Abstract
Recent studies show that returning global health trainees often report having felt inadequately prepared to deal with ethical dilemmas they encountered during outreach clinical work. While global health training guidelines emphasize the importance of developing ethical and cultural competencies before embarking on fieldwork, their practical implementation is often lacking and consists mainly of recommendations regarding professional behavior and discussions of case studies. Evidence suggests that one of the most effective ways to teach certain skills in global health, including ethical and cultural competencies, is through service learning. This approach combines community service with experiential learning. Unfortunately, this approach to global health ethics training is often unattainable due to a lack of supervision and resources available at host locations. This often means that trainees enter global health initiatives unprepared to deal with ethical dilemmas, which has the potential for adverse consequences for patients and host institutions, thus contributing to growing concerns about exploitation and “medical tourism.” From an educational perspective, exposure alone to such ethical dilemmas does not contribute to learning, due to lack of proper guidance. We propose that the tension between the benefits of service learning on the one hand and the respect for patients’ rights and well-being on the other could be resolved by the application of a simulation-based approach to global health ethics education.
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Notes
Various combinations of these issues form the basis of ethical dilemmas that involve challenges to the preservation of patient privacy and confidentiality, obtaining informed consent, and successful relationships between host staff and visiting trainees (Barnard et al. 2011)
Although the term “medical tourism” is sometimes used to describe this problem, the same term is used in bioethics literature to describe the practice of individuals seeking treatment in international hospitals and clinics outside of their local health communities. For a better understanding of the difference between the two meanings, see Snyder, Dharamsi, and Crooks (2011).
We developed four simulation scenarios for our pilot. In the first scenario, the trainee has to decide whether to report a hospital pharmacist who secretly diverts a large amount of medications to the poor patients who cannot afford treatment. In the second scenario, the trainee has to decide whether to insist on giving HIV treatment to a woman who will become homeless and abused if her family finds out that she is HIV-positive. The third scenario features a teenager with a complicated pregnancy that demands a Caesarian section, but the proper treatment is unattainable due to various cultural limitations. In the fourth scenario, the trainee has to decide whether to perform a pericardiocentesis, which is a procedure outside of her scope of practice but at the same time the only apparent means to save the patient’s life.
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Logar, T., Le, P., Harrison, J.D. et al. Teaching Corner: “First Do No Harm”: Teaching Global Health Ethics to Medical Trainees Through Experiential Learning. Bioethical Inquiry 12, 69–78 (2015). https://doi.org/10.1007/s11673-014-9603-7
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DOI: https://doi.org/10.1007/s11673-014-9603-7