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Davey AK. Internationalisation of the curriculum in health programs. BMC MEDICAL EDUCATION 2023; 23:285. [PMID: 37101183 PMCID: PMC10132790 DOI: 10.1186/s12909-023-04271-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Internationalisation is a broad term that has been used to encompass a range of activities including international student recruitment, student mobility and exchange, international teaching and research collaborations, institutional partnerships, and embedding international and/or intercultural perspectives within curricula.There are numerous drivers for institutions to develop an internationalisation strategy including building global reputation and influence, having a positive influence on communities, income generation, and helping their students gain a global perspective or develop intercultural competencies. Health students benefit from internationalisation activities as they will enter a workforce that increasingly engages with global diseases and works within multicultural societies.However, there are risks associated with internationalisation that stem from disjointed institutional decision making, power imbalances, and neo-colonial attitudes. There are also multiple barriers to effectively engaging in internationalisation including individual student circumstances, staff and institutional preparedness, and geopolitical factors.Within this broader context, internationalisation of the curriculum (IoC) is aimed at incorporating international, intercultural, and global dimensions into the curriculum, including consideration of content, teaching methods, learning outcomes, and how these are supported at a program and institutional level. This is a major undertaking requiring alignment of philosophy between teaching academics, senior university leadership, and the relevant professional body. Examples of IoC within health programs, and the significant challenges involved, are critically discussed in this paper, and strategies to overcome these challenges highlighted.Whilst recognising the challenges, this paper concludes that undertaking purposeful IoC is a critical step towards ensuring that the future health workforce is adequately prepared for the 21st Century environment.
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Affiliation(s)
- Andrew Keith Davey
- Griffith Health, Griffith University, G40_8.43, Gold Coast Campus, Southport, QLD, 4222, Australia.
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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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International medical electives during and after the COVID-19 pandemic - current state and future scenarios: a narrative review. Global Health 2022; 18:44. [PMID: 35459191 PMCID: PMC9026059 DOI: 10.1186/s12992-022-00838-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background International medical electives are an important and popular component of the academic curriculum in many medical schools and universities worldwide. The purpose of abroad electives is to provide medical students with an opportunity to gain a better understanding of education and healthcare in an international context. The COVID-19 pandemic, however, has substantially changed the international elective landscape. Travel restrictions, closures of international elective programs and the expansion of virtual methods for education caused a widespread disruption to abroad electives. A comprehensive analysis with regard to other consequences for abroad electives, however, has not been done before. Thus, we sought to a) summarize the current transformation of the international medical elective and b) to address potential challenges for post-pandemic international medical electives. Methods The methodology employed is a multidisciplinary narrative review of the published and grey literature on international electives during the last two years of the COVID-19 pandemic. Results Students worldwide had electives postponed or canceled. Apart from evident immediate pandemic-related consequences (such as the substantial decline in global electives and impaired elective research opportunities for educators), there are other several problems that have received little attention during the last two years. These include challenges in the elective application process, poorly-understood consequences for host institutions, and growing global (ethical) disparities that are likely to increase once elective programs will gradually re-open. There is ample evidence that the post-pandemic elective landscape will be characterized by increasing elective fees, and a more competitive seat-to-applicant ratio. Ethical problems for international electives arising from an unequal global vaccine distribution will pose an additional challenge to students and elective coordinators alike. Conclusion The COVID-19 pandemic transformed the international medical elective landscape in an unprecedented way, and future generations of medical students will face a series of additional challenges when applying for global medical electives.
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Imafuku R, Saiki T, Hayakawa K, Sakashita K, Suzuki Y. Rewarding journeys: exploring medical students' learning experiences in international electives. MEDICAL EDUCATION ONLINE 2021; 26:1913784. [PMID: 33829969 PMCID: PMC8043609 DOI: 10.1080/10872981.2021.1913784] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 05/21/2023]
Abstract
International electives are recognized as a high-impact practice in clinical education. However, medical students' actual learning experiences during electives have not been explored fully. Specifically, drawing on language management theory, this exploratory case study investigates students' perceived learning outcomes and the managing processes by which they gained benefits from cross-cultural learning experiences in international electives. Written reflective reports in a series of e-portfolios were collected from 43 Japanese medical students who participated in a four-week international elective. Moreover, to further explore their emotions and the reasons behind adopting a particular adjustment behaviour, follow-up interviews with 12 students were undertaken soon after they returned home. Using reflexive thematic analysis, the qualitative data were analysed. Their perceived learning outcomes were categorized into seven themes: medical knowledge and skills, communication, career management and development, international healthcare, society and culture, medical education, and personal development. During the programme, they experienced linguistic, sociolinguistic, and sociocultural difficulties, and attempted to overcome them by employing various adjustment strategies, such as meaning-focused coping, social relationship building, management of learning opportunities, communication management, and developing approaches to learning. Managing problems in academic contact situations is not a linear process; it is iterative and cyclical. Since the combination of several strategies was needed depending on the situation, the management process is a context-dependent and complex phenomenon. The findings in this study provide new insights into student participation in short-term international elective programmes in order to develop academic and social support strategies for educators at both home and host institutions.
