The complex relationships involved in global health: a qualitative description

BMC Medical Education

Lara Varpio¹  Andrew Petrosoniak³  Anne E McCarthy² 

[1] Academy for Innovation of Medical Education, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, K1H 8M5 Ottawa, ON, Canada;Office of Global Health, Faculty of Medicine, University of Ottawa, 451 Smyth Road, K1H 8M5 Ottawa, ON, Canada;Emergency Medicine Residency Program, Division of Emergency Medicine, University of Toronto, 2075 Bayview Ave, M4N 3M5 Ontario, Canada

关键词: Medical education;    Trainees;    Global health;   

Others  :  1138659
DOI  :  10.1186/1472-6920-13-136

 received in 2013-02-15, accepted in 2013-09-06,  发布年份 2013

【 摘 要 】

Background

Growing numbers of medical trainees now participate in global health experiences (GHEs) during their training. To enhance these experiences we sought to explore expectations inherent in the relationships between GHE stakeholder groups.

Methods

20 open-ended, semi-structured interviews probed participant perceptions and assumptions embedded in GHEs. A fundamental qualitative descriptive approach was applied, with conventional content analysis and constant comparison methods, to identify and refine emerging themes. Thematic structure was finalized when saturation was achieved. Participants all had experience as global health participants (10 trainees, 10 professionals) from an urban, academic, Canadian medical centre.

Results

We identified three stakeholder groups: participants (trainees and professionals), host communities, and sponsoring institutions. During interviews, four major themes emerged: (i) cultural challenges, (ii) expectations and perceptions, (iii) relationships and communication, and (iv) discordant objectives. Within each theme, participants recurrently described tensions existing between the three stakeholder groups.

Conclusions

GHE participants frequently face substantial tensions with host communities and sponsoring agencies. Trainees are particularly vulnerable as they lack experience to navigate these tensions. In the design of GHEs, the needs of each group must be considered to ensure that benefits outweigh potential harms. We propose a conceptual model for developing educational objectives that acknowledge all three GHE stakeholder groups.

【 授权许可】

   
2013 McCarthy et al.; licensee BioMed Central Ltd.

【 图 表 】

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Figure 2.

