The ethics and safety of medical student global health electives

Evelyn M. Dell1, Lara Varpio2, Andrew Petrosoniak1, Amy Gajaria3 and Anne E. McCarthy4

1Department of Medicine, Emergency Medicine, University of Toronto, Toronto, Canada

2Department of Medicine, University of Ottawa, Academy for Innovation of Medical Education, Canada

3Department of Medicine, Psychiatry, University of Toronto, Canada

4Department of Medicine, Infectious Disease/Global Health, University of Ottawa, Canada

Submitted: 17/12/2013; Accepted: 27/03/2014; Published: 10/04/2014

Int J Med Educ. 2014; 5:63-72; doi: 10.5116/ijme.5334.8051

© 2014 Evelyn M. Dell et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0

Objectives: To explore and characterize the ethical and safety challenges of global health experiences as they affect medical students in order to better prepare trainees to face them.

Methods: Semi-structured interviews were conducted with 23 Canadian medical trainees who had participated in global health experiences during medical school. Convenience and snowball sampling were utilized. Using Moustakas's transcendental phenomenological approach, participant descriptions of ethical dilemmas and patient/trainee safety problems were analyzed. This generated an aggregate that illustrates the essential meanings of global health experience ethical and safety issues faced.

Results: We interviewed 23 participants who had completed 38 electives (71%, n=27, during pre-clinical years) spending a mean 6.9 weeks abroad, and having visited 23 countries. Sixty percent (n=23) had pre-departure training while 36% (n=14) had post-experience debriefing. Three macro-level themes were identified: resource disparities and provision of care; navigating clinical ethical dilemmas; and threats to trainee safety.

Conclusions: Medical schools have a responsibility to ensure ethical and safe global health experiences. However, our findings suggest that medical students are often poorly prepared for the ethical and safety dilemmas they encounter during these electives. Medical students require intensive pre-departure training that will prepare them emotionally to deal with these dilemmas. Such training should include discussions of how to comply with clinical limitations.