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Heist BS, Torok HM, Michael Elnicki D. Effective Clinical Externships for International Medical Students: A Qualitative Study. J Gen Intern Med 2024:10.1007/s11606-024-09082-1. [PMID: 39358499 DOI: 10.1007/s11606-024-09082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 09/24/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND International student exchanges are a significant part of medical education, and experiences of North American and European medical students abroad have been extensively examined. By contrast, knowledge of visiting medical students in the United States (US) is limited largely to surveys of administrators and course directors. OBJECTIVE To understand US attending physicians' thoughts on visiting international student clinical externships. DESIGN AND PARTICIPANTS Three clinician-educator physician focus groups were conducted across two US medical schools with broad representation of training backgrounds, clinical disciplines, and career stages. Focus groups and constant comparison analysis of transcripts were performed iteratively to identify emerging themes. MAIN MEASURES Qualitative themes and subthemes. KEY RESULTS Two main themes emerged from the data: (1) administrative requirements for success: hosting international students requires careful planning and coordination, which is daunting amidst demanding faculty responsibilities. Externships must address experiences of the people directly involved in the clinical setting, leadership, communication, and institutional, financial, physical, and personnel resources. (2) Impact of student qualities: When working with international students, the importance of administrative details and student characteristics increases due to higher student variability overall, inconsistent language and cultural fluency, and the consequent recognition of the student as an ambassador for their home institution and country. CONCLUSIONS Amidst already busy schedules, clinician educators identify the hosting of international medical students as a commitment resembling that for their own trainees. Linguistic and cultural distances, and the overall variability of international students amplify the importance of effective administration. The findings have influenced related processes at the University of Pittsburgh.
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Affiliation(s)
- Brian S Heist
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | | | - D Michael Elnicki
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Amick E, Naanyu V, Bucher S, Henry BW. Perceptions of Global Health Engagements in Relation to the COVID-19 Pandemic Among Kenyan Health Care Workers and Administrators in Western Kenya: Protocol for Multi-stage Qualitative Study. JMIR Res Protoc 2023. [PMID: 37315197 PMCID: PMC10365599 DOI: 10.2196/41836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND There has been significant interest in global health in low- and middle-income countries (LMICs) among individuals living in high-income countries (HICs) over the past 30 years. Much of the literature on global health engagements (GHEs) has been presented from the perspective of individuals from HIC participants. Local stakeholders such as health care workers and health care administrators represent critical constituencies for global health activities, yet their perspectives are under-represented in the literature. The purpose of this study is to examine local health worker and administrator experiences with GHEs in Kenya. We will explore the perceived role GHEs play in preparing the health system to address a public health crisis, as well as their role in pandemic recovery and its aftermath. OBJECTIVE The aim of this study is to 1) examine how Kenyan health care workers and administrators interpret experiences with global health engagements as having advantaged or hindered them and the local health system to provide care during an acute public health crisis and 2) to explore recommendations to reimagine GHEs in a post-pandemic Kenya. METHODS This study will be conducted at a large teaching and referral hospital in western Kenya, with a long history of hosting GHEs in support of its tripartite mission of providing care, training, and research. This qualitative study will be conducted in three phases. In Phase 1, in-depth interviews (IDIs) will be conducted to capture participants' lived experience in relation to their unique understandings of the pandemic, GHEs, and the local health system. In Phase 2, group discussions, using nominal group technique (NGTs) will be conducted to determine potential priority areas to reimagine future GHEs. In Phase 3, IDIs will be conducted to explore these priority areas in greater detail to explore potential recommendations for potential strategies, policies, and other actions that might be employed to achieve the priorities determined to be of highest importance. RESULTS Study activities will commence late summer 2022, with findings to be published in 2023. It is anticipated that findings from this study will provide insight into the role GHEs play in a local health system in Kenya, and provide critical stakeholder and partner input, from persons hitherto ignored in the design, implementation, and management of GHEs. CONCLUSIONS This qualitative study will examine perspectives of global health engagements in relation to the COVID-19 pandemic among Kenyan health care workers and health care administrators in western Kenya using a multi-stage protocol. Using a combination of in-depth interviews and nominal group techniques this study aims to shed light on the roles global health activities are perceived to play in preparing health care professionals and the health system to address an acute public health crisis. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT PRR1-10.2196/41836.
