Beyond Medical "Missions" to Impact-Driven Short-Term Experiences in Global Health (STEGHs): Ethical Principles to Optimize Community Benefit and Learner Experience
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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DOI：
10.1097/acm.0000000000001009
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发表时间：
2016-05-01
影响因子：
7.4
通讯作者：
Khan, Omar A.
中科院分区：
文献类型：
--
作者：
Melby, Melissa K.;Loh, Lawrence C.;Khan, Omar A.
对医疗培训中全球健康教育的需求不断增长，推动了以国外短期医疗服务模式为基础的教育项目的增长。近三分之二的医学生希望在医学院期间参与全球健康体验，并继续实习和早期职业生涯。尽管意图积极，但这种全球健康短期经历（STEGH）可能会加剧全球健康不平等，甚至造成伤害。源于“医疗使命”传统，当代参与不断发展。可以纳入道德问题和其他学科方法，例如公共卫生和人类学，以提高有效性和可持续性，并将 STEGH 文化从关注学员及其所在机构转变为考虑东道社区的利益和培育伙伴关系。作者提出了指导教育 STEGH 道德发展的四项核心原则：(1) 跨文化有效性和文化谦逊的技能建设，(2) 双向参与关系，(3) 当地能力建设，以及 (4) 长期可持续性。这些原则的应用凸显了对 STEGH 进行评估的必要性：允许透明比较的数据收集、质量标准、协议的双向性、明确的课程以及满足东道国和派遣国标准和需求的道德规范。为了发挥 STEGH 的巨大潜力，需要对 STEGH 文化进行范式转变，以确保这些体验在培训水平、个人能力、医学和跨文化道德以及教育目标之间取得平衡，从而最大限度地减少伤害并最大限度地提高所有参与者的利益。
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 incorporated 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 nurturing partnerships. The authors propose four core principles to guide ethical development of educational STEGHs: (1) skills building in cross-cultural effectiveness 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 comparisons, 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.