“Global challenge program” projects themed on preventing zoonosis: developing One Health core competences in medical students at SJTU

Implementation framework of the GCP projects

Figure 1 illustrates the implementation framework of GCP projects. It comprises three modules: student recruitment, project design, and project implementation.

Figure 1:

The implementation frameworks of GCP projects. The GCP projects start with student recruitment and project design. The implementation of GCP projects typically involves three modules: theoretical study, practical research, and outputs.

Participants in the GCP projects are recruited from undergraduate and graduate students at SJTU with diverse academic backgrounds, including environmental science, public health, pharmacy, management, and other fields. The counterpart implementers are responsible for recruiting participants from the local area.

Each year, GCP projects focus on translating and applying China’s experience in the prevention and control of zoonotic diseases. The schedules for these projects are carefully designed around specific themes. Table 1 provides an overview of the GCP projects from 2021 to 2023.

The implementation of GCP projects usually includes three components: theoretical studies, practical research, and outputs (Figure 1). The projects generally start with literature review and lecture learning to improve the participating students’ theoretical knowledge. This is followed by on-site practical research, where students have the opportunity to apply theoretical knowledge in real-world settings. Due to the global COVID-19 pandemic, the on-site activities for the GCP-2021 and GCP-2022 projects were carried out within China, while field visits were conducted both domestically and internationally for the GCP-2023 project. Finally, based on theoretical study and local practical research, participating students compile analysis reports and summarize their practical experiences.

Evaluation of the GCP projects

To evaluate the effectiveness in the improvement of the OH core competitiveness of students from GCP projects, 48 participating SJTU students who participated in the projects over the past three years were invited to complete an online questionnaire survey (Supporting Information). The questionnaire consists of 32 questions divided into four aspects: basic information, overall assessment of the project, assessment of communication skills, and interdisciplinary collaboration (Supporting Information). The survey results were statistically analyzed using software like Excel and subjected to descriptive statistical analysis.

Demographic and background information

From 2021 to 2023, a total of 152 participants, including teachers and students from China and abroad, were involved in the GCP projects. Among them, 84 were students (48 from SJTU and 36 from other countries) and 68 were teachers (47 from SJTU and 21 from other countries). The teacher-student ratio was 1:1.24. The GCP project attracted participants from diverse international backgrounds, as evidenced by the consistent participation of non-Chinese teachers and students each year (Figure 2A). The average proportion of non-Chinese teachers and students were 30.8 % (21/68) and 42.8 % (36/84), respectively. Such a diverse composition of personnel provided the participants with the opportunity for a clash and a broad exchange of ideas. The number of SJTU students in the GCP projects increased from 12 in 2021 to 20 in 2023 (Figure 2B). In particular, the number of undergraduate students showed a seven-fold increase, from only 2 in 2021 to 14 in 2023, aligning with the concept that OH education and practice should be promoted early in students’ academic study [14, 17].

Figure 2:

The statistics and analysis of participants’ information. (A) The numbers of Chinese and non-Chinese teachers and students in GCP-2021, GCP-2022, and GCP-2023. (B) The numbers of graduates and undergraduates from SJTU students in GCP-2021, GCP-2022, and GCP-2023. (C–E) The disciplinary background of the participating SJTU students in GCP-2021, GCP-2022, and GCP-2023.

We also analyzed the majors of the participants in the GCP projects and found a notable growth in the diversity of their academic backgrounds (Figure 2C–E). In the GCP-2021 project, 67.0 % of the students majored in OH at SGH, SJTU. The remaining one-third of the students majored in basic bioscience or medical disciplines, such as public health, biomedical engineering, and clinical medicine (Figure 2C). In the GCP-2022 project, 50.0 % of students majored in OH, while the other 50.0 % came from seven different majors, including natural sciences such as public health, biomedical engineering, and clinical medicine, and humanities such as management and culture management (Figure 2D). In 2023, SJTU students from 10 different majors participated in the GCP project. It is noteworthy that students majoring in clinical medicine have replaced those in OH as the predominant component, comprising nearly 50.0 % of the participants. The remaining portion included students from OH, public health, biomedical engineering, medical technology, agriculture, food hygiene & nutrition, culture management, Marxism, and design (Figure 2E). With the broader inclusion of students from multiple academic backgrounds, the diverse characteristics of OH were fully exemplified in the GCP-2023 project.

Implementation of GCP projects

Taking GCP-2023 as an example, the implementation and outcomes of GCP projects are presented in Table 2. In the theoretical study section, participants distilled experiences in malaria control and explored pathways for translating these experiences by reviewing 164 pieces of literature. Additionally, 15 lectures were conducted by 21 experts from eight countries to enhance participants’ proficiency in implementation research and practical investigation. Furthermore, participants engaged in discussions with experts from domestic and international organizations, as well as local teachers and students, to deepen their understanding and visualize theoretical knowledge on malaria elimination in China and around the globe.

