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Acad Med. 2016 May;91(5):633-8. doi: 10.1097/ACM.0000000000001009.

Beyond Medical "Missions" to Impact-Driven Short-Term Experiences in Global Health (STEGHs): Ethical Principles to Optimize Community Benefit and Learner Experience.

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M.K. Melby is assistant professor, Departments of Anthropology and Behavioral Health and Nutrition, University of Delaware, Newark, Delaware. L.C. Loh is adjunct professor, Department of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, and director of programs, The 53rd Week, Brooklyn, New York. J. Evert is executive director, Child Family Health International, and faculty, Department of Family and Community Medicine, University of California San Francisco, San Francisco, California. C. Prater is internal medicine-pediatrics physician, Baltimore Medical System, Baltimore, Maryland. H. Lin is attending physician, Children's Hospital of Philadelphia, Division of Gastroenterology, Hepatology, and Nutrition, assistant professor, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, and executive director, The 53rd Week, Brooklyn, New York. O.A. Khan is associate vice chair, Department of Family and Community Medicine, and director, Global Health Residency Track, Christiana Care Health System, Wilmington, Delaware, and associate director, Delaware Health Sciences Alliance, Newark, Delaware.


Increasing demand for global health education in medical training has driven the growth of educational programs predicated on a model of short-term medical service abroad. Almost two-thirds of matriculating medical students expect to participate in a global health experience during medical school, continuing into residency and early careers. Despite positive intent, such short-term experiences in global health (STEGHs) may exacerbate global health inequities and even cause harm. Growing out of the "medical missions" tradition, contemporary participation continues to evolve. Ethical concerns and other disciplinary approaches, such as public health and anthropology, can be incorpo rated to increase effectiveness and sustainability, and to shift the culture of STEGHs from focusing on trainees and their home institutions to also considering benefits in host communities and nurtur ing partnerships. The authors propose four core principles to guide ethical development of educational STEGHs: (1) skills building in cross-cultural effective ness and cultural humility, (2) bidirectional participatory relationships, (3) local capacity building, and (4) long-term sustainability. Application of these principles highlights the need for assessment of STEGHs: data collection that allows transparent compar isons, standards of quality, bidirectionality of agreements, defined curricula, and ethics that meet both host and sending countries' standards and needs. To capture the enormous potential of STEGHs, a paradigm shift in the culture of STEGHs is needed to ensure that these experiences balance training level, personal competencies, medical and cross-cultural ethics, and educational objectives to minimize harm and maximize benefits for all involved.

[Indexed for MEDLINE]

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