Developing Ethical and Sustainable Global Health Educational Exchanges for Clinical Trainees: Implementation and Lessons Learned from the 30-Year Academic Model Providing Access to Healthcare (AMPATH) Partnership

Abstract

Introduction Short Term Experiences in Global Health (STEGHs) are a popular and well-acknowledged valuable component of medical education. Thirty-one percent of United States (US) medical students graduating in 2015 had a global health experience during medical school, up from 15% in 1998 [1]. A growing number of trainees in U.S. residency programs are interested in global health as well, prompting an increase in global health education and international opportunities during postgraduate training [2-5]. However, there are significantly fewer opportunities for trainees from low-and middle-income countries (LMICs) to travel to clinical sites other than their own compared to the opportunities for trainees from North America [6-10]. Moreover, when providers from low-and middle-income countries do have clinical experiences in the US, they are typically limited to observation, unlike the frequent hands-on learning when the situation is reversed [38]. "Global health" can be both all-encompassing and vague. Consistent with the Alma Ata declaration, we use "global health" to mean health for all, regardless of location or ethnicity [39]. Global health may or may not include aspects of international medicine, tropical medicine, and public health, but must include a focus on the wellbeing of all aspects of the human experience (physical, social, environmental, spiritual) and be concerned with how health is achieved, with an emphasis on social determinants of health, health disparities, and transnational health solutions [40]. "Global health experiences" in our academic context indicate a dedicated focus on the health of a population different from one's usual setting. For North American (NA) trainees, "global health" rotations, therefore, are typically in a low-income setting-either domestic or international. For trainees from low-and middleincome countries, "global health" electives indicate an experience either in a different low-income setting or in a higher-income setting such as NA or Europe.

Increasing diversity in genomics requires investment in equitable partnerships and capacity building

“…The most critical communication usually happened in person, initially precipitated by tough conversations about what needed to take place and resulting requirements. NeuroGAP-Psychosis and GINGER could be further enriched by more consultation with other longstanding training programs that exist among some of our collaborating institutions 20 .…”

Reciprocal innovation: a new approach to equitable and mutually beneficial global health research and partnerships

“…In partnership with the Kenyan Government, AMPATH serves a population of 8 million people across western Kenya at more than 500 clinical sites, with comprehensive care programs in HIV/AIDS, oncology, chronic diseases, and maternal child health, among others, and pioneering population health and community-based approaches to care [29]. The partnership facilitates bilateral exchanges for Kenyan and North American faculty, residents, and students, and leverages academic partnerships to build critical clinical and research infrastructure in Kenya, train global health researchers, and conduct research to improve the health of under-served populations in Kenya and globally [30][31][32].…”

Global Health Education in the Time of COVID-19: An Opportunity to Restructure Relationships and Address Supremacy

“… 7 This program, which is in its 15th year and has expanded to incorporate participants from other U.S. institutions, is structured according to a framework of 4 global health ethics principles (introspection, humility, solidarity, and social justice) 8 that are useful in guiding conversations about partnership equity. Examples of other HIC–LMIC academic partnerships that have similar goals with respect to building equitable relationships include the Academic Model Providing Access to Healthcare 9 and the Toronto Addis Ababa Academic Collaboration. 10 For those who seek additional guidance, Adams et al 11 provide a set of core components for equitable HIC–LMIC GHE and practice partnerships, including the presence of: interdisciplinary teams that work together in a respectful and open collaborative manner; shared leadership; explicit, shared goals; the LMIC partner as the driver of partnership priorities, the research agenda, and program management; and prioritization of the education of LMIC trainees over HIC trainees.…”