? 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