142nd APHA Annual Meeting and Exposition

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Evolution of ‘medical missions' into short-term experiential education in global health: Implications for learners and practitioners

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 3:30 PM - 3:45 PM

Lawrence Loh, MD, MPH, CCFP, FRCPC , Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Jessica Evert, MD , Child Family Health International, San Francisco, CA
Omar Khan, MD, MHS, FAAFP , Associate Vice Chair, Department of Family & Community Medicine, Christiana Care Health System, Wilmington, DE
Melissa Melby, PhD , Department of Anthropology, University of Delaware, Newark, DE
Christopher Prater, MD , Medicine-Pediatrics, Christiana Care Health System, Newark, DE
Henry C. Lin, MD , Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
Audio (mp3) recording Recorded Presentation (mp4)
Purpose
Increasing demand for global health (GH) education in medical training has fuelled the growth of GH educational programs predicated on a model of short-term medical service abroad. Such efforts, despite positive intent, might worsen global health inequities and cause harm. Educators must increasingly retool such experiences into academically informed, multi-disciplinary efforts. We examine the current state of short-term GH education and provide recommendations for their improvement.

Data and methods
Synthesis and discussion of a structured review of published literature on short-term GH experiences and examination of successful archetypes of GH programs.

Results
Literature suggests that nearly half (45%) of graduating medical students had global health experiences during training, with participation continuing into residency and early careers. Various types of opportunities are offered by academic medical institutions, non-profit organisations, community groups, and unstructured, ad-hoc groups. Despite increasing calls for responsible participation, only a limited number of opportunities appeared to be competency-based. Many such programs also occur in the current context of shrinking support from hospitals and institutions, ethical concerns, and a greater recognition of other disciplines (e.g. public health and anthropology) that need to be incorporated to ensure impact and sustainability.

Recommendations
Contemporary participation growing out of the historical "medical missions" context continues to evolve. Four core principles to guide ethical development of GH educational experiences must be: sustainability; bi-directional relationships; an upstream, multidisciplinary focus; and cultural competency / humility. It is critical that GH electives responsibly balance training level and personal competencies, medical and cross-cultural ethics, and educational objectives.

Learning Areas:

Ethics, professional and legal requirements
Other professions or practice related to public health
Public health or related education

Learning Objectives:
Discuss factors driving increasing participation in short-term global health educational experiences by healthcare and public health trainees Describe the origins, history and evolution of short-term global health educational experiences over the past century List core principles in a framework to guide the ethical development of short-term global health educational experiences

Keyword(s): International Health, Teaching

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Previous experience in presenting on this topic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3368.0: Global health in medical education