Original Publication
Open Access

Global Health Clinical Ethics

Published: September 24, 2015 | 10.15766/mep_2374-8265.10232

Included in this publication:

  • Instructor's Guide.pdf
  • Facilitator Guide.pdf
  • Student Handout.pdf
  • Student Handout with Discussion.pdf
  • Annotated Bibliography.pdf
  • Pre-Workshop Evaluation Questions.pdf
  • Post-Workshop Evaluation Questions.pdf
  • Post-Return Workshop.pdf
  • Post-Return Evaluation Questions.pdf

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

Abstract

In recent years, increasing numbers of United States–based health professions students have traveled to low-resource settings for short-term clinical electives. The content of predeparture training can be highly variable, leaving students unprepared for the ethical challenges posed by these experiences. This is magnified by the lack of attention paid to the burdens and benefits for local staff, institutions, and patient well-being in the setting of disproportionate poverty and disease. Adequate predeparture training is necessary to help trainees recognize and navigate these ethical issues, avoid harm both to themselves and to others, and promote equitable global health partnerships. The case studies presented here, all of which are based on real student experiences, form the basis of this tool for predeparture training of health professions students preparing for international electives. The curriculum is designed to be implemented in a 90-minute session, in groups of up to 25 students. Student leaders, ideally a group of students who have had experience doing clinical rotations abroad, may serve as facilitators with faculty guidance. This module also includes evaluation tools to encourage continued curricular improvements. Analysis of the preworkshop, postworkshop, and posttrip questionnaires indicates that the students who engaged in these predeparture workshops demonstrated improved awareness of the range of ethical dilemmas that they might encounter while engaged in clinical work abroad, as well as increasing their self-rated ability to identify and negotiate these situations. Importantly, those students who participated in this workshop prior to travel felt more prepared to manage the ethical dilemmas that they encountered during their clinical rotations compared to those who did not participate.


Educational Objectives

By the end of this session, learners will be able to:

  1. Consider the potential ethical dilemmas that may arise in global health clinical electives, based on prior student experiences.
  2. Discuss means of mitigating these dilemmas and means of seeking support when participating in a global health clinical elective.
  3. Recognize that every workshop participant may approach a situation differently.

Author Information

  • Mei Elansary, MD, MPhil: Boston Children's Hospital
  • Michael Peluso, MD, MPhil: Brigham and Women's Hospital
  • Stacey Kallem, MD: Children’s Hospital of Philadelphia
  • John Thomas, MD: Yale-New Haven Hospital
  • Tracy Rabin, MD, MS: Yale School of Medicine

Disclosures
None to report.

Funding/Support
None to report.


References

  1. Association of American Medical Colleges. 2014 Medical School Graduation Questionnaire: All Schools Summary Report. https://www.aamc.org/download/397432/data/2014gqallschoolssummaryreport.pdf. Published July 2014.
  2. Crump JA, Sugarman J, Working Group on Ethics Guidelines for Global Health Training. Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg. 2010;83(6):1178-1182. http://dx.doi.org/10.4269/ajtmh.2010.10-0527
  3. Gupta AR, Wells CK, Horwitz RI, Bia FJ, Barry M. The International Health Program: The fifteen-year experience with Yale University’s Internal Medicine Residency Program. Am J Trop Med Hyg. 1999;61(6):1019-1023.
  4. Izadnegahdar R, Correia S, Ohata B, et al. Global health in Canadian medical education: current practices and opportunities. Acad Med. 2008;83(2):192-198. http://dx.doi.org/10.1097/ACM.0b013e31816095cd
  5. Kallem S, Peluso M, Rabin T. Identification and management of ethical dilemmas during global health clinical rotations: evaluating the impact of pre-departure training on student knowledge, skills, and attitudes. Poster presented at: the Fourth Annual Consortium of Universities for Global Health Conference; March 14-16, 2013; Washington, DC.
  6. McKinley DW, Williams SR, Norcini JJ, Anderson MB. International exchange programs and U.S. medical schools. Acad Med. 2008;83(suppl 10):S53-S57. http://dx.doi.org/10.1097/ACM.0b013e318183e351
  7. Mutchnick IS, Moyer CA, Stern DT. Expanding the boundaries of medical education: evidence for cross-cultural exchanges. Acad Med. 2003;78(suppl 10):S1-S5. http://dx.doi.org/10.1097/00001888-200310001-00002
  8. Panosian C, Coates TJ. The new medical “missionaries”—grooming the next generation of global health workers. N Engl J Med. 2006;354(17):1771-1773. http://dx.doi.org/10.1056/NEJMp068035
  9. Provenzano AM, Graber LK, Elansary M, Khoshnood K, Rastegar A, Barry M. Short-term global health research projects by US medical students: ethical challenges for partnerships. Am J Trop Med Hyg. 2010;83(2):211-214. http://dx.doi.org/10.4269/ajtmh.2010.09-0692
  10. Ramsey AH, Haq C, Gjerde CL, Rothenberg D. Career influence of an international health experience during medical school. Fam Med. 2004;36(6):412-416.
  11. Shah S, Wu T. The medical student global health experience: professionalism and ethical implications. J Med Ethics. 2008;34(5):375-378. http://dx.doi.org/10.1136/jme.2006.019265
  12. Shaywitz DA, Ausiello DA. Global health: a chance for Western physicians to give—and receive. Am J Med. 2002;113(4):354-357. http://dx.doi.org/10.1016/S0002-9343(02)01307-4 


Citation

Elansary M, Peluso M, Kallem S, Thomas J, Rabin T. Global health clinical ethics. MedEdPORTAL. 2015;11:10232. https://doi.org/10.15766/mep_2374-8265.10232