Global Primary Care Program
More than thirty years after the Declaration of Alma-Ata, the promise of primary health care has not been met for billions of people around the world. This is no less true for vulnerable populations in the United States than for poor farmers in rural Uganda – two countries at opposite ends of the wealth spectrum. We can do better. We believe the MGH has a professional and ethical responsibility to help address the unmet promise of primary health care for all.
The Global Primary Care (GPC) Program at Massachusetts General Hospital (MGH) is an initiative of the Department of Medicine that integrates the principles and practice of global health and primary care in order to develop future leaders to advance health equity and strengthen health systems in the U.S. and around the world. GPC invests in innovative curricula and mutually rewarding partnerships in urban Boston and rural Uganda to create a continuum of service, teaching, and research opportunities with a specific focus on vulnerable populations.
The GPC program has three strategic objectives:
- Develop future leaders to advance health equity and strengthen health systems in the U.S. and around the world;
- Pioneer new models of primary care for vulnerable populations through mutually rewarding, long-term partnerships; and
- Foster a global learning community to accelerate primary care innovation and knowledge transfer across settings.
MGH offers an ACGME-approved four-year track in Global Primary Care (GPC) featuring:
Two GPC positions are offered each year through the National Residency Matching Program. Applicants interested in the GPC track should indicate this preference on their ERAS application file. Qualified applicants will be invited for a two-day interview, which will include the Primary Care Interview Day.
- Clinical training in internal medicine and primary care, equivalent to MGH Primary Care residents;
- Continuity practice in a new clinic at MGH Chelsea Health Center, serving post-incarceration and urgent care high-utilizing populations;
- Tuition support for an MPH degree at the Harvard School of Public Health;
- Four months of dedicated, US-based ambulatory training focused on primary care delivery, policy, implementation, and evaluation;
- Ten months of international fieldwork, including eight months over four years at Bugoye Health Center in rural Uganda; and
- Mentored thesis work in global primary care, expected to result in a first-author publication or academic equivalent.
Global Primary Care residents will complete a total of 52 four-week blocks (“months”) of multi-disciplinary training. This expanded program fulfills the requirements for RRC-IM accreditation and the requirements for a Masters of Public Health at the Harvard School of Public Health.
- Achieve clinical excellence in the practice of internal medicine and global health across a range of domestic and international settings;
- Develop a dynamic skill set to address global primary care systems improvement including: operational research; continuous quality improvement; policy analysis; the science of health care delivery; and advanced leadership training to work effectively across diverse teams, cultures, sectors, and settings; and
- Achieve an exceptional post-residency career path in global primary care through active mentorship and broad exposure to opportunities in practice, policy, research, and education.
Syllabus and Activities
The Global Primary Care residency includes:
- 22 months of inpatient training (equivalent to Primary Care residents)
- 9 months of ambulatory training
- 10 months of international fieldwork
- 6 months of MPH coursework
- 1 month of elective
- 4 months of vacation
Masters of Public Health
Global Primary Care residents may apply to complete an MPH at the Harvard School of Public Health in the Clinical Effectiveness concentration. The course of study comprises 42.5 total credits and fulfills the core requirements for the MPH Program over three years.
Longitudinal Thesis Work
Global Primary Care residents will conduct longitudinal thesis research in collaboration with global health and general medicine faculty at MGH, other Harvard-affiliated institutions, and/or other domestic or international partner institutions. This research is anticipated to:
Residents will rotate through and engage with faculty mentors at GPC partner sites in Boston and Uganda with the goal of selecting a scholarly focus by the middle of the PGY-2 year. Residents will submit a thesis proposal for committee review by MGH and partnering faculty at the end of the PGY-2 year. Faculty mentors will meet with residents on a quarterly basis to review progress throughout the PGY-2 to PGY-4 years. Residents will be provided with appropriate funding and support to conduct approved thesis research.
