Host clinical preceptors' perceptions of professionalism among learners completing global health electives.

Chris A Rees,Teri L Turner,Padma Swamy,Peter N Kazembe,Heather Lukolyo,Edith Q Mohapi,Gordon E Schutze,Elizabeth M Keating,Jill Sanders,Stephanie Marton

doi:10.5116/ijme.5b40.6e4b

Abstract

ObjectivesThis study aims to gain an understanding of the perceptions of host clinical preceptors in Malawi and Lesotho of the professionalism exhibited by short-term learners from the United States and Canada during short-term global health electives. MethodsFocus group discussions were conducted with 11 host clinical preceptors at two outpatient pediatric HIV clinics in sub-Saharan Africa (Malawi and Lesotho). These clinics host approximately 50 short-term global health learners from the United States and Canada each year. Focus group moderators used open-ended discussion guides to explore host clinical preceptors’ perceptions of the professionalism of short-term global health learners. Thematic analysis with an inductive approach was used to identify salient themes from these focus group discussions. ResultsEleven of the 18 possible respondents participated in two focus group discussions. Adaptability, eagerness to learn, active listening, gratitude, initiative, and punctuality was cited as professional behaviors among short-term global health learners. Cited unprofessional behaviors included disregard of local clinicians’ expertise and unresponsiveness to feedback. Host clinical preceptors described difficulty providing feedback to short-term global health learners and discrepancies between what may be considered professional in their home setting versus in the study settings. Respondents requested pre-departure orientation for learners and their own orientation before hosting learners. ConclusionsBoth host clinical preceptors and short-term global health learners should be aware that behaviors that may be considered best practice in one clinical setting may be perceived as unprofessional in another. Future studies to develop a common definition of professionalism during short-term global health electives are merited.

Highlights

One-third of medical students in the United States complete rotations in countries other than their own during medical school,[1] and one-fifth of pediatrics residents spend time abroad during their residency training.[2]
One host clinical preceptor commented: “You will find that some learners are ready to learn
Host clinical preceptors commented on multiple unprofessional behaviors that shortterm global health electives (STGHEs) learners exhibit, some of which are similar to those encountered in traditional medical education settings in the United States and Canada

Summary

Introduction

One-third of medical students in the United States complete rotations in countries other than their own during medical school,[1] and one-fifth of pediatrics residents spend time abroad during their residency training.[2]. Participation in STGHEs is associated with improved cross-cultural communication, enhanced knowledge of tropical diseases, and decreased reliance on laboratory testing and imaging among medical trainees when they return to their high-resource setting.[3,4,5]. The term professionalism encompasses many elements, its framework includes the pillars of excellence, humanism, accountability, and altruism based on ethical and legal understanding, communication skills, and clinical competence.[7] Professionalism in clinical settings is a complex social construct and includes both workplacebased norms as well as the health care delivery system.[8] appropriate behavior in one setting may be viewed as unprofessional in another due to differing cultural norms

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Discussion

Conclusion