All Together Now: Developing a Team Skills Competency Domain for Global Health Education Virginia Rowthorn and Jody Olsen

1. Introduction Global health is by definition and necessity a collaborative field; one that requires diverse professionals to address the clinical, biological, social, and political factors that contribute to the health of communities, regions, and nations. For universities with global health programs, the interprofessional nature of global health presents both vast opportunities and distinct challenges. In addition to helping students develop mastery within their chosen fields, universities must also ensure that students learn to collaborate with other professionals to address complex global health needs. While much work has been done in recent years to define the field of global health and set forth discipline-specific competencies, less has been done in the area of interdisciplinary or interprofessional global health education.1 This gap in scholarship is troubling given the clear and well-acknowledged need for proVirginia Rowthorn, J.D., is Co-Director of the University of Maryland, Baltimore Global Health Interprofessional Council and Deputy Director of the University of Maryland, Baltimore Center for Global Education Initiatives. She is also the Managing Director of the Law & Health Care Program and Director of the Health Law Externship Program at the University of Maryland Carey School of Law. Prior to joining UM Carey Law in 2006, Rowthorn was an attorney in the Legislative Division of the Office of General Counsel at the U.S. Department of Health and Human Services and an associate at the law firm of DLA Piper. Jody Olsen, Ph.D., M.S.W., is Executive Director of the University of Maryland, Baltimore Center for Global Education Initiatives and Co-Director of the University of Maryland, Baltimore Global Health Interprofessional Council. She is also a Visiting Professor at the University of Maryland School of Social Work. Prior to joining the University of Maryland, Olsen was Deputy Director and then Acting Director of the Peace Corps. She also directed the Fulbright Senior Scholar Program.

550

fessionals across a broad spectrum of disciplines to take part in global health initiatives.2 Within the universe of what is considered interprofessional global health education are two separate areas of learning — shared substantive content (often called cognitive or “hard skills”) and non-cognitive individual and interpersonal skills, such as perseverance, openness, and ability to work as part of a team (often called social/relational or “soft” skills).3 While developing (or agreeing upon) a body of core global health content for all professions is critical to achieve a shared knowledge base among global health practitioners, this paper focuses on the latter: the individual and interpersonal abilities that global health students should be taught to ensure that they can succeed as part of an interprofessional global health team. Because interprofessional global health education can refer to teaching both content and soft skills to students, to avoid confusion this paper will refer to the individual and interpersonal competencies needed by all global health students as “team skills” and later, “team competencies.” This is consistent with our view, and the view of many global health experts, that the ability to work on a team requires a broad range of skills, attitudes, and knowledge including team values, understanding relevant roles and responsibilities, and communication skills. This paper reports on an October 2013 roundtable organized by the University of Maryland, Baltimore (UMB) Center for Global Education Initiatives that brought together experts in global health and interprofessional education from across North America to capture, for the first time, a preliminary list of team competencies that should be mastered by students in graduate4 global health programs.5 The ultimate goal of this project is to create a final list of team compejournal of law, medicine & ethics

Rowthorn and Olsen

tencies that can be incorporated into global health curricula. As noted by Institute of Medicine (IOM) representatives to the UMB roundtable Dr. Bridget Kelley and Patricia Cuff, this effort to develop a team skills competency domain is essential to ensure that the future global health workforce is prepared to collaborate across disciplines and sectors to:

synthesis of population-based prevention with individual-level clinical care.9 The importance of interprofessional collaboration has also been emphasized by the World Health Organization (WHO) which, in 2006, encouraged stakeholders in global health endeavors to “…work together through inclusive alliances and networks — local, national, and

This paper reports on an October 2013 roundtable organized by the University of Maryland, Baltimore (UMB) Center for Global Education Initiatives that brought together experts in global health and interprofessional education from across North America to capture, for the first time, a preliminary list of team competencies that should be mastered by students in graduate global health programs. address the full range of social, behavioral, and biological determinants of health and disease; to adapt to new issues and priorities as they emerge; to be innovative in creating solutions to global health problems, including seeking and respecting contributions from new disciplines that may not be traditionally perceived as part of global health “expertise” — in short, a workforce that is prepared to effectively come together to tackle the most complex and pressing challenges in global health.6

2. Background

global — across health problems, professions, disciplines, ministries, sectors, and countries.”10 Working from the understanding that global health is an interprofessional collaborative field, we are faced with the imperative of teaching students how to be collaborative. Collaboration has been defined as “a way to . . . allow partners to reach an aspiration that would be impossible to achieve without each member of the team working toward the same end. It requires the partnership and the commitment of all members working toward a common goal to succeed.”11 To work collaboratively, teamwork is essential. As one expert noted:

a. Global Health Education and the Need for Team Competencies Over the past decade, interest in global health among undergraduate and graduate students has reached unprecedented levels.7 As awareness of global health has expanded, so too has the realization that addressing the complex factors that contribute to the health of individuals and communities requires the participation of a broad range of professionals from health and non-health disciplines.8 Indeed, the importance of interprofessional collaboration is reflected in one of the most widely accepted definitions of global health proposed by Koplan and colleagues:

[t]oo often the problems we face are not reflections of a lack of knowledge or skill, but rather, a lack of understanding of the true nature of the problem to be addressed, and the resources at our disposal. Sometimes the necessary knowledge or resources rest with another — perhaps an individual, agency, or even a community — that could be mobilized in an effective way. But generally we fall short of identifying our assets, and even when we do know what their potential is, we have difficulty marshalling them in an effective way.12

Global health is an area for study, research, and practice that places a priority on improving health for all people worldwide. Global health emphasizes transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a

To bolster the field of global health, students need to be taught the value of teamwork and the management of the relationships that are key to making the endeavor possible.13 This is particularly important in a field where teamwork can — and should — take many forms, including teams comprised of students, community members, health care practitioners, research-

the buying and selling of health care • winter 2014

551

IND EPEND ENT

ers, faculty members and any combination thereof. To add to their complexity, global health teams are also likely to include individuals from different communities, nations, and educational levels working toward a common purpose. While many professionals working in the global health arena appreciate the value of an interprofessional approach, colleges and universities have been slower to absorb its implications for professional education, which remains highly siloed. As noted by one expert in the field, “Global health seeks to address health inequities, locally and internationally. Yet one challenge is how to create interdisciplinary or interprofessional education programs in training systems predicated on single disciplines, and therefore not necessarily conducive for taking on these activities.”14 Even among universities that offer campus-wide global health programs, administrators of these programs report substantive and logistical barriers because professional education is largely provided through schools that focus on assuring that students acquire the skill base required by a specific profession and its licensing requirements.15 The result is an approach to global health education that favors the parts over the whole and that encourages students to undervalue or even ignore the expertise and contributions of other professions.16 In addition to professional and logistical barriers that universities face when implementing an interprofessional global health program, little work has been done to create shared curricula once these barriers have been overcome. Some have argued that the expansion of global health programs at the university level has proceeded haphazardly and resulted in a lack of agreed-upon definitions and failure to standardize curricula and competencies.17 To remedy these concerns and promote standardization, much work has been done in recent years in a number of professions, such as nursing and medicine, to develop global health competencies.18 Competencies are used in the workplace and educational institutions to express a standard level of performance that can be assessed to measure if the competency has been achieved.19 Competencies are often framed in terms of knowledge, skills, and attitudes or “KSAs.” 20 This taxonomy of learning behaviors is thought to represent the goals of the learning process. That is, after a learning episode, the learner should have acquired new skills, knowledge, and/or attitudes that meet a pre-defined learning objective.21 Competency statements are not “wish lists” or lists of content topics, but rather describe an acceptable level of performance and the skills needed to perform at that level.22 A listing of competency statements is not a cur552

