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Acad Med. 2018 Nov 5. doi: 10.1097/ACM.0000000000002511. [Epub ahead of print]

Reconfiguring a One-Way Street: A Position Paper on Why and How to Improve Equity in Global Physician Training.

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J.C. Hudspeth is assistant professor and director, Residency Global Health, Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts. T.L. Rabin is assistant professor of internal medicine and associate program director, Global and Community Health, Yale Primary Care Internal Medicine Residency Program; and assistant director, Office of Global Health, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut. B.A. Dreifuss is assistant professor of emergency medicine and public health, and director, Rural, Border, and Global Programs in Emergency Medicine, Colleges of Medicine and Public Health, University of Arizona, Tucson, Arizona. M. Schaaf is professor and associate director, Global Health Pathway, School of Medicine, and director, Global Outreach, University of California San Francisco, San Francisco, California. M.S. Lipnick is assistant professor and program director, Anesthesia Global Health Fellowships, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California. C.M. Russ is assistant professor, Department of Pediatrics, Harvard University, and associate director, Global Health Program, Boston Children's Hospital, Boston, Massachusetts. A. Autry is professor and director, Graduate Medical Education, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California. M.B. Pitt is associate professor and director, Global Health Education, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota. V. Rowthorn is executive director, University of Maryland - Baltimore Center for Global Education Initiatives, Baltimore, Maryland.


Large numbers of U.S. physicians and medical trainees engage in hands-on clinical global health experiences abroad, where they gain skills working across cultures with limited resources. Increasingly, these experiences are becoming bidirectional, with providers from low- and middle-income countries traveling to experience health care in the United States, yet the same hands-on experiences afforded stateside physicians are rarely available for foreign medical graduates or postgraduate trainees when they arrive. These physicians are typically limited to observership experiences where they cannot interact with patients in most U.S. institutions. In this article, the authors discuss this inequity in global medical education, highlighting the shortcomings of the observership training model and the legal and regulatory barriers prohibiting foreign physicians from engaging in short-term clinical training experiences. They provide concrete recommendations on regulatory modifications that would allow meaningful short-term clinical training experiences for foreign medical graduates, including the creation of a new visa category, the designation of a specific temporary licensure category by state medical boards, and guidance for U.S. host institutions supporting such experiences. By proposing this framework, the authors hope to improve equity in global health partnerships via improved access to meaningful and productive educational experiences, particularly for foreign medical graduates with commitment to using their new knowledge and training upon return to their home countries.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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