- Serve as the basis for scholarly activities including the junior and senior resident talks and the senior poster presentation;
- Integrate into the 7.5 credit MPH Clinical Effectiveness practicum; and
- Culminate in a first-author publication (or academic equivalent).
Global Primary Care Curriculum
The Global Primary Care Curriculum explores how “health for all” may be achieved for people and communities around the world. It highlights comparative lessons across a diversity of country and resource settings, considers the broader socioeconomic and political context of health, and examines the full arc of care delivery – from governmental policy and planning to local communities where “the rubber meets the road.”
The curriculum has three main objectives:
- Teach core concepts in primary health care delivery, policy, evaluation, and community engagement – optimized for busy residents and students;
- Introduce primary care interns to potential faculty mentors with a view to future collaborations and career development; and
- Accelerate primary care innovation and knowledge transfer across settings by actively seeking opportunities to collaborate, learn, and teach with GPC’s U.S. and international partners.
- An immersive four-week experience offered to all primary care and selected categorical interns;
- Varied teaching methods, including: case studies, lectures, critical reading of literature, analysis of current events, faculty Q&A panels, and interactive team-based problem-solving; and
- Integrated community-based experiences, aligned with in-class learning objectives (e.g., health policy/advocacy with Doctors for America, community leadership at Boston Health Care for the Homeless, home visits with Chelsea Refugee Health Program, etc.).
- Primary Health Care and Health Sector Reform – an introduction to the Primary Health Care movement and how countries across the wealth spectrum (U.S., Mexico, Liberia) have attempted to create a more just and effective health care system for their citizens.
- Community-Oriented Primary Care – a deeper inquiry into specific U.S. and international examples of health care delivery, examining the challenges, successes, and pitfalls faced in several innovative primary care systems.
Core faculty and potential mentors for the Global Primary Care Program include:
- Elisha H. Atkins, MD
- Travis P. Baggett, MD, MPH
- David R. Bangsberg, MD, MPH
- Anna Baylor, MD
- Hasan Bazari, MD
- Monica R. Bharel, MD
- Vanessa Bradford Kerry, MD, MSc
- Stephen B. Calderwood, MD
- Brian T. Chan, MD
- Marya J. Cohen, MD
- Jeffrey P. Collins, MD, PhD
- Susan Edgman-Levitan, PA
- Kenneth A. Freedberg, MD, MSc
- Jessica Haberer, MD
- Clemens S. Hong, MD, MPH
- Rocio M. Hurtado, MD
- Emily Hyle, MD
- Patrick T. Lee, MD, DTM&H
- Edgar M. Mulogo, DDS, MPH
- Conrad K. Muzoora, MMed
- James J. O’Connell, MD, MA
- Kristian R. Olson, MD, MPH, DTM&H
- Rajesh R. Panjabi, MD, MPH
- Valerie E. Stone, MD, MPH
- Ryan W.Thompson, MD
- Dean C. Xerras, MD
MGH Chelsea Health Center
The city of Chelsea, located directly across the Mystic River from Boston, is home to some of the poorest and most underserved communities in all of Massachusetts. Waves of immigrants and refugees have settled here, from Eastern European Jews in the World War II era, to many South and Central American immigrants in the 1980s and 1990s, to the most recent influx of Afghani and Iraqi refugees. Now, nearly half of Chelsea’s population considers itself “Hispanic/Latino.” Despite the availability of high quality health services and free care through state and federal assistance programs, health disparities persist in Chelsea.
Together, the Global Primary Care Program, MGH Chelsea Health Center, and the MGH John D. Stoeckle Center for Primary Care Innovation have developed a joint service initiative, the Chelsea Partnership clinic, which seeks to create exciting training opportunities in primary care while improving the health of Chelsea’s most vulnerable populations.
