Global Health Experiences (GHEs) in Physical Therapist Education: Balancing Moral Imperative With Inherent Moral Hazard

Abstract

Background and Purpose. Income inequality and grinding poverty continue almost unabated in many low-income or developing countries, and the summative effect has been increased rates of global morbidity and disability. In order to address these important health disparities, health professionals from high-income or developed countries have increasingly become involved in global health initiatives. Health professional students have also followed this trend, progressively becoming involved in global health experiences (GHEs) as part of their formal education. Position and Rationale. In this position paper, we argue that GHEs are a moral imperative for physical therapy education programs to implement in order to meet students' learning needs and address (in some capacity) emerging global disability patterns. However, GHEs can create moral hazard against which the individual and the host organization must be guarded. Discussion and Conclusion. There are multiple ways to increase the likelihood of mutually beneficial GHEs and mitigate potential risks of moral hazards. This paper highlights the following steps: (1) Establish suitable selection processes for physical therapy student participants; (2) Develop formal and sustainable relationships between the students' education program and the host institution for the GHE; (3) Set and monitor specific learning objectives and mutually established contribution goals for GHEs; and (4) Establish formal pre-departure preparation and post-trip debriefing. While GHEs offer a partial solution to emerging global disability trends, it is our contention that the issue is not whether, but rather how, GHEs should be incorporated into physical therapy curricula to address students' needs, the missions and outcomes of their home institutions, and the needs of the host organizations. Key Words: Global health, Education, Physical therapy. BACKGROUND AND PURPOSE Despite growing attention to the global health landscape, health disparities persist within and between high, middle, and low-income countries.1, 2 Recognizing selected improvements in health status, income inequality and grinding poverty continue almost unabated in many low-income or developing countries and the summative effect has been increased rates of global morbidity and disability.35 In 2010, the Global Commission on Education of Health Professionals for the 21st Century reported that health professional education curricula have not kept pace with these and other emerging global challenges, and that the global inequalities threaten health security for all.1(pl923) They suggested that there are insufficient health human resources emerging from the global network of education programs, and that health student curricula are not reflective of actual health needs of the global population. The Commission, which is an international consortium of academic leaders, signaled the need to strengthen global learning activities such as global health experiences (GHEs) as a key element in global educational reform. In this position paper, we argue that physical therapist student participation in GHEs within their formal curricula can create positive outcomes for students, their educational institutions, and the host organizations. On the one hand, GHEs are a moral imperative for education programs to implement so as to meet students' learning needs and address (in some capacity) emerging global disability patterns; however, GHEs can create moral hazards for the individual and/or the host organization that must be minimized. Strategies such as effective planning and partnershipbuilding can protect against the unfortunate doing more harm than good conundrum,6 and would provide physical therapist students an opportunity to grow and mature as health professionals. However, a test of true performance of GHEs may be the extent to which the host organization has equally benefited from the experience. …