Abstract
BackgroundGlobalization 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. ObjectiveWe conducted a qualitative assessment of trainee-reported critical incidents to more deeply understand the impact of our global health experience on trainees. MethodsA 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. FindingsFour 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. ConclusionsCircumstances 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.
Highlights
Globalization has increased both the need and the demand for international experiences in undergraduate and graduate medical education
Pertinent transformative learning theory asserts the critical importance of processes of self-reflective practices essential for selfdevelopment leading to sustained changes in perspectives.[8,9,10]
From October to December 2013, a cross-sectional survey was administered to Indiana University School of Medicine (IUSOM) alumni who had participated in a two month elective at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya from January 1989 to May 2013
Summary
Globalization has increased both the need and the demand for international experiences in undergraduate and graduate medical education. Short-term international experiences can improve medical knowledge and clinical skills,[1] influence career objectives,[2] provide insights on ethical and societal issues,[3] and self-development.[4,5] little is known about the process and theoretical underpinning of learning through these experiences. Global health rotations can end up being no more than tourism if not structured to foster personal transformation and global citizenship.[6] Social transformation theoretical models suggest that experiences that promote global citizenship should be guided by principles of mutuality and reciprocity through established partnerships.[7] Pertinent transformative learning theory asserts the critical importance of processes of self-reflective practices essential for selfdevelopment leading to sustained changes in perspectives.[8,9,10] Sustained changes in perspective are often triggered following intense experiences that have evoked strong personal emotions.[11]. International experiences improve medical knowledge, clinical skills, self-development, influence career objectives, and provide insights on ethical and societal issues. Global health rotations can end up being no more than tourism if not structured to foster personal transformation and global citizenship
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