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Affiliation(s)
- Erick Amick
- College of Health and Human Sciences, Northern Illinois University, DeKalb, US
- Susan and Richard Kiphart Center for Global Health and Social Development, Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E 60th st, Chicago, US
| | - Violet Naanyu
- School of Public Health, Moi University, Eldoret, KE
| | - Sherri Bucher
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, US
| | - Beverly W Henry
- College of Health and Human Sciences, Northern Illinois University, DeKalb, US
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Quaglio G, Nsubuga JB, Maziku D, Tsegaye A, Parise N, Cavagna C, Lochoro P, Strepparava MG, Dalt LD, Okori S, Gatta A, Kamunga AM, Putoto G. International medical electives in Sub-Saharan Africa: experiences from a 19-year NGO-driven initiative. BMC MEDICAL EDUCATION 2023; 23:184. [PMID: 36973742 PMCID: PMC10041499 DOI: 10.1186/s12909-023-04154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Mainstream medical education remains largely focused on national health issues. Therefore, in order to expose medical students to international health issues, it is beneficial to facilitate international medical electives. METHODS This article describes the Junior Project Officer (JPO) program, a medical experience based on clinical electives in Sub-Saharan Africa, supported by a Non-Governmental Organisation (NGO). Residents spend 6 months as part of a multidisciplinary medical team in Africa. A post-elective online survey was administered to all who participated in the program in the period 2002-2020. The questionnaire comprised three domains: (i) general and pre-departure information; (ii) the experience; (iii) the post-experience. RESULTS Questionnaires were received from 157/241 subjects, a response rate of 65%. The most common specialties were pediatrics, public health, and internal medicine. Of all, 87% carried out clinical activities; 45% also worked in the management of health services, and 60% carried out research activities. About 64% reported difficulties linked to a lack of equipment, different ways of working (57%), and exposure to situations for which they did not feel technically prepared (56%). In 25% of cases, residents reported that their school's attitude to their doing the elective was not positive: upon their return, over 50% felt that their experience was not sufficiently valued by their institution. Respondents considered the experience important for professional and personal growth (93% and 80% respectively ). Forty-two participants (27%) reported that the experience had a significant impact on their future career choices. CONCLUSION Despite the difficulties encountered, a well-structured experience in international health can have a positive impact on residents, professionally and personally. Key factors behind the positive outcomes are the substantial length (6 months) of the experience, and the long term working relationships between the sending and receiving institutions. The schools in Italy that provide the students for the electives need to see more evidence that international electives are worth the investment.
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Affiliation(s)
- Gianluca Quaglio
- Medical Preparedness and Crisis Management Unit (MPCMU), Directorate-General for Personnel, European Parliament, Rue Wiertz, 60, B-1047, Brussels, Belgium.
- Operational Research Unit, Doctors with Africa Cuamm, Padova, Italy.