riculum, but having the competencies as a beginning, however, facilitates the process of developing curriculum.23 Once a competency list is accepted, universities must go through the work of deciding how the competencies will be taught and designing the curriculum accordingly. In addition to their role in curriculum development, cross-cutting competencies can be used to create a coordinated effort to embed essential content in multiple professions and provide a framework for evaluation and research to strengthen scholarship in the field that is the subject of the competencies.24 A major first step toward addressing the need for a standardized global health curriculum was taken by the Association of Schools and Programs of Public Health (ASPPH) in 2011 when it published a global health competency model for schools of public health and other global health educational programs.25 The model defines essential competencies for students specializing in global health. In a related vein, the Consortium of Universities for Global Health (CUGH) commenced a project headed up by roundtable participant Dr. Lynda Wilson to define the interdisciplinary core content expected of all global health programs.26 Both the ASPPH and CUGH initiatives are long overdue efforts to define a standardized core content for global health curricula, but neither effort is focused on the urgent need to teach students the team skills they need to successfully employ their substantive knowledge as part of an effective global health team.27 The UMB Center for Global Education Initiatives (CGEI)’s interest in team competencies grew out of the center’s experience sending interprofessional faculty and student teams to Malawi for four consecutive years. CGEI was initially created as part of a National Institutes of Health (NIH) Fogarty International Center “Framework Program for Global Health” grant to create university-wide global health training programs for the six schools on the UMB campus (nursing, pharmacy, dentistry, social work, law, and medicine).28 As part of this mission, CGEI has sent interprofessional teams of students and faculty to Malawi for six-week periods to study global health issues with local counterparts [hereinafter the Malawi program]. The projects have been successful in helping students learn about a specific global health topic from a hands-on perspective, develop discipline-specific global health skills, and appreciate the interprofessional nature of global health. However, as is often the case in the process of educational innovation, we learned more from our failures than from our successes. The Malawi program highlighted the need for a more comprehensive approach to teaching students from multiple professional schools how to work collaboratively. We learned that failure of a team to gel can undo the best intenjournal of law, medicine & ethics

Rowthorn and Olsen

tions and preparations.29 While this is true in any educational or professional venture, it is particularly the case in the area of global health, which often places individuals in unfamiliar settings to tackle complex and emotionally-laden situations. b. Interprofessional Education as a Framework for Global Health Team Skills To incorporate team skills into the Malawi project, CGEI faculty members accessed a field that is growing just as fast on university campuses as global health education, namely interprofessional education or IPE. IPE is an approach to teaching clinical teamwork to improve patient outcomes.30 The growing body of research that demonstrates the value of IPE31 and literature regarding how to introduce IPE concepts into graduate curricula32 provided valuable lessons to CGEI as we set about creating a team training module for the Malawi program. However, as this paper will discuss, as essential as the work of IPE scholars is to training students how to work effectively as part of a mixed team, IPE concepts are not sufficiently adapted for global health education. IPE is directed almost exclusively to the education of health professional students and is most frequently framed as a way to improve clinical care.33 This limits IPE’s utility to the field of global health which, in addition to patient care, contemplates a broad systems and policy approach to health. Nonetheless, the frameworks and methods created by IPE experts for helping teach health professionals to work cooperatively across professions are clearly relevant to global health education. As background, it is useful to understand the IPE landscape. As defined by WHO, IPE occurs “...when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.”34 The modern IPE movement began in 1972 when an interprofessional committee convened by IOM identified the importance of an interdisciplinary healthcare team in assuring optimal patient care and urged health care institutions and health professional schools to foster and promote teamwork through IPE.35 Despite IOM’s initial recommendations, however, IPE did not gain traction until more recently, after IOM and other groups began emphasizing the role of teamwork in improving health care quality and patient safety.36 In 2009, representatives from six professional associations came together to form the Interprofessional Education Collaborative (IPEC).37 In 2011, IPEC published Core Competencies for Interprofessional Collaborative Practice [hereinafter IPEC Core Competencies] which provides a framework for colleges and the buying and selling of health care • winter 2014

universities to “prepare all health professions students for deliberatively working together with the common goal of building a safer and better patient-centered and community/population oriented U.S. health care system.”38 The report identified the following four interprofessional competency domains as essential for health care practitioners: Values/Ethics for Interprofessional Practice; Roles/Responsibilities, Interprofessional Communication; and Teams and Teamwork.39 Within each domain are listed between 10-12 specific competencies. IPEC’s recommendations for interprofessional competencies provide a strong starting point to develop a more comprehensive and team-based approach to teaching interprofessional global health skills. Roundtable representatives from IPEC and ASPPH noted in their submitted roundtable comments the “potential for concurrence” between the IPEC competencies and ASPPH global health competencies, and agreed that the IPEC model might serve as “an important starting point for developing interprofessional competencies for global health education.”40

3. Roundtable and Methods In 2013, CGEI resolved to address the scholarly and didactic gap between IPE and global health education by using IPEC Core Competencies as a starting point to develop team competencies appropriate for global health. As a first step in this process, on October 25, 2013, CGEI hosted an invitational roundtable titled Building Global Health Team Excellence: Developing an Interprofessional Skills Competency Domain that brought together 42 global health and IPE experts from across multiple professions, including medicine, nursing, dentistry, pharmacy, public health, physical therapy, environmental health, epidemiology, basic and applied sciences, engineering, law, and social work (the list of participants appears in Appendix A). The purpose of the roundtable was to work with experts in both fields to identify the team competencies necessary for collaborative global health practice, and study how these competencies can be incorporated into global health curricula and their effectiveness measured. Prior to the roundtable, we invited participants to share their experiences and insights in IPE, team skills, and global health education by submitting comments responding to one or more of the following four issues: the value of incorporating team skills into global health education; what those skills should be; how they should be incorporated into curricula; and how to measure whether they are being taught effectively. The comments submitted by roundtable participants [hereinafter participants] were synthe553