The Chelsea Partnership has three primary objectives:
- Improve primary care access, services, and health outcomes for vulnerable populations in Chelsea
- Create new training opportunities in primary care delivery and evaluation for MGH residents and Harvard medical students
- Evaluate the impact of the Chelsea Partnership on health outcomes of its patients and trainees’ interest in primary care
Global Primary Care residents will have their continuity clinic based at MGH Chelsea Health Center, alternating between daytime patient care sessions in Adult Medicine and evening sessions in the Chelsea Partnership clinic; all sessions will be precepted by MGH Chelsea faculty. GPC residents’ clinics will thus serve as an important pathway for patients seen in the Chelsea Partnership clinic to have longitudinal primary care and to continue to access the range of regular services available at the health center. In addition, the Chelsea Partnership is one of the primary sites where GPC residents may consider focusing their scholarly thesis.
Consult the following links for more information about MGH Chelsea Health Center and opportunities for Global Primary Care residents within the Chelsea Partnership:
MGH Center for Global Health
The Mass General Center for Global Health (CGH), launched in 2006, provides leadership and support at MGH to reduce health disparities for the world's most vulnerable and crisis-affected populations through education, research and service.
CGH is committed to training future leaders in global health as well as in primary care. Global Primary Care, as an innovative four-year program, is a core programmatic area for the Center. CGH and GPC faculty will work closely to nurture partnerships such as with the Mbarara University of Science and Technology, as well as to develop opportunities for research and professional development for MGH and in-country faculty and students. CGH has a number of programs focused on capacity building, teaching, and training from which GPC will be able to draw. Core areas of collaboration will include:
- Strengthening on-site education through dedicated joint clinical faculty
- Creating multidisciplinary solutions across a range of clinical specialties
- Focusing channels of advocacy for global health policy
- Improving comprehensive care delivery in the places we work both at home and abroad
Consult the following link for more information about MGH Center for Global Health:
Mbarara University of Science and Technology | Bugoye Health Center (Uganda)
The Mbarara University of Science and Technology (MUST) was founded in 1989 with a vision of training and retaining health professionals to serve Uganda’s rural communities. Bugoye Health Center, situated three hours west of Mbarara, serves a picturesque but deeply underserved community characterized by severe resource constraints and a high prevalence of malaria and water-borne diseases.
Building on a strong existing HIV/AIDS partnership led by Dr. David Bangsberg, the Global Primary Care Program will partner with MUST,
Bugoye Health Center, and government and community leaders to develop
locally-driven, rigorously evaluated solutions to health priorities which are
aligned with the national health plan. The partnership will seek to:
- Implement and evaluate improved primary care services in rural Uganda, beginning with a community-based malaria prevention and treatment program;
- Create new training opportunities including rural health experiences for MUST internal medicine residents and MGH’s first international ambulatory training site; and
- Pioneer a new leadership model for responsible academic-community partnership.
Consult the following link for more information about Mbarara University of Science and Technology:
Boston Health Care for the Homeless Program
An estimated 2.3 – 3.5 million Americans experience homelessness each year, and on any given night more than 7,000 people are homeless in Boston. Homeless people experience a disproportionate burden of medical and mental illness, contributing to higher rates of death than those who are housed. Founded in 1985, Boston Health Care for the Homeless Program (BHCHP) has sought to address these disparities. For 25 years, BHCHP’s mission has remained the same: to provide or assure access to the highest quality health care for all homeless men, women, and children in the greater Boston area. BHCHP currently serves more than 11,000 individuals annually in over 90,000 outpatient medical, oral health, and behavioral health encounters through an elaborate network of hospital- and shelter-based clinics, outreach services, and a 102-bed medical respite program.
The MGH Global Primary Care Program and Boston Health Care for the Homeless Program are actively developing a joint service initiative to foster the development of future leaders in primary care delivery for vulnerable populations. Opportunities emerging out of this collaboration will include clinical, educational, evaluative, and research activities, all geared toward providing residents and other learners with the chance to experience and critically examine a novel and nationally-renowned model of health care delivery.
Consult the following links for more information on the Boston Health Care for the Homeless Program and opportunities for Global Primary Care residents within BHCHP:
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