Doug Gruner and Kevin Pottie – Using E-learning to Introduce Global and Refugee Health Competencies. [PDF]

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After reading this piece you should be able to identify:

  1. The essence of Global health is to improve health and achieve health equity for all people worldwide. To achieve health equity implies a need to understand and then address the unique health needs of societies’ most vulnerable, and refugees are a vulnerable group who are often underserved.
  2. Medical school curriculum is evolving to ensure our future physicians have the knowledge, skills and attitudes necessary to meet the needs of the most vulnerable in our communities. E-Learning is emerging as an important tool to support and supplement the Global and refugee health curriculum.


Medical schools are now bound and accountable by a social contract where in return for financial subsidies they need to train students to serve needs of communities especially the most vulnerable (Philips 2012; Earnest 2010; Rourke 2006). As migration causes communities in Western countries to become more diverse, medical students need to enhance their global health knowledge and skills to effectively care for patients who may face health inequities (O’Neill 2014; Marmot 2012; Pottie 2011). Community service learning has emerged as a promising training method to address the changing needs of medical students and to improve their social accountability (McIntosh 2008; Buck 2005).

A refugee patient’s vulnerability stems from pre-migratory factors such as threatened or actual physical or sexual assault, intimate partner violence, armed conflict, arbitrary imprisonment, torture, murder of loved ones or other forms of violence (Fazel 2012; Pottie 2011). Positive conditions in the receiving country such as access to permanent migratory status, employment, health care, social assistance and schooling, as well as speedy family reunification, can play a role in mitigating the impact of trauma and foster integration into a new society (Pottie 2008). It is therefore imperative that refugees have access to health care, especially primary and preventative care to ensure that health conditions be identified early and treated, thereby protecting public health as well as the health of the refugee. Training must include an understanding of health equity for the underserved and vulnerable members of our societies

E-learning, where educational material is presented electronically often using multimedia approaches including video, pictures, and PowerPoint format, is now emerging as a viable alternative to supplement and support medical student curriculum (Ruiz 2006). At the University of Ottawa the authors created the Refugees and Global Health e-learning modules ( (Pottie 2011) based on the CanMEDS for global health competencies framework (Redwood-Campbell 2011; RCPS 2005). The modules have been used at the University of Ottawa for a number of years as an introduction to global health and working with marginalized and vulnerable populations for first year medical students before they begin their community service learning. Each module focuses on one of the seven core competencies essential in becoming a competent physician in global health (see table). For example, in the communication module, students are exposed to the challenges of practicing in resource limited settings using interpreters and communicating across cultures.

The e-learning modules were created as a collaborative effort between physicians with expertise in global health, experts in Information technology (IT), and experts in multimedia. The physicians provided the content with the focus on each of the CanMEDS competencies. The content was then fashioned by the multimedia experts into a format that would provide the reader with an opportunity to interact with the information being presented. This was done by creating small videos, interactive case studies, and quizzes at the end of the modules to help consolidate the information being presented. The multimedia experts were able to provide input as to how best to present the information to the target audience. With each edition the IT specialists ensured that various technological obstacles could be dealt with effectively. They also were able to offer suggestions on various options that would maximize the electronic format to ensure the e-learning module’s content was easy to use and pleasing to the learner’s eye.

To assess these e-learning modules, the authors conducted a mixed methods pilot study of the usability and effectiveness of the tool: “Introducing global health into the undergraduate medical school curriculum using an e-learning program: a mixed method pilot study” ( The findings suggested that the modules were preferred over traditional forms of learning material given its flexibility, interactive nature and links to other resources. The authors concluded that, the e-learning modules should be used by educators as a tool to supplement their global health curriculum.

