Global health electives: Ethical engagement in building global health capacity

Abstract

Purpose: Little is known about the impact medical trainees undertaking global health electives (GHEs) have on host institutions and their communities in low-and middle-income countries. The goal of this study was to explore the relationship dynamics associated with GHEs as perceived by host stakeholders at three sites in sub-Saharan Africa.

Method: This case-based interpretive phenomenological study examined stakeholder perspectives in Mwanza, Tanzania, and Mbarara and Rugazi, Uganda, where the University of Calgary, Alberta, Canada has long-standing institutional collaborations. Between September and November 2017, 33 host stakeholders participated in semi-structured interviews and 28 host stakeholders participated in focus group discussions. Participant experiences were analyzed using interpretive phenomenological techniques.

Results: The findings revealed that, although GHEs are well-established and a common experience for host stakeholders, their perceptions about who visiting medical trainees (VMTs) are remains indistinct. Participants acknowledged that there are a variety of benefits to GHEs, but overall VMTs appear to benefit the most from this unique learning opportunity. Host stakeholders described significant challenges and burdens of GHEs and recommended ways in which GHEs could be improved.

Conclusions: GHEs need to be designed to better embrace ethical engagement and reciprocity with host stakeholders to ensure equity in benefits and responsibilities.

Keywords:

• Global health
• medical education
• low and middle-income country
• qualitative research
• international educational exchange

Ethical approval

University of Calgary Conjoint Health Research Ethics Board (CHREB) (REB 17-0483), the ethics review boards at MUST (No. 15/07-17), CUHAS (CREC/222/2017), and the Uganda National Council of Science and Technology (SS229ES).

Acknowledgments

The authors wish to thank all of the study participants for generously contributing their time and perspectives. They would also like to thank Flora Madaha, Roze Kyarisiima, Rogers Ankunda, Judith Owukohaisa, Joyce Silas, and Neema Gambishi for their dedicated work as research assistants in the context of this study.

Disclosure statement

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

Previous presentations

Aspects of this work have been presented at the International Conference on Medical Education and at the Bethune Round Table.

Glossary

Emotional Self-Regulation: “Emotional self-regulation refers to the complex process of initiating, inhibiting, and modulating the conscious aspects of emotion to effectively achieve one’s goals. Although this concept, at the most basic level, refers to controlling one’s feelings, theory and research on emotional self-regulation have addressed various cognitions, physiological processes, and behavioral outcomes associated with individual differences in the capacity to effectively manage one’s emotions.”

Sonnentag TL, Barnett MA. 2011. Emotional Self-Regulation. In: Goldstein S, Naglieri JA (eds) Encyclopedia of Child Behavior and Development. Springer, Boston, MA.

Global Health Elective: Within the field of medical education, this is commonly understood to be a clinical care or health research experience by a health care trainee from a highly-resourced setting within an underserved or resource-constrained population.

University of Calgary. 2008. Global Health Electives. Retrieved from http://www.ucalgary.ca/ghealth/education/electives.

Crump JA, Sugarman J. 2008. Ethical considerations for short-term experiences by trainees in global health. JAMA. 300. doi:10.1001/jama.300.12.1456.

Additional information

Funding

This research was supported by a grant from the McLaughlin Travelling Medical Education Fund. The first author’s travel was funded by the Canadian Queen Elizabeth II Diamond Jubilee Scholarship. The Canadian Queen Elizabeth II Diamond Jubilee Scholarships (QES) is managed through a unique partnership of Universities Canada, the Rideau Hall Foundation (RHF), Community Foundations of Canada (CFC) and Canadian Universities. This program is made possible with financial support from the Government of Canada, provincial governments and the private sector.

Notes on contributors

Adriena De Visser

Dr. Adriena De Visser, MD, MSc, is a general surgery resident, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta.

Jennifer Hatfield

Dr. Jennifer Hatfield, PhD, is a professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta.

Rachel Ellaway

Dr. Rachel Ellaway, PhD, is a professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta.

Denise Buchner

Dr. Denise Buchner, PhD, is an adjunct assistant professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta.

Jeremiah Seni

Dr. Jeremiah Seni, MD, PhD, is a senior lecturer, Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.

Wilfred Arubaku

Dr. Wilfred Arubaku, BDS, MSc, is a senior lecturer, Department of Dental Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.

Josephine Nambi Najjuma

Ms. Josephine Nambi Najjuma, BNS, PGD, is a nurse, Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.

Gwendolyn Hollaar

Dr. Gwendolyn Hollaar, MD, MPH, is an associate professor, Departments of Surgery and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta.