title: The ethics and safety of medical student global health electives.
abstract: OBJECTIVE
  To explore and characterize the ethical and safety challenges of global health experiences as they affect medical students in order to better prepare trainees to face them.
  
  
  METHODS
  Semi-structured interviews were conducted with 23 Canadian medical trainees who had participated in global health experiences during medical school. Convenience and snowball sampling were utilized. Using Moustakas's transcendental phenomenological approach, participant descriptions of ethical dilemmas and patient/trainee safety problems were analyzed. This generated an aggregate that illustrates the essential meanings of global health experience ethical and safety issues faced.
  
  
  RESULTS
  We interviewed 23 participants who had completed 38 electives (71%, n=27, during pre-clinical years) spending a mean 6.9 weeks abroad, and having visited 23 countries. Sixty percent (n=23) had pre-departure training while 36% (n=14) had post-experience debriefing. Three macro-level themes were identified: resource disparities and provision of care; navigating clinical ethical dilemmas; and threats to trainee safety.
  
  
  CONCLUSIONS
  Medical schools have a responsibility to ensure ethical and safe global health experiences. However, our findings suggest that medical students are often poorly prepared for the ethical and safety dilemmas they encounter during these electives. Medical students require intensive pre-departure training that will prepare them emotionally to deal with these dilemmas. Such training should include discussions of how to comply with clinical limitations.
authors.affiliation: Department of Medicine, Emergency Medicine, University of Toronto, Toronto, Canada.
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Dell
authors.affiliation: Department of Medicine, University of Ottawa, Academy for Innovation of Medical Education, Canada.
authors.forename: Lara
authors.initials: L
authors.lastname: Varpio
authors.affiliation: Department of Medicine, Emergency Medicine, University of Toronto, Toronto, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Petrosoniak
authors.affiliation: Department of Medicine, Psychiatry, University of Toronto, Canada.
authors.forename: Amy
authors.initials: A
authors.lastname: Gajaria
authors.affiliation: Department of Medicine, Infectious Disease/Global Health, University of Ottawa, Canada.
authors.forename: Anne E
authors.initials: AE
authors.lastname: McMcarthy
mesh_terms: D002170:Canada; D003625:Data Collection; D004501:Education, Medical / Q000941:ethics / Q000379:methods*; D005260:Female; D014943:Global Health / Q000193:education* / Q000941:ethics; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D013337:Students, Medical / Q000523:psychology*
keywords: Ethic; clinical; international medic
  al educatio; medicine