Ethical dilemmas during international clinical rotations in global health settings: Findings from a training and debriefing program

Abstract

Purpose: This study describes the impact of an open-access, case-based global health ethics workshop and describes the breadth of dilemmas faced by students to inform future interventions.

Methods: Eighty-two medical students who undertook electives at 16 international sites between 2012 and 2015 received web-based surveys at three time points, incorporating quantitative and free-text probes of knowledge, skills, and attitudes related to global health clinical ethics dilemmas. Sixty students (73%) completed the pre-workshop survey, 38 (46%) completed the post-workshop survey, and 43 (52%) completed the post-trip survey.

Results: Analysis demonstrated improvement following the workshop in self-rated preparedness to manage ethical dilemmas abroad, identify ways to prepare for dilemmas, engage support persons, and manage related emotions (all comparisons, p < 0.001). Participants described 245 anticipated or actual dilemmas, comprising nine domains. Nearly one-third of the dilemmas that were experienced involved the student as an active participant. Only 21% of respondents experiencing a dilemma discussed the dilemma with a local support person.

Conclusions: This analysis describes an ethics curriculum that prepares students to face ethical dilemmas during international clinical rotations. It broadens the representation of the dilemmas that students face, and highlights areas for curricular focus and optimization of on-site and post-trip student support resources.

Acknowledgements

We thank the students who participated in the study. We acknowledge the support of the Office of International Medical Student Education and the Office of Global Health in the Department of Internal Medicine at the Yale School of Medicine. We specifically acknowledge the support of Dr. Robert Rohrbaugh and Ms Anne Kellett, and the contributions of Dr. Oluwatosin Onibokun and Dr. John Thomas to the curriculum.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Ethical approval

The study was approved by the Yale School of Medicine Human Subjects Committee.

Glossary

Global health clinical ethics: The study of the ethical challenges faced by health professions students, trainees, and faculty in the context of their clinical work or education in global health settings, with specific focus on recognizing and navigating ethical dilemmas, avoiding harm, and promoting equitable global health partnerships.

Notes on contributors

Michael J. Peluso, MD, MPhil, MHS, DTM&H, is a clinical fellow in infectious diseases at the University of California-San Francisco Medical Center.

Stacey Kallem, MD, is a pediatrician and National Clinical Scholar at the University of Pennsylvania.

Mei Elansary, MD, MPhil, is a Pediatric Global Health Research Fellow at Boston University’s Center for Global Health and Development.

Tracy Rabin, MD, SM, is an Associate Program Director for Global and Community Health in the Yale Primary Care Internal Medicine residency program, assistant director of the Office of Global Health, and assistant professor in the Department of Medicine at the Yale School of Medicine.