【 参考文献 】

• [1]Brewer TF, Saba N, Clair V: From boutique to basic: a call for standardised medical education in global health. Med Educ 2009, 43(10):930-933.
• [2]Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P: Global health in medical education: a call for more training and opportunities. Acad Med 2007, 82(3):226-230.
• [3]Eckhert NL: Getting the most out of medical students' global health experiences. Ann Fam Med 2006, 4(Suppl 1):S38-39. discussion S58-60
• [4]Epstein RM: Assessment in medical education. N Engl J Med 2007, 356(4):387-396.
• [5]Houpt ER, Pearson RD, Hall TL: Three domains of competency in global health education: recommendations for all medical students. Acad Med 2007, 82(3):222-225.
• [6]Ramsey AH, Haq C, Gjerde CL, Rothenberg D: Career influence of an international health experience during medical school. Fam Med 2004, 36(6):412-416.
• [7]Banatvala N, Doyal L: Knowing when to say "no" on the student elective. Students going on electives abroad need clinical guidelines. BMJ 1998, 316(7142):1404-1405.
• [8]Edwards R, Piachaud J, Rowson M, Miranda J: Understanding global health issues: are international medical electives the answer? Med Educ 2004, 38(7):688-690.
• [9]Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ: Educational effects of international health electives on U.S. and Canadian medical students and residents: a literature review. Acad Med 2003, 78(3):342-347.
• [10]Petrosoniak A, McCarthy A, Varpio L: International health electives: thematic results of student and professional interviews. Med Educ 2010, 44(7):683-689.
• [11]Elit L, Hunt M, Redwood-Campbell L, Ranford J, Adelson N, Schwartz L: Ethical issues encountered by medical students during international health electives. Med Educ 2011, 45(7):704-711.
• [12]Sharafeldin E, Soonawala D, Vandenbroucke JP, Hack E, Visser LG: Health risks encountered by Dutch medical students during an elective in the tropics and the quality and comprehensiveness of pre-and post-travel care. BMC Med Educ 2010, 10:89.
• [13]Dowell J, Merrylees N: Electives: isn't it time for a change? Med Educ 2009, 43(2):121-126.
• [14]Shah S, Wu T: The medical student global health experience: professionalism and ethical implications. J Med Ethics 2008, 34(5):375-378.
• [15]Bozorgmehr K, Schubert K, Menzel-Severing J, Tinnemann P: Global health education: a cross-sectional study among German medical students to identify needs, deficits and potential benefits (part 1 of 2: mobility patterns & educational needs and demands). BMC Med Educ 2010, 10:66.
• [16]Haq C, Rothenberg D, Gjerde C, Bobula J, Wilson C, Bickley L, Cardelle A, Joseph A: New world views: preparing physicians in training for global health work. Fam Med 2000, 32(8):566-572.
• [17]Drain PK, Holmes KK, Skeff KM, Hall TL, Gardner P: Global health training and international clinical rotations during residency: current status, needs, and opportunities. Acad Med 2009, 84(3):320-325.
• [18]Developing global health curricula: A guidebook for US medical schools. [http://globalhealthedu.org/PublicDocs/Developing%20GH%20Curricula_Guidebook%20for%20US%20Medical%20Schools.pdf webcite]
• [19]Battat R, Seidman G, Chadi N, Chanda MY, Nehme J, Hulme J, Li A, Faridi N, Brewer TF: Global health competencies and approaches in medical education: a literature review. BMC Med Educ 2010, 10:94.
• [20]McKinley DW, Williams SR, Norcini JJ, Anderson MB: International exchange programs and U.S. medical schools. Acad Med 2008, 83(10 Suppl):S53-57.
• [21]Grudzen CR, Legome E: Loss of international medical experiences: knowledge, attitudes and skills at risk. BMC Med Educ 2007, 7:47.
• [22]Suchdev PS, Shah A, Derby KS, Hall L, Schubert C, Pak-Gorstein S, Howard C, Wagner S, Anspacher M, Staton D, et al.: A proposed model curriculum in global child health for pediatric residents. Acad Pediatr 2012, 12(3):229-237.
• [23]Riner ME: Globally engaged nursing education: an academic program framework. Nurs Outlook 2011, 59(6):308-317.
• [24]Sandelowski M: Whatever happened to qualitative description? Res Nurs Health 2000, 23(4):334-340.
• [25]Kuzel A: Sampling in qualitative inquiry. In Doing qualitative research. Edited by Crabtree B, Miller W. Thousand Oaks: Sage Publications; 1999:33-45.
• [26]Charmaz K: Grounded theory: objectivist and constructivist methods. In Handbook of qualitative research. 2nd edition. Edited by Denzin N, Lincoln Y. Thousand Oaks, CA: Sage Publications, Inc; 2000.
• [27]Charmaz K: Constructing Grounded Theory: A practical guide through qualitative analysis. Thousand Oaks, California: Sage Publications; 2006.
• [28]Maxwell JA: Understanding and validity in qualitative research. Harv Educ Rev 1992, 62(3):279-300.
• [29]Hsieh HF, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res 2005, 15(9):1277-1288.
• [30]Wendland CL: Moral maps and medical imaginaries: clinical tourism at Malawi's college of medicine. Am Anthropol 2012, 114(1):108-122.
• [31]Crump JA, Sugarman J: Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg 2010, 83(6):1178-1182.
• [32]Anderson KC, Slatnik MA, Pereira I, Cheung E, Xu K, Brewer TF: Are we there yet? Preparing Canadian medical students for global health electives. Acad Med 2012, 87(2):206-209.
• [33]Howard CR, Gladding SP, Kiguli S, Andrews JS, John CC: Development of a competency-based curriculum in global child health. Acad Med 2011, 86(4):521-528.
• [34]Glaser B, Strauss A: The Discovery of Grounded Theory: Strategies for qualitative research. Piscataway, NJ: Transaction Publishers; 1967.