Core Content, Competencies, and Accreditation in US Global Health Fellowships: A Survey of Leaders' Perspectives

The number of global health (GH) fellowships in the United States has increased over the past two decades. However, there are currently no standard requirements, shared core content, or widespread systems of accreditation. With the growth in programs, it is appropriate to consider these issues. We conducted a national survey to understand GH fellowship leaders' perspectives on the existence of core content and competencies and on the need for accreditation, including by the Accreditation Council of Graduate Medical Education (ACGME). We sent survey invitations to 123 fellowship leaders. Forty-five completed the survey (37%), representing seven specialties. Eighty-nine percent of respondents indicated that there is important core content for fellows to learn regardless of specialty; 30% indicated that accreditation would be "very" or "extremely" beneficial, whereas 21% indicated that it would be "not at all" beneficial. When asked what form of accreditation would result in training the most competent GH practitioners, 35% indicated that accreditation is unnecessary. Of those selecting a form of accreditation, the largest proportion (21%) selected accreditation from a professional society; 52% "disagreed" or "strongly disagreed" that ACGME accreditation is needed. More than 65% indicated that loss of training flexibility, funding restrictions, and increased administrative and fellow funding burdens are "very" or "extremely" important barriers. These results suggest that broad agreement on important core content exists across specialties, with a lack of consensus about the need for accreditation. More discussion with stakeholders, including international partners, is needed to understand their perceptions and build consensus before pursuing fellowship accreditation.