| | | | - Donald Maziku
- Tosamaganga Hospital, Iringa, United Republic of Tanzania
| | | | - Nicoletta Parise
- Department of Statistical Sciences, Padova University, Padova, Italy
| | - Chiara Cavagna
- Operational Research Unit, Doctors with Africa Cuamm, Padova, Italy
| | | | - Maria Grazia Strepparava
- Clinical Psychology Unit, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Liviana Da Dalt
- Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | - Alessandra Gatta
- Operational Research Unit, Doctors with Africa Cuamm, Padova, Italy
| | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa Cuamm, Padova, Italy
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Versluis MAC, Jöbsis NC, Jaarsma ADC, Tuinsma R, Duvivier R. International Health Electives: defining learning outcomes for a unique experience. BMC MEDICAL EDUCATION 2023; 23:157. [PMID: 36922810 PMCID: PMC10015142 DOI: 10.1186/s12909-023-04124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND An International Health Elective (IHE) can be a unique learning experience for students. However, it has proven difficult to clearly define learning outcomes that capture the complexity of an IHE and are aligned with future professional performance. This study aimed to further define learning outcomes for IHEs in low- to middle-income countries (LMIC) from a student perspective. METHODS We conducted a deductive analysis of pre-departure and post-elective reflective reports of fifth-year medical students who participated in an IHE as part of their program. This provided possible learning objectives that were further explored in semi-structured individual interviews with medical students who had recently returned from an IHE. RESULTS We analyzed 33 reports of students participating in an IHE from 2017-2019 and held 19 interviews. Thematic analysis revealed 9 themes: developing intercultural competence, developing appreciation for differences in health care delivery systems, understanding international health, understanding the global burden of disease, developing a career perspective, developing clinical skills in resource low settings, becoming cost conscious, developing social responsibility and self-actualization. CONCLUSIONS We identified 9 learning outcomes that are directly and indirectly related to clinical practice. They add to the on-going discourse on the benefits of IHEs. These outcomes can be further developed by investigating the perspectives of home and host supervisors and educationalists, while taking the local context into account. Follow-up studies can evaluate to what extend these outcomes are achieve during an IHE.
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Affiliation(s)
- M A C Versluis
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, PO Box 30001, 9700RB, Groningen, the Netherlands.
- Rijksuniversiteit Groningen, Faculteit der Medische Wetenschappen, Groningen, the Netherlands.
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong learning, Education and Assessment Research Network (LEARN), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - N C Jöbsis
- Faculty of Medical Sciences, University Medical Center Groningen, Groningen, the Netherlands
| | - A D C Jaarsma
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong learning, Education and Assessment Research Network (LEARN), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - R Tuinsma
- International Office, Wenckebach Institute for Education and Training, University Medical Center Groningen, Groningen, the Netherlands
| | - R Duvivier
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong learning, Education and Assessment Research Network (LEARN), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Parnassia Psychiatric Institute, The Hague, the Netherlands
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Stone SL, Moore JN, Tweed S, Poobalan AS. Preparation, relationship and reflection: Lessons for international medical electives. J R Coll Physicians Edinb 2022; 52:95-99. [DOI: 10.1177/14782715221103406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: International medical electives (IMEs) provide opportunities for global health education within undergraduate medical curricula; however, ethical and practical preparations vary. Methods: Single-centre, prospective, mixed-methods study, utilising online questionnaires with students and host supervisors, contemporaneous reflective diaries and focus groups, to explore the preparedness and experiences of final-year UK medical students undertaking IMEs. Results: Students experienced communication challenges and felt underprepared prior to IME. Students undervalued cultural preparation, whereas host supervisors primarily desired humility and cultural sensitivity. Visitors to high-income countries underpredicted cultural differences with reflective practice supporting understanding of global health inequalities. Burden on hosts and ethical dilemmas related to acting beyond competence remained significant concerns. Discussion: International medical electives provide experiential learning, and with authentic reflection facilitate professional development. Enhanced culturally competent preparation and debriefing is however essential for collaborative and responsible student learning. Acting beyond competency persists, requiring concerted reform during the pandemic-mandated hiatus of IMEs.
