AM Rounds

Beyond the pages of Academic Medicine, journal of the AAMC

Journal Club: April 2013

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by David J. Roesel MD, MPH, Clinical Associate Professor, Dept. of Medicine, University of Washington

“We Learn From Them, They Learn From Us”: Global Health Experiences and Host Perceptions of Visiting Health Care Professionals

Christian Kraeker, MD, FRCPC, MSc, DTM&H, and Clare Chandler, MSc, PhD

About Global Health Experiences and Host Perceptions

The past decade has shown a rapid rise in the numbers of students and faculty at medical institutions in North America and Europe engaging in training and teaching in under-resourced countries. However, these “global health” experiences are generally created to meet the needs and interests of the visitors, rather than those of the host institutions or communities. There is little published research on the impact of these programs, except for a small number of papers exploring the influence they have on the participants. Little is known about how foreign visitors affect the patients, institutions, and communities where they go to learn and teach.

Article Summary

Kraeker and Chandler have published what they believe to be the first qualitative research study evaluating how health professionals and medical students from affluent countries are perceived by their colleagues in the developing country where they have gone to learn or teach. The study was conducted at the University of Namibia School of Medicine by a pair of researchers from London and Ontario. The authors conducted semi-structured interviews with nine individuals about their experiences with visiting health care professionals, and analyzed the transcripts to identify key themes. Three main narratives emerged:

  • Visitors’ lack of understanding or respecting the local culture and context was a source of frustration
  • Study participants felt they were inadequately involved in deciding who could come to their institution and what their activities should be
  • Despite these criticisms, there was an eagerness to continue sharing their culture, country, and health care model with visitors, and to work to build stronger and more equal partnerships

The authors discuss the implications of these findings for building mutually beneficial partnerships.

Questions

  1. How might the findings of this study have been different had it been carried out by a Namibian researcher?
  2. What are some ways in which visiting health care professionals to low income countries might negatively impact the patients, institutions, or communities where they are going to teach or study?
  3. What are the implications of this study for creating more mutually beneficial partnerships between academic institutions in developed and developing countries?
  4. Should academic institutions require that an ethical oversight board review educational exchanges to developing countries, analogous to what is required for research programs?
  5. What additional research should be conducted on this topic, and how should it be carried out?

Further reading

Crump JA  and Sugarman J. Ethical Considerations for Short-term Experiences by Trainees in Global Health. JAMA.  2008; 300: 1456-1458.

Crump JA, Sugarman J; Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg. 2010; 83: 1178–1182.

Holland T and Holland A. First, Do No Harm: A Qualitative Research Documentary. 2011. [VIDEO - downloaded from Vimeo.]

Kolars JC, Cahill K, Donkor P, et al. Perspective: Partnering for Medical Education in Sub-Saharan Africa: Seeking the Evidence for Effective Collaborations. Acad Med. 2012;87:216–220.

Lahey T. Perspective: A Proposed Medical School Curriculum to Help Students Recognize and Resolve Ethical Issues of Global Health Outreach Work. Acad Med. 2012; 87: 210–215.

Pinto AD and Upshur RE. Global Health Ethics for Students. Developing World Bioethics.  2009; 9: 1–10.

Wall, A. The Context of Ethical Problems in Medical Volunteer Work. HEC Forum. 2011; 23: 79–90.

White MT and Cauley KL. A Caution against Medical Student Tourism. Virtual Mentor. 2006; 8: 851-4.

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