Table 3

Results of evaluations on anticolonial educational approaches to global health (n=10)

Author year	Educational approach	Description	Institutions involved	Results of evaluation
Evert 201551	Global health experience	Child Family Health International (CHFI) Global Health Education Programmes Principles of learning: non-maleficence, respect for persons, cultural humility and social justice. Delivery: 2 to 16 week global health education programmes for individual students and university partners predominantly from the Global North. CHFI places learners in clinical, public health and NGO settings in LMICs. Interaction with host community and partners: Offers social entrepreneurship opportunities (hosts to create and administer educational programmes), honoraria for local preceptors, compensation for homestay families, remuneration of community members for programme coordination and leadership and opportunities for professional development and CHPs. Claims to use an Asset-Based Community Development approach.	Child Family Health International	Increased prestige for local health professionals when framed as experts and an increase in global connectedness for lay and professional community members83 Participants report a broadened sense of determinants of health and increased appreciation for the cultural influences on health and healthcare84
Ferrel et al 202052	Curriculum or course	Social Medicine Immersion Month; Residency Programme in Social Medicine at Montefiore Topics: Forms of systematic family separation including immigration, mass incarceration, mandated reporting Antiracism and racial equity within public health and medicine Global health partnerships and imperialism Labour movements in healthcare Activism, advocacy and allyship in medicine Delivery: 27, 1 to 2 hour sessions delivered over 3 weeks (lectures, panel discussions, workshops, reflection sessions, optional after-hours off-site activities). Facilitators who were engaged in the community were sought out.	Residency Programme in Social Medicine at Montefiore	Participants reported that sessions facilitated needed conversations regarding physicians’ power within healthcare delivery to minoritised and oppressed populations Participants reported changes in their perception of power dynamics in healthcare within marginalised populations, and greater awareness of issues of segregation, critiques of health systems and community self-determination
Finnegan et al 201742	Global health experience	SocMed and Equal Health Social Medicine Course Topics (from website http://www.equalhealth.org/socialmedicine-2021, not article): Part 1—Social Determinants of Health: Accounting for Local and Global Contexts Part 2—Health Interventions: paradigms of Charity, Development and Social Justice Part 3—Core Issues in Social Medicine: Primary Healthcare, Community Health Workers, Health and Human Rights and Health Financing Part 4—Making Social Medicine Visible: Writing, Narrative Medicine, Deep Listening, Photography and Community Organising and Leadership Delivery: 3 to 4 week courses in Uganda, Haiti and the USA for medical, nursing and other health professions students from host country and other countries. Instruction through community visits, film, group work, theatre of the oppressed and small-group and large-group discussion. Teaching philosophy focused on facilitating the cocreation of knowledge with participants, developing critical self-awareness and developing equitable partnerships.	SocMed and EqualHealth	Participants identified the following challenges: Lack of diversity among course directors Course content developed by North Americans Socioeconomic and educational inequities among students Sense of demoralisation and discouragement reported by students following course Lessons Learnt: Build equitable partnerships Embrace discomfort Link reflection with action through praxis Build an intentional community
Hutchins et al 201453	Global health experience	University of Wisconsin–Madison Global Health Institute Field School for the Study of Language, Culture and Community Health Pilot Programme Preparatory course curriculum: Spanish language, region-specific topics, community engagement principles In-country curriculum: Language classes; anthropology seminars informed by medical anthropology, medical geography and applied anthropology (study, discussion, field observations and community visits); CBPR-informed community engagement activities and service-learning projects supervised by UW faculty and collaborating HCPs (eg, distributing antiparasitic medications, leading health workshops). Delivery: Semester long preparatory course involving didactic lectures. Spring orientation with course director; 5 week placement in Ecuador (students placed with homestays).	University of Wisconsin–Madison Field School for the Study of Language, Culture and Community Health.	Lessons Learnt: Building trusted networks in the university and host country and continuity in community partner relationships is fundamental for safe, sustainable, quality global health experiences. Interdisciplinary expertise, community engagement and critical reflection facilitates learning
Neff et al 202055	Curriculum or course	Structural Competency Curriculum for Medical Students, Residents and Interprofessional Teams Learning objectives: Identify the influences of structures on patient health. Identify the influences of structures on the clinical encounter. Generate strategies to respond to the influences of structures in the clinic. Generate strategies to respond to the influences of structures beyond the clinic. Describe structural humility as an approach to apply in and beyond the clinic. Delivery: 3, 1 hour modules led by a facilitator in a classroom environment. Modules 1 and 2: cases, discussion, arrow diagrams, didactics with definitions of terms to provide trainees with shared frameworks and vocabulary. Module 3: Examples of responses to harmful social structures, brainstorming exercise designed to inspire action at various scales among participants. All modules: ‘Reflective segments to encourage trainees to apply the learning to their own experience thus far and to their intentions moving forward’.	University of California San Francisco	Participants valued the focus on application of the structural competency framework in real-world clinical, community and policy contexts. Participants with clinical experience (residents, fellows and faculty) reported that the training helped them reframe how they think about patients (away from blaming and other possible misconceptions). Participants reported feeling reconnected to their original motivations for entering the health professions.
