Best Practices

As a result of the increased student interest in global health, learners are increasingly exposed to challenging ethical dilemmas and potentially hazardous situations. These situations require careful preparation and considerable awareness among learners, supervising faculty, and the host and sponsoring institutions. Several resources related to best practices, safety, and ethics in global health are available, including:

Articulating ethical concerns and potential hazards:

• Some health programs overseas let students do too much, too soon (2013; The Chronicle of Higher Education)
• Medical tourism (YouTube video)
• Ethical dilemmas during the global health elective (2015; EM Resident)
• Developing ethical awareness in global health: four cases for medical educators (2014; Developing World Bioethics)
• Host community perspectives on trainees participating in short-term experiences in global health (2016; Medical Education)

Best practice guidelines and competency development:

Adhering to established best practices and ensuring the development of competencies in those participating in global health activities can help maximize the benefits and minimize the harms of global health programs.

• Ethics and best practice guidelines for training experiences in global health (2010; American Journal of Tropical Medicine & Hygiene)
• Identifying interprofessional global health competencies for 21st-century health professionals (2015; Annals of Global Health)
• Perspective: a proposed medical school curriculum to help students recognize and resolve ethical issues of global health work (2012; Academic Medicine)
• Beyond medical "missions" to impact-driven short-term experiences in global health (STEGHs): ethical principles to optimize community benefit and learner experiences (2016; Academic Medicine)
• The ethical conundrum of international health electives in medical education (2012; Journal of Global Citizenship & Equity Education)
• Unite for Sight offers a free online course that helps to ensure that volunteers understand their role and how to make an impactful difference while abroad. This pre-service training focuses on ethics and professionalism.
• Child Family Health International has published an anthology that highlights the impact of global health experiences and illustrates the perspectives of undergraduate students, health science trainees, and young doctors working in international health systems, revealing their expectations, ideals, biases, limitations, and ambitions. Reflection in Global Health: an Anthology includes essays that encourage learners to become critical reflectors and to nurture fully reflective health professionals with the ability to learn from experience after formal training.
• The Consortium of Universities for Global Health created a Global Health Education Competencies Tool Kit that provides learning objectives and curricular content to support the development of global health competencies for trainees at various levels of proficiency. The recent Workshop on Best Practices in Global Health Experiential Learning provides an excellent resource manual.
• GASP (the Working Group on Global Activities by Students at Pre-Health Levels) is charged with advancing best practice standards for undergraduate students in health-related settings abroad. GASP shares resources, articles, presentations, etc. to enable consistent talking points, mutual support, and additive impacts for health students and professionals to maintain ethical boundaries.

Ensuring trainee safety

Trainee safety is an essential element of any global health experience; yet many trainees may not be adequately prepared for their experience. Several organizations have developed pre-trip trainings, including:

• The Global Ambassadors for Patient Safety online workshop is designed for all students who are going abroad and plan to work or volunteer in a healthcare setting. The workshop content is available to everyone, everywhere, at no cost.
• The Society for Academic Emergency Medicine has collaborated with other medical associations to created guidelines for trainees conducting global health electives.

A checklist of specific actions that can be taken to develop safety and security plans is also available in the following publication: Improving the safety and security of those engaged in global health traveling abroad (2016; Global Health: Science and Practice).