IND EPEND ENT

sized and distributed to all participants prior to the roundtable.41 At the roundtable, to assist with drawing up a preliminary set of team competencies for global health, we used the IPEC Core Competencies as the framework for discussion. In addition to the competency lists developed by IPEC, participants reviewed an adaptation of the IPEC Core Competencies developed by Dr. Andrea Pfeifle, the Assistant Dean and Director of the Center for Interprofessional Health Education and Practice, and an Associate Professor of Family Medicine at Indiana University in Indianapolis, Indiana, who modified them for global health education by taking out any specific references to clinical care and by including global health concepts in the com-

ing team competencies for global health students. Participants further noted that such competencies would be a valuable supplement to existing disciplinespecific and cross-disciplinary global health competencies43 and would play an important role in guiding curriculum development and improving global health program performance, accountability, and quality. a. Teams and Teamwork A resounding theme that emerged from the roundtable — if not the resounding theme — was that global health students need to know how to work in teams and that educators need to teach them how. The particular relevance of team collaboration in the global health context was underscored by Drs. Samer El-

In addition to developing a draft list of competencies, participants were asked to list the most effective ways to incorporate the competencies they identified into global health curricula and how to evaluate their effectiveness to global health, to universities, and to students. In the discussion below, the major themes that emerged from the roundtable are described. This paper is not meant to be a consensus document; rather it represents the numerous viewpoints and perspectives raised by participants at the roundtable. petencies when appropriate.42 Participants also considered competencies suggested by participants in their pre-roundtable comments, some of which were novel and some of which were very similar to existing competencies. From these sources, participants made recommendations for team competencies at the roundtable. We distilled these recommendations and surrounding discussions to create a final list of ten competencies that we call “team competencies.” These appear in subsection (f ). In addition to developing a draft list of competencies, participants were asked to list the most effective ways to incorporate the competencies they identified into global health curricula and how to evaluate their effectiveness to global health, to universities, and to students. In the discussion below, the major themes that emerged from the roundtable are described. This paper is not meant to be a consensus document; rather it represents the numerous viewpoints and perspectives raised by participants at the roundtable.

4. Components of a Global Health Team Competencies Domain As a preliminary point, there was widespread agreement among participants about the benefits of defin554

Kamary and Jon Mark Hirshon in their pre-roundtable comments, “[i]n a global and complex environment, the ability to cooperate between professions and work across cultures is vitally important. Sharing knowledge is a crucial component of this process, yet in many cases the greatest challenge to the success of interprofessional education is the collaborative component.”44 Although students can gain many team skills through informal social interactions, evidence shows that they benefit greatly from having them made explicit.45 To hone their skills, students also need opportunities to practice team skills, as well as to receive regular feedback on how they are doing.46 There is abundant literature on how to teach the various components of teamwork and no one faculty member can be expected to be an expert in all or even some of these skills.47 Therefore, universities must make a commitment to provide the necessary training to a sufficient number of faculty, hire a dedicated faculty member, or hire adjunct faculty or contractors who can teach these skills. The most critical themes that arose in the discussion of the IPEC’s teams and teamwork competencies were the importance of viewing other professionals as journal of law, medicine & ethics

Rowthorn and Olsen

equal partners; the importance of developing a shared vision for the team; and teaching students how to deal with inevitable team breakdowns and conflicts through effective communication and negotiation. Interestingly, a team skills competency that participants suggested was the ability to know when a team is not required in a particular situation, e.g., when a team of nurses may be singularly well-suited to conduct a vaccination clinic, and the value of avoiding “consortium fatigue.”48 Participants’ own experiences — often failed experiences — working with interprofessional teams of students in educational and work settings was a prominent theme in most pre-roundtable comments, which underscores the value of teaching students how to work together as team members. Participants noted that factors particularly relevant to global health, such as role uncertainty and the heightened sense of vulnerability that comes with being in an unfamiliar culture, make team conflict a likely occurrence, and that helping students learn to address conflicts constructively is therefore essential for effective team performance. b. Values/Ethics for Interprofessional Global Health Teams Having a code of ethics is a key variable that distinguishes a profession from an occupation. In the IPEC Core Competencies document, IPEC highlighted the important role that values and ethics play in shaping an individual’s and a discipline’s professional identity, and observed that ethical codes for health professions should be expanded to include values that “undergird relationships among the professions, joint relationships with patients, the quality of cross-professional exchanges, and interprofessional considerations in delivering health care and in formulating public health policies, programs, and services.”49 Roundtable participants articulated the need for competencies for ethical behaviors and values to guide members of interprofessional global health teams as they interact with one another and residents of host communities. Rather than simply adopt IPEC’s values/ethics domain wholesale into global health education, however, participants noted that global health students frequently encounter ethical questions that are different from those encountered in their home settings, especially when practicing outside of their home countries. Outside of a familiar setting, global health practitioners encounter different political structures and different societal and cultural norms that may pose unique ethical and values questions relating to teamwork, especially if the team includes individuals from the host community. Part of the challenge for students and practitioners is to understand the buying and selling of health care • winter 2014

how these factors shape their work, and how they influence the role of global health professionals and what they are able to accomplish. Additionally, just as domestic health care providers must keep the interests of patients at the center of what they do, global health professionals must keep the host community and host partners at the center of their work, even if their values and those of the community are not completely aligned. c. Roles/Responsibilities In discussing the inclusion of Roles/Responsibilities as an interprofessional competency domain, IPEC observed that for interprofessional cooperation and collaboration to occur, team members must first understand their own roles and capabilities, as well as the roles, responsibilities, and expertise of other professionals on the team.50 Participants offered similar observations in their pre-roundtable comments. For example, American Association of Medical Colleges (AAMC) representative and roundtable participant Dr. Janette Samaan noted: An essential first step in building a healthy team is...recognizing, respecting, and honoring the differences among the team members as strengths they bring....Providing team members with time to reflect on their own ‘culture’ and explore how similar or different they may be from their team members can provide valuable insights for understanding team dynamics. Additionally valuable is for each member to gain an understanding of their role on the team and how these roles may change, depending on the circumstances.51 UMB School of Pharmacy professor Dr. Robert Beardsley noted that a special challenge for students in global health involves understanding the role that different professions play within the host country and “...how the perceptions of both the general public and other care providers shape what the various professions are allowed to do.”52 Beardsley cited an example of a student pharmacist who was initially rebuffed by a patient when she tried to provide information about the patient’s medications because the country’s pharmacists generally did not receive professional education, and thus patients did not view pharmacists as professionals.53 Similarly, some cultures may rely on alternative providers, such as medicine men or “root ladies,” which may challenge an individual’s or group’s perception of a particular profession’s role and responsibility in a given situation.

