Do no harm: Examining the impact of medical students' short-term international study

January 05, 2016

As American medical students increasingly want and expect to have international work experience, more and more short-term programs are being offered to give them that opportunity, according to Melissa Melby, assistant professor of anthropology at the University of Delaware.

The trouble is, she writes in a new article in Academic Medicine, that too many of these programs -- called STEGH, or short-term experiences in global health -- focus on the needs of the student trainees and not on what's best for their patients or for overall health care in the countries they visit.

"Most students who participate in these programs genuinely want to help people," Melby said. "But many of them may not be aware of the unintended consequences that can occur. In this article, we propose four core principles that we hope will help guide both the developers and the participants in STEGH programs."

Melby, who specializes in the biological and medical aspects of anthropology, is the lead author of the article, written with colleagues who are medical doctors involved with global health care issues. She said her co-authors, who connected with her through the Delaware Health Sciences Alliance, of which UD is a founding partner, saw problems with many STEGH programs and sought her out for an anthropological perspective.

"STEGHs are often very short term, perhaps about three weeks or even less, and many times the participants are dropped into an area with very little preparation," Melby said. "They don't know the language, they don't know the culture, and they're jet-lagged. They're well-intentioned, but this is often not the best way to help people."

The authors of the paper list four principles that they say can be used to create better STEGH programs and to help students evaluate existing programs and make good choices about which to join. The principles are:

While STEGHs can provide students with important global and cross-cultural education, the authors say they believe a paradigm shift is needed to ensure that the programs benefit both the trainees and the communities they visit. And, Melby said, the proposed guidelines can apply beyond medical or pre-med students to include other study-abroad and global service-learning programs.

"We think these principles are relevant to a lot of student groups that do global work," she said. "Most people's hearts are in the right place, but there are often aspects to what they're doing that they just don't think about."

The article, "Beyond Medical 'Missions' to Impact-Driven STEGHs: Ethical Principles to Optimize Community Benefit and Learner Experience," is available online. It will be published in an upcoming print edition of Academic Medicine, the journal of the Association of American Medical Colleges.
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The co-authors are Drs. Lawrence C. Loh, Jessica Evert, Christopher Prater, Henry Lin and Omar Khan, who also is an affiliated faculty member in UD's College of Health Sciences.

University of Delaware

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