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Affiliation(s)
- Rintaro Imafuku
- Medical Education Development Centre, Gifu University, Gifu City, Japan
- CONTACT Rintaro Imafuku Medical Education Development Centre,Gifu University,1-1 Yanagido Gifu, Gifu, 501-1194, Japan
| | - Takuya Saiki
- Medical Education Development Centre, Gifu University, Gifu City, Japan
| | - Kaho Hayakawa
- Medical Education Development Centre, Gifu University, Gifu City, Japan
| | - Kazumi Sakashita
- Department of General Paediatrics, National Centre for Child Health and Development, Tokyo, Japan
| | - Yasuyuki Suzuki
- Medical Education Development Centre, Gifu University, Gifu City, Japan
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Xu D, Atkinson M, Yap T, Yap M, Hossain R, Chong F, Gupta S, Hou L, Ding LS, Yang Q, Kuang M, Xiao H. Reflecting on exchange students' learning: Structure, objectives and supervision. MEDICAL TEACHER 2020; 42:278-284. [PMID: 31718353 DOI: 10.1080/0142159x.2019.1676886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background and aim: The increasing opportunities for medical students to participate in international electives may improve students' professionalism and cultural competence. However, the students' overall experiences may be unpredictable, unstructured and lack supervision. There is scant evidence with respect to their learning outcomes. These reflections demonstrate that short-term supervised elective can provide students with structured learning experiences to achieve specific learning objectives.Methods: We carried out daily debriefs and a weekly summary with seven Curtin Medical School students from Perth, Australia during an 18-days supervised elective in the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. The daily debriefs and the weekly summary in different disciplines become the content of the reflections discussed in this article.Results: The main themes identified in the feedback were as follows: Skills in history taking and physical examination; clinical reasoning; diagnosis and management of diseases rarely seen in Australia; awareness of clinical ethics; merits and demerits of different systems of healthcare; sensitivity to issues in doctor-patient relationships; work ethics; enhancement of cultural competence; and personal development.Conclusions: These reflections provide insight into how overseas electives may be structured to improve students' clinical reasoning skills in this hospital. These students achieved their learning outcomes under joint supervision from both institutions. The clinical skills learned from these experiences enhanced the students' professionalism and cultural competence, giving students the opportunities to appreciate the multitude healthcare model of bio-psycho-social-political-economical-spiritual dimensions.
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Affiliation(s)
- Dan Xu
- Curtin Medical School, Curtin University, Perth, Australia
| | | | - Timothy Yap
- Curtin Medical School, Curtin University, Perth, Australia
| | - Max Yap
- Curtin Medical School, Curtin University, Perth, Australia
| | - Raphin Hossain
- Curtin Medical School, Curtin University, Perth, Australia
| | - Felicity Chong
- Curtin Medical School, Curtin University, Perth, Australia
| | - Shivangi Gupta
- Curtin Medical School, Curtin University, Perth, Australia
| | - Lachlan Hou
- Curtin Medical School, Curtin University, Perth, Australia
| | - Lucy Shuqing Ding
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qing Yang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Kuang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haipeng Xiao
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Reciprocity? International Preceptors' Perceptions of Global Health Elective Learners at African Sites. Ann Glob Health 2019; 85. [PMID: 30896132 PMCID: PMC6634447 DOI: 10.5334/aogh.2342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Short-term global health electives (STGHEs) have become increasingly common, with evidence showing educational and clinical benefits for short-term learners (STLs). Despite increased recognition that STGHEs should be mutually beneficial for host sites and STLs, evidence demonstrating the impact on international host preceptors is lacking. Objectives: To understand international host preceptors’ perceptions regarding benefits and burdens of hosting STLs. Methods: Focus group discussions with a convenience sample of 10 of 18 eligible preceptors were conducted at pediatric STGHE sites in Malawi and Lesotho. Qualitative content analysis was performed to identify themes using a deductive-inductive approach. Findings: Common themes regarding benefits to preceptors included increased knowledge and resources for learning from STLs, broadened differential diagnoses, and the satisfaction of teaching. Regarding burdens, preceptors perceived that supervising STLs decreases efficiency. Preceptors identified the burden of having to intervene in instances that could lead to patient harm. Some preceptors perceived that STLs under-valued preceptors’ clinical decision-making in resource-limited contexts. Conclusions: Our findings emphasize the need for institutions to identify mutuality of benefits between STLs and host sites when developing STGHEs. Host preceptors identified robust pre-departure training for STLs, lengthened duration of STGHEs, and formal preceptor orientation as ways to enhance mutuality of benefits.
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Leathers JS, Davidson H, Desai N. Interprofessional education between medical students and nurse practitioner students in a Global Health course. BMC MEDICAL EDUCATION 2018; 18:200. [PMID: 30119625 PMCID: PMC6098586 DOI: 10.1186/s12909-018-1307-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/01/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Few global health experiences include intentionally-directed interprofessional training. We aim to prospectively evaluate the impact of a global health elective in facilitating interprofessional education (IPE) and promoting cultural sensitivity. METHODS We included in our study, medical and nursing students who participated in the 2015 and 2016 cohorts of the Nicaragua Global Health course. The course consisted of a 12-week curriculum, and included an in-country immersion where students were organized into small-groups that participated in a variety of interprofessional activities. Students filled out pre- and post-course surveys. We performed quantitative analysis on numeric data and qualitative analysis on open-ended questions. RESULTS Of 39 total students enrolled in the course, 26 (18 medical and 8 nursing students) participated in the study and filled out the pre- and post-course surveys. Mean competency scores increased for all questions between pre- and post-course surveys, and of these, 5 of 7 reached statistical significance. Qualitative themes identified included: 1) the importance of understanding other team member's roles and relative strengths; 2) the value provided by the breaking down of traditional power dynamics between clinicians. CONCLUSIONS Global health experiences represent a unique and under-utilized opportunity for facilitating IPE.
