Introduction
Global exposure in health professional training is a key component in promoting transformative educational approaches through short-term electives. 1,2 Africa has hosted nursing students from around the world, offering electives and internships through African nursing training institutions, hospitals, and Non-Governmental organizations (NGOs).2 Through these placements, many nursing students from abroad have learned through observships, ward rounds and supervised assistantships in patient care.3 These experiences has enabled them to gain exposure to Africa’s health systems, practices that work in a resource limited settings, coupled with adherence to standardized nursing procedures and protocols. This has led to nursing students’ increased knowledge, enhanced professional resume, and advocacy for change by developing interest in specific arms of global health action and advocacy.4,5 African nursing students have limited access to the same opportunities compared to nursing students from developed countries due to high costs associated with going on elective outside of Africa.6,7 To address this gap, GEMx® - the Global Educational Exchanges in Medicine and the Health - a service of the Educational Commission of Foreign Medical Graduates (ECFMG®), launched a South-South student nursing exchange model in April 2017, in partnership with the African Forum for Research and Education in Health (AFREhealth). GEMx formed intra-institutional partnerships amongst five African nursing institutional members of AFREhealth for the exchange of their nursing students in Africa.
Aim
The aim of this initiative was to facilitate accessible and affordable exchange opportunities for African nursing students to gain global exposure through regional mobility, South-South exchange model.
Institutions
The five nursing institutions that participated in the pilot were: Ekwendeni School of Nursing, Malawi; Kamuzu School of Nursing, Malawi; Lusaka School of Nursing, Zambia; Makerere University School of the Health Sciences, Uganda; and Muhimbili University of Health and Allied Health Sciences, Tanzania.
Role of GEMx
As facilitator, GEMx provided a Charter, the multi-lateral agreement amongst institutions, and a web-based system to centralize and manage elective placements and application process. Through ECFMG’s Challenge Grant, GEMx provided student mini-grant awards to help defray costs associated with travel, accommodations, visas, incidentals. GEMx hired a regional representative based in Kampala, Uganda who coordinated and executed the program, and served as a resource to institutions and exchange students.
Role of Institutions
Participating institutions served both as home (sending students) and host institutions (receiving students). Institutions utilized the GEMx web-based system to publish their elective offerings, application requirements, and learning objectives. Selected nursing students gained access to the GEMx web-based system and applied to electives online. Institutions reviewed incoming student applications; eligible students were accepted. Each institution agreed to waive incoming student administrative and/or tuition fees. Each institution assigned a GEMx “Program Manager” who partnered with the GEMx Africa Regional Representative on all aspects of the student mobility processes.
Preliminary Results
There were 34 nursing students who have gone on electives to date since April 2017. The chart below provides a breakdown of the elective specialties taken by nursing students. All nursing exchange students (100%) reported that this exchange opportunity was their first global exposure to a different health care system. [i] Each elective was one month in duration.
AFREhealth Leadership and Participating Institutions
ECFMG surveyed AFREhealth leadership, deans, faculty members and program managers (n=10). All respondents (100%) agreed that GEMx contributed to enhancing international exposure for their own students. All respondents (100%) agreed to a need for GEMx to continue its role as a facilitator. Almost all (90%) of respondents agreed that GEMx contributes to breaking mobility barriers that exists in various African countries. In addition, (90%) of the various network leadership agreed that GEMx adds value to the network.[1]
Student Feedback
Each student submitted a post-elective report. All students (100%) confirmed that this was their first time travelling outside their home country, and gained exposure to new health systems. Almost all (97%) students stated the cost of an elective in Africa was less than 2,000USD. Almost all (94%) students agreed that they received adequate faculty supervision during their exchange. Almost all (94%) students agreed they had opportunities to voice challenges and gained suggested strategies from faculty supervisors. All students (100%) documented their experience as transformative in terms of skills and knowledge gained, acquired transferrable knowledge, appreciated the differences that exists, and garnered interest in becoming global health advocates. [2]
Conclusion
The South-South nursing student exchange model provided accessible and affordable elective exchange opportunities for students in Africa. Students gained global exposure to enhance their knowledge, skills, perspectives and global exposure. More ongoing research is needed to ascertain the long-term impact on nursing students from taking a global health elective in Africa. The GEMx model and system is one that can be replicated in other parts of the world and we wish to build a global elective nursing network with representation from all regions.If you wish to learn more about ECFMG GEMx and how your institution or association can be involved, please contact fnawagi@gmail.com or AIacone@ecfmg.org. For more information on GEMx, please visit our website at www.gemxelectives.org.
1 Source: Student Reports provided to ECFMG
[2] Source: ECFMG GEMx Survey 2017-2018