What Are the Ethical Issues Facing Global-Health Trainees Working Overseas? A Multi-Professional Qualitative Study

Abstract

The aim of this study was to identify global health ethical issues that health professional trainees may encounter during electives or placements in resource-limited countries. We conducted a qualitative study involving focus groups and an interview at the University of California San Francisco. Participants were multi-professional from the Schools of Medicine, Nursing and Pharmacy and had experience working, or teaching, as providers in resource-limited countries. Eighteen participants provided examples of ethical dilemmas associated with global-health outreach work. Ethical dilemmas fell into four major themes relating to (1) cultural differences (informed consent, truth-telling, autonomy); (2) professional issues (power dynamics, training of local staff, corruption); (3) limited resources (scope of practice, material shortages); (4) personal moral development (dealing with moral distress, establishing a moral compass, humility and self awareness). Three themes (cultural differences, professional issues, limited resources) were grouped under the core category of “external environmental and/or situational issues” that trainees are confronted when overseas. The fourth theme, moral development, refers to the development of a moral compass and the exercise of humility and self-awareness. The study has identified case vignettes that can be used for curriculum content for global-health ethics training.

Parental Preference Assessment for Vesicoureteral Reflux Management in Children

“…Our enrollment number compares with similar qualitative studies, which interviewed 17–18 individuals. 11, 12 Qualitative studies’ sample sizes are typically much smaller than for quantitative studies because we need just one occurrence of each common construct. The median age of patients at initial VUR consultation was 18 months (IQR 10–36).…”

Reflections on Study Abroad: Insights from Registered Nurses

“…Exposure to poverty and health care inequities was emotionally upsetting for some participants. Nursing students in other SA programs in low-resource countries have similarly reported the need to negotiate ethical dilemmas (Harrison et al, 2016). With guidance, examination of such ethical issues can lead to transformational learning through critically examining own assumptions and considering other perspectives, including the realities of the host context (Caldwell & Purtzer, 2014).…”

Developing and validating learning domains, competencies, and evaluation items for global health clinical immersion practicums for graduate‐level nursing programs

“…Accepted principles of global health initiatives, especially those for student learners, began to emerge. These principles, which include early partnership between host and university personnel (Chavez et al, 2010;Middleton et al, 2014;Powell, Gilliss, Hewitt, & Flint, 2010), evidence of measurable sustainability goals (Loiseau et al, 2016;Melby et al, 2015) and rigorous predeployment orientation for students (Cherniak et al, 2017;Harrison, Logar, Le, & Glass, 2016), began to thread through global health curricula. From these principles, eight graduate-level learning domains were derived.…”