Beyond Medical “Missions” to Impact-Driven Short-Term Experiences in Global Health (STEGHs): Ethical Principles to Optimize Community Benefit and Learner Experience

Abstract

Increasing demand for global health education in medical training has driven the growth of educational programs predicated on a model of short-term medical service abroad. Almost two-thirds of matriculating medical students expect to participate in a global health experience during medical school, continuing into residency and early careers. Despite positive intent, such short-term experiences in global health (STEGHs) may exacerbate global health inequities and even cause harm. Growing out of the "medical missions" tradition, contemporary participation continues to evolve. Ethical concerns and other disciplinary approaches, such as public health and anthropology, can be incorpo rated to increase effectiveness and sustainability, and to shift the culture of STEGHs from focusing on trainees and their home institutions to also considering benefits in host communities and nurtur ing partnerships. The authors propose four core principles to guide ethical development of educational STEGHs: (1) skills building in cross-cultural effective ness and cultural humility, (2) bidirectional participatory relationships, (3) local capacity building, and (4) long-term sustainability. Application of these principles highlights the need for assessment of STEGHs: data collection that allows transparent compar isons, standards of quality, bidirectionality of agreements, defined curricula, and ethics that meet both host and sending countries' standards and needs. To capture the enormous potential of STEGHs, a paradigm shift in the culture of STEGHs is needed to ensure that these experiences balance training level, personal competencies, medical and cross-cultural ethics, and educational objectives to minimize harm and maximize benefits for all involved.

The Practitioner’s Guide to Global Health: an interactive, online, open-access curriculum preparing medical learners for global health experiences

“…Short-term experiences in global health (STEGH) [1,2] – including clinical rotations, research, language immersion, and volunteer work – are becoming more common at all levels of USA (US) medical education. Medical student participation in STEGH increased from 8% in 1986 to 31% in 2015 [3,4].…”

The Guatemala-Penn Partners: An Innovative Inter-Institutional Model for Scientific Capacity-Building, Healthcare Education, and Public Health

“…In general, Guatemalan participants benefit from the academic expertise and financial resources that are lacking in Guatemala. In turn, Penn participants conduct international research, gain global health skills, and experience a different culture, all of which are highly demanded skills in the USA academic centers (23). The scientific initiatives allow Guatemalans to access the research education provided by Penn, while Penn mentors gain teaching experience and disseminate their scientific work in international settings.…”

Developing and validating learning domains, competencies, and evaluation items for global health clinical immersion practicums for graduate‐level nursing programs

“…Many of these partnerships have involved students from high-resource countries (HRC) travelling to low-resource countries (LRC) for clinical practicums. The academic global health community and the nursing discipline specifically, have identified competencies needed by these students for successful partnerships (Brown, 2014;Chavez, Bender, Hardie, & Gastaldo, 2010;Clark, Raffray, Hendricks, & Gagnon, 2016;Melby et al, 2015;Rowthorn & Olsen, 2014;Wilson et al, 2012Wilson et al, , 2014Wilson et al, , 2016. However, heretofore the collection of these competencies has not been synthesized and delineated by educational level, such as Why is this research or review needed?…”