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Affiliation(s)
- James S. Leathers
- Vanderbilt University School of Medicine, 2209 Garland Ave., Nashville, TN 37232 USA
| | - Heather Davidson
- Vanderbilt University School of Medicine, 2209 Garland Ave., Nashville, TN 37232 USA
| | - Neerav Desai
- Vanderbilt University School of Medicine, 2209 Garland Ave., Nashville, TN 37232 USA
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232 USA
- Vanderbilt Health One Hundred Oaks, 719 Thompson Lane Suite 36300, Nashville, TN 37204 USA
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Peluso MJ, Rodman A, Mata DA, Kellett AT, van Schalkwyk S, Rohrbaugh RM. A Comparison of the Expectations and Experiences of Medical Students From High-, Middle-, and Low-Income Countries Participating in Global Health Clinical Electives. TEACHING AND LEARNING IN MEDICINE 2018; 30:45-56. [PMID: 29240454 DOI: 10.1080/10401334.2017.1347510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED Phenomenon: Global health education (GHE) is expanding to include socioculturally and resource-different settings, with the goal of developing a workforce with members who can promote health equity locally and globally. GHE is also no longer limited to students from high-income countries (HICs). However, it is unknown whether the motivations and experiences of medical students from HICs and from low- and middle-income countries (LMICs) participating in GHE clinical electives through institutional partnerships are similar or different. Such an understanding is needed to design programs that meet the needs of participants and effectively train them in the principles and practice of global health. APPROACH This was a cross-sectional, mixed-methods survey of LMIC students from partner sites rotating at one U.S. medical school, and U.S. students from one medical school rotating at partner sites, between 2010 and 2015. Variables included demographic characteristics of participants, components of the curriculum at the home institution, and components of the away rotation, including perceptions of its content and impact. Content analysis was used to identify themes in the responses provided to open-ended questions. FINDINGS In all, 63 of 84 (75%) LMIC and 61 of 152 (40%) U.S. students participated. Recall of predeparture training was low for both LMIC and U.S. students (44% and 55%, respectively). Opportunities to experience different healthcare systems, resource-different settings, and cultural exposure emerged as motivators for both groups. Both groups noted differences in doctor-patient relationships, interactions between colleagues, and use of diagnostic testing. U.S. respondents were more likely to perceive differences in the impact of social determinants of health and ethical issues. Both groups felt that their experience affected their interactions with patients and perspectives on education, but U.S. students were more likely to mention perspectives on healthcare delivery and social determinants of health, whereas LMIC respondents noted impacts on career goals. Insights: These results argue that GHE is not restricted to resource-constrained settings and that students from LMICs have similar reasons for participation as those from HICs. LMIC students also identified a lack of emphasis on GHE topics like social determinants of health during GH electives, which could diminish the effectiveness of these experiences. Both U.S. and LMIC students emphasized the cultural component of their GHE experience but had different perceptions regarding core tenets of GHE, such as the social determinants of health and health equity, during these experiences.
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Affiliation(s)
- Michael J Peluso
- a Department of Medicine and Division of Global Health Equity , Brigham and Women's Hospital , Boston , Massachusetts , USA
- b Harvard Medical School , Boston , Massachusetts , USA
| | - Adam Rodman
- b Harvard Medical School , Boston , Massachusetts , USA
- c Department of Medicine , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
| | - Douglas A Mata
- b Harvard Medical School , Boston , Massachusetts , USA
- d Department of Pathology , Brigham and Women's Hospital , Boston , Massachusetts , USA
- e Brigham Education Institute , Boston , Massachusetts , USA
| | - Anne T Kellett
- f Office of International Medical Student Education , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Susan van Schalkwyk
- g Centre for Health Professions Education, Faculty of Medicine and Health Sciences , Stellenbosch University , Stellenbosch , South Africa
| | - Robert M Rohrbaugh
- f Office of International Medical Student Education , Yale University School of Medicine , New Haven , Connecticut , USA
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Litzelman DK, Gardner A, Einterz RM, Owiti P, Wambui C, Huskins JC, Schmitt-Wendholt KM, Stone GS, Ayuo PO, Inui TS, Umoren RA. On Becoming a Global Citizen: Transformative Learning Through Global Health Experiences. Ann Glob Health 2017; 83:596-604. [PMID: 29221534 DOI: 10.1016/j.aogh.2017.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Globalization has increased the demand for international experiences in medical education. International experiences improve medical knowledge, clinical skills, and self-development; influence career objectives; and provide insights on ethical and societal issues. However, global health rotations can end up being no more than tourism if not structured to foster personal transformation and global citizenship. OBJECTIVE We conducted a qualitative assessment of trainee-reported critical incidents to more deeply understand the impact of our global health experience on trainees. METHODS A cross-sectional survey was administered to trainees who had participated in a 2-month elective in Kenya from January 1989 to May 2013. We report the results of a qualitative assessment of the critical incident reflections participants (n = 137) entered in response to the prompt, "Write about one of your most memorable experiences and explain why you chose to describe this particular one." Qualitative analyses were conducted using thematic analysis and crystallization immersion analytic methods based on the principles of grounded theory, employing a constructivists' research paradigm. FINDINGS Four major themes emerged. These themes were Opening Oneself to a Broader World View; Impact of Suffering and Death; Life-Changing Experiences; and Commitment to Care for the Medically Underserved. CONCLUSIONS Circumstances that learners encounter in the resource-scarce environment in Kenya are eye-opening and life-changing. When exposed to these frame-shifting circumstances, students elaborate on or transform existing points of view. These emotionally disruptive experiences in an international health setting allowed students to enter a transformational learning process with a global mind. Students can see the world as an interdependent society and develop the capacity to advance both their enlightened self-interest and the interest of people elsewhere in the world as they mature as global citizens. Medical schools are encouraged to foster these experiences by finding ways to integrate them into curriculum.