To facilitate a thorough understanding of anti-malaria measures among participants, the GCP-2023 project conducted “point-line-surface” practice activities. At the “surface” level, the participants visited local authorities in malaria prevention and control, including the CDC of Yiwu City in Zhejiang Province, China, as well as the health department of Savannakhet Province, Laos, to gain a comprehensive understanding of the anti-malaria network and procedures. At the “line” level, participants engaged in key informant interviews with frontline clinical doctors in hospitals in Yiwu or village health clinics in Savannakhet, with key attention paid to the diagnosis and treatment of malaria, reporting procedures, and current challenges. At the “point” level, participants conducted an on-site field research, gathering residents’ understanding of malaria through questionnaire surveys and analyzing the potential risks of malaria infection in the area. Based on the investigation results, participants summarized the main challenges facing malaria elimination in the region of Laos, including a suitable natural environment for malaria transmission, inadequate healthcare facilities and resources, residents’ low awareness of malaria prevention, and frequent population flow.

Combining theoretical study with the on-site field research on malaria prevention and control, participants completed project reports (one report, two proposals, and one model) and provided recommendations for preventing imported malaria and combating malaria in Southeast Asia (Table 2).

Participants’ feedback on GCP projects

A total of 42 out of 48 students completed the survey with a response rate of 87.5 %, wherein three of them participated in the GCP program twice. The questionnaire covered three aspects apart from basic information, including overall assessment, communication skills, and interdisciplinary collaboration.

Overall assessment

In the section on overall assessment, the GCP projects were evaluated based on the students’ recognition and acceptance of OH concepts and approaches before and after participating in the projects. As shown in Figure 3A, more than two-thirds of the students (69.0 %) had not participated in any OH practical activities before the GCP projects. The remaining students with prior experience in other OH practical activities all majored in OH from SGH of SJTU. Generally, the majority of the students had little knowledge about the OH concept before joining the GCP project, as half (21 out of 42) of the students were not familiar or totally unfamiliar with OH (Figure 3B). After the GCP projects, the students’ recognition and acceptance of OH were significantly improved. About 64.3 % (27 out of 42) and 35.7 % (15 out of 42) of the students, respectively, believed that the OH concept and approach could have a very positive and positive impact in preventing emerging and re-emerging infectious diseases (Figure 3C). Almost all the students (41 out of 42) expressed their willingness to spread the OH concept. Similarly, as shown in Figure 3D, 64.3 % (27 out of 42) and 35.7 % (15 out of 42) of the students, respectively, felt that their recognition of the OH concept and approach had improved after the GCP projects significantly and moderately.

Figure 3:

The overall evaluation of the GCP projects in 2021–2023. (A) The experience in OH practice of the interviewed students. The percentage indicates the proportion of students who chose the corresponding option among all students. (B) The recognition of OH concepts and approaches among the students before participating in the GCP projects. The unit of the radar map represents the number of students who selected the corresponding option. (C) The acceptance of OH concepts and approaches among students after participating in the GCP projects. (D) The recognition of OH concepts and approaches among students after participating in the GCP projects. The unit of the radar map represents the number of students who selected the corresponding option.

Communication skills

In the section on communication skills, about four-fifths of the students (79.0 %) reported experience of communication with teachers or students from other countries during the GCP projects (Figure 4A). Nearly half (45.5 %) and 27.3 % of the students, respectively, communicated face-to-face and online with teachers or students from another country (Figure 4B). The proportion of students who communicated with teachers or classmates from two or more countries online (72.7 %) was significantly higher than that on face-to-face occasions (51.5 %), which demonstrated the flexibility and accessibility of online communication. The communication frequency during the GCP projects is relatively scattered (Figure 4C). An equal share of 30.0 % of students engaged in communication exceeding 5 times weekly, 1–4 times weekly, and 1–4 times monthly. Benefiting from the communication opportunities offered by the GCP projects, 24.0 %, 49.0 %, and 24.0 % of the students felt that their communication skills had been significantly improved, moderately improved, and slightly improved, respectively (Figure 4D).

Figure 4:

Improvement in the communication skills of students after participating in the GCP projects. (A) Communication experience of students during the GCP projects. (B) The diversity of communication experience of students during the GCP projects, including face-to-face communication and online communication. (C) The frequency of communication of students during the GCP projects. (D) Evaluation of the extent of improvement in communication skills after the GCP projects. The percentage in (A), (B), and (D) indicates the proportion of the students who chose the corresponding option among all students surveyed.

Interdisciplinary collaboration

Interdisciplinary collaboration is one of the key characteristics of OH. The development of students’ interdisciplinary collaboration skills through the GCP projects was assessed in the section on interdisciplinary collaboration of the questionnaire. During the GCP projects, interdisciplinary collaboration among participants was frequent. As shown in Figure 5A, benefiting from the diverse disciplines of the participants (Figure 2C–E), nearly all students (97.3 %) collaborated with teachers or students from two or more different disciplines. It was found that more than half of the students (63.9 %) actively engaged in interdisciplinary collaboration with participants from various disciplines more than 5 times per week (Figure 5B). This indicates that, on average, each student had the opportunity to engage in daily interdisciplinary discussions on complex health issues during the GCP projects. When asked the question “How did collaborating with students from different academic backgrounds enhance your understanding of practical OH issues?”, 72.0 % of students agreed that the interdisciplinary collaboration significantly improved their understanding of practical OH issues (Figure 5C). Likewise, three-fourths of the students (74.0 %) believed that the interdisciplinary nature of the GCP projects notably contributed to their deep thinking and analysis of the complex OH issues (Figure 5D).