555

IND EPEND ENT

Participants agreed that for a team to be effective, its members must first recognize the unique contributions of each individual, including non-professional and community members of the team. In global health work, recognizing and being open to discussing the roles and responsibilities of team members is especially important in unfamiliar settings where roles and responsibilities may be different than in the students’ or practitioners’ home setting. d. Interprofessional Communication The ability to communicate with other members of the team is a particularly important skill for global health practitioners and one that should be taught as part of global health curricula. IPEC identified communication as key to the success of the health care team and, in fact, a precursor to collaborative practice because appropriate and respectful communication initiates an effective interprofessional collaboration.54 The essence of communication was defined by IPEC in its broadest sense as “being receptive through displaying interest, engaging in active listening, conveying openness, and being willing to discuss and avoiding professional jargon in lieu of seeking a common language for team communication.”55 An explanation was offered by Georgia State Law professor Charity Scott: “One problem in interprofessional work is that the professions tend to have very specialized ways of communicating (jargon, specialized terminology, and particular ways of organizing information). Learning to speak in ways that other professionals can understand is a valuable communication skill.”56 The components of communication identified by IPEC are arguably even more important in the global health setting where language barriers and unfamiliar settings and technology may make communication difficult. Participants noted that the point of communication is not just to transfer information, but also to develop rapport and understanding among team members. Participants agreed that students in global health must learn how to communicate their professional expertise respectfully and with confidence, provide and receive feedback, and listen respectfully without judging others. Additionally, students need to learn how and when to use technology to facilitate communication. Important skills in this area include learning to choose, adapt, and develop technologies that are appropriate to the task and setting, and understanding when a low-tech approach to communicating (i.e., face-to-face discussion) is best. Understanding the importance of how to communicate is particularly important across cultural barriers. In terms of teaching communication skills, University of Washington Global Business Center Director Dr. Debra Glassman 556

pointed out that “having a common problem to work on is not sufficient to erase those [professional and cultural] barriers,”57 and therefore communication skills must be taught and actively fostered in multiple ways. e. Personal Attributes Important to Global Health Practice Departing from the IPEC competency framework, many participants pointed out the importance of personal attributes to success in global health practice such as leadership skills,58 mindfulness, openness, self-awareness, self-discipline, sensitivity, vulnerability, and tolerance. They also tackled two difficult questions: (a) should personal attributes be used to screen students for global health programs,59 or would doing so exclude a group of students who could benefit from developing the appropriate personal attributes necessary for global health work, and (b) can these valuable personal attributes be taught? If teaching (or enhancing) certain personal attributes should indeed be incorporated into global health curricula, participants considered whether these attributes merited their own competency domain, but again faced the problem of how such competencies would be taught or measured. A number of participants noted the influence of non-cognitive or personal qualities on student performance in global health and as members of interprofessional global health teams. For example, Dr. Hala Azzam observed: Several basic skills are essential to build a new generation of [global health] professionals. These include at the very core openness and intellectual curiosity that values diversity, conscientiousness, and a service orientation disposition to help create and maintain a higher vision and common goals that benefit society. Additionally, self-awareness and the ability to self-reflect are critical to guide the process and assess one’s mindset and dealings with others.60 Azzam went on to note that these qualities are essential to all professionals, but are especially important in global health, where the issues being addressed, the challenge of working in an unfamiliar setting, and the need for interprofessional collaboration add complexity. The link between personal attributes and successful participation in a team was raised by many. For instance, UMB Carey School of Law Clinical Instructor Toby Treem Guerin drew on her experiences in conflict resolution and noted that empathy, sensitivity, tolerance, and other “soft skills... [that] journal of law, medicine & ethics

Rowthorn and Olsen

focus on relationships with oneself and others...are necessary for successful short- and long-term interpersonal interaction.”61 Social-emotional skills (e.g., self-awareness, self-management, social awareness, relationship skills, and responsible decision-making) are critical, says Guerin, since these “equip individuals to address changing internal and external dynamics and use a rational rather than emotional approach to decision-making.”62 Participants agreed that, ideally, students accepted into global health programs should possess certain key personal attributes at a basic level and also demonstrate openness for further developing desired personal attributes and social-emotional skills since these provide a solid foundation for the development of communication, teamwork, and other interprofessional skills required for global health work. In general, however, participants did not endorse using personal attributes as selection criteria. Several participants also noted that while it is outside the scope of an educational program to change a student’s personality or innate traits, many personal attributes and social-emotional skills can be taught and developed. Rather than identifying attributes and social-emotional skills as a separate competency domain, participants appeared to favor incorporating them into other competencies. For example, open-mindedness and tolerance could be included as a values/ethics competency. Others observed that relationship skills, such as listening respectfully and withholding judgment, could be incorporated into communication competencies. Participants also noted that global health programs could facilitate the development of key attributes and social-emotional skills through journaling, team debriefing exercises, and other activities that promote self-reflection. f. Preliminary Team Competency Domain Although competencies provide a critical and useful framework upon which to build a curriculum, they can also represent a daunting challenge to educators who must incorporate them into existing curricula and work within the skill sets of program faculty. Therefore, an exhaustive list of competencies may be overwhelming and actually serve as a disincentive to expand curricula in lieu of a more general (shorter) list that could serve as a blueprint for desired curricular components. However, as noted above, in the strict sense of the term, competencies are abilities that individuals in a certain profession must master at a standard level and therefore a broad general list defeats this purpose and becomes nothing more than a list of desired curricular topics. Not ignoring this tension, but hoping to create a list of competencies that the buying and selling of health care • winter 2014

encourages — not discourages — teaching team abilities to global health students, we distilled the work of the participants into a single domain with 10 competencies that cover the areas of teams and teamwork, values/ethics, roles/responsibilities, and interprofessional communication. We also developed a general competency statement based on the results of the roundtable to summarize the purpose of the domain. See Table 1. Table 1 Team Skills Competency Domain General Competency Statement for Team Skills Competency Domain:Work with individuals of other professions and use the knowledge of one’s own role and those of other professions to establish shared goals and perform effectively as a team. Communicate and apply team-building values and principles to plan and execute project goals in a responsive and responsible manner that supports a team approach to global health initiatives. Team Skills Competency (TC)1: Identify which global health issues require or could benefit from an interprofessional approach. TC2: Describe the process of team development and the roles and practices of effective teams. TC3: Apply leadership practices that support collaborative practice and team effectiveness. TC4: Apply relationship-building values and principles of team dynamics to perform effectively in different team roles. TC5: Exhibit interprofessional values and communication skills that demonstrate respect for, and awareness of, the unique cultures, values, roles/responsibilities, and expertise represented by other professionals and groups that work in global health. TC6: Communicate with team members to clarify one’s own role and responsibility and each member’s role and responsibility on the team. TC7: Recognize one’s limitations in skills, knowledge, attitudes, and abilities. TC8: Choose effective communication tools and techniques, including information systems and communication technologies, to facilitate discussions and interactions that enhance team function, avoiding discipline- or culturallyspecific terminology when appropriate. TC9: Give timely, sensitive, instructive feedback to others about their performance on the team, responding respectfully as a team member to feedback from others. TC10: Engage self and others to constructively manage disagreements about values, roles, goals, and actions using respectful language appropriate for a given difficult situation, crucial conversation, or interprofessional conflict.

