Ensuring the Health, Safety and Preparedness of U.S. Medical Students Participating in Global Health Electives Overseas

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• 作者：Pascal James Imperato ; Denise M. Bruno ; M. Monica Sweeney
• 关键词：Preparedness for global health electives ; Global health electives ; Health and safety of students participating in global health electives
• 刊名：Journal of Community Health
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：41
• 期：2
• 页码：442-450
• 全文大小：370 KB
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  2.Imperato, P. J. (2004). A third world international health elective for U.S. medical students. The 25-year experience of the State University of New York, Downstate Medical Center. Journal of Community Health, 29(5), 337–373.CrossRef PubMed
  3.Bruno, D. M., & Imperato, P. J. (2015). A global health elective for U.S. medical students: The 35-year experience of the State University of New York, Downstate Medical Center, School of Public Health. Journal of Community Health, 40(2), 197–198.CrossRef
  4.Drain, P. K., Primack, A., Hunt, D. D., Fawzi, W. W., Holmes, K. K., & Gardner, P. (2007). Global health in medical education: A call for more training and opportunities. Academic Medicine, 82(3), 226–230. doi:10.​1097/​ACM.​0b013e3180305cf9​ .CrossRef PubMed
  5.Smith, J. K., & Weaver, D. B. (2006). Capturing medical students’ idealism. Annals of Family Medicine, 4(Suppl 1), S32–S37, discussion S58–S60. doi:10.​137/​afm.​543 .CrossRef PubMed PubMedCentral
  6.Hayward, A. S., Jacquet, G. A., Sanson, T., Mowafi, H., & Hansoti, B. (2015). Academic affairs and global health: How global health electives can accelerate progress towards ACGME milestones. International Journal of Emergency Medicine, 8(1), 45.CrossRef PubMed PubMedCentral
  7.Anderson, M. B., & Kanter, S. L. (2010). Medical education in the United States and Canada, 2010. Academic Medicine, 85(9 Suppl), S2–18. doi:10.​1907/​ACM.​0b013e3181f16f52​ .CrossRef PubMed
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  13.Association of American Medical Colleges. Global Health Learning Opportunities. https://​www.​aamc.​org/​services/​ghlo . Accessed February 1, 2016.
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  15.de Cortina, S. H., Aroa, G., Wells, T., & Hoffman, R. M. (2016). Evaluation of a structured pre-departure orientation at the David Geffen School of Medicine’s global health education programs. American Journal of Tropical Medicine and Hygiene. doi:10.​4269/​ajtmh.​15-0553 .PubMed
  16.Wallace, L. J., & Webb, A. (2014). Pre-departure training and the social accountability of international medical electives. Education for Health, 27(2), 143–147.CrossRef PubMed
  17.Dell, E. M., Varpio, L., Petrosoniak, A., Gajaria, A., & McCarthy, A. E. (2014). The ethics and safety of medical student global health electives. International Journal of Medical Education, 10(5), 63–72.CrossRef
  18.Imperato, P. J., LaRosa, J. H., Kavaler, F., Benker, K., & Schechter, L. (2011). The establishment of the School of Public Health at the State University of New York, Downstate Medical Center: The first nationally accredited school of public health in a public university in New York City. Journal of Community Health, 36(1), 1–13.CrossRef PubMed
  19.Bruno, D. M., Imperato, P. J., & Szarek, M. (2013). The correlation between global health experiences in low-income countries on choice of primary care residencies for graduates of an urban U.S. medical school. Journal of Urban Health, 91(2), 394–402.CrossRef PubMedCentral
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• 作者单位：Pascal James Imperato (1)
  Denise M. Bruno (1)
  M. Monica Sweeney (1)
  
  1. School of Public Health, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, MSc 43, Brooklyn, NY, 11203, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Public Health
  Health Promotion and Disease Prevention
  Ethics
  
• 出版者：Springer Netherlands
• ISSN：1573-3610

文摘

Global health electives based in resource-poor countries have become extremely popular with medical students from resource rich ones. As the number of such programs and participants increase, so too do the absolute health and safety risks. It is clear from a number of published reports that many institutions provide little or no meaningful preparedness for students and do little to ensure their health and safety. These deficiencies together can affect students, their foreign hosts, and sponsoring institutions. The School of Public Health at the State University of New York, Downstate Medical Center, and its predecessor, the Department of Preventive Medicine and Community Health, have sponsored a 6–8 week global health elective for fourth year medical students since 1980. The purposes of this elective are to provide students with an opportunity to observe the health care and public health systems in resource-poor countries, provide medical service, and have a cross-cultural experience. Over the course of the past 35 years, 386 students have participated in this global health elective in more than 41 resource-poor countries. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007–2008 to a high of 74 % in 2010–2011 and 2013–2014. Careful screening, including a written application, review of academic records and personal interviews, has resulted in the selection of highly mature, adaptable, and dedicated students who have performed well at overseas sites. Appropriately preparing students for an overseas global health experience in resource-poor countries requires the investment of much professional and staff time and effort. At the SUNY Downstate School of Public Health, these resources have underpinned our Global Health in Developing Countries elective for many years. As a result, the elective is characterized by meticulous organization, extensive preparedness measures for students, and continuous monitoring of site and country safety. The health of students is ensured by one-on-one assessment of immunization needs, anti-malarials, and the provision of a five-day supply of post-exposure HIV prophylaxis. Students sign agreements regarding the legal issues, immunizations, and anti-malarials recommended as well as HIV post-exposure prophylaxis. They are also required to obtain medical evacuation insurance provided by the university, and medical care insurance valid overseas. Student travel plans are also approved as is in-country lodging. The focus of our 6–8 week global health elective is not clinical medicine. Rather, it is to enable students to learn about the health care and public health systems in a resource-poor country. Through that focus, they also come to understand the causes of health and health care disparities that exist in the country to which they are assigned. Our students are greatly advantaged with regard to cross-cultural understanding since our school is located in New York City’s Borough of Brooklyn, where 40 % of the population was born outside of the U.S. Our comprehensive effort at risk management for this global health elective includes a thorough debriefing for each student upon his/her return. Special attention is given to ascertaining illness or injury while overseas, and, when necessary, immediate referral is made to an appropriate university clinical department where a student can be appropriately case managed. Meticulous oversight, careful selection of safe overseas sites, and attention to preparing students have resulted in significant risk reduction and successful experiences for the majority of our 386 students. This article describes the model we have developed for ensuring the health, safety, and preparedness of students participating in our global health elective.