Abstract
The aim of this study was to identify global health ethical issues that health professional trainees may encounter during electives or placements in resource-limited countries. We conducted a qualitative study involving focus groups and an interview at the University of California San Francisco. Participants were multi-professional from the Schools of Medicine, Nursing and Pharmacy and had experience working, or teaching, as providers in resource-limited countries. Eighteen participants provided examples of ethical dilemmas associated with global-health outreach work. Ethical dilemmas fell into four major themes relating to (1) cultural differences (informed consent, truth-telling, autonomy); (2) professional issues (power dynamics, training of local staff, corruption); (3) limited resources (scope of practice, material shortages); (4) personal moral development (dealing with moral distress, establishing a moral compass, humility and self awareness). Three themes (cultural differences, professional issues, limited resources) were grouped under the core category of “external environmental and/or situational issues” that trainees are confronted when overseas. The fourth theme, moral development, refers to the development of a moral compass and the exercise of humility and self-awareness. The study has identified case vignettes that can be used for curriculum content for global-health ethics training.
Highlights
The last decade has witnessed a steady increase in the number of health science trainees from medicine, nursing and pharmacy traveling to resource-limited countries to engage in global-health activities [1]
Of the 18, nine were from the field of pharmacy, six from medicine and three from nursing
This study has identified a diverse range of ethical issues from a multi-professional group of Medicine, nurses is constantly changing” (Nursing) and Pharmacy faculty who described ethical challenges that they had experienced and believed that trainees may encounter when they are working in resource-limited settings
Summary
The last decade has witnessed a steady increase in the number of health science trainees from medicine, nursing and pharmacy traveling to resource-limited countries to engage in global-health activities [1]. This increase is a reflection of the presence of global health electives and training programs within many health sciences curricula [2]. Benefits include a better understanding of other cultures, an appreciation of global socio-political health issues and the development of cultural competence [4] Trainees who complete such electives are more likely to focus their clinical career working with disadvantaged communities and often display increased levels of volunteerism and humanitarianism [3]
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