Designing an ethics curriculum to support global health experiences in surgery.
BACKGROUND
The field of global health is rapidly expanding in many medical centers across the US. As a result, medical students have increasing opportunities to incorporate global health experiences (GHEs) into their medical education. Ethics is a critical component of global health curricula, yet little literature exists to direct the further development of didactic training. Therefore, we sought to define ethical encounters experienced by medical students participating in short-term surgical GHEs and create a framework for the design of ethics curriculum specific to global surgery.


METHODS
Emory University Departments of Surgery, Urology, and Anesthesia, in partnership with the non-profit organization Project Medishare, have taken annual humanitarian surgical trips to Hinche, Haiti. All medical students returning from the trips in 2011 and 2012 received a 35-question survey to assess demographic data, extent of prior ethics education, frequency of exposure and situational confidence to ethical subject matter, as well as ethical conflicts involved in surgical GHEs. The same comparative data were also collected for domestic clinical clerkships.


RESULTS
Seventeen out of 21 medical students completed the survey. Nearly all (88.3%) students had previous formal ethics training as an undergraduate or in medical school. Ethical issues were commonly encountered during domestic clinical encounters and volunteerism. However, students reported enhanced exposure to the professional obligation of surgeons (P = 0.025) and truth-telling/surgeon-patient relationships (P = 0.044) during surgical volunteerism. Despite increased exposure, situational confidence did not change.


CONCLUSIONS
Ethical issues are commonly confronted during GHEs in surgery and differ from domestic clinical encounters. Healthcare ethics curriculum should be designed to meet the needs of medical students involved in global health.
Division of General Surgery, Department of Surgery, Emory University, Atlanta, Georgia.
Benjamin M
BM
Martin
Division of General Surgery, Department of Surgery, Emory University, Atlanta, Georgia.
Timothy P
TP
Love
Division of General Surgery, Department of Surgery, Emory University, Atlanta, Georgia.
Jahnavi
J
Srinivasan
Division of General Surgery, Department of Surgery, Emory University, Atlanta, Georgia.
Jyotirmay
J
Sharma
Division of Pediatric Surgery, Department of Surgery, Emory University, Atlanta, Georgia.
Barbara
B
Pettitt
Department of Anesthesiology, Emory University, Atlanta, Georgia.
Cinnamon
C
Sullivan
Division of Urology, Department of Surgery, Emory University, Atlanta, Georgia.
John
J
Pattaras
Division of Urology, Department of Surgery, Emory University, Atlanta, Georgia.
Viraj A
VA
Master
Division of Vascular Surgery, Department of Surgery, Emory University, Atlanta, Georgia; Surgical and Research Services, Atlanta VA Medical Center, Atlanta, Georgia; Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, Georgia. Electronic address: lbrewst@emory.edu.
Luke P
LP
Brewster
D000328:Adult; D002982:Clinical Clerkship / Q000941:ethics* / Q000379:methods; D003430:Cross-Sectional Studies; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000941:ethics* / Q000379:methods; D004992:Ethics, Medical / Q000193:education*; D013502:General Surgery / Q000193:education* / Q000941:ethics; D014943:Global Health / Q000193:education* / Q000941:ethics*; D006801:Humans; D010817:Physician-Patient Relations / Q000941:ethics; D013337:Students, Medical
Education; Ethics; Global health; Surgery