How Do We Decolonize Global Health in Medical Education?

Abstract

Medical schools are increasing global health training opportunities, but these have been marketed to medical students as an exotic vocation. The challenges of global health education in high income country (HIC) medical schools are rooted within broader inequities in global health partnerships. More meaningful engagement during medical training is hindered by students' inability to take extended absences, difficulty securing funding, a paucity of mentors with demonstrated commitment to equitable global health practice, and inadequate preparation. Calls for decolonizing global health have recently amplified, and medical schools must seize the opportunity to train decolonizers. We outline steps medical schools can adopt to shift their global health education approach to develop practitioners better prepared to contribute equitably. First, students should be exposed to more global health courses, including the history of colonial medicine and its effects on specific local contexts. Medical schools should deemphasize short-term unidirectional engagement, and encourage extended experiences. International experiences must have clearly defined roles, clarified with pre-visit contracts and supervision of the experience to ensure students do not engage in medicine above their level of training. For any exchange, medical schools must provide pre-visit training that includes site-specific orientation and strategies for effective collaboration. Finally, medical schools must recruit faculty committed to developing equitable, long-term collaborations, and institutional promotion criteria must be aligned to encourage this work. An understanding and commitment to this lifelong practice can be fostered through medical school curricula that expose students to global health work that prioritizes equity in clinical work and research.

Uncovering the Overlap of Global and Domestic Rural Surgery for Medical Trainees

“…In developing these opportunities for medical students, institutions should be mindful of the lessons learned from global surgery to prevent medical tourism and promote sustainable development. 39 , 40 …”

What Do Global Health Practitioners Think about Decolonizing Global Health?

“…Many are student-initiated and student-led. There also are calls to address the issue in the medical school curriculum (and this could/should apply to other health sciences disciplines), which are discussed in detail by Eichbaum et al [ 21 ] and Garba et al [ 22 ].…”

“…Many are student-initiated and student-led. There also are calls to address the issue in the medical school curriculum (and this could/should apply to other health sciences disciplines), which are discussed in detail by Eichbaum et al[21] and Garba et al[22].Academic institutions with ongoing decolonizing initiatives include (but are not limited to) the Karolinska Institute, the School of Global Health at the University of Copenhagen, the Harvard TH Chan School of Public Health, the Decolonize Global Health Working Group at the University of Edinburgh, and the Duke Decolonizing Global Health student working group at Duke University. Many other medical schools and universities are beginning to address the issue in various ways (e.g., conferences, webinars, curriculum changes, etc.).…”

Global health educational trips: ethical, equitable, environmental?

“…More recent conceptualisations of global health also include local health, although shaped by global forces, with emphasis on marginalised communities and achieving health equity and justice for all1 2. In the wake of recent calls to decolonise global health2–6 and critical reflections of the current field of practice7–9, and the lifting of COVID-19 travel restrictions within many academic institutions, there is an imperative to reassess global health educational trips organised or initiated by high-income country (HIC) institutions from an ethical perspective. Meanwhile, due to the worsening climate crisis and the emergence of the concept of planetary health—a solution-orientated transdisciplinary field that envisions a healthy future for both humanity and the earth’s natural systems on which it depends10.…”