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Affiliation(s)
- Debra K Litzelman
- Department of Medicine, Indiana University School of Medicine and Center for Global Health, Indianapolis, IN.
| | - Adrian Gardner
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Robert M Einterz
- Department of Medicine, Indiana University School of Medicine and Center for Global Health, Indianapolis, IN
| | - Philip Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Charity Wambui
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Jordan C Huskins
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | | | - Geren S Stone
- Department of Medicine, Massachusetts General Hospital (MGH), Boston, MA; Global Medicine Program, MGH Global Health, Boston, MA
| | - Paul O Ayuo
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Thomas S Inui
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Rachel A Umoren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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Ambrose M, Murray L, Handoyo NE, Tunggal D, Cooling N. Learning global health: a pilot study of an online collaborative intercultural peer group activity involving medical students in Australia and Indonesia. BMC MEDICAL EDUCATION 2017; 17:10. [PMID: 28086875 PMCID: PMC5237179 DOI: 10.1186/s12909-016-0851-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 12/21/2016] [Indexed: 05/17/2023]
Abstract
BACKGROUND There is limited research to inform effective pedagogies for teaching global health to undergraduate medical students. Theoretically, using a combination of teaching pedagogies typically used in 'international classrooms' may prove to be an effective way of learning global health. This pilot study aimed to explore the experiences of medical students in Australia and Indonesia who participated in a reciprocal intercultural participatory peer e-learning activity (RIPPLE) in global health. METHODS Seventy-one third year medical students (49 from Australia and 22 from Indonesia) from the University of Tasmania (Australia) and the University of Nusa Cendana (Indonesia) participated in the RIPPLE activity. Participants were randomly distributed into 11 intercultural 'virtual' groups. The groups collaborated online over two weeks to study a global health topic of their choice, and each group produced a structured research abstract. Pre- and post-RIPPLE questionnaires were used to capture students' experiences of the activity. Descriptive quantitative data were analysed with Microsoft Excel and qualitative data were thematically analysed. RESULTS Students' motivation to volunteer for this activity included: curiosity about the innovative approach to learning; wanting to expand knowledge of global health; hoping to build personal and professional relationships; and a desire to be part of an intercultural experience. Afer completing the RIPPLE program, participants reported on global health knowledge acquisition, the development of peer relationships, and insight into another culture. Barriers to achieving the learning outcomes associated with RIPPLE included problems with establishing consistent online communication, and effectively managing time to simultaneously complete RIPPLE and other curricula activities. CONCLUSIONS Medical students from both countries found benefits in working together in small virtual groups to complement existing teaching in global health. However, our pilot study demonstrated that while intercultural collaborative peer learning activities like RIPPLE are feasible, they require robust logistical support and an awareness of the need to manage curriculum alignment in ways that facilitate more effective student engagement.
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Affiliation(s)
- Mark Ambrose
- School of Medicine, University of Tasmania, Private Bag 34, Hobart, 7000 Australia
| | - Linda Murray
- School of Medicine, University of Tasmania, Private Bag 34, Hobart, 7000 Australia
| | - Nicholas E. Handoyo
- Medical Faculty, University of Nusa Cendana, Adi Sucipto St. Penfui, Kota Kupang, 85000 Timor Island, NTT Province Indonesia
| | - Deif Tunggal
- Medical Faculty, University of Nusa Cendana, Adi Sucipto St. Penfui, Kota Kupang, 85000 Timor Island, NTT Province Indonesia
| | - Nick Cooling
- School of Medicine, University of Tasmania, Private Bag 34, Hobart, 7000 Australia
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Rahim A, Knights Née Jones F, Fyfe M, Alagarajah J, Baraitser P. Preparing students for the ethical challenges on international health electives: A systematic review of the literature on educational interventions. MEDICAL TEACHER 2016; 38:911-20. [PMID: 26841123 DOI: 10.3109/0142159x.2015.1132832] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
International health electives pose specific ethical challenges for students travelling from to low and middle income countries. We undertook a systematic review of the literature on interventions to prepare students to identify ethical issues addressed, educational approaches and to collate evidence on the effectiveness of different strategies. We searched nine electronic databases of peer-reviewed literature and identified grey literature through key word searches; supplemented through citation mapping and expert consultation. Articles that described ethical training conducted by universities or professional bodies were included for review. We reviewed forty-four full text articles. Ten sources of published literature and seven sources of grey literature met our inclusion criteria. We identified thirteen ethical situations that students should be prepared to manage and eight generic skills to support this process. Most interventions were delivered before the elective, used case studies or guidelines. Some suggested ethical principles or a framework for analysis of ethical issues. Only two papers evaluated the intervention described. Our paper collates a small but growing body of work on education to prepare students to manage ethical issues. Ethical training should have elements that are delivered before, during and after the elective. Interventions should include case studies covering thirteen ethical issues identified here, linked to ethical principles and a process for responding to ethical issues. We suggest that evaluations of interventions are an important area for future research.
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Affiliation(s)
| | | | | | | | - Paula Baraitser
- a King's College London , UK
- b King's Centre for Global Health , UK
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Dornblaser EK, Ratka A, Gleason SE, Ombengi DN, Tofade T, Wigle PR, Zapantis A, Ryan M, Connor S, Jonkman LJ, Ochs L, Jungnickel PW, Abrons JP, Alsharif NZ. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2016; 80:39. [PMID: 27170810 PMCID: PMC4857634 DOI: 10.5688/ajpe80339] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 08/11/2015] [Indexed: 05/11/2023]
Abstract
The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students.
