Global health electives: Ethical engagement in building global health capacity

Abstract

Increasingly, medical trainees are seeking global health electives (GHEs) as part of their medical education. However, little is known about the impact medical trainees undertaking global health electives have on host institutions, staff, local trainees, patients or communities in low-and middle-income countries. The goal of this study was to explore the relationship dynamics associated with global health electives as perceived by stakeholders at three sites in sub-Saharan Africa. More specifically, I examined stakeholder perspectives in Mwanza, Tanzania and Mbarara and Rugazi, Uganda where the University of Calgary Cumming School of Medicine (CSM) has long-standing institutional collaborations. In this case-based interpretive phenomenological study, thirty-four host stakeholders (health facility administrators, physicians, clinical officers, registrars, nurses, and community liaison members) participated in semistructured interviews and twenty-eight host stakeholders (medical students, residents, interns, and patients) participated in focus groups. Participant experiences were described using interpretive phenomenological analysis techniques. The findings revealed that although GHEs are well-established and a common experience for host stakeholders there are many indistinct aspects which are poorly understood by host stakeholders. Participants acknowledged that there are a variety of benefits they gain because of GHEs, but overall visiting medical trainees benefit the most from this unique learning opportunity. Despite reluctance to directly admit to harms, host stakeholders described significant challenges and burdens of GHEs and recommended ways in which GHEs could be improved to ensure that the relationships they depend on are mutually beneficial and equitable. One of the main recommendations from this study is that to work towards an equitable, effective, and ethical elective, GHEs should occur between collaborating institutions with a bidirectional focus.

Global Health Training Collaborations: Lessons Learned and Best Practices

“…There is a growing interest in longer term partnerships to create mutual benefit from collaborations between institutions from higher income countries and lower income countries. 9,17,18 These longer term partnerships are consistent with a global effort to recruit, train, and retain health workers where they are needed. 17,[19][20][21] The Working Group on Ethics Guidelines for Global Health Training (WEIGHT) ethics and best practice guidelines were created to support collaborative partnerships in meeting global health training needs.…”

“…7,8,25,33 Standardizing preparation across the various training programs and global health partnerships could improve our collective ability to meet both training program goals and host community needs in a way that enhances sustainability. 18 There continues to be a need to understand which practices work in global health practice and training for meeting shared goals. As groups clarify global health competencies for training institutions, 34 attention needs to be paid to meeting the needs of communities globally and locally.…”

“…8,12,[22][23][24][25] Programs that are sending their trainees have difficulty monitoring the learning environment for ethical practice and for fostering local sustainability. 18 Conversely, hosts may find it difficult to lead priority setting endeavors, such as identifying visitor projects or community needs. Managing hospitality expectations inherent to hosting visitors while also ensuring that associated costs are covered without using limited local funds to support visiting partners can be challenging.…”

Taking Pause: A COVID-19 Student Reflection on Global Health Research Opportunities, Training, and Institutional Reform

“…GHRE encompasses the governance of research practices, ethical principles, and moral integrity in global health research. It is a necessary safeguard for global health research because harm still occurs even when well-intentioned researchers follow the proper ethical review processes and have well-established research partnerships ( Yassi et al, 2013 ; De Visser et al, 2020 ; Nyirenda et al, 2020 ).…”

Assessment of research ethics education offerings of pharmacy master programs: a qualitative content analysis

“…were previously reported to exist in the ethics guidelines and regulations of countries in low and middle 325 income countries in the Middle East and Africa [26,27]. A study by Hayder et al under the former National Bioethics Advisory Commission surveyed health researchers in developing countries to explore issues related to the IRB review.…”