title: Career choices and global health engagement: 24-year follow-up of U.S. participants in the Indiana University-Moi University elective.
abstract: BACKGROUND
  Global health experiences evoke a profound awareness of cultural differences, inspire learners to prioritize professional values, and provide a lens for addressing global health care challenges. This study compares the long-term career and practice choices of participants in a 2-month Indiana University-Moi University, Kenya elective from 1989-2013 with those of a control group.
  
  
  METHODS
  Global health elective (GHE) participants and a random sample of alumni without GHE experience were surveyed on their clinical practice, public health and global health activities.
  
  
  RESULTS
  Responses from 176 former participants were compared with a control group of 177 alumni. GHE participants were more likely than similar controls to provide care to underserved U.S. populations (p=0.037), spend time in global health, public health, and public policy activities (p=0.005) and be involved in global health advocacy (p=0.001). Using multivariable analysis, GHE participants were more likely to be generalists (p<0.05), report that healthcare costs influenced medical decision-making (p<0.05), and provide healthcare outside the U.S. for ≥1 week/year (p<0.001).
  
  
  CONCLUSIONS
  Many years out of training, GHE participants were more likely to be generalists working with underserved populations, to be cost-conscious in their healthcare decision-making, and to be involved in global health, public health or public policy.
  
  
  CONCLUSIONS
  With the primary care provider shortage and need for greater awareness among providers of healthcare costs, our study shows that that global health experiences may yield broader benefits to the U.S. medical system.
authors.affiliation: Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, United States; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States. Electronic address: rumoren@uw.edu.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Umoren
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Adrian
authors.initials: A
authors.lastname: Gardner
authors.affiliation: Global Primary Care (GPC) Program, Center for Global Health, Division of General Medicine, Department of Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: Geren S
authors.initials: GS
authors.lastname: Stone
authors.affiliation: Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.
authors.forename: Jill
authors.initials: J
authors.lastname: Helphinstine
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.
authors.forename: Emily P
authors.initials: EP
authors.lastname: Machogu
authors.affiliation: Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.
authors.forename: Jordan C
authors.initials: JC
authors.lastname: Huskins
authors.affiliation: Department of Biostatistics, Indiana University, Indianapolis, IN, United States.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.affiliation: Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Paul O
authors.initials: PO
authors.lastname: Ayuo
authors.affiliation: Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Simeon
authors.initials: S
authors.lastname: Mining
authors.affiliation: Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, United States; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Indiana University Center for Global Health, Indianapolis, IN, United States.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Litzelman
mesh_terms: D002321:Career Choice; D014943:Global Health; D006801:Humans; D007196:Indiana; D007630:Kenya; D013337:Students, Medical; D014495:Universities
keywords: Career choice; Global health electives; Medical education; Medical practice; Residents