Short-term Experiences In Global Health Research Articles

Short Term Experiences in Global Health (STEGH)

Short Term Experiences in Global Health (STEGH) are becoming increasingly prevalent, where students and volunteers predominately from high income countries travel to lower income countries to work with local community organizations. Although the benefits of STEGHs have been touted, they have also been increasingly criticized as representing a new form of colonialism and have been shown to harm host communities in a number of ways. Can the enterprise of STEGHs be ethically justified? We argue that STEGHs must incorporate principles of bi-directionality, continuity, cultural humility and decolonization in order to be equitable and sustainable.

Ethics and benefits of family participation in global surgery: a review of the One World Surgery experience

Short-term experiences in global health (STEGHs) provide the opportunity to improve individual patient care and build systemic capacity in under-resourced communities. While most STEGHs are conducted by teams of clinical practitioners and/or trainees, there are some organizations in which nonclinical family members of medical/surgical volunteers participate. One World Surgery is an example of an organization that encourages family member participation in its short-term volunteer trips to Honduras. Through careful pretrip orientation, on-site supervision, and consistent educational programs, One World Surgery has developed a program which promotes safe and effective participation of family members. A recent survey of preprofessional volunteers confirmed that participants felt appropriately supervised and well prepared for their STEGH duties; as a testament to their experience, 100% of these volunteers indicated they would like to return for another One World Surgery experience. The purpose of this paper is to highlight the benefits of family member participation in STEGHs and share the experience of one organization in which family member participation has been developed to provide ethical, beneficial, and sustainable care.

Ten-year evaluation of an immersive global health medical school course using a four-principle equity framework

IntroductionResponding to a growing need for health care professionals equipped with global expertise in local and international settings, an innovative global health medical school course was developed that combines rigorous didactics, mentorship, cross-cultural training, and international experiences to build students’ cultural humility and clinical skills.MethodsRecognizing that global health service trips and courses can unintentionally exacerbate inequities and power imbalances, this course was evaluated using the four principles of Melby et al.’s Guidelines for Implementing Short-term Experiences in Global Health. These principles include skill building in cross-cultural effectiveness and cultural humility, bidirectional participatory relationships, local capacity building, and long-term sustainability.ResultsThe course was developed with long-standing global partners and includes a capstone project that is intended to strengthen local capacity with benefits to the site and student. Student course evaluations, supervisors’ observations of students, and supervisor feedback forms indicate that this course achieves these principles. Furthermore, there is evidence that students developed cultural humility, acquired foundational science knowledge and relevant skills, and changed their medical practice.DiscussionThis approach could serve as a model for institutions seeking to enhance training in global health for medical students.

Applying the Brocher Declaration to short-term experiences in global health in dental education

Participating in Short-Term Experiences in Global Health (STEGHs) has become an increasingly popular way for dental students to learn about the global burden of disease and health inequalities by traveling to a low-income community. However, there is little information available in the dental education literature providing guidelines on best practices for STEGHs. Often little is known about the local dental practice laws and ethics guidelines. One useful resource is the Brocher Declaration. The Brocher Declaration, created by the Advocacy for Global Health Partnerships (AGHP), is a comprehensive document outlining best practices for developing ethical and sustainable global health partnerships. The six guiding principles are: (1) mutual partnership with bidirectional input and learning, (2) empowered host country and community-defined needs and activities, (3) sustainable programs and capacity building, (4) compliance with applicable laws, ethical standards, and code of conduct, (5) humility, cultural sensitivity, and respect for all involved, and (6) accountability for actions. The principles of the Brocher declaration can serve as a foundation for ethics and sustainability and can be easily applied to STEGHs in dental education. The authors present a set of recommendations specific to each principle to guide dental schools in offering STEGHs to their students. Participating in STEGHs represents a unique opportunity for students to learn about the global burden of oral disease, its risk factors, and the population and public health strategies to reduce oral disease in diverse populations. When done ethically, they may serve as a spark for students to become future leaders in global health.