557

IND EPEND ENT

5. From Theory into Practice: Incorporating Team Competencies into Global Health Education and Evaluating their Success It is easier to develop competencies than to implement and measure them, especially competencies that will require faculty members to work across different disciplines and professional schools. Therefore, in addition to identifying competencies, participants pooled their experience and considered strategies for incorporating the competencies into global health curricula and measuring their impact on students, universities, and global health. Unlike the development of team competencies in the prior section, which highlighted the unique features and challenges of global health, most participants agreed that the challenges of implementation and evaluation of these competencies are the same challenges that arise with regard to all crossdisciplinary educational initiatives. The IPE literature is rife with evidence that interprofessional programming is difficult to implement on campuses for multiple reasons, including university-level logistical barriers, disincentives for faculty participation, and professional silos.63 Participants agreed that these are the same barriers they face (or will face) when incorporating team competencies into their global health curricula. Similarly, the impact and success of global health team training is (or will be) difficult to measure just in the same way that IPE is difficult to measure, because there are few common terms in IPE, no clear conceptualization of what is being investigated, and differences in opinion regarding what the unit of analysis should be and where such an assessment should start.64 Therefore the following sections do not provide an exhaustive list of the barriers to implementation and evaluation that are already well documented in other sources, but will set forth opportunities or challenges specific to global health education in these areas. a. Incorporating Team Competencies into Global Health Curricula The first critical theme that emerged in the area of implementation is actually a step that must take place before implementation, namely faculty development. This central concern was noted by Lori DiPrete Brown of University of Wisconsin-Madison’s Global Health Institute, who posed the question: “How can faculty foster development of [interprofessional] skills effectively when they may not have interprofessional or interdisciplinary training themselves?”65 As stated earlier, although teamwork can be taught, global health faculty members cannot be expected to teach all or even some of these skills. Therefore, universities must make a commitment to ensure that the resources are 558

available — via faculty training existing faculty, hiring new faculty, or hiring contractors to teach team skills. Participants offered a range of suggestions for increasing faculty interest in, and support for, teaching team competencies and for developing the faculty skills required to teach them. Participants suggested that universities look at their incentive structures and introduce changes to make interprofessional collaboration in global health education more appealing. Possible changes include reducing teaching loads in return for interprofessional activities that add value to the university; providing faculty travel budgets; assuring access to needed technology; and redefining tenure criteria to include non-traditional ways of demonstrating value. Participants also suggested that universities reach out to new faculty, who are often more open to collaborating with colleagues in other disciplines, and encourage their participation in interprofessional learning through new teaching opportunities. Moving beyond faculty development to implementation, participants agreed that incorporating team skills into the curriculum is a challenge even with trained and motivated faculty members, but participants identified ways in which they had successfully taught team skills through classroom teaching, simulations, and experiential learning.66 The value of a classroom approach was noted by Dr. Flora Katz of the NIH Fogarty International Center who observed: While it is important to move from different professions sitting in the same classroom to different professions actually working together on a project, the educational experience of talking together in the safe environment of a classroom, without the associated challenges in the field, is an extremely valuable prior experience.67 Many agreed that one way to teach team skills is to fit them “around the edges” of what is currently being offered, e.g., through case studies and by building opportunities for team-based problem-solving into courses that use didactic teaching methods. UM School of Medicine faculty member Dr. Gregory Carey suggested including content and assignments that require students to engage in collaborative problem solving into as many global health courses as appropriate. Additionally, he noted that opportunities for interprofessional projects can often be found in the surrounding community. With the teacher serving as mentor or guide, such projects can help students learn invaluable teamwork skills while also learning to assess community-based problems and construct journal of law, medicine & ethics

Rowthorn and Olsen

and execute plans and solutions.68 Participants noted that even short bursts of team-based activity are useful to help students appreciate the contributions of other disciplines and develop interprofessional skills. One caution raised in this area was the importance of avoiding “curriculum obesity” by helping departments and individuals reframe — rather than add to — what is taught, and incorporating team methods into the existing curriculum when possible. Experiential learning opportunities, such as field experiences, simulations, and externships, are a critical part of many global health programs. Dr. Jeffrey Johnson, Director of the Office of Global Health at the University of Maryland School of Nursing, highlighted the value of experiential learning by noting that field placements allow students to learn “...something about the nature of global health practice – it’s demanding and requires self-discipline, flexibility, and considerable self and cultural awareness... [as well as] an understanding of the importance of working as a member of the team.”69 Many participants noted that, in addition to offcampus learning opportunities, experiential learning can take place through creative use of technology in the classroom. For example, through Skype, students can converse with experts and teams in the field; through social media, blogs, and websites, students can follow the work of interprofessional global health teams in real time; and computer gaming technology offers opportunities for allowing students to work as members of “virtual” interprofessional teams.

include assessments of critical interprofessional competencies, with measures obtained before, during, and after immersion in the field. Assessments of student emotions and feelings about the project and student resiliency should also be part of the project evaluation. Participants generally agreed that team effectiveness can be measured by collecting data on appropriate project outcomes, such as the number of vaccines or treatments administered, and by obtaining feedback from the community preceptor, community members, and the students themselves. They also agreed that experiential learning projects and programs should be evaluated over the long term, i.e., not just in relation to a single group visit, but by assessing variables such as the program’s impact on the community, faculty performance, and the sustainability of the program/ initiative. Participants suggested that students and the host community could play a role in designing the evaluation by establishing the goals and expectations for the project and helping to identify evaluation methods and measures.

b. Evaluating Effectiveness of Global Health Interprofessional Training A significant purpose for developing competencies is to delineate a set of standards that can be measured objectively to ensure the quality of a program’s curriculum.70 Effective measurement and evaluation also provides feedback for program improvement and provides a firm base upon which programs can grow and seek funding. The importance of evaluation was highlighted by UM School of Medicine faculty member Dr. Leslie Glickman who noted that evaluation is essential not only to assess the value of the interprofessional education experience, but also “...to justify time, labor, [and] resources;...[and ensure] necessary funding and administrative support.”71 An area of particular (and perennial) challenge is how to measure successful team building and “soft skill” training.72 This challenge is the same for global health educators as it is for educators in other fields. A key point raised by participants was the importance of assessing individual student achievement as well as team effectiveness. Student evaluations should