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Affiliation(s)
- Stephanie L Stone
- Institute for Education in Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jolene N Moore
- Institute for Education in Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Sam Tweed
- Institute for Global Health, University College London, London, UK
| | - Amudha S Poobalan
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Quaglio G, Maziku D, Bortolozzo M, Parise N, Di Benedetto C, Lupato A, Cavagna C, Tsegaye A, Putoto G. Medical Electives in Sub-Saharan Africa: A 15-Year Student/NGO-Driven Initiative. J Community Health 2022; 47:273-283. [PMID: 34762223 PMCID: PMC8582340 DOI: 10.1007/s10900-021-01045-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 10/26/2022]
Abstract
Medical schools are developing global health programmes, and medical students are requesting global health training and creating opportunities when these are not provided by medical schools. This article described the Wolisso Project (WP), a medical experience on clinical electives in Sub-Saharan Africa, driven by a collaboration between a student organisation and a Nongovernmental Organization (NGO). Preclinical medical students spent 4 weeks as part of a multidisciplinary medical team in Africa. Post-elective questionnaires were administered to all subjects who participated in the project. Of all, 141 students responded to the questionnaire. The participants came from 30 Italian universities. The main difficulties reported are due to the lack of resources for the exercise of the medical activity, and difficulties related to language and communication. The African experience had a positive impact on the progress of the studies upon return, with an increase in determination and motivation. The experience had also positive influences on the future professional choices and carriers. The experience seems to contribute not only to the professional growth, but also to the personal development. A key factor in the positive outcomes of this experience is it being implemented by an NGO with long-term working relationships with the African populations. Another is that the project is carried out in health facilities where NGO staff have been working for a long time. These factors reduce the potential risks connected with this type of experience. They ensure a satisfactory level of supervision, the lack of which has been a serious problem in many similar experiences. A well-structured, mentored experience in international health can have a positive impact on preclinical students' attitudes, including their compassion, volunteerism, and interest in serving underserved populations. Only a small number of Italian universities facilitate pre-graduate medical elective experiences in LMICs. The WP seems to be attempting to compensate for the lack of international experience in LMICs offered by universities. Italian medical schools should incorporate changes in their curricula to train socially responsible physicians.
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Affiliation(s)
- Gianluca Quaglio
- European Parliamentary Research Services, (EPRS), European Parliament, Rue Wiertz, 60, B-1047, Brussels, Belgium.
- Operational Research Unit, Doctors with Africa-Cuamm, Padua, Italy.
- Department of International Health, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), University of Maastricht, Maastricht, The Netherlands.
| | - Donald Maziku
- Tosamaganga Council Designated Hospital, Iringa, United Republic of Tanzania
| | | | - Nicoletta Parise
- Department of Statistical Sciences, Padua University, Padova, Italy
| | | | - Alice Lupato
- Italian Medical Students Association (SISM), Padova, Italy
| | - Chiara Cavagna
- Operational Research Unit, Doctors with Africa-Cuamm, Padua, Italy
| | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa-Cuamm, Padua, Italy
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Lu PM, Mansour R, Qiu MK, Biraro IA, Rabin TL. Low- and Middle-Income Country Host Perceptions of Short-Term Experiences in Global Health: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:460-469. [PMID: 33298696 DOI: 10.1097/acm.0000000000003867] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Stakeholders have expressed concerns regarding the impact of visiting trainees and physicians from high-income countries (HICs) providing education and/or short-term clinical care in low- and middle-income countries (LMICs). This systematic review aimed to summarize LMIC host perceptions of visiting trainees and physicians from HICs during short-term experiences in global health (STEGH). METHOD In September 2018 then again in August 2020, the authors searched 7 databases (PubMed, Embase, Scopus, Web of Science, ERIC, Cochrane Library, Global Index Medicus) for peer-reviewed studies that described LMIC host perceptions of STEGH. They extracted information pertaining to study design, participant demographics, participant perceptions, representation of LMICs and HICs, and HIC visitors' roles and used thematic synthesis to code the text, develop descriptive themes, and generate analytical themes. RESULTS Of the 4,020 studies identified, 17 met the inclusion criteria. In total, the studies included 448 participants, of which 395 (88%) represented LMICs. The authors identified and organized 42 codes under 8 descriptive themes. They further organized these descriptive themes into 4 analytical themes related to STEGH: (1) sociocultural and contextual differences, (2) institutional and programmatic components, (3) impact on host institutions and individuals, and (4) visitor characteristics and conduct. CONCLUSIONS STEGH can have both beneficial and detrimental effects on LMIC host institutions and individuals. The authors translated these findings into a set of evidence-based best practices for STEGH that provide specific guidance for LMIC and HIC stakeholders. Moving forward, LMIC and HIC institutions must work together to focus on the quality of their relationships and create conditions in which all stakeholders feel empowered to openly communicate to ensure equity and mutual benefit for all parties.