Creating International Student Experiences Through Academic-INGO Partnerships.

Short-term experiences in global health (STEGH) provide nursing students with opportunities to develop global health competencies through immersion in another culture. Skills that students obtain by participating in STEGHs can inform future practice with diverse patient populations. However, educators encounter unique challenges to the quality and sustainability of STEGHs. This article describes an academic partnership between a baccalaureate nursing program and a community-based international nongovernmental organization (INGO), how the partnership informed development of STEGH for nursing students, the benefits of the program for students and community, and the lessons learned through the process. Academic-INGO partnerships provide unique benefits for creating sustainable, rigorous STEGHs that are informed and guided by the needs of the hosting community. By partnering with community-based INGOs, faculty can design STEGHs that offer robust learning opportunities that facilitate the development of global health competencies while providing thoughtful, sustainable outreach for communities.

Going Remote: Evaluating a Global Health Practicum Program During COVID-19 Travel Restrictions

Short-term experiences in global health (STEGHs) are an important part of global health degree programs. Due to the COVID-19 pandemic, travel was not possible for students planning to participate in the Johns Hopkins Center for Global Health's Global Health Established Field Placement (GHEFP) program in 2020. Working with willing faculty mentors, in-country collaborators, and students, the Center allowed students to complete their practicums remotely so that students could gain practicum experience despite not being able to travel, and faculty and collaborators could receive the planned support on their projects. This evaluation aims to describe the experience of pivoting the GHEFP program from an in-person, in-country program to a remote practicum. We analyzed program evaluation data from 30 students, 20 faculty members, and 10 in-country collaborators. Surveys for each group consisted of multiple choice, scale rating, and open-ended questions. The quantitative data was analyzed using Microsoft Excel to calculate survey response frequencies. The open-ended responses were analyzed for emergent themes. The remote GHEFP experience enabled students to gain practice working on global health projects from a distance, but it came with challenges related to preparation, communication, shifting scopes of work, and contextualization. All participants would have preferred an in-person experience if given a choice, but most agreed that a remote practicum was better than not participating at all. The remote program served its purpose during the height of the pandemic. Given the hybrid nature of global health today, many aspects of the remote practicum experience are helpful for global health training. Future iterations of remote STEGHs should initially be designed for remote work to ensure meaningful scopes for students that are helpful to faculty mentors and collaborators. Hybrid models may also be useful. Mutually beneficial twinning relationships should also be incorporated into remote and in-person STEGHs to foster a more equitable global health training environment.

Scholarly Products for the Global Health Trainee: a Guide for Educators.

There is consistent interest from medical trainees in high-income countries in academic global health education (GHE) programs. Academic scholarship in global health has traditionally been linked to longer-term programs. However, most programs for medical trainees offer short-term experiences in global health (STEGH). These experiences are typically brief and clinical, and present logistical and ethical challenges for producing scholarship. Given challenges inherent in global health medical education, educators should cultivate ethically sound scholarship prioritizing power, privilege, and decision-making within local communities. Utilizing the framework of community-engaged scholarship, GHE ethics guidelines and examples we present suggestions to guide scholarship in GHE.

Cultural Sensitivity and Ethical Considerations.

Global surgery is a burgeoning area of global health. Surgeons can engage in one-or many-of the facets of global healthcare delivery: clinical care, capacity building, education, research, etc. Working in an increasingly global community, surgeons must be aware of the richness of cultural diversity at home and around the world such that they can provide culturally sensitive care. This chapter focuses on the most common way in which surgeons engage in global surgery: surgical short-term experiences in global health (STEGHs). Surgical STEGHs pose an intricate set of ethical dilemmas. As team leaders, surgeons must understand the community they intend to serve on these trips. Further, they should confirm that everyone who joins them is prepared to deliver care in a culturally sensitive and competent manner. Finally, surgeons must consider potential ethical dilemmas that may arise before, during, and after surgical STEGHs and have strategies to navigate them.

