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Scope of Global Health Training in U.S. Obstetrics and Gynecology Residency Programs

Hung, Kristin J. MD; Tsai, Alexander C. MD, PhD; Johnson, Timothy R.B. MD; Walensky, Rochelle P. MD, MPH; Bangsberg, David R. MD, MPH; Kerry, Vanessa B. MD, MSc

doi: 10.1097/AOG.0b013e3182a9c1c8
Original Research

OBJECTIVE: To enumerate global health training activities in U.S. obstetrics and gynecology residency programs and to examine the worldwide distribution of programmatic activity relative to the maternal and perinatal disease burden.

METHODS: Using a systematic, web-based protocol, we searched for global health training opportunities at all U.S. obstetrics and gynecology residency programs. Country-level data on disability-adjusted life-years resulting from maternal and perinatal conditions were obtained from the Global Burden of Disease study. We calculated Spearman's rank correlation coefficients to estimate the cross-country association between programmatic activity and disease burden.

RESULTS: Of the 243 accredited U.S. obstetrics and gynecology residency programs, we identified 41 (17%) with one of several possible predefined categories of programmatic activity. Thirty-three residency programs offered their residents opportunities to participate in one or more elective-based rotations, eight offered extended field-based training, and 18 offered research activities. A total of 128 programmatic activities were dispersed across 64 different countries. At the country level, the number of programmatic activities had a statistically significant association with the total disease burden resulting from maternal (Spearman's ρ=0.37, 95% confidence interval [CI] 0.14–0.57) and perinatal conditions (ρ=0.34, 95% CI 0.10–0.54) but not gynecologic cancers (ρ=−0.24, 95% CI −0.46 to 0.01).

CONCLUSIONS: There are few global health training opportunities for U.S. obstetrics and gynecology residents. These activities are disproportionately distributed among countries with greater burdens of disease.


There are relatively few global health training opportunities for U.S. obstetrics and gynecology residents with differential program placement in countries with higher burdens of disease.

Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, the Chester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, the Center for Global Health, and the Divisions of Pulmonary and Critical Care, General Medicine, and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, the Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts; the Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan; and Mbarara University of Science and Technology, Mbarara, Uganda.

Corresponding author: Kristin J. Hung, MD, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, East Campus, Kirstein 317, Boston, MA 02215; e-mail:

Supported by the Mark and Lisa Schwartz Foundation; the Klingenstein Family Foundation; and the Harvard University Center for AIDS Research, through U.S. National Institutes of Health (NIH) P30AI060354. The authors also acknowledge salary support from NIH K23MH096620 (A.C.T.), NIH R01AI058736 (R.P.W.), and NIH K24MH087227 (D.R.B.).

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Brian A. Bergmark, Regan W. Bergmark, and Chaturia Rouse for research assistance.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.