Limiting clinical activities of students from HIC in LMIC settings

30 September, 2019

Dear HIFA Colleagues,

As some of you might know I am an advocate for critically thinking about how we structure international electives/rotations, both for students and residents. There has been calls for reform (https://www.annalsofglobalhealth.org/articles/10.5334/aogh.2525/) and evidence that professionals and students from high-income countries (HIC) are practicing beyond their scope of training when in low and middle-income countries (LMIC) (https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30291-8/fulltext). And that this has led to patient harms and is against the competencies of outsiders who are engaging for short time periods in a novel setting/culture/clinical context both from the perspective of educators and community members (https://www.cfhi.org/global-health-programs-resources and https://www.cfhi.org/publications).

Alongside colleagues from University of Minnesota and AAMC, I have published this piece which I think captures a key aspect of this dynamic, the breakdown of the social contract that occurs when students are abroad in settings where they will not actually be sustainable/longitudinal members of the healthcare workforce in the long-term (thus the hands-on clinical activities and resultant risk to patients must be modified).

I wanted to get your feedback and perspective about this idea and pose the following questions:

- Should we modify the hands-on clinical care done by HIC students when abroad in LMIC settings?

- Is the social contract at play here?

- What other arguments or considerations come to mind?

Here is the article "How the Social Contract can Frame International Electives" (AMA Journal of Ethics, Sept 2019) https://journalofethics.ama-assn.org/article/how-social-contract-can-fra...

Thank you in advance for your thoughts. Best, Jessica

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Jessica Evert MD

Executive Director, Child Family Health International

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