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      Ethics and Best Practice Guidelines for Training Experiences in Global Health

      research-article
      * , * , the Working Group on Ethics Guidelines for Global Health Training (WEIGHT)
      The American Journal of Tropical Medicine and Hygiene
      The American Society of Tropical Medicine and Hygiene

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          Abstract

          Academic global health programs are growing rapidly in scale and number. Students of many disciplines increasingly desire global health content in their curricula. Global health curricula often include field experiences that involve crossing international and socio-cultural borders. Although global health training experiences offer potential benefits to trainees and to sending institutions, these experiences are sometimes problematic and raise ethical challenges. The Working Group on Ethics Guidelines for Global Health Training (WEIGHT) developed a set of guidelines for institutions, trainees, and sponsors of field-based global health training on ethics and best practices in this setting. Because only limited data have been collected within the context of existing global health training, the guidelines were informed by the published literature and the experience of WEIGHT members. The Working Group on Ethics Guidelines for Global Health Training encourages efforts to develop and implement a means of assessing the potential benefits and harms of global health training programs.

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          Most cited references31

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          Towards a common definition of global health

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            Global health in medical education: a call for more training and opportunities.

            Worldwide increases in global migration and trade have been making communicable diseases a concern throughout the world and have highlighted the connections in health and medicine among and between continents. Physicians in developed countries are now expected to have a broader knowledge of tropical disease and newly emerging infections, while being culturally sensitive to the increasing number of international travelers and ethnic minority populations. Exposing medical students to these global health issues encourages students to enter primary care medicine, obtain public health degrees, and practice medicine among the poor and ethnic minorities. In addition, medical students who have completed an international clinical rotation often report a greater ability to recognize disease presentations, more comprehensive physical exam skills with less reliance on expensive imaging, and greater cultural sensitivity. American medical students have become increasingly more interested and active in global health, but medical schools have been slow to respond. The authors review the evidence supporting the benefits of promoting more global health teaching and opportunities among medical students. Finally, the authors suggest several steps that medical schools can take to meet the growing global health interest of medical students, which will make them better physicians and strengthen our medical system.
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              Global health training and international clinical rotations during residency: current status, needs, and opportunities.

              Increasing international travel and migration have contributed to globalization of diseases. Physicians today must understand the global burden and epidemiology of diseases, the disparities and inequities in global health systems, and the importance of cross-cultural sensitivity. To meet these needs, resident physicians across all specialties have expressed growing interest in global health training and international clinical rotations. More residents are acquiring international experience, despite inadequate guidance and support from most accreditation organizations and residency programs. Surveys of global health training, including international clinical rotations, highlight the benefits of global health training as well as the need for a more coordinated approach. In particular, international rotations broaden a resident's medical knowledge, reinforce physical examination skills, and encourage practicing medicine among underserved and multicultural populations. As residents recognize these personal and professional benefits, a strong majority of them seek to gain international clinical experience. In conclusion, with feasible and appropriate administrative steps, all residents can receive global health training and be afforded the accreditation and programmatic support to participate in safe international rotations. The next steps should address accreditation for international rotations and allowance for training away from continuity clinics by residency accreditation bodies, and stipend and travel support for six or more weeks of call-free elective time from residency programs.
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                Author and article information

                Journal
                Am J Trop Med Hyg
                tpmd
                The American Journal of Tropical Medicine and Hygiene
                The American Society of Tropical Medicine and Hygiene
                0002-9637
                1476-1645
                06 December 2010
                06 December 2010
                : 83
                : 6
                : 1178-1182
                Affiliations
                Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Baltimore, Maryland; Office of Global Health, Stanford University, Stanford, California; Researcher, Bioethics and Global Health, Pune, India; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Departments of Medicine and Public Health, Stony Brook University School of Medicine, Stony Brook, New York; Emory Global Health Institute, Emory University, Atlanta, Georgia; Naval Medical Research Center Detachment, Lima, Peru; Doris Duke Charitable Foundation, New York, New York; BMJ, London, United Kingdom; Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Chula Medical Research Center (ChulaMRC), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; HIVNAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand; College of Health Sciences, Makerere University, Kampala, Uganda
                Author notes
                *Address correspondence to John A. Crump, Division of Infectious Diseases and International Health, Box 102359, Duke University Medical Center, Durham, NC 27710, E-mail: crump017@ 123456mc.duke.edu ; and Jeremy Sugarman, Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Hampton House 351, 624 North Broadway, Baltimore, MD 21205, E-mail: jsugarm1@ 123456jhmi.edu .
                †Working Group on Ethics Guidelines for Global Health Training (WEIGHT) members include: Michele Barry, Anant Bhan, Pierce Gardner, Jeffrey P. Koplan, Ahaz T. Kulanga, Silvia M. Montano, Elizabeth Myers, Kirsten Patrick, John D. Porter, Alan C. Regenberg, Kiat Ruxrungtham, Nelson K. Sewankambo, and John F. Shao.
                Article
                10.4269/ajtmh.2010.10-0527
                2990028
                21118918
                375befe8-a408-4f83-9f24-6b55ed90a55c
                ©The American Society of Tropical Medicine and Hygiene

                This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 September 2010
                : 30 September 2010
                Categories
                Global Health Training

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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