Global health and social accountability curriculum are beginning to play a fundamental role in helping shape the future of medical education, research and health care. As we move toward global health training, we are responding to the need to have competent physicians who have a sense of social justice. Medical schools are beginning to incorporate community service learning into their curriculums and looking for innovative approaches to introduce students to the complicated world of delivering care to vulnerable populations. The Refugee and Global Health e-learning modules are a useful primer for educators who want to introduce students to concepts of global health before they begin their community service learning. More study is needed to understand if this focus on global health curriculum translates to greater social accountability and higher quality care of vulnerable populations.

Table 1: Examples of Global Health Competency Introduced under CanMEDs Role





EXPERT Demonstrate an awareness of how war, conflict, and famine impact the health of refugees.
COMMUNICATOR Recognize how your own cultural biases, values and belief systems may affect your interaction with patients
COLLABORATOR Skills include assessing problems, identifying key players, listening to team members, and working together in design and implementation of programs.
MANAGER In humanitarian contexts, manager skills play a critical role in directing human resources, engaging and training local staff, networking with nongovernmental organizations, and effectively utilizing limited resources
ADVOCATE Being a health advocate means treating your patient in their own particular context, without dismissing their cultural concerns.
SCHOLAR As Scholars, professionals demonstrate a lifelong commitment to learning, as well as the creation of knowledge


Professionals learn to maintain healthy boundaries to keep both themselves and their patients safe.


  1. Why is it important to address the health needs of refugees, one of the most vulnerable groups in our society?
  2. What are the unique health needs of the refugee population and what specialized skills do todays’ health care providers need to ensure they are able to deliver high quality evidenced based care.
  3. What resources, tools and or approaches are available to those delivering the medical school curriculum to the learners that  addresses social accountability, health equity and social justice.


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Earnest, M. A., Wong, S. L., and Federico, S. G. “Perspective: Physician advocacy: What is it and how do we do it?” Acad Med 85, no. 1 (2010): 63-67.

Fazel, M., Reed, R.V., Panter-Brick, C., and Stein, A. ” Mental health of displaced and refugee children resettled in high-income countries: Risk and protective factors.” The Lancet 379, no. 9812 (2012): 266–282.

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O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, Evans T, Pardo Pardo J, Waters E, White H, and Tugwell P. “Applying an Equity Lens to interventions: Using PROGRESS to ensure consideration of socially stratifying factors to illuminate inequities.” J Clin Epidemiol 67, no. 1 (2014): 56-64.

Phillips, S. P., and Clarke, M. ” More than an education: The hidden curriculum, professional attitudes and career choice.” Med Educ 46, no. 9 (2012): 887-893.

Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer L, Ueffing E, MacDonald N, Hassan G, McNally M, Kahn K, Buhrmann R, Dunn S, Dominic A, McCarthy AE, Gagnon AJ, Rousseau C, Tugwell P and co-authors of the Canadian Collaboration for Immigrant and Refugee Health. “Overview: Evidence-based clinical guidelines for immigrants and refugees.” CMAJ 183, no. 12 (2011): E824-E925.

Pottie K, Gruner D, Ferreyra M, Ratnayake A, Ezzat O, Ponka D, Rashid M, Kellam H, Sun R, and Miller K. “Refugees and Global Health: A Global Health E-Learning Program.” , Canadian Collaboration for Immigrant and Refugee Health (CCIRH) and the University of Ottawa.[].

Redwood-Campbell L, Pakes B, Rouleau K, MacDonald C, Arya N, Purkey E, Schultz K, Dhatt R, Wilson B, Hadi A, and Pottie K. “Developing a curriculum framework for global health in family medicine: emerging principles, competencies, and educational approaches.” BMC Medical Education 11, no. 46 (2011).

Royal College of Physicians and Surgeons of Canada: CanMEDS 2005 Framework [

Rourke, J. “Social accountability in theory and practice.” Ann Fam Med 4, no. 1 (2006): S45–S48.

Ruiz JG, Mintzer MJ, Leipzig RM. “The impact of E-learning in medical education.” Acad Med 81, no. 3 (2006): 207-212.