Figure 5:

Evaluation of students’ interdisciplinary collaboration abilities cultivated by the GCP projects. (A) The interdisciplinary collaboration experience of students during the GCP projects. (B) The frequency of interdisciplinary collaboration of students during the GCP projects. (C&D) The students’ recognition of the improvement in their understanding of OH through interdisciplinary collaboration. The percentage in (A), (C), and (D) indicates the proportion students who chose the corresponding option among all students.

Achievements of GCP projects

Over the past three years, the GCP projects have received significant recognition and have been honored with numerous collective and individual accolades. The GCP projects have won the Third Prize in the “Zhixing Cup” Shanghai College Students’ Social Practice Competition, as well as the Third Prize in the Shanghai Jiao Tong University Social Practice Competition. Additionally, four faculty advisors and six students have been awarded the titles of “Outstanding Social Practice Advisor” and “Advanced Individual”, respectively, by Shanghai Jiao Tong University.

Enhancing the competency in systems thinking

Each GCP project focuses on one specific health issue, studying the feasibility of translation of Chinese experience to other countries and regions, which in design allows students to concentrate on and thoroughly analyze a single complex health issue comprehensively. During the GCP projects, students fully realized the necessity and importance of the OH concept and approach in addressing complex health issues. They learned to analyze and solve health issues from the human-animal-ecosystem perspectives and adopted these approaches effectively. For example, after the on-site investigation in GCP-2023, students summarized the main challenges of malaria elimination at the Nong District in Laos, encompassing both natural factors (like humid climate and diverse mosquito species) and human factors (like agricultural laboring modes).

Enhancing the competency in international communication

The cultivation of international communication ability is one of the key and challenging aspects of OH education programs. The GCP projects provide participating students with abundant opportunities to communicate with international experts, researchers, and organizers throughout three parts (theoretical study, field research, and output delivery) of the project. Additionally, the on-site investigation and visits with local individuals not only improved students’ language proficiency and communication skills but also broadened their global perspective and cultural sensitivity and awareness. We found the major obstacles faced by students in international communication during the GCP projects were language barriers and cultural differences (Figure 6A). Therefore, training on basic language and cultural sensitivity should be included in future GCP projects.

Figure 6:

The challenges that students faced during the GCP projects, as well as their advice on the GCP projects. (A) The feedback from students when they were asked the multiple-choice question regarding the biggest obstacles encountered during communication in GCP projects. (B) The feedback from students when they were asked the multiple-choice question “which disciplinary knowledge is important when analyzing OH issues during the GCP projects”. (C) The feedback from students when they were asked the multiple-choice question “which disciplinary knowledge is lacking when analyzing OH issues during the GCP projects”.

Enhancing competency in interdisciplinary collaboration

The diverse academic profiles of student participants in GCP projects have greatly enhanced the extensive and profound interdisciplinary collaboration. By collaborating with others from different origins and educational backgrounds, students were challenged to think about the most effective ways to share knowledge and combine their expertise. Through the GCP projects, students were exposed to diverse perspectives, approaches, and expertise, which not only broadened their understanding of complex health issues but also strengthened their ability to integrate knowledge and information to address these issues comprehensively.

After participating in the GCP projects, students reported high recognition that interdisciplinary collaboration is central to solving complex health issues with the OH approach. They acknowledged that multiple disciplines such as public health, environmental science, basic medicine, ecology, and clinical medicine, play important roles in the implementation of the OH approach (Figure 6B). Moreover, according to the feedback from students who were asked by the question “Which disciplinary knowledge is lacking when analyzing OH issues during the GCP projects,” it was perceived that additional knowledge in environmental science, ecology, agricultural sciences, and veterinary medicine should be included (Figure 6C). This indicated that the GCP projects should recruit more students or invite more experts majoring in the above disciplines in the future to enhance the knowledge network for better analysis and understanding of complex health issues.

Suggestions for the future GCP projects

The evaluation questionnaire in this study (questions 2.10 to 2.12) also provided valuable insights into the GCP projects. Almost all of the students interviewed suggested reducing the number of online lectures and compressing the time of theoretical study. On the contrary, two-thirds of the students expressed the expectation for an increase in field experience and investigations, both domestically and internationally. In addition, one-fourth of the students pointed out that laboratory training and data analysis skills should be included into the GCP projects. Cultural exchange activities and knowledge dissemination skill trainings are also recommended to be incorporated into the projects. Furthermore, upon engaging in the GCP projects, students also aspire to deliver academic outcomes, including publications, patents, policy briefs, etc. Therefore, future GCP projects will focus on enhancing laboratory skill training, data analysis, and local cultural investigations, while reduce theoretical lectures online. Additionally, we intend to develop specific scientific topics and research proposals to facilitate the attainment of more quantifiable academic outcomes.