Perspectives and Solutions from Clinical Trainees and Mentors Regarding Ethical Challenges During Global Health Experiences

Abstract

Background: Clinical trainees face challenges throughout short-term experiences in global health (STEGH) that are not routinely addressed. Objectives: Describe common professional and ethical dilemmas faced by clinical trainees and identify gaps and solutions for pre, during, and post-STEGH training and mentoring. Methods: We conducted a mixed-methods study among trainees and mentors involved in global health. The study utilized focus groups with trainees (November-December 2015) and online surveys of trainees, in-country and stateside faculty mentors (October 2016-April 2017). Results: 85% (17/20) of students reported feeling prepared for their STEGH; however, 59% (23/39) of faculty felt students were unprepared. A majority of both students (90%) and faculty (77%) stated students would likely experience an ethical dilemma during STEGH. Major themes relating to meaningful global health work were elucidated: personal and inter-professional skills; interpersonal networks and collaboration; and awareness of power dynamics and bias. Conclusions: The most common challenges faced by trainees during STEGH related to leadership, bias, ethics and interprofessional collaboration. Redirecting trainee energies from a focus on 'doing' and deliverables to attitudes (e.g., humility, professionalism) that cultivate personal and professional growth will help create lifelong global health learners and leaders.

LMIC Research Centers’ Experiences Hosting U.S. and LMIC Trainees: Evaluation of the Fogarty Global Health Fellows and Scholars Program, 2012 to 2020

“…Other desirable qualities included understanding cultural effects on patient behavior, acknowledging patient barriers to accessing health care, and appreciating the role of local public health systems. Our findings are consistent with a recent mixed-methods study 22 of global health clinical trainees and their mentors that highlighted the importance of visiting trainees possessing key personal attributes of humility, respect, and flexibility.…”

Defining ethical challenge(s) in healthcare research: a rapid review

“…Of the 72 included records, 53 were empirical studies [ 34 – 86 ], 10 non-systematic reviews [ 87 – 96 ], 7 systematic reviews [ 12 – 14 , 97 – 100 ], 1 systematic review protocol [ 101 ], and 1 non-systematic review protocol [ 102 ]. Of the 53 empirical studies, 42 (79%) were qualitative studies [ 34 – 36 , 38 – 44 , 47 , 48 , 50 – 52 , 54 – 58 , 60 , 62 – 67 , 69 , 71 – 77 , 79 – 81 , 83 – 86 ], 6 (12%) used a mixed methods approach [ 45 , 46 , 53 , 59 , 61 , 68 ], and 5 (10%) were quantitative [ 37 , 49 , 70 , 78 , 82 ]. 7/56 empirical studies, all qualitative interview studies, recruited participants internationally with no specific location stated [ 40 , 54 , 55 , 58 , 60 , 63 , 73 ].…”

“…7/56 empirical studies, all qualitative interview studies, recruited participants internationally with no specific location stated [ 40 , 54 , 55 , 58 , 60 , 63 , 73 ]. Of the remaining studies, all but one were single-country studies: Botswana [ 75 ], Canada [ 41 , 65 ], China [ 57 ], Denmark [ 39 , 43 ], Dominican Republic [ 44 ], Germany [ 51 , 84 ], India [ 61 ], Iran [ 38 , 46 , 49 , 68 , 70 – 72 , 78 , 82 , 98 ], Italy [ 45 ], Mexico [ 87 ], the Netherlands [ 76 ], New Zealand [ 47 ], Norway [ 42 , 52 , 56 , 64 , 80 , 81 , 83 ], Saudi Arabia [ 34 – 37 ], Tanzania [ 69 , 74 ], Uganda [ 67 ], UK [ 86 ], and USA [ 50 , 53 , 59 , 62 , 66 , 77 , 79 , 85 , 85 ]. The remaining study was undertaken in both Sierra Leone and the UK [ 48 ].…”

Are Global Experiences During Medical School Associated with Future Medical Practice? A Cross-Sectional Analysis of Survey and Medical School Application Data

“…Global health electives during medical school may provide students the opportunity to learn from resourceful healthcare workers in often constrained systems; develop a deeper understanding of the barriers to healthcare, learn about public health systems in other countries, and contribute to research studies to address a high priority health problem in the population. Global health engagement has increased rapidly within both medical school and residency programs and the reported bene ts include improved medical knowledge, procedural skills, increased recognition of cost-effective practices and improvement in cultural competence (Kasper, J., 2020;Lu, P. M. et al, 2018). Graduates self-report a greater understanding of the social determinants of health, intentions to practice in rural settings, and a commitment to care for the medically underserved (Litzelman, D. K. et al, 2017).…”