A Global Health Elective for US Medical Students: The 35 Year Experience of the State University of New York, Downstate Medical Center, School of Public Health

Abstract

The School of Public Health at the State University of New York, Downstate Medical Center has sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purpose of this elective is to provide students with an opportunity to observe the health care and public health delivery systems in low-income countries, provide medical service and have a cross-cultural experience. Over the course of the past 35 years, 388 students have participated in this global health elective in more than 41 low-income countries. The most popular sites include the Dominican Republic, Guatemala, India, Kenya and Thailand. Overall, interest in this elective has persisted throughout the course of time, sometimes temporarily increasing or decreasing with outside factors, such as the events of 11 September 2001 and the outbreak of Severe Acute Respiratory Syndrome in Asia. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews has resulted in the selection of highly mature, adaptable and dedicated students who have performed well at overseas sites. Student rated satisfaction levels with this elective are almost universally high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to their travel overseas, including a review of individual health and safety issues, travel and lodging, and the nature of the host country culture, health care system and assignment site. Downstate medical students are especially experienced in cross-cultural understanding because of the unusual diversity of the patient population in Brooklyn, and the diversity of local hospital staff and the medical school class. The Alumni Fund of the College of Medicine has steadfastly supported this elective with both a philosophical commitment and financial grants to help defray costs since the very early years. The Dr. Michael and Lona B. Kennéy Endowment, the Joshua H. Weiner endowment, and the LSK Foundation have also provided financial support for this elective. Throughout the course of this elective, overseas preceptors have willingly given of their time and institutional resources to make these experiences available and meaningful for our students.

Global Health Career Interest among Medical and Nursing Students: Survey and Analysis

“…This is consistent with another study of US medical students, which found that a 1-week trip was sufficient to stimulate students' interest in GH and encourage future longer-term efforts. 16,26 However, care should be taken when interpreting this finding. Although increasing GHE duration may not translate directly into increased GH interest, GHEs serve various purposes aside from simply stimulating student interest in GH careers.…”

“…However, this finding contrasts with another study wherein increasing age was associated with decreasing GH interest. 15 The difference in these findings may result from population differences-Nathan et al 15 studied OB/GYN residents rather than medical/nursing students 16 -and it may be that as health care train-ees progress to these more advanced stages of training, increasing age becomes a restricting factor in one's GH interest because of an increased focus on clinical medicine and career development. Direct comparisons with this study are further limited because their questionnaire addressed interest in a GH elective and perceived GH importance rather than GH career interest.…”

“…Many educational institutions provide funding for students to undertake GHEs, which may have offset the financial burden of GH travel for some students who completed our survey. 8,16 Also, the socalled global health tax, which suggests that a clinical career involving GH comes with financial and other sacrifices, may also play a role. 21 For instance, research has found that young adults from wealthier backgrounds feel high levels of "achievement pressures," which in American society is often associated with financial success.…”

The benefits of international health experiences for Australian and New Zealand medical education

“…In medicine specifically, there is consistent evidence for the educational and personal benefits of IHEs in both pre‐certification and early post‐practice settings, as well as their broader value for the health care system. A number of qualitative and quantitative evaluations, including those comparing medical students who have undertaken IHEs with those who have not, have shown the positive impact of IHEs on personal consultation, clinical and diagnostic skills; 3 , 9 , 10 significantly higher average scores in the preventive medicine and public health portions of the National Board of Medical Examiners assessments; 11 and a greater appreciation of the importance of public health, health service delivery and cross‐cultural communication 3 , 9 . ‐ 12 Further, an increased appreciation of the role of primary care and the importance of addressing the unmet needs of under‐served communities is demonstrated by the career destinations of these graduates 3 , 10 …”

“…3,[9][10][11][12] Further, an increased appreciation of the role of primary care and the importance of addressing the unmet needs of under-served communities is demonstrated by the career destinations of these graduates. 3,10 Many global student experiences take place between two developed countries. While these IHEs have advantages in terms of risk minimisation for students, they can limit the potential benefits that might present with experiences in developing countries.…”