An Online Ethics Curriculum for Short-Term Global Health Experiences: Evaluating a Decade of Use

Background:Medical students and early career healthcare professionals commonly participate in short-term experiences in global health (STEGH).Objective:The authors evaluate the use of a free-to-access, case-based online curriculum addressing ethical issues trainees should consider prior to engaging in STEGH.Methods:Demographic data and feedback on specific cases were collected from 5,226 respondents accessing the online curriculum between November 1, 2011 and October 31, 2021. Feedback on the curriculum included 5-point Likert scale and open-ended responses. Quantitative data were analyzed using standard descriptive statistics. Qualitative data were independently dual coded and analyzed thematically in NVivo.Findings:The curriculum reached respondents from 106 countries. Undergraduate (36%) and graduate (38%) respondents included those from several different professional specialties. Less than a quarter of all of respondents, less than half with previous global health experience, and one-third with planned future global health experiences had received prior global health ethics training. Overall, the curriculum was highly rated; respondents felt it provided necessary tools to improve their thought processes, confidence, and behavior when encountering ethical issues during STEGH. Areas for curriculum improvement include balancing case specificity with generalizability.Conclusion:This curriculum has met a need for accessible introductory global health ethics education and demonstrates successful use of an online platform in case-based ethics learning.

Global Health Partnerships and the Brocher Declaration: Principles for Ethical Short-Term Engagements in Global Health.

Short- term experiences in global health (STEGH), also known as short-term medical missions continue to be a popular mode of engagement in global health activities for students, healthcare providers, and religious groups, driven primarily by organizations from high-income countries. While STEGH have the potential to be beneficial, a large proportion of these do not sustainably benefit the communities they intend to serve, may undermine local health systems, operate without appropriate licenses, go beyond their intended purposes, and may cause harm to patients. With heightened calls to “decolonize” global health, and to achieve ethical, sustainable, and practical engagements, there is a need to establish strong guiding principles for global health engagements. The Advocacy for Global Health Partnerships (AGHP), a multi-sectoral coalition, was established to reflect on and address the concerns relating to STEGH. Towards this end, AGHP created the Brocher Declaration to lay out six main principles that should guide ethical and appropriate STEGH practices. A variety of organizations have accepted the Declaration and are using it to provide guidance for effective implementation of appropriate global health efforts. The Declaration joins broader efforts to promote equity in global health and a critical reevaluation of volunteer-centric, charity-based missions. The current state of the world’s health demands a new model of collaboration – one that sparks deep discussions of shared innovation and builds ethical partnerships to address pressing issues in global health.

The Impact of Global Health Experiences on the Emergency Medicine Residency Milestones.

OBJECTIVESIdentify the impact of experiences in global health (GH) on the Accreditation Council for Graduate Medical Education (ACGME) competencies in emergency medicine (EM) residents and describe the individual characteristics of EM residents with global health experience compared to those without.METHODSFrom 2015 to 2018, 117 residents from 13 nationally accredited United States EM residency training programs were surveyed. Specifically, the survey gathered demographic data and information regarding timing, type, location and duration of short term experiences in global health (STEGH). The survey collected both qualitative and quantitative data regarding resident experiences, including number of procedures performed and self-assessment of the impact on their residency milestones. ACGME milestone data from survey respondents was collected from each resident's training program coordinators. Chi-squared analysis and t-tests were conducted to assess differences between residents with STEGH and those without. A generalized linear model (GLM) was utilized to assess the effects of time and experience with interaction on achieving milestones in each of the competency domains, to compare milestone achievement over time between residents with STEGH and those without.RESULTSOut of 117 EM residents, 60 were female (44%), the mean age was 30 years (standard deviation = 3.1), and 84 (71.8%) reported STEGH in general, including prior to residency (64.5%). 33 (28.2%) reported having completed STEGH during residency. The results of the GLM analysis showed that residents with STEGH during residency had significantly higher scores compared to those without the experience or STEGH pre-residency across all six competenciesCONCLUSIONSSTEGH in EM residents was associated with higher milestone achievement in certain ACGME competency domains including medical knowledge, practice-based learning and improvement, and professionalism. Participation in STEGH during residency appeared to show the strongest effect, with higher scores across all six competencies.

