Adopting an Ethical Approach to Global Health Training

Abstract

Global health training opportunities for medical students and residents have proliferated in recent years. These short-term elective rotations allow trainees to learn about global health issues by participating in various aspects of education and health care in resource-limited settings. Recently published consensus-based ethical guidelines have suggested considerations for the design of international electives that address the activities of host and sending sites, visiting students and residents, and sponsors.The authors analyze the value of global health training opportunities for medical students, residents, faculty, host and sending institutions, and other stakeholders from the perspective of the Botswana-University of Pennsylvania Partnership, a program that has provided global health experiences for health care trainees for more than 10 years. Drawing from the Working Group on Ethics Guidelines for Global Health Training framework, they illustrate the ethical and logistical challenges faced by the program's organizers and the solutions that they implemented alongside their host site partners. They conclude with a summary of recommendations to guide implementation of ethically sound international health electives in resource-limited settings.

Healthy, safe and effective international medical student electives: a systematic review and recommendations for program coordinators

“…The extent to which sending institutions are involved in the organization and supervision of electives ranges from programs where students themselves organize just about everything, to robust and well-funded global health partnerships between medical schools and hospitals in high and low- and middle-income countries, respectively [ 24 , 25 ]. Whatever the model, written and regularly updated policies and guidelines should be in place, and readily available to students.…”

“…Inform students of their responsibilities (Table 3 ). [ 3 , 24 , 27 , 42 , 49 ] Consider creating a detailed webpage for the program, to be kept up-to-date and embedded with an institutional site. [ 15 , 16 ] Assess all elective applications on the basis of personal risk and educational merit.…”

“… [ 21 , 27 , 32 , 41 ] Inform students of medical indemnity, public liability and personal protection insurance provisions for electives. [ 27 ] Policies should be created in collaboration with host institutions, particularly where formal partnerships are being forged [ 24 ] Policies need to be implemented and a degree of compliance achieved by both elective program coordinators and students. [ 85 ] Travel advisories Consider elective destinations in the light of national travel advisories and be prepared to deal with unexpected changes in risk status.…”

“… [ 85 ] Travel advisories Consider elective destinations in the light of national travel advisories and be prepared to deal with unexpected changes in risk status. [ 24 , 32 ] Ensure that students travelling to higher-risk destinations have sought pre-travel health advice and have purchased travel insurance. [ 5 , 21 , 32 , 49 ] Instruct students to register with institutional travel registries.…”

Introducing a Trauma Registry in Mozambique: An Ethics Case Study

“…The primary objective of any global health partnership, whether clinical or developmental in nature, should ensure a long-term and sustainable outlook. [15]- [17] based on the following principles:…”