• 1.

    Nelson B, Izadnegahdar R, Hall L, Lee PT , 2012. Global health fellowships: a national, cross-disciplinary survey of US training opportunities. J Grad Med Educ 4: 184189.

    • Search Google Scholar
    • Export Citation
  • 2.

    Melby MK, Loh LC, Evert J, Prater C, Lin H, Khan OA , 2016. Beyond medical “missions” to impact-driven short-term experiences in global health (STEGHs): ethical principles to optimize community benefit and learner experience. Acad Med 91: 633638.

    • Search Google Scholar
    • Export Citation
  • 3.

    Association of American Medical Colleges , 2012. Matriculating Student Questionnaire: 2012 All Schools Summary Report. Available at: https://www.aamc.org/data-reports/students-residents/report/matriculating-student-questionnaire-msq.

  • 4.

    Kerry VB, Ndung’u T, Walensky RP, Lee PT, Kayanja VF, Bangsberg DR , 2011. Managing the demand for global health education. PLoS Med 8: e1001118.

  • 5.

    Drain PK, Holmes KK, Skeff KM, Hall TL, Gardner P , 2009. Global health training and international clinical rotations during residency: current status, needs, and opportunities. Acad Med 84: 320325.

    • Search Google Scholar
    • Export Citation
  • 6.

    Merson MH, Page C , 2009. The Dramatic Expansion of University Engagement in Global Health: Implications for US Policy: A Report by the CSIS Global Health Policy Center. Washington, DC: Center for Strategic and International Studies.

  • 7.

    Macfarlane SB, Jacobs M, Kaaya EE , 2008. In the name of global health: trends in academic institutions. J Public Health Policy 29: 383401.

    • Search Google Scholar
    • Export Citation
  • 8.

    Lu PM, Park EE, Rabin TL, Schwartz JI, Shearer LS, Siegler EL, Peck RN , 2018. Impact of global health electives on US medical residents: a systematic review. Ann Glob Health 84: 692703.

    • Search Google Scholar
    • Export Citation
  • 9.

    Mutchnick IS, Moyer CA, Stern DT , 2003. Expanding the boundaries of medical education: evidence for cross-cultural exchanges. Acad Med 78: S1S5.

    • Search Google Scholar
    • Export Citation
  • 10.

    Miller WC, Corey GR, Lallinger GJ, Durack DT , 1995. International health and internal medicine residency training: the Duke University experience. Am J Med 99: 291297.

    • Search Google Scholar
    • Export Citation
  • 11.

    Monroe-Wise A, Kibore M, Kiarie J, Nduati R, Mburu J, Drake FT, Bremner W, Holmes K, Farquhar C , 2014. The Clinical Education Partnership Initiative: an innovative approach to global health education. BMC Med Educ 14: 1043.

    • Search Google Scholar
    • Export Citation
  • 12.

    Sawatsky AP, Rosenman DJ, Merry SP, McDonald FS , 2010. Eight years of the Mayo International Health Program: what an international elective adds to resident education. Mayo Clin Proc 85: 734741.

    • Search Google Scholar
    • Export Citation
  • 13.

    Smilkstein G, Culjat D , 1990. An international health fellowship in primary care in the developing world. Acad Med 65: 781.

  • 14.

    Haq C, Rothenberg D, Gjerde C, Bobula J, Wilson C, Bickley L, Cardelle A, Joseph A , 2000. New world views: preparing physicians in training for global health work. Fam Med 32: 566572.

    • Search Google Scholar
    • Export Citation
  • 15.

    Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ , 2003. Educational effects of international health electives on U.S. and Canadian medical students and residents: a literature review. Acad Med 78: 342347.

    • Search Google Scholar
    • Export Citation
  • 16.

    Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P , 2007. Global health in medical education: a call for more training and opportunities. Acad Med 82: 226230.

    • Search Google Scholar
    • Export Citation
  • 17.