When numbers eclipse narratives: a cultural-political critique of the ‘ethical’ impacts of short-term experiences in global health in Dominican Republic bateyes

With the rising demand for short-term experiences in global health (STEGH) is an ever-increasing volume of literature that focuses attention on ethics and ethical concerns, such as the effects of...

The Ethical Implications of Student Participation in Short-Term Experiences in Global Health

Student interest in short-term experiences in global health (STEGHs) has grown in recent years. Typically, students travel from high-income countries (HIC), standing to benefit from varied clinical exposure and participation beyond what is allowed in their home jurisdictions. Whether STEGHs benefit the hosting low- and middle-income countries (LMICs) are less clear. We seek to mitigate the ethical implications of student participation in STEGHs by examining three domains: (a) the medical scope of practice for students; (b) cultural competency; and (c) reciprocal partnerships. These domains permit further elucidation of key issues relating to ethics, and public policy, to clarify how STEGH initiatives can be evaluated. Our analysis implicates that STEGHs can be described as post-colonial enterprises that perpetuate structural violence in LMICs and may cultivate hubris and savior complexes in learners. Examination of these domains necessitates two points for further analysis and evaluation with respect to STEGHs: (1) a stronger idea of justice and distributive justice that includes considerations of structural violence and reciprocity; and (2) realignment of student global health priorities towards the communities being cared for as opposed to the benefits of high income countries and volunteers. To improve global health knowledge transfer worldwide, we advocate for reciprocity between HIC and LMIC institutions and training in the colonial history of global health. We hope these changes will reduce eurocentrism within student global healthand any potential harms.

Exploring global health programs in U.S. dental schools.

The purpose of this study was to survey and describe key curricular and extracurricular components of U.S. dental schools' global health programs. A 22-item web-based survey invitation was sent to administrators at all 66 US dental schools. Topics included both curricular and extracurricular global health activities offered, including Short-term Experiences in Global Health (STEGHs). Key components were identified and classified as domains and components for the purpose of discussion: Domain #1: Program support and administrative factors (components: a support, faculty support, and extracurricular activities), Domain #2: Academic teaching (components: global health track, didactic courses, and cultural awareness and communication teaching), and Domain #3: STEGHs, (components: School-based STEGHs, al organization-based STEGHs, and exchange programs). Most notably among respondents, 72% strongly agreed/agreed that global health should be a part of the dental curriculum, 81% strongly agreed/agreed that students benefit from participating in global health experiences, and 43% of schools had a faculty member dedicated to global health work. In this study of dental schools, 44% offered didactic courses in global health, and 62% of schools offered STEGHs. The results of this study offer a description of key components of global health education programs in U.S. dental schools. Schools surveyed offer a combination of both didactic courses and STEGH programs for their students. Global health education may improve dental students' skills related to managing a diverse patient population.

Low- and Middle-Income Country Host Perceptions of Short-Term Experiences in Global Health: A Systematic Review.

