Almost 20% of United States (U.S.) Graduate Medical Education (GME) programs offer some global health experience during training and short-term experiences in global health (STEGH) are available in most disciplines.1,2 Often, trainees from high-income countries may be asked to and perform outside of their typical scope of practice during STEGH.3 Although various pre-departure training programs exist4, challenges remain in providing trainees with the tools to navigate the ethics and implications of their clinical work and address affronts to personal scope of practice when applied to STEGH.
It is imperative to develop and assess training curricula that encourage trainees to evaluate their own personal scope of clinical skills and leverage ethical frameworks for decision-making to guide future clinical practice during STEGH, because without adequate training, harm may come to trainees, host institutions, and patients.
Many trainees enter GME programs having already participated in STEGH5,6 and twenty percent of all U.S. GME programs offer some global health experience,1,2 although this varies by specialty.1,7,8,9 These opportunities also vary widely in terms of duration, clinical activities, supervision, and pre-departure training.10
While the experiential benefits are well-documented for high income country (HIC) participants,10,11,12 risks can occur sending unprepared participants to resource-limited settings (RLS).13,14,15 These risks involve the participants, the patients they are intending to serve, and the STEGH partnership.16 Risks include inappropriate or harmful patient care, ineffective resource utilization, and undermining local health infrastructure.17,18,19
In part, these risks arise from a mismatch between the participants’ medical knowledge, skills, and behaviors and local expectations of these.20,21,22 This is exacerbated by training typical to HICs. Trainees based in HICs often receive highly specialized training and can develop a scope of clinical practice that is narrower than their peers practicing in resource-limited settings (RLS) typically encountered during STEGH. When HIC trainees rotate in these settings, they often report feeling pressure to perform beyond their scope of practice3,21,23 or experience difficulties managing care with unfamiliar and often fewer resources.13 Trainees must have tools to deal with these pressures unique to STEGH to ensure safety.
Pre-departure training varies across institutions and can include online modules, lectures, and case-based simulation sessions that teach clinical content and skills. High-quality pre-departure training, particularly about ethics, should be provided within HIC institutions and should be standard of practice for all global health trainees, as global health work poses unique ethical challenges.15 Innovative simulation curricula focus on emotional and social needs of the trainees.10,24,25 Ethics Simulation in Global Health Training (ESIGHT) is a high-technology simulation training focusing on common dilemmas and how to safely navigate care and avoid patient harm.26
The Northwestern University (NU) McGaw Global Health Clinical Scholars (GHCS) program is a selective interdisciplinary program supporting GME trainees with interest in global health. The program consists of lectures, mentored projects, and on-site rotations at partner institutions. In 2015, an ethics simulation curriculum adapted from ESIGHT was developed to address the unique challenges faced in global health work, including navigating the dilemma of practicing outside scope of training. Concurrently, a skills curriculum was created for trainees reviewing surgical and anesthesia (Surg/Anes) and obstetrics and gynecology (ObG) clinical skills addressing RLS content and challenged individual trainee comfort and understanding of their scope of practice. Here we discuss the content and evaluation of this curriculum.