Developing an interprofessional skills competency domain for graduate global health students will send a clear message that interprofessional education and global health are priorities for educational institutions. The young professionals, who are products of a re-envisioned graduate education system, will benefit from this globalized, interprofessional effort along with nations around the world as these students become tomorrow’s academy members, policy makers, educators and leaders in health- and non-health related fields.73

the buying and selling of health care • winter 2014

6. Conclusion A significant outcome of the roundtable was an ongoing commitment on the part of participants to ensure that global health training programs prepare students to enter a collaborative, interprofessional working environment. IOM program managers and roundtable participants Dr. Bridget Kelley and Patricia Cuff sounded this call to action in their pre-roundtable comments, observing:

Others noted that the value of successful interprofessional collaboration is not merely a desirable educational strategy but also a rational approach to secure funding from global health funders who “...seek the best global health teams available to accomplish their specific global health goals.”74 The roundtable accomplished a great deal, but more remains to be done. As noted earlier, we consider the competencies presented in this white paper 559

IND EPEND ENT

a starter set, one that needs to be vetted and refined by a broader group of global health and IPE experts. Once an agreed upon set of competencies is defined, a valuable next task will be development of a model curriculum to teach team skills to students in global health. The recommendations offered by roundtable participants regarding faculty and curriculum development represent a good first step toward achieving this longer term goal. Global health is a collaborative field that demands highly trained practitioners who can work across disciplines to achieve the innovations necessary to address complex, often intractable, public health concerns. Global health educators must dedicate themselves to doing what they are asking of their students, namely, work with all the professions at the global health table to make the field as cohesive and collaborative as the mighty task of global health demands.

Appendix A University of Maryland, Baltimore, Center for Global Education Initiatives Building Global Health Team Excellence: Developing an Interprofessional Skills Competency Domain Roundtable Participant List October 25, 2013 Organizers Jody Olsen, Executive Director of the University of Maryland, Baltimore Center for Global Education Initiatives, Co-Director of the University of Maryland, Baltimore Global Health Interprofessional Council, and Visiting Professor, University of Maryland Virginia Rowthorn, Co-Director of the University of Maryland, Baltimore Global Health Interprofessional Council, Deputy Director of the University of Maryland, Baltimore Center for Global Education Initiatives, and Managing Director, Law & Health Care Program, University of Maryland Francis King Carey School of Law

Participants Barbara Alving, Research Professor, University of Maryland, School of Public Health Hala Azzam, President, CoEmpower, LLC Jane Barrow, Assistant Dean for Global and Community Health, Harvard School of Dental Medicine Robert Beardsley, Professor, University of Maryland, Baltimore, School of Pharmacy, Dept. of Pharmaceutical Health Services Research 560

Dorothy A. Biberman, Manager of Global Health Programs, Association of Schools and Programs of Public Health (ASPPH) Timothy F. Brewer, Vice Provost for Interdisciplinary and Cross-campus Affairs, UCLA Oscar A. Cabrera, Executive Director, O’Neill Institute for National and Global Health Law, Georgetown University Gregory Carey, Director of Student Summer Research and Community Outreach, Assistant Professor of Microbiology and Immunology, Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine Reba Cornman, Director, Geriatrics and Gerontology Education, University of Maryland, Baltimore Patricia Cuff, Senior Program Office, Institute of Medicine Lori DiPrete Brown, Associate Director for Education and Engagement, Global Health Institute, School of Medicine and Public Health, University of Wisconsin-Madison Samer El-Kamary, Associate Professor, Epidemiology and Public Health and Pediatrics, University of Maryland School of Medicine Jody Frost, Lead Academic Affairs Specialist, American Physical Therapy Association Debra Glassman, Lecturer in Business Economics, Director, Global Business Center, Director, Certificate of International Studies in Business, University of Washington Leslie Glickman, Assistant Professor, , University of Maryland School of Medicine, Department of Physical Therapy Toby Guerin, Managing Director, Center for Dispute Resolution, University of Maryland Francis King Carey School of Law Haider Muhiuddin, Research Associate Professor, University of Maryland School of Public Health Jeffrey W. Herrmann, Associate Professor, Department of Mechanical Engineering, Institute for Systems Research, and Associate Director, QUEST, University of Maryland College Park Jon Mark Hirshon, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine Laura Hungerford, Professor, Department of Epidemiology and Public Health, University of Maryland School of Medicine Jeffrey Johnson, Professor and Director, Office of Global Health, University of Maryland School of Nursing, Flora Katz, Program Officer, Division of International Training and Research, NIH Fogarty International Center journal of law, medicine & ethics

Rowthorn and Olsen

Bridget Kelly, Senior Program Officer, Institute of Medicine Miriam Laufer, Associate Professor, Department of Pediatrics, University of Maryland School of Medicine Elisabeth F. Maring, Research Assistant Professor & Family Life Specialist, University of Maryland School of Public Keith Martin, Executive Director, Consortium of Universities for Global Health Donald K. Milton, Professor and Director, Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health John T. Monahan, Assistant to the President for Global Initiatives, Office of the President, Georgetown University Yolanda Ogbolu, Assistant Professor and Deputy Director for Office of Global Health, University of Maryland School of Nursing Jody Olsen, Director, University of Maryland, Baltimore, Center for Global Education Initiatives and Visiting Professor, University of Maryland Howard Palley, Professor Emeritus, University of Maryland School of Social Work Edward Pecukonis, Associate Professor, University of Maryland School of Social Work Andrea Pfeifle, the Assistant Dean and Director of the Center for Interprofessional Health Education, Research, and Practice, and an Associate Professor of Family Medicine at Indiana University in Indianapolis, Indiana Andrew Pinto, Staff Physician, Department of Family and Community Medicine, Research Fellow, Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Canada Jason Roffenbender, Georgetown University Law Center Janette Samaan, Director, Global Health Learning Opportunities, Association of American Medical Colleges Charity Scott, Catherine C. Henson Professor of Law, Georgia State University College of Law Brittany A. Seymour, Assistant Professor for Global and Community Health, Harvard School of Dental Medicine Harrison C. Spencer, President and CEO, Association of Programs and Schools of Public Health Lynda H. Wilson, Assistant Dean for International Affairs, Deputy Director, PAHO/WHO Collaborating Center for International Nursing, and Professor, University of Alabama School of Nursing Anthony K. Wutoh, Dean Howard University College of Pharmacy

the buying and selling of health care • winter 2014

Acknowledgement

The authors would like to thank the experts in global health and interprofessional education who participated in the October 25, 2013, roundtable Building Global Health Team Excellence: Developing an Interprofessional Skills Competency Domain at the University of Maryland, Baltimore (UMB) for their participation in this project and their ongoing commitment to ensure that global health students are prepared to meet the challenges of the 21st century together.  We are also particularly grateful to UMB faculty members Dr. Gregory Carey, Dr. Samer El-Kamary, Marjorie Forster, Dr. Leslie Glickman, Dr. Jon Mark Hirshon, Dr. Jeffrey Johnson, Dr. Miriam Laufer, and Dr. Yolanda Ogbolu who helped us organize the roundtable, facilitate small group discussion, and evaluate results. Working with these individuals has clearly demonstrated to us the value and joy of working as part of an interprofessional team.  We would also like to thank Dr. Jay Perman, the President of UMB, and his colleagues Dr. Bruce Jarrell and James Hughes, MBA, for their support of this initiative, and more broadly, for their enthusiastic support of the work of the UMB Center for Global Education Initiatives.  Finally, we would like to express our heartfelt thanks to the UMB Global Health Interprofessional Council whose members have worked for years to advance interprofessional global health education at UMB and beyond, particularly the faculty members noted above and Bonnie Bissonette, Director of the UMB Student Center for Global Education, Dr. Edward Moreton, Dr. Judith Porter, and Rosemary Riel.