Stakeholders have expressed concerns regarding the impact of visiting trainees and physicians from high-income countries (HICs) providing education and/or short-term clinical care in low- and middle-income countries (LMICs). This systematic review aimed to summarize LMIC host perceptions of visiting trainees and physicians from HICs during short-term experiences in global health (STEGH). In September 2018 then again in August 2020, the authors searched 7 databases (PubMed, Embase, Scopus, Web of Science, ERIC, Cochrane Library, Global Index Medicus) for peer-reviewed studies that described LMIC host perceptions of STEGH. They extracted information pertaining to study design, participant demographics, participant perceptions, representation of LMICs and HICs, and HIC visitors' roles and used thematic synthesis to code the text, develop descriptive themes, and generate analytical themes. Of the 4,020 studies identified, 17 met the inclusion criteria. In total, the studies included 448 participants, of which 395 (88%) represented LMICs. The authors identified and organized 42 codes under 8 descriptive themes. They further organized these descriptive themes into 4 analytical themes related to STEGH: (1) sociocultural and contextual differences, (2) institutional and programmatic components, (3) impact on host institutions and individuals, and (4) visitor characteristics and conduct. STEGH can have both beneficial and detrimental effects on LMIC host institutions and individuals. The authors translated these findings into a set of evidence-based best practices for STEGH that provide specific guidance for LMIC and HIC stakeholders. Moving forward, LMIC and HIC institutions must work together to focus on the quality of their relationships and create conditions in which all stakeholders feel empowered to openly communicate to ensure equity and mutual benefit for all parties.

Using a Health Equity Lens to Evaluate Short-Term Experiences in Global Health (STEGH).

Background:The growing popularity of short-term experiences in global health (STEGH) has given rise to increasing criticism around their purported benefits and outcomes. With the global health and development community’s growing focus on improving population health and equity worldwide as outlined in the United Nation’s Sustainable Development Goals, there is a growing opportunity to examine and optimize the conduct of STEGH using an outcomes and equity focused lens.Objectives:This viewpoint aims to develop a framework that can be used to plan and evaluate STEGH on outcomes underpinned by a health equity focus.Methods:Drawing on logic model theory, the analysis first identifies extant issues and their drivers around the planning, implementation, and evaluation of tradition STEGH (focused on clinical service provision.) The analysis then explores various definitions of health equity, settling on a broad definition around context that promotes health for all as opposed to equity of access to healthcare services. With that definition as the ultimate benchmark of success, the analysis then proposes questions that can be used to determine how and when a STEGH might best be deployed to meet that goal.Findings:Traditional reliance on process outputs from service-based approaches have historically limited an understanding of if and how STEGH might advance health equity. Using an outcomes-focused approach identifies critical questions around the value of such experiences, when weighed against a broad definition of equity and other key global health themes such as sustainability, cultural humility, and impact. Measuring STEGH against the goal of improving population health status and equity worldwide allows careful consideration of the appropriateness and effectiveness of such efforts on their own and in concert with other interventions.Conclusions:The extent to which health equity is advanced should be the ultimate metric used to evaluate not only STEGH, but any global health endeavours.

Pursuit to Post: Ethical issues of social media use by international medical volunteers.

Medical volunteers from high-income countries seek short-term global health experiences in low- and middle-income countries to learn and practice medicine, complete service-learning projects, conduct research, and burnish their curricula vitae. The uniqueness and poignancy of these global health experiences frequently compel medical volunteers to not only capture visual reminders of their experience but to share them online through social media. Prioritizing image creation and sharing, which center on the volunteer's priorities over patient-centered priorities, risks failing to acknowledge the ethical issues inherent in power imbalances between the medical volunteers, patients, hosts, organizational partners and others, and bypasses the values of the host community. Using social media as an example of an emerging ethical challenge in the context of short-term experiences in global health, the authors examine potential consequences for patients, host communities, and international partnerships and discuss important pre-posting considerations.

Short-term Experiences in Global Health: What is the Cost of Cultural Competence?

Students in a wide variety of health professions are increasingly interested in volunteering on a short-term experience in global health (STEGH). The literature suggests that STEGHs pose a variety of potential risks and benefits, and may carry a significant cost to plan and provide. One potential mitigating factor for any risks and costs is that student participation on a STEGH may enhance their cultural competence. Since monies spent on STEGHs are fungible, and there may be other opportunities to improve students' cultural competence, the objectives of this study were to determine if participation on a STEGH increased students' cultural competence and if so, what the cost for any such increase was. In this study, 20 students who participated on a 1-week STEGH to the Dominican Republic completed the Inventory for Assessing the Process of Cultural Competence Among Health Care Professionals - Student Version (IAPCC-SV) before and after the STEGH. The costs for all students and 7 supervising health professionals to volunteer for the STEGH were calculated, and the size of any increase in cultural competence was determined. The cost was divided by the change in cultural competence to ascertain the cost of the change. Students showed a measureable increase on the IAPCC-SV overall and on the subscales of knowledge and skill. The cost of a 1% overall increase in students' cultural competence ranged from $287 to $401. These results may allow schools offering STEGHs to determine if their offerings are cost-effective or not.