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Affiliation(s)
- Paul M Lu
- P.M. Lu is assistant professor, Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-7519-9689
| | - Rania Mansour
- R. Mansour is a first-year medical student, St. George's, University of London, London, United Kingdom; ORCID: http://orcid.org/0000-0002-2822-5645
| | - Maylene K Qiu
- M.K. Qiu is systematic review coordinator, Biomedical Library, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-6912-3733
| | - Irene A Biraro
- I.A. Biraro is senior lecturer, Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; ORCID: http://orcid.org/0000-0002-8303-6046
| | - Tracy L Rabin
- T.L. Rabin is associate professor of medicine and director, Office of Global Health, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut; ORCID: http://orcid.org/0000-0002-4829-9051
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Perspectives and Solutions from Clinical Trainees and Mentors Regarding Ethical Challenges During Global Health Experiences. Ann Glob Health 2020; 86:34. [PMID: 32257834 PMCID: PMC7101005 DOI: 10.5334/aogh.2721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Clinical trainees face challenges throughout short-term experiences in global health (STEGH) that are not routinely addressed. Objectives Describe common professional and ethical dilemmas faced by clinical trainees and identify gaps and solutions for pre, during, and post-STEGH training and mentoring. Methods We conducted a mixed-methods study among trainees and mentors involved in global health. The study utilized focus groups with trainees (November-December 2015) and online surveys of trainees, in-country and stateside faculty mentors (October 2016-April 2017). Results 85% (17/20) of students reported feeling prepared for their STEGH; however, 59% (23/39) of faculty felt students were unprepared. A majority of both students (90%) and faculty (77%) stated students would likely experience an ethical dilemma during STEGH. Major themes relating to meaningful global health work were elucidated: personal and inter-professional skills; interpersonal networks and collaboration; and awareness of power dynamics and bias. Conclusions The most common challenges faced by trainees during STEGH related to leadership, bias, ethics and interprofessional collaboration. Redirecting trainee energies from a focus on 'doing' and deliverables to attitudes (e.g., humility, professionalism) that cultivate personal and professional growth will help create lifelong global health learners and leaders.
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Wenlock RD, Bath MF, Bashford T, Kohler K, Hutchinson PJ. The global variation of medical student engagement in teaching: Implications for medical electives. PLoS One 2020; 15:e0229338. [PMID: 32092102 PMCID: PMC7039511 DOI: 10.1371/journal.pone.0229338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 02/04/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION International medical electives, whereby undergraduates visit an institution in a country other than their own, are a common part of medical training. Visiting students are often asked to provide local teaching, which may be acceptable where the visitor is acting within the bounds of their own competency and the normal practices of both their home and host institutions. However, the extent to which teaching is an accepted student activity globally has not previously been described. This study aims to address this using an international survey approach. METHODS A voluntary electronic survey, created using the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) framework, was distributed across established international medical student networks. This assessed the involvement of medical students in teaching and the educator training they receive, with the intention of comparing experiences between high-income countries (HICs) and low/middle-income countries (LMICs) to gauge the engagement of both "host" and "visiting" students. RESULTS 443 students from 61 countries completed the survey, with an equal proportion of respondents from LMICs (49.4%, 219/443) and HICs (50.6%, 224/443). Around two thirds of students reported providing teaching whilst at medical school, with most reporting teaching numerous times a year, mainly to more junior medical students. There was with no significant difference between LMICs and HICs. Around 30 per cent of all medical students reported having received no teacher training, including 40 per cent of those already providing teaching. CONCLUSION This study suggests that students are engaged in teaching globally, with no difference between HIC and LMIC contexts. However, students are underprepared to act as educators in both settings. Providing teaching as part of an elective experience may be ethically acceptable to both host and home institutions, but needs to be supported by formal training in delivering teaching.
