The COVID-19 pandemic has brought many challenges for medical education, one of the most prominent being the widespread cancellation of international and domestic medical elective placements. There is no doubt that medical students as a whole have embraced the situation admirably and stepped up to become or support key workers. However, for those interested in global health, wanting to experience other healthcare systems and observe the practice of medicine in resource-limited settings, this is understandably an extremely disappointing turn of events.
Health systems in high-income countries and low- and middle-income countries are facing common challenges during the pandemic. An editorial in the BMJ( 1) comments on the difficulties encountered by low- and middle-income countries in addressing healthcare demands during the pandemic, including “increasing numbers of very old people…being cared for in nursing homes” and “the ability of health systems to cope with surges in demand”, both of which will be very familiar to any clinician working in the NHS. Furthermore, “disruption of supply chains and depletion of stock” (2), a long-standing issue in low-resource healthcare systems2, is proving to be increasingly problematic in high-income countries battling PPE shortages.
This blurring of lines between “global” and “local”, brought about by the current situation, presents an opportunity for medical education.
As highlighted by Rahim et al’s systematic review (3), there is a core set of ethical skills that medical students need to develop to face the ethical issues during international health electives. These are:
Self-awareness/introspection
Humility
Critical reflection
Cultural competence
Dealing appropriately with conflict
Consulting appropriately in decision making
Willingness to listen and learn
Commitment to addressing social injustice
In addition, the UK Medical Schools Elective Council has identified the sub-set of global health learning outcomes4 which are best achieved through undertaking a medical elective:
Recognise that health systems are structured and function differently (across the globe).
Describe how the environment and health interact (at the global level).
Discuss communicable and non-communicable diseases (at the global level).
Demonstrate awareness that climate change will become an increasing threat to global health in the twenty-first century.
In recognition of the above, we at GASOC have taken the liberty of compiling a list of learning opportunities within the UK which would fulfill at least some of the aforementioned ethical and academic objectives. Some of them are COVID-19-specific, and others are not. Some opportunities may be available currently, and others will probably become more relevant at a later stage. Nevertheless, they allow medical students, or newly qualified doctors, to engage in experiences that add value to their medical education in a similar fashion to a medical elective.
Links:
In the current climate, the term “global” has begotten a whole new meaning. It is imperative to widen our horizons and re-shape the way global health education is perceived.
Krithi Ravi
GASOC Journal Club Coordinator
References
1. Lloyd-Sherlock P, Ebrahim S, Geffen L, McKee M. Bearing the brunt of covid-19: older people in low and middle income countries. Vol. 368, BMJ (Clinical research ed.). NLM (Medline); 2020. p. m1052.
2. Hopman J, Allegranzi B, Mehtar S. Managing COVID-19 in Low- and Middle-Income Countries. JAMA [Internet]. 2020 Mar 16 [cited 2020 Apr 6]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32176764
3. Rahim A, Knights (Née Jones) F, Fyfe M, Alagarajah J, Baraitser P. Preparing students for the ethical challenges on international health electives: A systematic review of the literature on educational interventions. Med Teach. 2016 Sep 1;38(9):911–20.
4. Hastings A, Dowell J, Eliasz MK. Medical student electives and learning outcomes for global health: A commentary on behalf of the UK Medical Schools Elective Council. Med Teach. 2014 Apr;36(4):355–7.