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Affiliation(s)
| | - Anna Ratka
- Chicago State University College of Pharmacy, Chicago, Illinois
| | - Shaun E. Gleason
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
| | | | - Toyin Tofade
- University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Patricia R. Wigle
- University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Antonia Zapantis
- Nova Southeastern University College of Pharmacy, Fort Lauderdale, Florida
| | - Melody Ryan
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Sharon Connor
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Lauren J. Jonkman
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Leslie Ochs
- University of New England College of Pharmacy, Portland, Maine
| | | | | | - Naser Z. Alsharif
- Creighton University Medical Center School of Pharmacy and Health Professions, Omaha, Nebraska
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Hudon C, Loignon C, Grabovschi C, Bush P, Lambert M, Goulet É, Boyer S, De Laat M, Fournier N. Medical education for equity in health: a participatory action research involving persons living in poverty and healthcare professionals. BMC MEDICAL EDUCATION 2016; 16:106. [PMID: 27066826 PMCID: PMC4828813 DOI: 10.1186/s12909-016-0630-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/06/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Improving the knowledge and competencies of healthcare professionals is crucial to better address the specific needs of persons living in poverty and avoid stigmatization. This study aimed to explore the needs and expectations of persons living in poverty and healthcare professionals in terms of medical training regarding poverty and its effects on health and healthcare. METHODS We conducted a participatory action research study using photovoice, a method using photography, together with merging of knowledge and practice, an approach promoting dialogue between different sources of knowledge. Nineteen healthcare professionals and persons from an international community organization against poverty participated in the study. The first phase included 60 meetings and group sessions to identify the perceived barriers between persons living in poverty and healthcare teams. In the second phase, sub-committees deployed action plans in academic teaching units to overcome barriers identified in the first phase. Data were analysed through thematic analysis, using NVivo, in collaboration with five non-academic co-researchers. RESULTS Four themes in regard to medical training were highlighted: improving medical students' and residents' knowledge on poverty and the living conditions of persons living in poverty; improving their understanding of the reality of those people; improving their relational skills pertaining to communication and interaction with persons living in poverty; improving their awareness and capacity for self-reflection. At the end of the second phase, actions were undertaken such as improving knowledge of the living conditions of persons living in poverty by posting social assistance rates, and tailoring interventions to patients' reality by including sociodemographic information in electronic medical records. Our findings also led to a participatory research project aiming to improve the skills and competency of residents and health professionals in regard to the quality of healthcare provided to persons living in poverty. CONCLUSIONS Medical training and residency programs should aim to improve students' and residents' relational skills, more specifically their communication skills, as well as their awareness and capacity for self-reflection, by helping them to identify and recognize their biases, and limitations.
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Affiliation(s)
- Catherine Hudon
- />Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke, QC Canada
| | - Christine Loignon
- />Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke, QC Canada
| | - Cristina Grabovschi
- />Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke, QC Canada
| | - Paula Bush
- />Department of Family Medicine, McGill University, 5858 chemin de la Côte des Neiges, Montreal, QC Canada
| | - Mireille Lambert
- />Centre de santé et de services sociaux de Chicoutimi, 305 rue Saint-Vallier, Chicoutimi, QC Canada
| | - Émilie Goulet
- />Charles-LeMoyne Research Centre, 150 Place Charles-LeMoyne, Longueuil, QC Canada
| | - Sophie Boyer
- />ATD (All Together in Dignity) Fourth World Movement, an international community organization against poverty, 6747 rue Drolet, Montreal, QC Canada
| | - Marianne De Laat
- />ATD (All Together in Dignity) Fourth World Movement, an international community organization against poverty, 6747 rue Drolet, Montreal, QC Canada
| | - Nathalie Fournier
- />Academic Primary Care Unit Charles-LeMoyne, 299 boulevard Sir-Wilfrid-Laurier, Saint-Lambert, QC Canada
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Herbst de Cortina S, Arora G, Wells T, Hoffman RM. Evaluation of a Structured Predeparture Orientation at the David Geffen School of Medicine's Global Health Education Programs. Am J Trop Med Hyg 2016; 94:563-7. [PMID: 26755562 DOI: 10.4269/ajtmh.15-0553] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/14/2015] [Indexed: 11/07/2022] Open
Abstract
Given the lack of a standardized approach to medical student global health predeparture preparation, we evaluated an in-person, interactive predeparture orientation (PDO) at the University of California Los Angeles (UCLA) to understand program strengths, weaknesses, and areas for improvement. We administered anonymous surveys to assess the structure and content of the PDO and also surveyed a subset of students after travel on the utility of the PDO. We used Fisher's exact test to evaluate the association between prior global health experience and satisfaction with the PDO. One hundred and five students attended the PDO between 2010 and 2014 and completed the survey. One hundred and four students (99.0%) reported learning new information. Major strengths included faculty mentorship (N = 38, 19.7%), opportunities to interact with the UCLA global health community (N = 34, 17.6%), and sharing global health experiences (N = 32, 16.6%). Of students surveyed after their elective, 94.4% (N = 51) agreed or strongly agreed that the PDO provided effective preparation. Students with prior global health experience found the PDO to be as useful as students without experience (92.7% versus 94.4%, P = 1.0). On the basis of these findings, we believe that a well-composed PDO is beneficial for students participating in global health experiences and recommend further comparative studies of PDO content and delivery.
