Volume 195 - Issue 11
Doctors and global health: tips for medical students and junior doctors
Authors: Jeffrey J Leow, Daryl R Cheng and Frederick M Burkle Jr
Med J Aust 2011; 195 (11): 657-659. || doi: 10.5694/mja10.11491
Published online: 12 December 2011
Published online: 12 December 2011
Preparing for a future in humanitarian medicine
Many young doctors are becoming aware that their careers will be spent in an increasingly globalised society — one in which major challenges will be managed by global initiatives and not by individual nation states alone. The concept of “global health” transcending geographical borders and requiring cooperative solutions between governments, organisations and individuals is becoming widely accepted in developing and developed countries.1 Over the past decade alone, the number of individuals who identify themselves as humanitarian and global health professionals has doubled, at least in the Western world.2
It is therefore no surprise that in recent years Australian medical students have been keen to join this growing movement.3 The Australian medical education system appears to be offering more opportunities to meet these interests. Recent initiatives range from academic and education options to policy development and grassroots conferences.
To some people, working for global health means serving a humanitarian organisation, so some medical students and junior doctors make it a priority to get involved with humanitarian organisations locally and abroad. However, humanitarian aid is just one subset of the global health area and requires a specific skill set. A big picture understanding of all areas of global health allows for a balanced and solid foundation.1 Those who have an appreciation of the nuances of culture, poverty, gender inequities, corporate and social governance, health diplomacy, public health, and ethnic and religious factors will make better health care providers in emergency aid and other settings.
For a young medical student or junior doctor, the plethora of global health opportunities can be overwhelming. We present a list of suggestions to help medical students and junior doctors prepare for a career in global health, with some pointers for faculty members.
Tips for medical students and faculty members
Get involved as early as possible
During our medical training, we were privileged to be involved in global health projects as junior students. These experiences reaffirmed and strengthened our interest in the global health movement by exposing us to complex issues and needs in unfamiliar environments.
The Australian Medical Students’ Association (AMSA) has restructured all Australian university global health groups so they are now in the AMSA Global Health Network.4 Being an active part of a global health group at our university helped us to better understand and appreciate the challenges that pioneers working for global health face. It also allowed us time to bond and network with like-minded colleagues around the country, to exchange ideas and discuss projects, and to fundraise and initiate practical help to communities in developing regions.
Attend global health meetings
The annual AMSA Global Health Conference is a 4-day intensive program. Renowned speakers educate delegates and raise awareness of current global health issues, and students are able to interact with like-minded students and faculty members. Notable presenters with interests in global health are often invited to conduct plenary sessions, deliver a keynote speech or train students in a workshop setting.
For other meetings, check the Global Health Gateway website (http://www.globalhealthgateway.org.au/), which is updated frequently to reflect new global health-related events in Australia.
Arrange a global health elective
Once armed with knowledge of the conceptual framework of the global health sector, students are strongly encouraged to spend time in a national or international location during their elective or in vacation time. This allows an invaluable opportunity to transfer principles into practical experience.5 Overseas elective opportunities can be identified using well researched books, journals and media resources.
It is important to be thorough in choosing an appropriate elective. Seeking references from others who have served with the organisation or agency can be helpful. One suggestion is to approach a host hospital directly, but remember to allow enough time for applications to be processed.
This year, the Australian Medical Association Council of Doctors-in-Training and AMSA have jointly authored a Medical Journal of Australia supplement, A guide to working abroad, a resource for medical students and junior doctors who want to work and/or study abroad.6
Curriculum development
Regular dialogue between students and faculty members should be facilitated to increase interest in and commitment to global health. At the least, faculty members should be encouraged to support students who are interested in this area.7 Most other specialty and subspecialty areas are well addressed within the undergraduate medical curriculum; there should be little reason why global health should not be given some attention.
Take classes focusing on global health
Some medical schools have responded to the growing interest in global health and are now offering optional classes or modules focusing on global health issues. Teaching about global health issues, addressing access and availability of health care, inequities in health services and outcome-based evaluations provide the theoretical framework in which students can structure and make sense of future or previous global health experiences.7 Ideally, the expanding role of global health education in undergraduate medical curricula will lead to a proportionate increase in the number of practical international opportunities available to students.8,9
Some medical student societies run their own short courses on global health, with different weekly lecture topics. If there are no such modules or courses available, it may be worthwhile inviting noteworthy speakers for guest lectures, symposia or workshops. A monthly journal club or meeting can also help students stay abreast of global health developments and share ideas with colleagues.
