Status of global health fellowship training in the United States and Canada

BACKGROUND: Increasing numbers of residency graduates desire global health (GH) fellowship training. However, the full extent of training options is not clear. OBJECTIVE: To identify clinical GH fellowships in all specialties in the U.S. and Canada and to describe their demographics, innovative features, and challenges. METHODS: The authors surveyed program directors or designees from GH fellowships with a web-based tool in 2017. RESULTS: The authors identified 85 programs. Fifty-four programs (63.5%) responded confirming 50 fellowships. One- third of fellowships accepted graduates from more than one specialty, and the most common single-specialty programs were Emergency Medicine and Family Medicine. Fellowships most commonly were 24 months in duration with a median size of one fellow per year. Funding and lack of qualified applicants were significant challenges. Most programs were funded through fellow billing for patient care or other self-support. CONCLUSION: The number of U.S. and Canadian GH fellowship programs has nearly doubled since 2010. Challenges include lack of funding and qualified applicants. Further work is needed to understand how best to identify and disseminate fellowship best practices to meet the diverse needs of international partners, fellows, and the patients they serve and to determine if consensus regarding training requirements would be beneficial.