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Affiliation(s)
- Sasha Herbst de Cortina
- Center for World Health, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pediatrics, University of California, Los Angeles, California; Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California
| | - Gitanjli Arora
- Center for World Health, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pediatrics, University of California, Los Angeles, California; Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California
| | - Traci Wells
- Center for World Health, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pediatrics, University of California, Los Angeles, California; Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California
| | - Risa M Hoffman
- Center for World Health, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Pediatrics, University of California, Los Angeles, California; Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California
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The Ethics of Short-Term International Health Electives in Developing Countries. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/bf03355131] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arora G, Perkins KL, Hoffman R. Optimizing Global Health Electives Through Partnerships: A Pilot Study of Pediatric Residents. Acad Pediatr 2015; 15:565-7. [PMID: 26233833 DOI: 10.1016/j.acap.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Gitanjli Arora
- Department of Pediatrics, UCLA, Los Angeles, Calif; Center for World Health, Global Health Education Programs, UCLA, Los Angeles, Calif.
| | | | - Risa Hoffman
- Department of Medicine and Division of Infectious Diseases, UCLA, Los Angeles, Calif; Center for World Health, Global Health Education Programs, UCLA, Los Angeles, Calif
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Flinkenflögel M, Ogunbanjo G, Cubaka VK, De Maeseneer J. Rwandan family medicine residents expanding their training into South Africa: the use of South-South medical electives in enhancing learning experiences. BMC MEDICAL EDUCATION 2015; 15:124. [PMID: 26231997 PMCID: PMC4522112 DOI: 10.1186/s12909-015-0405-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 07/06/2015] [Indexed: 06/01/2023]
Abstract
BACKGROUND International medical electives are well-accepted in medical education, with the flow of students generally being North-South. In this article we explore the learning outcomes of Rwandan family medicine residents who completed their final year elective in South Africa. We compare the learning outcomes of this South-South elective to those of North-South electives from the literature. METHODS In-depth interviews were conducted with Rwandan postgraduate family medicine residents who completed a 4-week elective in South Africa during their final year of training. The interviews were thematically analysed in an inductive way. RESULTS The residents reported important learning outcomes in four overarching domains namely: medical, organisational, educational, and personal. CONCLUSIONS The learning outcomes of the residents in this South-South elective had substantial similarities to findings in literature on learning outcomes of students from the North undertaking electives in the Southern hemisphere. Electives are a useful learning tool, both for Northern students, and students from universities in the South. A reciprocity-framework is needed to increase mutual benefits for Southern universities when students from the North come for electives. We suggest further research on the possibility of supporting South-South electives by Northern colleagues.
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Affiliation(s)
- Maaike Flinkenflögel
- Discipline Primary Health Care, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Partners in Health, Rwinkwavu, Rwanda.
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
| | - Gboyega Ogunbanjo
- Department of Family Medicine & Primary Health Care, Sefako Makgatho Health Sciences University, South Africa (previously known as University of Limpopo - Medunsa Campus, South Africa), Limpopo, South Africa.
| | - Vincent Kalumire Cubaka
- Discipline Primary Health Care, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Center for Global Health, Department of Public Health, Aarhus, Denmark.
| | - Jan De Maeseneer
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
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Dell EM, Varpio L, Petrosoniak A, Gajaria A, McCarthy AE. The ethics and safety of medical student global health electives. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2014; 5:63-72. [PMID: 25341214 PMCID: PMC4207171 DOI: 10.5116/ijme.5334.8051] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/27/2014] [Indexed: 05/04/2023]
Abstract
OBJECTIVE 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.
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Affiliation(s)
- Evelyn M. Dell
- Department of Medicine, Emergency Medicine, University of Toronto, Toronto, Canada
| | - Lara Varpio
- Department of Medicine, University of Ottawa, Academy for Innovation of Medical Education, Canada
| | - Andrew Petrosoniak
- Department of Medicine, Emergency Medicine, University of Toronto, Toronto, Canada
| | - Amy Gajaria
- Department of Medicine, Psychiatry, University of Toronto, Canada
| | - Anne E. McCarthy
- Department of Medicine, Infectious Disease/Global Health, University of Ottawa, Canada
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Bozinoff N, Dorman KP, Kerr D, Roebbelen E, Rogers E, Hunter A, O'Shea T, Kraeker C. Toward reciprocity: host supervisor perspectives on international medical electives. MEDICAL EDUCATION 2014; 48:397-404. [PMID: 24606623 DOI: 10.1111/medu.12386] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 09/18/2013] [Indexed: 05/04/2023]
Abstract
CONTEXT An increasing number of medical students are engaging in international medical electives, the majority of which involve travel from northern, higher-income countries to southern, lower-income countries. Existing research has identified benefits to students participating in these experiences. However, reports on the impacts on host communities are largely absent from the literature. OBJECTIVES The current study aims to identify host country perspectives on international medical electives. METHODS Questionnaires were delivered to a convenience sample of supervisors hosting international elective students (n = 39) from a Canadian medical school. Responses represented 22 countries. Conventional content analysis of the qualitative data was used to identify themes in host supervisor perspectives on the impact of international medical electives. RESULTS Host country supervisors identified that in addition to the benefits realised by the elective students, supervisors and their institutions also benefited from hosting Canadian students. Although some host supervisors denied the occurrence of any harm, others expressed concern that international elective students may negatively impact the local community in terms of resource use and patient care. Host country supervisors also identified potential harms to travelling students including health risks and emotional distress. Ideas for improving international electives were identified and were largely centred around increasing the bidirectional flow of students by establishing formal partnerships between institutions. CONCLUSIONS This research provides important insights into the impacts of international medical student electives from the perspective of host country supervisors. This research may be a starting point for further research and the establishment of meaningful partnerships that incorporate the self-identified needs of receiving institutions, especially those in lower-income settings.
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Affiliation(s)
- Nikki Bozinoff
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Stys D, Hopman W, Carpenter J. What is the value of global health electives during medical school? MEDICAL TEACHER 2012; 35:209-218. [PMID: 23102163 DOI: 10.3109/0142159x.2012.731107] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To determine whether global health (GH) electives enhanced the development of medical students and to examine the influence on host communities. METHODS A retrospective survey study was conducted with Queen's University undergraduate medical students who had participated in a GH elective. Participants rated the influence of their elective on the aspects of their professional and personal development and their perceived community impact on a scale of 0-5. RESULTS The highest rated statements focused on the students' personal development and whether the elective provided a valuable learning experience (4.39 and 4.07, respectively). Students also reported a heightened level of awareness of social determinants of health (mean rating of 3.98). The statements with the lowest mean ratings involved students' perceptions of their impact on the communities. Overall, 73.5% of participants agreed or strongly agreed that GH electives are valuable to medical education. CONCLUSION GH electives benefit the professional and personal development of medical students. Although students gain significantly from their experience, they are unable to assess the impact of their work on the community. Thus, there is a need to assess the effect from both the perspective of the students and of the community members.