Global Health Training in U.S. Emergency Medicine Residency Programs.

Formal education in global health (GH) and short-term experiences in GH (STEGH) are offered by many emergency medicine (EM) residency programs in the United States. In an increasingly connected world, training in GH and STEGH can provide essential knowledge and practical skills to trainees, particularly at the graduate medical education level. The current core programmatic components and the essential competencies and curricula that support ethical and effective STEGH, however, still vary widely.The authors conducted a survey of the228 EM residency programs in the United States to describe the current state of GH training and STEGH. An online survey was developed in REDCap by a team of GH faculty. In July 2018, programs were invited to participate via individual invitation of program directors from a directory. The programs received two reminders to participate until January 2019. Of the 84 programs that responded, 75% offer STEGH and 39% have longitudinal GH curricula. Within these programs, only 55% have dedicated GH faculty and only 70% have dedicated sites. Both faculty and residents encounter funding and insurance barriers; most notably, only 20% of programs that offer STEGH provide evacuation insurance for their residents.Most residents (95%) engage in clinical work along with teaching and other activities, but 24% of programs do not allow these activities to fulfill any residency requirements. Finally, only 80 and 85% of programs offer preparatory and debriefing activities for residents, respectively. While the results of this survey show progress relative to prior surveys, there are still barriers to implementing GH curricula and supporting safe, ethical, and effective STEGH, particularly in the form of continued financial and logistic support for faculty and for residents, in U.S. EM training programs.

Reassessing Global Health Education in the Age of COVID-19.

To the Editor: The COVID-19 pandemic has killed over a million people, stressed health care systems, and disrupted economies and societies globally. It has also created havoc in higher medical education. 1,2 This has been particularly notable in global health, where travel restrictions have brought traditional clinical global health rotations to a halt. These drastic changes in the learning environment offer an opportunity to rethink and improve global health education. The most concrete change is reduced international travel. Despite the possible adverse effects of short-term experiences in global health, 3,4 many academic institutions struggle to ensure that they meet the highest standards of long-term, bidirectional engagement. The pandemic-enforced travel pause may allow medical educators to refocus toward insuring longitudinal and high-quality programs rather than maximizing the number of trainees traveling. We can have a frank reckoning with finances, benefits, and sustainability. As travel is now removed as the “required” activity of global health education, we must rethink how we teach. In fact, many of us structure our curricula based on the fixed point of the trip, the experiential learning experience. Best practices in global health educational programs include robust predeparture training with significant time and energy spent preparing students for the local context. Educators should reconsider appropriate overarching learning objectives for global health. Can distance learning fulfill these requirements? Is it truly a sufficient replacement for in-country rotations? As medical educators, we need to reexamine the paradigmatic assumptions and “ground rules” implicitly built into our belief systems of what constitutes effective global health training. 5 The pandemic has now forced academic global health partnerships to be locally driven in practice rather than often previously only in theory. This has also accelerated innovation in partnering—virtual collaborations, investment in mobile health applications, funding for local activities, and astounding collaboration in global research. While exposing the still existing colonial aspects of global health, the pandemic highlights the critical importance of global health concepts. Disparate COVID-19 infection and mortality rates in underserved or minority communities underscore the importance of social determinants of health. The importance of proper funding for and training in public health is now painfully obvious. Global health education programs must use this opportunity to critically examine our paradigmatic grounding. We are invited to thoughtfully adapt and evolve promising practices and curricula to train the next generation to meet this challenge.