title: What Are the Ethical Issues Facing Global-Health Trainees Working Overseas? A Multi-Professional Qualitative Study.
abstract: The aim of this study was to identify global health ethical issues that health professional trainees may encounter during electives or placements in resource-limited countries. We conducted a qualitative study involving focus groups and an interview at the University of California San Francisco. Participants were multi-professional from the Schools of Medicine, Nursing and Pharmacy and had experience working, or teaching, as providers in resource-limited countries. Eighteen participants provided examples of ethical dilemmas associated with global-health outreach work. Ethical dilemmas fell into four major themes relating to (1) cultural differences (informed consent, truth-telling, autonomy); (2) professional issues (power dynamics, training of local staff, corruption); (3) limited resources (scope of practice, material shortages); (4) personal moral development (dealing with moral distress, establishing a moral compass, humility and self awareness). Three themes (cultural differences, professional issues, limited resources) were grouped under the core category of "external environmental and/or situational issues" that trainees are confronted when overseas. The fourth theme, moral development, refers to the development of a moral compass and the exercise of humility and self-awareness. The study has identified case vignettes that can be used for curriculum content for global-health ethics training.
authors.affiliation: Division of Hospital Medicine, University of California San Francisco, San Francisco, CA 94143, USA. james.harrison@ucsf.edu.
authors.forename: James D
authors.initials: JD
authors.lastname: Harrison
authors.affiliation: Division of Hospital Medicine, University of California San Francisco, San Francisco, CA 94143, USA. tea.logar@gmail.com.
authors.forename: Tea
authors.initials: T
authors.lastname: Logar
authors.affiliation: Division of Hospital Medicine, University of California San Francisco, San Francisco, CA 94143, USA. phuoc.le@ucsf.edu.
authors.forename: Phuoc
authors.initials: P
authors.lastname: Le
authors.affiliation: Division of Hospital Medicine, University of California San Francisco, San Francisco, CA 94143, USA. marcia.glass@ucsf.edu.
authors.forename: Marcia
authors.initials: M
authors.lastname: Glass
keywords: ethics; global health education; global health electives; global health training; healthcare education