    Keating EM, Haq H, Rees CA, Swamy P, Turner TL, Marton S, Sanders J, Mohapi EQ, Kazembe PN, Schutze GE , 2019. Reciprocity? International preceptors’ perceptions of global health elective learners at African sites. Ann Glob Health 85: 37.

    • Search Google Scholar
    • Export Citation
  • 18.

    Lukolyo H, Rees CA, Keating EM, Swamy P, Schutze GE, Marton S, Turner TL , 2016. Perceptions and expectations of host country preceptors of short-term learners at four clinical sites in sub-Saharan Africa. Acad Pediatr 16: 387393.

    • Search Google Scholar
    • Export Citation
  • 19.

    Stone GS, Olson KR , 2016. The ethics of medical volunteerism. Med Clin North Am 100: 237246.

  • 20.

    Wall A , 2011. The context of ethical problems in medical volunteer work. HEC Forum 23: 7990.

  • 21.

    DeCamp M, Lehmann LS, Jaeel P, Horwitch C , 2018. Ethical obligations regarding short-term global health clinical experiences: an American College of Physicians position paper. Ann Intern Med 168: 651657.

    • Search Google Scholar
    • Export Citation
  • 22.

    Shah S, Wu T , 2008. The medical student global health experience: professionalism and ethical implications. J Med Ethics 34: 375378.

  • 23.

    Lahey T , 2012. Perspective: a proposed medical school curriculum to help students recognize and resolve ethical issues of global health outreach work. Acad Med 87: 210215.

    • Search Google Scholar
    • Export Citation
  • 24.

    Raine SP , 2017. Ethical issues in education: medical trainees and the global health experience. Best Pract Res Clin Obstet Gynaecol 43: 115124.

    • Search Google Scholar
    • Export Citation
  • 25.

    Crump JA, Sugarman J, Working Group on Ethics Guidelines for Global Health T , 2010. Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg 83: 11781182.

    • Search Google Scholar
    • Export Citation
  • 26.

    Suchdev P, Ahrens K, Click E, Macklin L, Evangelista D, Graham E , 2007. A model for sustainable short-term international medical trips. Ambul Pediatr 7: 317320.

    • Search Google Scholar
    • Export Citation
  • 27.

    Mills J, Bonner A, Francis K , 2006. The development of constructivist grounded theory. Int J Qual Methods 5: 2535.

  • 28.

    Charmaz K , 2014. Constructing Grounded Theory. Thousand Oaks, CA: Sage Publications.

  • 29.

    Corbin J, Strauss A , 2014. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage Publications.

  • 30.

    Denzin NK, Lincoln YS , 2008. Collecting and interpreting qualitative materials. Thousand Oaks, CA: Sage Publications.

  • 31.

    Mezirow J , 2003. Transformative learning as discourse. J Transform Educ 1: 5863.

  • 32.

    Campbell SM, Ulrich CM, Grady C , 2016. A broader understanding of moral distress. Am J Bioeth 16: 29.

  • 33.

    Epstein EG, Hamric AB , 2009. Moral distress, moral residue, and the crescendo effect. J Clin Ethics 20: 330342.

  • 34.

    Elobu AE, Kintu A, Galukande M, Kaggwa S, Mijjumbi C, Tindimwebwa J, Roche A, Dubowitz G, Ozgediz D, Lipnick M , 2014. Evaluating international global health collaborations: perspectives from surgery and anesthesia trainees in Uganda. Surgery 155: 585592.

    • Search Google Scholar
    • Export Citation
  • 35.

    Pinto AD, Upshur RE , 2009. Global health ethics for students. Developing World Bioeth 9: 110.

  • 36.

    DeCamp M, Kalbarczyk A, Manabe YC, Sewankambo NK , 2019. A new vision for bioethics training in global health. Lancet Glob Health 7: e1002e1003.

    • Search Google Scholar
    • Export Citation
  • 37.

