How Should Academic Medical Centers Administer Students' “Domestic Global Health” Experiences?

Abstract

Academic medical centers (AMCs) promote educational benefits to students of immersive global health experiences (GHE), both abroad and locally in low-resource settings. Within the United States, these opportunities are called domestic GHEs and often take place in studentrun indigent care clinics (SRCs) that serve vulnerable populations. Domestic GHEs offer perspectives on the health care system that are similar to those of GHEs. In both, AMCs must balance benefits to students and patients against the potential risks of inadequate supervision and mentorship. This article reviews the roles of AMCs in preparing students for domestic GHEs with a focus on SRCs. "Domestic Global Health" Academic medical centers (AMCs) promote educational benefits to students of immersive global health experiences (GHE), both abroad and locally in low-resource settings. 1,2,3,4 GHE participants are more likely to pursue careers in primary care and other areas of medicine that focus on the needs of vulnerable patients. 5 GHEs are also highly valued by trainees. 6,7 Within the United States, these opportunities-which are called domestic GHEs-often take place in student-run indigent care clinics (SRCs), serve immigrant and other vulnerable populations, and are staffed by attending physicians who supervise medical trainees, including preclinical students who tend to be responsible for clinic management and organization. SRCs are popular because they offer students opportunities to gain early clinical experience with serving patients from diverse backgrounds 8 and to be exposed to systems-based perspectives on social status, public benefits eligibility, and health care financing that influence individuals' and populations' health status in the United States. 9 However, AMCs must balance benefits to students and patients against potential risks of inadequate supervision and mentorship. This article first describes SRCs and relevant guidelines for GHEs. The article then explores AMCs' roles in preparing students for domestic GHEs with a focus on ethical questions arising in SRC care settings.

Moving Toward Inclusion: Access to Care Models for Uninsured Immigrant Children

“…57,58,60,61,65 Merging medical education with charity care programs offers developmental opportunities and can also present ethical questions, including a demand for careful oversight of students. 66 However, partnerships between health systems and free clinics may create other challenges for both parties, including liability for health systems and decreased autonomy for free clinics.…”

Design of and outcomes in a student-run free mental health clinic serving the uninsured in East Harlem

“…Not yet able to establish their own independent practices, students gain hands-on, supervised clinical experience by providing care to individuals unable to afford treatment with established, more senior practitioners. Although these clinics provide valuable treatment services, ethical concerns remain about the quality of medical care provided to those without insurance and other vulnerable groups [ 10 ]. These concerns include the possibility that SRFCs benefit the trainees, who gain much-valued experience, at the expense of disadvantaged patient populations who have no or limited alternative options; because student-trainees are not as experienced and skilled as more advanced practitioners, there is potential risk that they provide lower-quality, perhaps even sub-standard, care to those they serve [ 11 ].…”