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Ann Glob Health. 2016 Sep - Oct;82(5):678-685. doi: 10.1016/j.aogh.2016.10.001.

A Protocol to Develop Practice Guidelines for Primary Care Medical Service Trips.

Author information

Department of Emergency Medicine, Grand River Hospital, Kitchener, Ontario, Canada. Electronic address:
Lawrence S. Bloomberg Faculty of Nursing, Institute of Aging, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Pediatrics, University of Pennsylvania, Philadelphia, PA.
Department of Family and Community Medicine, University of Toronto and Bridge to Health Medical and Dental, Toronto, Ontario, Canada.
Clinical Public Health Division, Office of Global Public Health Education and Training, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.



North American clinicians are increasingly participating in medical service trips (MSTs) that provide primary healthcare in Latin America and the Caribbean. Literature reviews have shown that the existence and use of evidence-based guidelines by these groups are limited, which presents potential for harm.


This paper proposes a 5-step methodology to develop protocols for diagnosis and treatment of conditions encountered by MST clinicians.


We reviewed the 2010 American College of Physicians guidance statement on guidelines development and developed our own adaptation. Ancestry search of the American College of Physicians statement identified specific publications that provided additional detail on key steps in the guideline development process, with additional focus given to evidence, equity, and local adaptation considerations.


Our adaptation produced a 5-step process for developing locally optimized protocols for diagnosis and treatment of common conditions seen in MSTs. For specified conditions, this process includes: 1) a focused environmental scan of current practices based on grey literature protocols from MST sending organizations; 2) a review of relevant practice guidelines; 3) a literature review assessing the epidemiology, diagnosis, and treatment of the specified condition; 4) an eDelphi process with experts representing MST and Latin American and the Caribbean partner organizations assessing identified guidelines; and 5) external peer review and summary.


This protocol will enable the creation of practice guidelines that are based on best available evidence, local knowledge, and equitable considerations. The development of guidelines using this process could optimize the conduct of MSTs, while prioritizing input from local community partners.


Latin America; global health; humanitarian health; international health; medical missions; medical service trips

[Indexed for MEDLINE]

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