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Affiliation(s)
- Dana Stys
- Faculty of Medicine, Queen's University, Canada.
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22
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Malau-Aduli BS. Exploring the experiences and coping strategies of international medical students. BMC MEDICAL EDUCATION 2011; 11:40. [PMID: 21702988 PMCID: PMC3141796 DOI: 10.1186/1472-6920-11-40] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 06/25/2011] [Indexed: 05/10/2023]
Abstract
BACKGROUND Few studies have addressed the challenges that international medical students face and there is a dearth of information on the behavioural strategies these students adopt to successfully progress through their academic program in the face of substantial difficulties of language barrier, curriculum overload, financial constraints and assessment tasks that require high proficiency in communication skills. METHODS This study was designed primarily with the aim of enhancing understanding of the coping strategies, skill perceptions and knowledge of assessment expectations of international students as they progress through the third and fourth years of their medical degree at the School of Medicine, University of Tasmania, Australia. RESULTS Survey, focus group discussion and individual interviews revealed that language barriers, communication skills, cultural differences, financial burdens, heavy workloads and discriminatory bottlenecks were key factors that hindered their adaptation to the Australian culture. Quantitative analyses of their examination results showed that there were highly significant (p < 0.001) variations between student performances in multiple choice questions, short answer questions and objective structured clinical examinations (70.3%, 49.7% & 61.7% respectively), indicating existence of communication issues. CONCLUSIONS Despite the challenges, these students have adopted commendable coping strategies and progressed through the course largely due to their high sense of responsibility towards their family, their focus on the goal of graduating as medical doctors and their support networks. It was concluded that faculty needs to provide both academic and moral support to their international medical students at three major intervention points, namely point of entry, mid way through the course and at the end of the course to enhance their coping skills and academic progression. Finally, appropriate recommendations were made.
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Affiliation(s)
- Bunmi S Malau-Aduli
- Medical Education Unit, School of Medicine, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania, Australia.
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23
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Tavakol M, Dennick R. Are Asian international medical students just rote learners? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2010; 15:369-77. [PMID: 19816780 DOI: 10.1007/s10459-009-9203-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 09/24/2009] [Indexed: 05/14/2023]
Abstract
A wide variety of countries are seeking to attract international medical students. This could be due to the fact that their universities not only receive the economic benefit from these students, but also because they recognise the issues of cultural diversity and pedagogical practice. This review paper draws on literature to understand more fully the learning process of Asian international students. Whereas views on learning are different across cultures, medical school teachers must understand how Asian international students learn based on their culture. Two general themes emerged from the literature review: firstly culture's influence on learning and secondly memorisation versus understanding, both of which relate to the learning process of Asian international students. This study shows that Asian international students have a different approach to learning, which is not just about rote learning. Changes in attitudes towards Asian international students may stimulate the internationalisation of a more culturally sensitive form of medical education. The paper suggests further work on the area of appreciative thinking in order to identify the epistemological and ontological dimensions for a flexible approach to learning.
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Leow JJ, Kingham TP, Casey KM, Kushner AL. Global surgery: thoughts on an emerging surgical subspecialty for students and residents. JOURNAL OF SURGICAL EDUCATION 2010; 67:143-148. [PMID: 20630423 DOI: 10.1016/j.jsurg.2010.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 03/12/2010] [Indexed: 05/29/2023]
Abstract
Interest is growing in global health among surgical residents and medical students. This article explores the newly developing concept of "global surgery." Providing surgical care to resource-limited populations, often found in low- and middle-income countries, has numerous professional and personal developmental benefits. A significant interest is found among most general surgical residents; however, it is necessary to formalize more exchange programs and fellowships like some institutions have done. Medical schools also should establish similar global clinical electives to channel the exuberance of students, develop properly their global health interests, and expose them early to the realities and health needs of the global population. Current opportunities for medical students and residents are reviewed along with the relevant literature.
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Nishigori H, Otani T, Plint S, Uchino M, Ban N. I came, I saw, I reflected: a qualitative study into learning outcomes of international electives for Japanese and British medical students. MEDICAL TEACHER 2009; 31:e196-201. [PMID: 19811124 DOI: 10.1080/01421590802516764] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND AIM Although medical students have increasingly more opportunities to participate in international electives, their experiences are usually unstructured and the literature referring to their learning outcomes, educational environment, and assessment is scanty. This study was undertaken to clarify qualitatively what students learn from their international electives. METHODS We carried out semi-structured individual interviews with 15 Japanese students studying clinical medicine in British medical schools and six British students studying in Japanese medical schools. The thematic synthesis method was used in analysing the transcribed data and triangulation by multiple researchers was used to achieve higher reliability. RESULTS The main learning outcomes identified were skills in history taking and physical examination with clinical reasoning and in management of diseases rarely seen in the students' own countries; awareness of clinical ethics and merits and demerits of different systems of healthcare and medical education; sensitivity to issues in doctor-patient relationships and work ethics; enhancement of cultural competence; and personal development. CONCLUSIONS Most learning outcomes of international electives are culture- or system-dependent. Students achieved outcomes related closely to medical professionalism, mainly through reflection. International electives may give students opportunities to learn both professionalism and cultural competence.
