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;
  • | 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

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 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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