Sbaiti 202159	Curriculum or course	Virtual Roundtable for Collaborative Education Design (ViRCoED) model of curriculum design Process: Educators elect stakeholders/partners to work with. Educators conduct roundtables with workgroups and define team objectives (and operations limits). Goals of programme: ‘Model attempts towards reflexivity and better inclusivity in their own work, thus contributing to students’ meta-learning’.	Imperial College London	Informal process evaluation completed by students, external examiners and partners. Increased self-reflexivity was observed in student assignments.
Willott et al 201956	Predeparture course; global health experience	Dundee online preparation modules for global health electives (required for all students) Topics: Module 1: Planning your elective (aims; factors influencing destination and specialty choices; concept of medical tourism; attitude; potential language, cultural and ethical issues) Module 2: Knowing your environment (introduces global health issues) Module 3: Thinking about risk (explores risks under seven themes: communication, personal health, clinical risks, accommodation, travel and leisure, people and culture and regional factors) Module 4: Elective ethics (using case examples explores the impact of language barriers; working within competency; impact of limited resources; decision-making in different cultures and consent) Goals of programme: ‘Optimise student learning, including developing a strong sense of global citizenship and promoting a more considered and fairer “trade” in electives, where host sites benefit’. Delivery: 6 week elective in the fifth year of undergraduate medical education focused on longitudinal engagement with existing partner sites. Students fundraise for the benefit of the host. Interaction with host community and partners: MOU developed with host sites.	University of Dundee, UK LMIC partners in Zambia and Malawi	Programme outcomes: Improved communication with host institutions Students reported an improved educational experience when compared with similar electives
Willott et al 201956	Global health experience	Ben-Gurion University of the Negev, Beer-sheva, Israel Medical School for International Health (MSIH) Predeparture orientation Curriculum: Health, safety, cross-cultural clinical care, 2 day intensive simulation programme with actors. Delivery: Predeparture orientation in third year. Global health experience Curriculum: Not reported. Delivery: 8 week global health experience for capstone experience in fourth year of undergraduate medical education; required for all students. Relationship with partners: Students from host countries receive scholarships to do clinical rotations at MSIH for 12 weeks. LMIC partners compensated for costs associated with student placement.	Medical School for International Health, Israel (MSIH) LMIC partners in Ghana, Ethiopia, India (three sites), Nepal, Sri Lanka, Mexico and Peru	No systematic evaluation of the programme Feedback from debriefing sessions universally positive
Wu 202158	Curriculum or course	Short-term structured international online programming Learning objectives: Cultural competency ‘Networking, leadership, collaboration skills’ Global literacy Delivery: 8 week online programme with international peer networking and exchanges. Weekly small group and large group online meetings; sessions facilitated by student leaders.	Columbia University, King’s College London, Kyoto University, Ludwig Maximilians University, Martin Luther University, McGill University, Medical University of Vienna, National Taiwan University, Tokyo Women’s Medical University, University of Cambridge, University of Copenhagen, University of Paris	Based on a prestudent and post student self-assessment of cultural competencies, the ‘majority of students felt that their level of intercultural awareness had improved’
Zaidi et al 201757	Instructional approach	Online educator discussion Topics: Training to introduce and handle sensitive cultural topics, particularly if educators were to facilitate such discussions, including when and how to pose clarifying questions to deepen the dialogue and how to navigate crucial/sensitive conversations. Issues related to cross-cultural competence being embedded within the curriculum rather than being addressed out of context. Delivery: Online discussion facilitated by three educators in an international health professions educator fellowship programme. Four scenarios were developed to facilitate cross-cultural conversations.	Foundation for the Advancement of International Medical Education & Research (FAIMER); Maastricht University’s School of Health Science Education (SHE)	Consensus regarding the importance of facilitating cross-cultural dialogue Participants made a case for careful instructional design to explicitly address skills for cross-cultural interaction Participants described their lack of ‘experience in multiculturalism and diversity’ as a major barrier to engaging in cross-cultural dialogue Noted the need to be facile in attending to pain as learners brought up traumatic experiences and other sensitive issues including racism and the impact of power dynamics Participants were reflective about their own understanding and tendency to be biased

CBPR, community-based participatory research; HCP, healthcare providers; MOU, memorandum of understanding; NGO, non-governmental organisation; UW, University of Wisconsin.