Develop links with facilities in developing countries
Medical faculties and student clubs involved in the global health area should also strive to develop links with countries and health services in national or international regions. With the support of faculty members, exchanges, learning opportunities, practical placements and research openings are more likely to be sustainable and hence beneficial to communities in the resource-poor settings they intend to serve.
Tips for junior doctors
Do subspecialty training in your area of interest
The value of attaining subspecialty training is rarely disputed in today’s era of specialised medical care. In resource-limited settings, this holds true as well. Groups such as Médecins sans Frontières and the International Committee of the Red Cross provide emergency and trauma surgical care in places of conflict and disaster, as well as establishing their own hospitals or working closely with local health officials to improve health infrastructure. Extra training for surgeons and anaesthetists in obstetrics and gynaecology, orthopaedics and trauma care is invaluable. Recognising that the highest mortality and morbidity arise from a lack of basic public health resources (eg, water, sanitation, food and shelter), physicians trained in paediatrics, public health, primary health care and infectious diseases (especially HIV, AIDS and tuberculosis) are urgently needed in many areas.
Repay student loans as early as possible
The reality is that most positions in humanitarian medicine are voluntary or only pay small stipends, so the earlier a student loan is repaid, the sooner there is unrestricted flexibility to work in the global health sector. It is not uncommon for hospital medical officers (HMOs) in Australia to use their salaries from locum work to fund their overseas travel and global health projects.
Tips for medical students and junior doctors
Learn a foreign language
Speaking the local language is a vital asset when practising in the field. Short courses are available, and some programs allow cultural immersion in the country while allowing day classes to learn the basics of a language within 6 weeks. Combining a medical school elective with a language course can be a viable and attractive option.
Find a faculty mentor with global health interests
It is highly beneficial to identify a mentor with interests in the global health area. Someone experienced in the field who is willing to motivate, empower, encourage, teach by example and provide advice and guidance will prove invaluable.10 A global health mentor for a medical student or junior doctor could assist in many areas ranging from research topics or collaborators to options for working in the field.
The importance of working with like-minded faculty should not be underestimated. The combination of the youthful passion and enthusiasm of students and the wisdom and experience of interested and dedicated faculty members is synergistic.
Choose an employer supportive of global health activities
Some employers are more flexible and supportive of global health activities. The capability and support of a director of clinical training and the HMO roster coordinator can be deciding factors for being able to undertake an international elective or sabbatical leave from training.
Elective rotations are not readily available during junior doctor residencies. HMOs may take time off or take unpaid leave to pursue their interest in the global health area. Once in a specialty training program, it can be difficult to balance training requirements with global health initiatives. A fully trained medical specialist is likely to make more complete contributions in the field.
Get an additional degree in the global health area
Global public health is primarily population-based care, not individual-based care. The benefits of dedicating time for further study of global health include:
development of theoretical and practical skills in core competencies of global public health for future practice; and
opportunities for networking and setting up global public health projects, which may culminate in further research or service opportunities.
Ideally, areas of global health research should be matched to a future specialty of choice. In the surgical arena, for example, future research could focus on the increasing burden of surgical disease in an area, safety of surgical care in resource-limited settings and developing long-term sustainable academic and service partnerships.11 Community health projects are also very useful for those interested in pursuing a career in family medicine, obstetrics or paediatrics.
A masters qualification in international health, public health or global health science can be obtained from one of the many Australian or international schools of public health. These institutions offer degrees varying in duration, structure and online capacity, and the different courses focus on different aspects of global health. With current global initiatives calling for a blueprint for professionalising humanitarian assistance, to ensure accountability and accreditation, our suggestions become even more crucial.12,13
Conclusion
Although by no means comprehensive, our snapshot of suggestions aims to provide medical students and junior doctors a platform to explore the myriad opportunities in the global health sector. Most importantly, we believe that students and doctors alike should continue to read extensively, ask critical questions, appreciate the global health context and become passionate about this exciting area of medicine.
Competing interests
No relevant disclosures.
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Provenance: Not commissioned; externally peer reviewed.