Abstract
BackgroundClinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training (“WEIGHT Guidelines”) were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master’s-level rehabilitation students at a Canadian university.MethodsIn-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research.ResultsFive themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about “costs”, (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing.ConclusionsInternational clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian “sending institution”, including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the “receiving organizations” based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.
Highlights
Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries
Study design and setting This qualitative, descriptive study was conducted at the Rehabilitation Sciences Sector (RSS) at the University of Toronto, which houses Master’s-level clinical training programmes in occupational therapy (OT), PT and speech-language pathology (SLP)
Most of the International clinical internship (ICI) are conducted at clinical training sites facilitated by the International Centre for Disability and Rehabilitation (ICDR), which include: a rehabilitation programme in Cameroon; a rural rehabilitation clinic in Kenya, a periurban hospital in the Philippines, an academic hospital and a community-based rehabilitation programme in Tanzania, and a school for children and vocational centre for adults with disabilities in Trinidad
Summary
Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. International clinical internships (ICIs) have been associated with positive personal and professional changes [7,10,11,12]. ICIs have been shown to enhance flexibility, cultural sensitivity, confidence, clinical skills, and cross-. Despite these potential benefits, when ICIs occur in low or middle income countries, they have been critiqued for increasing the burden on low and middle income country (LMIC) partners, and for creating harms when students or faculty have insufficient awareness of cultural norms in the host community [1,4,15]. Physiotherapy and occupational therapy students have found that differing cultural belief systems encountered on ICIs can be difficult to navigate without appropriate predeparture preparation and onsite support [11,12,16]
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