Incidence of Ethical Dilemmas on International Volunteer Trips Among Medical Trainees: Pilot Study of Global Health Ethics Curriculum at University of Massachusetts Medical School
Marian Younge1, Anna Schoenbrunner, MD2, Joyce K. McIntyre, MD1.
1University of Massachusetts Medical School, Worcester, MA, USA, 2Ohio State University, Columbus, OH, USA.
BACKGROUND: International clinical work can provide an enriching learning experience for medical students and among plastic surgeons, such experiences are highly predictive of volunteer activity abroad as attendings (Coates 2006 and McIntyre et al. 2017.)
Global health experiences—while increasing popular among millennial medical trainees—pose significant ethical issues around culturally appropriate care, the role of foreign trainees in delivering healthcare in country and potential strains on community resources (Jesus, 2015.)
The purpose of this study is to establish a baseline incidence of broadly defined ethical dilemmas faced by a single medical school’s trainees on global health experiences, establish an incidence of social media use on these trips and identify potential areas of future global health ethics education for trainees. METHODS: A validated survey tool was delivered via secure email to all medical trainees (medical students, residents, fellows, nursing and graduates students) who travelled abroad in the last 5 years on a clinical trip, as identified by our institution’s office of global health. Survey non-responders were repeatedly queried. Data was analyzed in Microsoft Excel (Redmond, WA). Descriptive statistics were calculated for all variables. Using grounded theory research practices, answers to open response questions were grouped into common themes and tallied.
RESULTS: 582 trainees were queried in the study, 134 respondents participated in the study, and the response rate was 23%. 53% of trainees said they faced an ethical dilemma on their trip, defined as uncertainties relating to scope of practice, cultural differences in practice, or a clinical situation that made them feel uncomfortable.
47% of respondents shared photos of their trip on social media, and 62% said they felt unsure of the cultural practices of the host institution and how they impacted clinical care. 11 % of respondents observed a situation where a visiting clinician acted outside of their level of training or scope of practice.
Subset analysis of surgery and specifically plastic surgery trainees will be presented.
CONCLUSIONS: International volunteer experiences in medical school are highly predictive of volunteer activity as an attending plastic surgeon, underscoring the importance of quality education on these trips. This research establishes a high incidence of ethical dilemmas faced by medical trainees from a single institution on international volunteer trips, with surgery and plastic surgery subgroup analysis. Social media use, cultural knowledge and scope of practice were identified via open ended responses as potentially important areas for future educational intervention for trainees on global health experiences.
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