The ethics and safety of medical student global health electives

Abstract

ObjectivesTo explore and characterize the ethical and safety challenges of global health experiences as they affect medical students in order to better prepare trainees to face them.MethodsSemi-structured interviews were conducted with 23 Canadian medical trainees who had participated in global health experiences during medical school. Convenience and snowball sampling were utilized. Using Moustakas’s transcendental phenomenological approach, participant descriptions of ethical dilemmas and patient/trainee safety problems were analyzed. This generated an aggregate that illustrates the essential meanings of global health experience ethical and safety issues faced.ResultsWe interviewed 23 participants who had completed 38 electives (71%, n=27, during pre-clinical years) spend-ing a mean 6.9 weeks abroad, and having visited 23 countries. Sixty percent (n=23) had pre-departure training while 36% (n=14) had post-experience debriefing. Three macro-level themes were identified: resource disparities and provision of care; navigating clinical ethical dilemmas; and threats to trainee safety.ConclusionsMedical schools have a responsibility to ensure ethical and safe global health experiences. However, our findings suggest that medical students are often poorly prepared for the ethical and safety dilemmas they encounter during these electives. Medical students require intensive pre-departure training that will prepare them emotionally to deal with these dilemmas. Such training should include discussions of how to comply with clinical limitations.

Host perspective on academic supervision, health care provision and institutional partnership during short‐term electives in global health

“…• Lack of sustainability of their actions 8,9,14 • Handling of White privilege 8,9,15 • Precariousness of resources and support 9,13 • Performance of procedures beyond their skills 8,13,14 • Psychological and physical integrity 13,15 • Poor fit between projects and local needs 9,10,25,28,29 • Inequality in partnership 8,15,25,26,29 • Potential detriments to patient care 9,10,25,27 • Increased workload 27,29,30 • Power imbalance 25 • Apathy of trainees [29][30][31] • Lack of cultural sensitivity 26 • Imposed conception of health care 26 Beninese institutions. All interviews were face to face, recorded and subsequently transcribed.…”

“…For medical faculties, it is a way to attract potential candidates and improve their curriculum . Even though a substantial body of literature exists on the impact of such experiences, the vast majority offered the perspective of returning STEGH students without any substantiation from local supervisors . Moreover, researchers focused primarily on the benefits and challenges for students and rarely on the impact on local communities and organisations.…”

Illness and risk behaviour in health care students studying abroad

“…Pre-departure information should be specific and should relate to the destination and the nature of study planned. Some studies have addressed how to best prepare medical students for electives abroad with respect to educational objectives and ethical aspects, [4][5][6][7][8] and others have discussed how health risks [9][10][11][12] and risks for accidents 12,13 can be reduced in this group of students.…”

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations

“…While not formally evaluated in the global health setting, debriefing sessions after returning from the host country are used as a teaching method for international experiences. 42, 43 Bender et al provide a valuable review of the literature on debriefing as a learning tool and propose a structured approach to debriefing sessions specifically for global health experiences. 44 Resource needs and assets of the host country or site should be considered when designing activities for a G/I APPE.…”