References

1. We use the term “interprofessional” in lieu of “interdisciplinary” throughout the paper, but the terms are interchangeable for the most part. When discussing education of health professionals, there has been an international movement towards the use of the suffix “professional” rather than “disciplinary” in education literature. See I. Oandasan and S. Reeves, “Key Elements for Interprofessional Education. Part 1: The Learner, the Educator and the Learning Context,” Journal of Interprofessional Care 19, no. S1 (2005): 21-38. 2. See, e.g., R. Battat et al., “Global Health Competencies and Approaches in Medical Education: A Literature Review,” BMC Medical Education 10, no. 94 (2010): 1-7, available at (last visited December 3, 2014) (“Global health is the study and practice of improving health and health equity for all people worldwide through international and interdisciplinary collaboration.”) (emphasis added). 3. There are three generally accepted broad areas or domains of human behavior in which learning can take place: thinking (cognitive), doing (psychomotor), and feeling (affective). See B. Bloom, Taxonomy of Educational Objectives, Handbook I: Cognitive Domain (New York: Longman, 1956) (described in M. D’Eon, “A Blueprint for Interprofessional Learning,” Journal of Interprofessional Care 19, no. S1 [2005]: 49-59). Others add to these categories a type of learning that is critical to interprofessional learning called social-emotional learning, which relates to how an individual interacts with others and in groups. See K. Mackway-Jones and M. Walker, The Pocket Guide to Teaching for Medical Instructors (London: MMJ Books, 1999) (described in D’Eon, supra, at 49). “‘Non-cognitive skills’ refer to a set of attitudes, behaviors, and strategies that are thought to underpin success in school and at work, such as motivation, perseverance, and self-control. They are usually contrasted with ‘hard skills’ of cognitive ability in areas such as literacy and numeracy, which are measured by academic tests.” L. M. Gutman and I. Schoon, Institute of Education, The Impact of Non-Cognitive Skills on Outcomes for Young People: Literature Review (2013), available at (last visited December 3, 2014). 4. The authors are aware that numerous global health programs exist at the undergraduate level and some global health programs bridge the gap between undergraduate and graduate

561

IND EPEND ENT learning, such as nursing programs that offer global health education at both levels. The concepts and themes in this paper are relevant to undergraduate and bridge programs, but the focus of this paper is graduate education. 5. By global health “program,” we mean to include the broad range of global health programs available to students, including certificate and degree programs, as well as degree “minors” and subspecialties in global health. 6. See comments submitted by roundtable participants Dr. Bridget Kelly, Senior Program Officer, IOM, and Patricia Cuff, Director of IOM’s Global Forum on Innovation in Health Professional Education (on file with authors). 7. See M. H. Merson and K. C. Page, The Dramatic Expansion of University Engagement in Global Health: Implications for U.S. Policy (Washington, D.C.: Center for Strategic and International Studies, 2009). 8. See, e.g., L. Fried et al., “Global Health is Public Health,” The Lancet 375, no. 9714 (2010): 535-537. 9. See J. P. Koplan et al., “Towards a Common Definition of Global Health,” The Lancet 373, no. 9679 (2009): 1993-1995 (emphasis added). 10. See World Health Organization, World Health Report 2006: Working Together for Health (Geneva: World Health Organization, 2006), available at (last visited December 3, 2014). 11. See Collaborative Justice, “How to Collaborate: A Working Definition of the Term ‘Collaboration,’” an essay adapted from C. Larsen and F. LaFasto, TeamWork: What Must Go Right/ What Can Go Wrong (Newbury Park, CA: Sage Publications, 1989), available at (last visited December 3, 2014). 12. Id. 13.  Id. 14. See comments submitted by roundtable participant Dr. Timothy Brewer, Vice Provost for Interdisciplinary and Cross-campus Affairs, UCLA (on file with authors). 15. See, e.g., M. S. Knapp et al., “University-Based Preparation for Collaborative Interprofessional Practice,” Journal of Education Policy 8, no. 5 (1993): 137-151; P. A. Cuff, Interprofessional Education for Collaboration: Learning How to Improve Health from Interprofessional Models across the Continuum of Education to Practice: Workshop Summary (Washington, D.C.: The National Academies Press, 2013). 16. See comments submitted by roundtable participant Dr. Hala Azzam, President, CoEmpower LLC (on file with authors). 17. Consortium of Universities for Global Health, Meeting Report of the Inaugural Meeting, September 7-9, 2008, available at (last visited December 3, 2014). 18. See, e.g., L. Wilson et al., “Global Health Competencies for Nurses in America,” Journal of Professional Nursing 28, no. 4 (2012): 213-222; Battat et al., supra note 2. 19. K . Gebbie et al., Center for Health Policy, Competency-toCurriculum Toolkit (New York: Columbia University School of Nursing, 2004), available at (December 3, 2014). 20. See Bloom, supra note 3. 21.  Id. 22. See Gebbie et al., supra note 19. 23. Id. 24. Interprofessional Education Collaborative, Core Competencies for Interprofessional Collaborative Practice (Washington, D.C.: Interprofessional Education Collaborative, 2011), available at (last visited December 3, 2014). 25. See Association of Schools and Programs of Public Health (ASPPH), Global Health Competency Model –Final Version 1.1 (October 31, 2011), available at (last visited December 3, 2014).

