Prioritizing Global Health Education in Pulmonary and Critical Care Fellowships: An Applicant Survey

Abstract Background Global Health (GH) is expanding, offering an increasing number of opportunities for engagement to trainees in medical schools and residency programs. This expansion of opportunities has not yet reached those at the fellowship level, particularly in Critical Care Medicine (CCM), Pulmonary and Critical Care Medicine (PCCM), and Pulmonary Medicine (PM) fellowships (collectively termed PCCM). Objective We surveyed applicants to US adult PCCM fellowship programs regarding interest in GH training and the influence of GH tracks and related opportunities on applicants’ rank list decisions. Methods We developed a survey to assess applicants' demographics, prior GH experience, interest in pursuing GH experiences during and after fellowship, and preferences regarding GH opportunities within fellowship programs. Survey questions included multiple choice, Likert scale, and free text questions. After initial pilot testing, the survey was sent to 1,024 applicants applying to PCCM programs through the National Resident Matching Program match during the 2025 appointment year. Both univariate and multivariate regression models were built to identify predictors of GH interest. Results Of the 325 applicants who completed the survey (31.7% response rate), 51% stated the GH was at least slightly important when ranking a given fellowship program. According to the surveyed applicants, the most important GH program elements were faculty mentors with GH experience within the division, opportunities for GH-related clinical service in the US, and established partnerships outside the US where fellows could rotate. Perceived barriers to a career in GH included lack of protected time for international work, family obligations, and lack of institutional funding. We also found a significant association on multivariate analysis between prior GH work and interest in pursuing it at the fellowship level (OR 2.76, 95% CI 1.04-5.49, p = 0.04). Conclusion Applicants to US PCCM fellowship programs with prior GH experience are most likely to have a significant interest in pursuing GH work at the fellowship level. Important elements to a GH program within PCCM include faculty mentorship, opportunities for GH-related clinical service in the US, and established partnerships outside the US. Funding MLS completed this work while supported on grant 5T32HL091816 from the National Heart, Lung, and Blood Institute.