Global Health: It’s Not About Becoming Worldly, It’s About Becoming Better Doctors

Heidi Chumley, MD

As we continue to evolve how we prepare medical students to join the US physician workforce, we should continue to create global health experiences that will impact how we approach clinical practice—whether that be when managing a diverse patient population or when addressing the global health issues that are now on our doorstep.

When I was in medical school, we often saw the term international health in the context of faraway villages where issues like access to clean water, sanitation, and basic understanding of the spread of disease were at the heart of figuring out how to improve a community’s well-being.

As medical students, we viewed short-term medical mission trips as our way of getting a glimpse of the world outside our environment and gaining exposure to not just tropical diseases that we would never see at home, but also to the ways that healthcare providers in these settings coped in order to care for their patients.

Things changed somewhere along the way, and what we used to call international health became global health, the term much more indicative of a connected world where diseases–and physicians–crossed borders. A decade ago it was SARS and later the avian flu. Recently we had our first cases of Ebola in Dallas and New York City. Global health, it seems, has come home.

In the journal Family Medicine, Dr John Frey III of the University of Wisconsin writes that global health experiences can be “a treatment for [US] medical myopia,” referring to a seeming inability for the US clinical and educational systems to learn from other cultures and systems. “At its best,” he writes, “global health offers a perspective based on humility rather than arrogance and on an openness and generosity of thought that changes thinking and practice in all directions.”

Medical students’ interest in global health has increased steadily, and many US medical schools have created elective courses that enable students to observe and learn about healthcare delivery in another country. The approach has often been ad hoc and variable, with schools still struggling to offer experiences that are relevant and tangible to practice.

As dean of an international medical school, I see students participating in global health every day. Our students enjoy elements of the study-abroad experience prized by many at US schools, including long-term immersion in another country and exposure to the local health care system. Through our collaboration with the Ministry of Health of Sint Maarten, our students also gain insight into government’s role in population health and take part in research initiatives, health screenings, public health interventions, and patient education.

When Sint Maarten was the first non-African location to see cases of chikungunya, our students participated in community-based research programs designed to determine the prevalence and rates of symptomatic infection. And through research our students conducted on type 2 diabetes mellitus in local patients—they found that Sint Maarten residents did not have the same risk factors for this disease as patients in the United States. Such a discovery helps broaden students’ perspective–later when they see diabetes in their own practice they won’t necessarily assume a US-centric view of the disease.

One might call these experiences elements of global health, but at my institution we talk about them in terms of service learning. They are not about becoming more worldly, rather they are about becoming better doctors. Each of these experiences encourages students to expand their scope of medical practice as well as their view of patient experience. They develop the cultural awareness and competency that is critical to providing excellent patient care and service in our increasingly globalized world.

Heidi Chumley, MD, is the executive dean and chief academic officer of American University of the Caribbean School of Medicine