Beyond the learning curve: length of global health electives

Keating, Elizabeth M.; Lukolyo, Heather; Rees, Chris A.; Dziuban, Eric J.; Ferris, Margaret G.; Schutze, Gordon E.; Marton, Stephanie

doi:10.5116/ijme.57c1.4e07

Cited by 6 publications

(5 citation statements)

References 9 publications

(10 reference statements)

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“…Ethical best practices cited in the literature include, but are not limited to, ensuring that motivations for global engagement are ethically sound 45,94 ; aiming to work as part of mutually beneficial, sustainable partnerships 14,22,95 ; considering the burden of the visitors' presence and resource redistribution 15,21,22,37,96,97 ; and strategizing about ways to minimize this burden (eg, longer experiences may allow providers to get beyond the steep learning curve common to these encounters). 98 Providers should realize that their own "standards of care" are often culturally and contextually defined and may not be practical or even feasible for use in the new setting, which may have its own standard way of approaching a clinical or research problem. 22,25,37 Providers may also encounter personal and professional ethical dilemmas while participating in GH experiences, including requests to practice outside of their knowledge base or scope or requests to supervise nonmedical volunteers assisting with medical work (eg, dispensing medications, helping with procedures) that may place patients and themselves at risk.…”

Section: Culture and Culture Shockmentioning

confidence: 99%

Global Health: Preparation for Working in Resource-Limited Settings

et al. 2017

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Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships.

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Section: Culture and Culture Shockmentioning

confidence: 99%

Global Health: Preparation for Working in Resource-Limited Settings

et al. 2017

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“…In our study, 15% of 3‐year programs reported five or more residents participating in STEGH, while 35% of 4‐year programs reported five or more residents (difference = 0.20, standard error = 0.11, p < 0.05). Acclimation to a new location as well as health care system takes time, and while 2 weeks may be sufficient for certain select STEGH, most STEGH should be at least 4 weeks 36,37 . In our survey, 75% of programs offer rotations up to 1 month, most commonly 2 or 4 weeks.…”

Section: Discussionmentioning

confidence: 91%

“…Acclimation to a new location as well as health care system takes time, and while 2 weeks may be sufficient for certain select STEGH, most STEGH should be at least 4 weeks. 36,37 In our survey, 75% of programs offer rotations up to 1 month, most commonly 2 or 4 weeks.…”

Section: Discussionmentioning

confidence: 97%

Global Health Training in U.S. Emergency Medicine Residency Programs

Rybarczyk

Muck

Kolkowitz

et al. 2020

AEM Education and Training

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Objectives: Formal education in global health (GH) and short-term experiences in GH (STEGH) are offered by many emergency medicine (EM) residency programs in the United States. In an increasingly connected world, training in GH and STEGH can provide essential knowledge and practical skills to trainees, particularly at the graduate medical education level. The current core programmatic components and the essential competencies and curricula that support ethical and effective STEGH, however, still vary widely. The authors conducted a survey of the 228 EM residency programs in the United States to describe the current state of GH training and STEGH.Methods: An online survey was developed in REDCap by a team of GH faculty. In July 2018, programs were invited to participate via individual invitation of program directors from a directory. The programs received two reminders to participate until January 2019.Results: Of the 84 programs that responded, 75% offer STEGH and 39% have longitudinal GH curricula. Within these programs, only 55% have dedicated GH faculty and only 70% have dedicated sites. Both faculty and residents encounter funding and insurance barriers; most notably, only 20% of programs that offer STEGH provide evacuation insurance for their residents. Most residents (95%) engage in clinical work along with teaching and other activities, but 24% of programs do not allow these activities to fulfill any residency requirements. Finally, only 80 and 85% of programs offer preparatory and debriefing activities for residents, respectively. Conclusions:While the results of this survey show progress relative to prior surveys, there are still barriers to implementing GH curricula and supporting safe, ethical, and effective STEGH, particularly in the form of continued financial and logistic support for faculty and for residents, in U.S. EM training programs.

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“…It is important to acknowledge that STEGH participants generally do not fill critical human resource gaps at host institutions and, when poorly executed, reflect “voluntourism,” impeding opportunities for local practitioners, undermining local health infrastructure, and potentially harming patients. 1 , 11 , 12 , 39 If traveling, trainees should take part in research or clinical activities that require in-person presence as a component of longitudinal programs showing demonstrable benefit to host institutions and professional communities. Passive learning via observation and lecture-based programs should be reconsidered given developments in virtual capabilities.…”

Section: Restructuring Rotationsmentioning

confidence: 99%

Ethical Considerations of Climate Justice and International Air Travel in Short-Term Electives in Global Health

Dhawan

Rammelkamp

Kayandabila

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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In July 2022, the American Society of Tropical Medicine and Hygiene Green Task Force advocated to acknowledge the health impacts of climate change, particularly on those in low- and middle-income countries, and called on global health organizations to act. Simultaneously, academic medical centers are resuming Short-Term Electives in Global Health (STEGH) as travel restrictions imposed during the COVID-19 pandemic ease in most countries. International flights by trainees from academic medical centers in high-income countries (HIC) on these electives encapsulate the climate injustice of who generates carbon emissions and who bears the impacts of climate change. Using “decolonization” and “decarbonization” as guiding principles, we suggest several strategies that global medical education programs in HIC could implement. First, restructure rotations to halt STEGH with minimal benefit to host institutions, optimize trainee activities while abroad, and lengthen rotation duration. Second, programs can calculate the carbon impact of their STEGH and implement concrete measures to cut emissions. Finally, we urge academic medical centers to promote climate-resilient healthcare infrastructure in host countries and advocate for climate solutions on the global stage.

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Beyond the learning curve: length of global health electives

Cited by 6 publications

References 9 publications

Global Health: Preparation for Working in Resource-Limited Settings

Global Health: Preparation for Working in Resource-Limited Settings

Global Health Training in U.S. Emergency Medicine Residency Programs

Ethical Considerations of Climate Justice and International Air Travel in Short-Term Electives in Global Health

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