562

26. See comments submitted by roundtable participant Dr. Lynda Wilson, Assistant Dean for International Affairs, Deputy Director, PAHO/WHO Collaborating Center for International Nursing, and Professor, University of Alabama School of Nursing (on file with authors). The CUGH Education Subcommittee on Global Health Competencies has tentatively included the list of team competencies developed in this project (see infra subsection (f )) in their broad list of content competencies. 27. The ASPPH competencies include a novel and useful “Collaborating and Partnering” domain that relates in some measure to working as part of a global health team but is primarily focused on relationships external to the team, in other words relationships between the team and outside collaborators and partners. See ASPPH, Global Health Competency Model, supra note 25. 28. GGEI is now housed in the UMB Office of the President and receives its funding through the same office. 29. See V. Rowthorn, “A Place for All at the Global Health Table: A Case Study about Creating an Interprofessional Global Health Project,” Journal of Law, Medicine & Ethics 41, no. 4 (2013): 907-914. 30. See, e.g., World Health Organization, Framework for Action on Interprofessional Education and Collaborative Practice (2010): at 7, available at (last visited December 3, 2014). 31. See, e.g., H. Barr et al., Effective Interprofessional Education: Argument, Assumption and Evidence (Oxford: Blackwell, 2005); H. Barr et al., Evaluations of Interprofessional Education: A United Kingdom Review for Health and Social Care (August 2000), available at (last visited December 3, 2014); M. Hammick et al., “A Best Evidence Systematic Review of Interprofessional Education: BEME Guide No. 9,” Medical Teacher 29, no. 8 (2007): 735-751. 32. See Knapp et al., supra note 15; Id. (Hammick et al.). 33. See IPEC Report, supra note 24. 34. See World Health Organization, Framework for Action on Interprofessional Education & Collaborative Practice (Geneva: WHO Press, 2010), available at (last visited December 3, 2014). 35. See Institute of Medicine, Educating for the Health Team (Washington, D.C.: National Academy of Sciences, 1972). 36. See Institute of Medicine, Health Professions Education: A Bridge to Quality (Washington, D.C.: The National Academies Press, 2003); WHO 2010 Report, supra note 30; J. Frenk et al., “Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World,” The Lancet 376, no. 9756 (2010): 1923-1958. 37. These six groups are the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the Association of Schools of Public Health, the American Association of Colleges of Pharmacy, the American Dental Education Association, and the American Association of Medical Colleges. 38. See IPEC Report, supra, note 24. 39. Id. 40. See Comments on behalf of the Interprofessional Education Collaborative (IPEC) and the Association of Schools and Programs of Public Health (ASPPH), for the roundtable discussion Building Global Health Team Excellence:Developing an Interprofessional Skills Competency Domain (on file with authors). 41. Nine of the participants developed their comments into short articles that will appear in a supplement edition of the Journal of Law, Medicine & Ethics 42, no. 4, Supp. (2014). 42.  S ee comments submitted by roundtable participant Dr. Andrea Pfeifle, the Assistant Dean and Director of the Center for Interprofessional Health Education and Practice and an Associate Professor of Family Medicine at Indiana University in Indianapolis, Indiana (on file with authors).

journal of law, medicine & ethics

Rowthorn and Olsen 43. See supra text accompanying notes 24-6. 44. S ee comments submitted by roundtable participants Dr. Samer El-Kamary, Associate Professor, Epidemiology and Public Health and Pediatrics, University of Maryland School of Medicine, and Dr. Jon Mark Hirshon Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine (on file with authors). 45. See, e.g., L. Breslow, “Teaching Teamwork Skills, Part 2,” MIT Faculty Newsletter: Teach Talk, March/April 1998, at 5; H. Hills, Team-Based Learning (Burlington, VT: Gower, 2001); M. Reynolds, Groupwork in Education and Training (London: Kogan Page, 1994). 46. Id. 47.  Id. 48. See, e.g., M. Papadaki and G. Hirsch, “Curing Consortium Fatigue,” Science Translational Medicine 5, no. 200 (2013): 200fs35. 49. See IPEC Report, supra note 24. 50. Id. 51. See comments submitted by roundtable participant Dr. Janette Samaan, Director, Global Health Learning Opportunities, AAMC (on file with authors). 52. See comments submitted by roundtable participant Dr. Robert Beardsley, Professor, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy (on file with authors). 53. Id. 54. See IPEC Report, supra note 24. 55.  Id. 56. See comments submitted by roundtable participant Charity Scott, Catherine C. Henson Professor of Law and Director for the Center for Law, Health & Society, Georgia State University College of Law (on file with authors). 57. See comments submitted by roundtable participant Dr. Deborah Glassman, Lecturer in Business Economics and Director, Global Business Center and Certificate of International Studies in Business, University of Washington (on file with authors). 58. Several participants suggested leadership as a potential competency domain in addition to team competencies, citing the importance of leadership to global health work and pointing out that leadership skills were not represented in the domains discussed at the roundtable. 59. T his consideration would be appropriate for programs or classes for which students apply for participation. 60. See comments submitted by roundtable participant Dr. Hala Azzam, President, CoEmpower, LLC (on file with authors). 61. See comments submitted by roundtable participant Toby Treem Guerin, J.D., Managing Director, Center for Dispute Resolution, University of Maryland Francis King Carey School of Law (on file with authors). 62. Id.

the buying and selling of health care • winter 2014

63. See supra text accompanying notes 31-32. 64. See L. Piterman et al., “Interprofessional Education for Interprofessional Practice: Does It Make a Difference?” Medical Journal of Australia 193, no. 2 (2010): 92-93. 65. See comments submitted by Roundtable participant Lori DiPrete Brown, Associate Director for Education and Engagement, Global Health Institute, School of Medicine and Public Health, University of Wisconsin-Madison (on file with authors). 66. Experiential learning is learning that takes place as a result of an encounter with an experience that is planned by instructors within a course, program, or curriculum. See, e.g., P. Hall and L. Weaver, “Interdisciplinary Education and Teamwork: A Long and Winding Road,” Medical Education 35, no. 9 (2001): 867-875. 67. See comments submitted by roundtable participant Dr. Flora Katz, Program Officer, Division of International Training and Research, NIH Fogarty International Center (on file with authors). 68. See comments submitted by roundtable participant Dr. Gregory Carey, Director of Student Summer Research and Community Outreach, Assistant Professor of Microbiology and Immunology, Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine (on file with authors). 69. See comments submitted by Roundtable participant Dr. Jeffrey Johnson, Professor and Director, Office of Global Health, University of Maryland School of Nursing (on file with authors). 70. See Gebbie et al., supra note 19. 71. See comments submitted by roundtable participant Dr. Leslie B. Glickman, Assistant Professor, Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine (on file with authors). 72. A . W. Ahlstrom et al., From Soft Skills to Hard Data: Measuring Youth Program Outcomes, 2nd ed. (Washington, D.C.: Forum for Youth Investment, 2013), available at (last visited December 3, 2014). 73. S ee comments submitted by roundtable participants Dr. Bridget Kelly, Senior Program Officer, IOM, and Patricia Cuff, Director of IOM’s Global Forum on Innovation in Health Professional Education (on file with authors). 74. See comments submitted by roundtable participants Dr. Donald K. Milton, Professor and Director, Maryland Institute for Applied Environmental Health, University of Maryland School of Public; Dr. Muhiuddin Haider, Research Associate Professor, University of Maryland School of Public Health; and Elisabeth F. Maring, Research Assistant Professor & Family Life Specialist, University of Maryland School of Public Health (on file with authors).

563

Copyright of Journal of Law, Medicine & Ethics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.