Extent, nature and consequences of performing outside scope of training in global health
- PDF / 657,889 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 56 Downloads / 178 Views
(2019) 15:60
RESEARCH
Open Access
Extent, nature and consequences of performing outside scope of training in global health Ashti Doobay-Persaud1,2* , Jessica Evert3,4, Matthew DeCamp5, Charlesnika T. Evans6, Kathryn H. Jacobsen7, Natalie E. Sheneman2, Joshua L. Goldstein8 and Brett D. Nelson9,10
Abstract Background: Globalization has made it possible for global health professionals and trainees to participate in short-term training and professional experiences in a variety of clinical- and non-clinical activities across borders. Consequently, greater numbers of healthcare professionals and trainees from high-income countries (HICs) are working or volunteering abroad and participating in short-term experiences in low- and middleincome countries (LMICs). How effective these activities are in advancing global health and in addressing the crisis of human resources for health remains controversial. What is known, however, is that during these short-term experiences in global health (STEGH), health professionals and those in training often face substantive ethical challenges. A common dilemma described is that of acting outside of one’s scope of training. However, the frequency, nature, circumstances, and consequences of performing outside scope of training (POST) have not been wellexplored or quantified. Methods: The authors conducted an online survey of HIC health professionals and trainees working or volunteering in LMICs about their experiences with POST, within the last 5 years. Results: A total of 223 survey responses were included in the final analysis. Half (49%) of respondents reported having been asked to perform outside their scope of training; of these, 61% reported POST. Trainees were nearly twice as likely as licensed professionals to report POST. Common reasons cited for POST were a mismatch of skills with host expectations, suboptimal supervision at host sites, inadequate preparation to decline POST, a perceived lack of alternative options and emergency situations. Many of the respondents who reported POST expressed moral distress that persisted over time. Conclusions: Given that POST is ethically problematic and legally impermissible, the high rates of being asked, and deciding to do so, were notable. Based on these findings, the authors suggest that additional efforts are needed to reduce the incidence of POST during STEGH, including pre-departure training to navigate dilemmas concerning POST, clear communication regarding expectations, and greater attention to the moral distress experienced by those contending with POST. Keywords: Global health, Medical education, Ethics, Scope of training, Scope of practice, Professionalism
* Correspondence: [email protected] 1 Division of Hospital Medicine, Departments of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University, 51 E Huron St, Chicago, IL 60611, USA 2 Institute for Global Health, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1058, Chicago, IL 60611, USA Full list of au
Data Loading...