In Reply to Hagopian

The specific statement I refer to in Dr. Hagopian and colleagues’1 article is their suggestion “that schools can use the publication of their competencies to convey to prospective students and faculty the unique identity and distinct values of their program.” In my Commentary,2 I contend that competencies should not be used “to further the interests of a training program but should, instead, be inextricably linked to local health systems’ needs and contexts.” I believe that the focus of competencies in global health education should not be to promote a program’s identity and values but should instead always be linked to specific health needs and contexts. A comprehensive article recently also emphasized this point: “Competencies do not exist as general attributes separate from the clinical content or context.”3 This view is not to discredit Hagopian and colleagues’ survey of competencies in U.S. public health schools, nor does it invalidate their carefully worded “international health program competencies.” The authors do, nonetheless, claim that their competencies pertain only to “MPH students trained in the United States” and not to the collectivist and low-resource settings in developing countries that I discuss in my Commentary. Five out of their nine competencies, however, make specific reference to “developing countries” or “low resource (or resource-constrained) settings,” and another two refer to “international settings.”1 Their competencies, therefore, do extend outside of the United States into developing countries and resource-constrained settings. Finally, my contention that Hagopian and colleagues’ survey “does not appear to include participation or input from host countries” is based on two factors: (1) their “framework for developing competencies” was driven by literature searches and consensus committees among “U.S. programs” and makes no mention of active participation by host developing/low-income countries; and (2) their survey was sent only to programs in the United States and likewise makes no mention of being distributed to any developing/low-income host country programs. Therefore, it seems that the process by which they developed their nine international health competencies did not include active participation or input from host developing/low-income countries—instead, their competencies just refer to these settings. Quentin Eichbaum, MD, PhD, MPH, MFA, MMHC Associate professor of medical education and administration, associate professor of pathology, microbiology, and immunology, director of global health electives, and clinical fellowship program director, Vanderbilt University School of Medicine, Nashville, Tennessee; [email protected]