    Hall-Clifford R, Addiss DG, Cook-Deegan R, Lavery JV , 2019. Global health fieldwork ethics: mapping the challenges. Health Hum Rights 21: 15.

    • Search Google Scholar
    • Export Citation
  • 38.

    Schroeder DA, Stephens E, Colgan D, Hunsinger M, Rubin D, Christopher MS , 2018. A brief mindfulness-based intervention for primary care physicians: a pilot randomized controlled trial. Am J Lifestyle Med 12: 8391.

    • Search Google Scholar
    • Export Citation
  • 39.

    Guillemin M, Gillam L , 2015. Emotions, narratives, and ethical mindfulness. Acad Med 90: 726731.

  • 40.

    Crump JA, Sugarman J , 2008. Ethical considerations for short-term experiences by trainees in global health. JAMA 300: 14561458.

  • 41.

    Radstone S , 2005. Practising on the poor? Healthcare workers’ beliefs about the role of medical students during their elective. J Med Ethics 31: 109110.

    • Search Google Scholar
    • Export Citation
  • 42.

    Harris H , 1998. Medical students’ electives abroad. Some care is better than none at all. BMJ 317: 1528.

  • 43.

    Doobay-Persaud A, Evert J, DeCamp M, Evans CT, Jacobsen KH, Sheneman NE, Goldstein JL, Nelson BD , 2019. Extent, nature and consequences of performing outside scope of training in global health. Global Health 15: 60.

    • Search Google Scholar
    • Export Citation
  • 44.

     Elansary M, Provenzano AM, Barry M, Khoshnood K, Rastegar A, 2011. Ethical dilemmas in global clinical electives. The Columbia University Journal of Global Health 1: 24–27.

  • 45.

    Provenzano AM, Graber LK, Elansary M, Khoshnood K, Rastegar A, Barry M , 2010. Short-term global health research projects by US medical students: ethical challenges for partnerships. Am J Trop Med Hyg 83: 211214.

    • Search Google Scholar
    • Export Citation
  • 46.

    Iserson KV, Biros MH, James Holliman C , 2012. Challenges in international medicine: ethical dilemmas, unanticipated consequences, and accepting limitations. Acad Emerg Med 19: 683692.

    • Search Google Scholar
    • Export Citation
  • 47.

    McCarthy J, Deady R , 2008. Moral distress reconsidered. Nurs Ethics 15: 254262.

  • 48.

    Blackhall LJ, Murphy ST, Frank G, Michel V, Azen S , 1995. Ethnicity and attitudes toward patient autonomy. JAMA 274: 820825.

  • 49.

    Beyene Y , 1992. Medical disclosure and refugees. Telling bad news to Ethiopian patients. West J Med 157: 328332.

  • 50.

    DeCamp M, Rodriguez J, Hecht S, Barry M, Sugarman J , 2013. An ethics curriculum for short-term global health trainees. Global Health 9: 5.

  • 51.

    Asao S, Lewis B, Harrison JD, Glass M, Brock TP, Dandu M, Le P , 2017. Ethics Simulation in Global Health Training (ESIGHT). MedEdPORTAL 13: 10590.

  • 52.

    Jacobs ZG, Tittle R, Scarpelli J, Cortez K, Aptekar SD, Shamasunder S , 2019. Reflective practices among global health fellows in the HEAL Initiative: a qualitative study. J Gen Intern Med 34: 521522.

    • Search Google Scholar
    • Export Citation
  • 53.

    Harrison JD, Logar T, Le P, Glass M , 2016. What are the ethical issues facing global-health trainees working overseas? A multi-professional qualitative study .Healthcare (Basel) 4: 43.

    • Search Google Scholar
    • Export Citation
  • 54.

    Bozinoff N, Dorman KP, Kerr D, Roebbelen E, Rogers E, Hunter A, O’Shea T, Kraeker C , 2014. Toward reciprocity: host supervisor perspectives on international medical electives. Med Educ 48: 397404.

