Medical students' perception of their current and career needs for defined global health and health equity competencies.


  • Patricia Mullan
  • Joy Williams
  • Julie Perry
  • Andrew Haig
  • Brent Williams


International Dimensions


University of Michigan Medical School

  • The move to frame and evaluate medical education in terms of competencies – the extent to which trainees “can do” a professional responsibility – is congruent with calls for accountability in medical education.
  • However, the focus on pre-defined competencies may be a poor fit with developing curricula intended to prepare students for competencies not emphasized in traditional medical education.
  • Further, medical students drawn to advocacy in promoting global health and health equity may vary in 
    • their scope of experience and expertise as they begin their medical school training and
    • the vision of the career that inspires their passion for advocacy.


  • This study examines the use of an innovative approach to the use of competency expectations related to promoting global health and health equity to
    • promote students’ self-reflection and self-assessment and
    • inform curriculum development.
Summary of Work


  • Reviews of published literature and key informant interviews with physician global and health equity role models informed the initial development of curriculum competencies for a new Global Health and Disparities co-curriculum Path of Excellence.
  • Second- and third-year medical students active in disparities and global health efforts reviewed and provided input into the curriculum’s learning experience, leadership, and assessment and evaluation workgroup curriculum design.
  • First-year medical students admitted to the GHD program were asked to review their level of competency on the GHD program’s 16 defined competencies, in terms of both:
    • their current ability to perform and
    • the level at which they perceived would be required for their future anticipated career.


For the ordinal rating of self-assessed competence, we used Wilcoxin’s paired T-test to compare current to future needed competency levels, with statistical significance set at p<.01.

Summary of Results








  • Among medical students drawn to a co-curricular pathway in global health and health disparity, 
    • statements of competencies most often eliciting students’ ratings that they currently held at least some skill related to disparities included:
      • cultural competence 
      • defining sustainability
      • strategies for resolving ethical issues and
      • identifying and applying frameworks describing the impact of social determinants of health.
    • statements of competencies least often eliciting students’ ratings that they currently held at least some skill related to disparities included:
      • program evaluation
      • internal-external health partnerships
      • capacity building
      • using health information systems
  • Analyses of differences between  students’ current and perceived needed levels of competence consistently characterized their careers as needing higher levels, at a statistically significant level.
  • All students agreed/strongly agreed that the careers they envisioned would require competence in
    • organizational leadership and 
    • demonstrating cultural competence in developing and implementing programs intended to ameliorate disparities


  • Leaders in medical education reform intended to enhance medical students’ awareness of the need to develop competencies as advocates emphasize the need for medical education to define its scope and practice.
  • Medical education programs promoting reflection of medical students drawn to these programs
    • are consistent with theories of learning and motivation for medical professionals
    • can inform responsive curriculum development and career planning that sustains inspirations for advocacy in medical careers.
Take-home Messages
  • Making explicit the range of professional activities associated with emerging physician roles can promote student reflection about their current skills and the level of competence they will need for the careers to which they aspire.
  • This "what can I do now" and "what do I hope to be able to do in my career" approach to assessment is consistent with self-directed motivation theories of teaching and learning in medical education
  • This approach of eliciting current and anticipated need for practice competencies can inform responsive curriculum development
  1. Earnest M, Wong S, Federico S. Physician advocacy: what is it and how do we do it? Academic Medicine. 2010. 85 (1): 63-67.
  2. O’Toole TP, Hanusa B, Gibbon J, Boyles SB. Experience and attitudes of residents and students influence voluntary service with homeless populations.  JGIM.  1999; 14: 211-216.
  3. O’Toole TP, Kathuria N, Mishra M, Schukart D. Teaching professionalism within a community context: perspectives from a national demonstration project.  Academic Medicine. 2005; 80: 339-343.
  4. Williams G; Saizow RB; Ryan RM. The importance of self-determination theory for medical education.  Academic Medicine. 1999. 74 (9): 992-995.
Summary of Work
Summary of Results










Take-home Messages
Send ePoster Link