A Pilot Curriculum in International Surgery for Medical Students

Exploration of Global Health Careers Across the Medical Fields

“…Moreover, different medical and surgical specialties lend themselves to different models of involvement in GH and might therefore restrict faculty perspectives to their own area of practice. 1,8 These challenges should be addressed and accounted for in the conceptualization of a framework for advising undergraduate medical students who plan to pursue GH careers.…”

The ethical experiences of trainees on short-term international trips: a systematic qualitative synthesis

“…Both described having felt like a medical tourist because of their relatively minimal contributions within the host community.” [23]Negative view of short-term trips[23, 38]“...the majority of participants described the IHE in negative terms.” [23]Awareness of sustainability[22, 23, 31–35, 40]“One student noted, “I believe it is unethical to perform a procedure or provide treatment, then leave without ensuring that adequate medical expertise remains to deal with any complications that arise.” [33]Concerns that short-term trips are neo-colonialist or exploitiveSub-codes• Fear of imposing Western values• Concerns about exploitation• Concerns with vulnerable populations[1, 22, 23]“[W]hen you’re really looking out for your own interests and there’s a huge power and economic differential … there’s a potential for exploitation, and … if you’re not really able to know the local interests, there’s a potential for doing harm.” [1]“They were also anxious not to adopt ‘a paternalistic view of “I know better than you because I come from this more developed country”’. One respondent reported that he ‘really did not want to be remembered as one of these people that come in and impose their values and their experiences’.” [22]Lack of ethical issues[35, 37]“A total of 32% of the programs interviewed reported having no ethical questions or situations.” [35]Theme 2: Struggling to Identify and Balance the Benefits and Harms of STINTTsPerceived benefit (or lack thereof) to community[1, 22, 23, 30, 32, 34, 35, 38, 39]“...seven students also perceived that they had a positive effect on the communities they served, by providing clinical care for patients…” [1]“For some reason we thought that we could go over there and [help] these people from a medical point of view but we only had classroom learning…So when people ask about my experience I always try to discourage [medical students] from doing observerships because you can’t really contribute.” [38]Perceived harms to community[1, 22, 23, 32, 35–38]“Although some host supervisors denied the occurrence of any harm, others expressed concern that international elective students may negatively impact the local community in terms of resource use and pat...…”

“…The wards are filled with HIV/TB patients, who are coughing” (Medicine Physician). [31]Theme 3: The Complicated Trainee Mens (mind)Emotional or moral distress• Sub-code: Debriefing—reflection or discussion[1, 22, 23, 30–32, 34, 36–39]“Trainees felt that GHEs presented ethical and psychological challenges, often as a consequence of resource disparity. Trainees primarily experienced guilt when unable to provide care to everyone.…”

The Potential Impact of Morality on Medical Student Global Health Participation

“…Myriad positive outcomes for GHE learners have been identified, including improved confidence with the history and physical exam, heightened cross-cultural awareness, greater appreciation for preventive services, and an increased disposition to care for the medically underserved (Bruno, Imperato, & Szarek, 2014;Jeffrey, Dumont, Kim, & Kuo, 2011;Thompson, Huntington, Hunt, Pinsky, & Brodie, 2003). Accordingly, students pursue GHEs for educationally practical reasons: to learn to care for patients in low resource environments, build collaborative relationships with international organizations, and integrate global health into their future careers (Leow et al, 2012;Moren et al, 2015). domains of 'local community,' 'all Americans,' and/or 'all humanity' and how this association might inform abroad participation.…”