    • Search Google Scholar
    • Export Citation
  • 55.

    Kung TH, Richardson ET, Mabud TS, Heaney CA, Jones E, Evert J , 2016. Host community perspectives on trainees participating in short-term experiences in global health. Med Educ 50: 11221130.

    • Search Google Scholar
    • Export Citation
  • 56.

    Kraeker C, Chandler C , 2013. “We learn from them, they learn from us”: global health experiences and host perceptions of visiting health care professionals. Acad Med 88: 483487.

    • Search Google Scholar
    • Export Citation
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American Medical Trainee Perspectives on Ethical Conflicts during a Short-Term Global Health Rotation in Ethiopia: A Qualitative Analysis of 30 Cases

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  • 1 Department of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland;
  • | 2 Department of Medicine, Emory University School of Medicine, Atlanta, Georgia;
  • | 3 Emory University Rollins School of Public Health, Atlanta, Georgia;
  • | 4 Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia;
  • | 5 Emory Center for Ethics, Atlanta, Georgia;
  • | 6 Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia;
  • | 7 Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;
  • | 8 Department of Pediatric Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;
  • | 9 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta Georgia
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ABSTRACT.

There has been a significant increase in the number of students, residents, and fellows from high-income settings participating in short-term global health experiences (STGHEs) during their medical training. This analysis explores a series of ethical conflicts reported by medical residents and fellows from Emory University School of Medicine in the United States who participated in a 1-month global health rotation in Ethiopia. A constant comparative analysis was conducted using 30 consecutive reflective essays to identify emerging categories and themes of ethical conflicts experienced by the trainees. Ethical conflicts were internal; based in the presence of the visiting trainee and their personal interactions; or external, occurring due to witnessed events. Themes within internal conflicts include issues around professional identity and insufficient preparation for the rotation. External experiences were further stratified by the trainee’s perception that Ethiopian colleagues agreed that the scenario represented an ethical conflict (congruent) or disagreed with the visiting trainee’s perspective (incongruent). Examples of congruent themes included recognizing opportunities for collaboration and witnessing ethical conflicts that are similar to those experienced in the United States. Incongruent themes included utilization of existing resources, issues surrounding informed consent, and differing expectations of clinical outcomes. By acknowledging the frequency and roots of ethical conflicts experienced during STGHEs, sponsors may better prepare visiting trainees and reframe these conflicts as collaborative educational experiences that benefit both the visiting trainee and host providers.

Author Notes

Address correspondence to Chelsea Modlin, Johns Hopkins University School of Medicine, 1830 E. Monument St., #450B, Baltimore, MD 21205. Email: cmodlin2@jh.edu

Financial support: This research was funded by the Alanna Stone Memorial “Firestarter” Award for Global Health Research, an internal funding source through the Emory University Department of Internal Medicine. Research in this publication was also supported in part by Imagine, Innovate and Impact (I3) Funds from the Emory School of Medicine and through Georgia Clinical & Translational Science Alliance National Institutes of Health award (UL1-TR002378).

Authors’ addresses: Chelsea E. Modlin, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, E-mail: cmodlin2@jh.edu. Andrea Vilorio and Dawn Comeau, Rollins School of Public Health, Emory University, Atlanta, GA, E-mails: vilorioandrea@gmail.com and dcomeau@emory.edu. Benjamin Stoff, Department of Dermatology, Emory University School of Medicine, and Emory Center for Ethics, Atlanta, GA, E-mail: bstoff@emory.edu. Tewodros H. Gebremariam, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, E-mail: drtewodroshaile@gmail.com. Miliard Derbew, Department of Pediatric Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, E-mail: milliardderbew@gmail.com. Henry Blumberg, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, E-mail: hblumbe@emory.edu. Carlos del Rio, Emory School of Medicine and Grady Health System; Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, and Hubert Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, E-mail: cdelrio@emory.edu. Russell R. Kempker, Department of Internal Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, E-mail: rkempke@emory.edu.

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