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Affiliation(s)
- Rhys D. Wenlock
- NIHR Global Health Research Group on Neurotrauma, Cambridge, England, United Kingdom
- School of Clinical Medicine, University of Cambridge, Cambridge, England, United Kingdom
- * E-mail:
| | - Michael F. Bath
- NIHR Global Health Research Group on Neurotrauma, Cambridge, England, United Kingdom
- Centre for Neuroscience, Surgery and Trauma, Queen Mary University of London, London, England, United Kingdom
| | - Tom Bashford
- NIHR Global Health Research Group on Neurotrauma, Cambridge, England, United Kingdom
- Division of Anaesthesia, Cambridge Biomedical Campus, Addenbrooke's Hospital, NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, England, United Kingdom
| | - Katharina Kohler
- NIHR Global Health Research Group on Neurotrauma, Cambridge, England, United Kingdom
- Division of Anaesthesia, Cambridge Biomedical Campus, Addenbrooke's Hospital, NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, England, United Kingdom
| | - Peter J. Hutchinson
- NIHR Global Health Research Group on Neurotrauma, Cambridge, England, United Kingdom
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, England, United Kingdom
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McMahon D, Shrestha R, Karmacharya B, Shrestha S, Koju R. The international medical elective in Nepal: perspectives from local patients, host physicians and visiting students. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2019; 10:216-222. [PMID: 31760382 PMCID: PMC7246114 DOI: 10.5116/ijme.5dc3.1e92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 11/06/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To understand the impact of the international medical elective (IME) on Nepali patients and physicians alongside visiting European and American medical students. METHODS At a hospital in Nepal, semi-structured interviews were conducted with 15 patients and 15 physicians about positive and negative experiences with visiting medical students. Likert scale surveys about knowledge of Nepal, clinical competencies, and post-elective feedback were administered to 56 visiting medical students before and after their elective. Interviews were coded using conventional content analysis and surveys were analyzed using descriptive statistics and paired t-tests. RESULTS Emergent positive themes from interviews were that visiting students enhanced the reputation of the hospital, afforded financial benefits, improved international collaboration, and increased knowledge, culture and language exchange. However, negative themes were the language barrier and time expended to orient students. Before vs. after the elective, visiting students had increased knowledge of Nepal's healthcare system (M=1.9, SD=0.6 vs. M=3.2, SD=0.6, t(55)=-10.22, p<.001), ability to communicate with health professionals from different backgrounds (M=3.3, SD=0.7 vs. M=3.6, SD=0.7, t(55)=-3.11, p=0.003) and practice in resource constrained environments (M=2.4, SD=0.9 vs. M=2.8, SD=0.9, t(55)=-2.42, p=0.02). However, students had no change in history (M=4.0, SD=0.7 vs. M=3.9, SD=0.7, t(55)=0.84, p=0.40), physical exam (M=3.9, SD=0.6 vs. M=3.9, SD= 0.7, t(55)=0.22, p=0.82) or diagnostic (M=3.5, SD=0.7 vs. M=3.4, SD=0.8, t(55)=1.52, p=0.14) abilities. CONCLUSIONS This study demonstrated a variety of benefits and harms of the IME. To improve the IME experience, medical educators should emphasize pre-departure orientation and fostering equitable partnerships between sending and receiving institutions.
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Affiliation(s)
| | - Rajeev Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| | - Shrinkhala Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rajendra Koju
- Department of Cardiology, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
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