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Affiliation(s)
- Hiroshi Nishigori
- International Research Center for Medical Education, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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Abstract
OBJECTIVES Medical student electives are memorable learning experiences, of which approximately 40% are spent in developing countries. Students often have laudable motivation but are rarely helped to learn most effectively or contribute meaningfully whilst away. Each year an estimated 350 years of elective time is spent in developing countries (by students from the UK alone), which represents substantial opportunity. METHODS We conducted a literature search prior to developing an alternative approach towards electives based upon educational and ethical principles. RESULTS Despite their anecdotal value there has been little empirical research conducted into electives. From our review we identified four key learning domains (Clinical Knowledge and Skills, Attitudes, Global Perspectives, Personal and Professional Development) and two broader issues (Institutional Benefits and Moral/Ethical Considerations). Potentially beneficial and more structured alternatives are emerging and improvements appear possible through institutional collaborations and greater planning in order to maximise the educational experience, opportunities to contribute and minimise the risks involved in electives. CONCLUSIONS Electives are a highlight of clinical training but probably often represent missed opportunities. There are both educational and moral reasons for seeking more considered approaches to reduce the 'medical tourism' that can result from the current largely ad hoc arrangements.
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Affiliation(s)
- Jon Dowell
- Tayside Centre for General Practice, Dundee University, Dundee, UK.
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Abstract
PURPOSE Students' idealism and desire to work with underserved populations decline as they progress from preclinical training through clerkships and residency. With an increasingly diverse population and increasing health disparities, academic health centers need to incorporate changes in their curricula to train socially responsible and idealistic physicians. International electives can provide valuable learning experiences to help achieve these goals. METHODS Sixty-six preclinical medical students at the University of Texas Medical Branch participated in an international elective from 1997 to 2005. After 1 week of didactics, they spent 3 weeks as part of a multidisciplinary medical team in rural Nicaragua. Postelective questionnaires were administered. From students' responses, we identified common learning themes and grouped them under the categories of attitudes, awareness, and skills. Limitations included a self-selection bias, lack of a control group, and limited follow-up. RESULTS After the elective, students had an increased interest in volunteerism, humanitarian efforts, and working with underserved populations both in the United States and abroad, as well as more compassion toward the underserved. Students also reported a heightened awareness of social determinants of health and public health, and a broadened global perspective, as well as increased self-awareness. CONCLUSIONS Our findings illustrate that 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 under-served populations, all measures of idealism.
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Affiliation(s)
- Janice K Smith
- Department of Family Medicine, The University of Texas Medical Branch, Galveston, Tex 77555-1123, USA.
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Niemantsverdriet S, van der Vleuten CPM, Majoor GD, Scherpbier AJJA. The learning processes of international students through the eyes of foreign supervisors. MEDICAL TEACHER 2006; 28:e104-11. [PMID: 16807160 DOI: 10.1080/01421590600726904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Semi-structured interviews were conducted with external supervisors of international electives undertaken by Dutch undergraduate students, in order to gain insight into student learning processes during these electives. The interviews served to triangulate information on these learning processes that was obtained from students' self-reports. The results of the case study reported in this paper were largely consistent with findings from prior studies of international electives in which learning processes and sociocultural differences were examined: experiential learning processes appeared to dominate and sociocultural differences occasionally seemed to blur productive learning, especially when the differences between the national cultures of host country and student home country were substantial. It is recommended that students' experiential learning from international electives should be supplemented with 'guided' and 'self-directed' learning with a focus on the sociocultural dimension.
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Affiliation(s)
- S Niemantsverdriet
- Department of Educational Development and Research, University of Maastricht, Maastricht, The Netherlands.
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Niemantsverdriet S, van der Vleuten CPM, Majoor GD, Scherpbier AJJA. An explorative study into learning on international traineeships: experiential learning processes dominate. MEDICAL EDUCATION 2005; 39:1236-42. [PMID: 16313583 DOI: 10.1111/j.1365-2929.2005.02114.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To explore the learning processes of undergraduate medical students undertaking international traineeships. METHODS Semi-structured, in-depth interviews were conducted with 24 undergraduate medical students from Maastricht University Medical School, the Netherlands. The 24 subjects were selected by purposeful sampling. Research methods resembled the grounded theory method. Although the data were initially gathered for an earlier study, the richness of the data enabled renewed scrutiny. RESULTS The data yielded the following categories concerning the description of the learning processes: motivation, preparation, internal supervisor, external supervisor, assessment, and positive and negative incidents. The majority of supervisors' influences on the learning process were facilitative or negligible. Socio-cultural differences between students and supervisors sometimes appeared to blur productive learning. The greater proportion of the students seemed to learn by 'experiential learning', a smaller proportion learned by 'active learning', and the learning of a very small minority of the students appeared to be 'guided'. DISCUSSION Although experiential learning seemed to be the dominant learning process, it is not clear whether this is also the most fruitful approach to learning. It could be argued that structuring learning outcomes by a more active learning process might be more effective. To guide the learning process and learning outcomes, it might be advisable to develop guidelines for writing international traineeship reports. Supervision of these reports should be more co-ordinated to prevent arbitrariness and to scaffold active learning.
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Affiliation(s)
- Susan Niemantsverdriet
- Department of Educational Development and Research, University of Maastricht, Maastricht, the Netherlands.
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Edwards R, Piachaud J, Rowson M, Miranda J. Understanding global health issues: are international medical electives the answer? MEDICAL EDUCATION 2004; 38:688-90. [PMID: 15200392 DOI: 10.1111/j.1365-2929.2004.01849.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Richard Edwards
- School of Epidemiology and Health Sciences, Medical School, Manchester, UK.
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