- AAP Abroad
Nearly two-thirds of pediatric residency programs offer the opportunity to rotate at clinical sites in low- and middle-income countries. As participation in global health experiences grows, proper preparation is essential for the resident, the host and above all, the patients.
Before boarding an airplane, review the following tips and resources.
- Encourage your institution to practice ethical partnerships.
Ideally, residents should rotate at sites that are part of ethical partnerships as outlined in the Working Group on Ethics Guidelines for Global Health Training recommendations (http://1.usa.gov/1QyWYgT). If your institution does not have a partnership, consider opportunities through partnerships at other institutions or through nongovernmental organizations, which may charge a fee to support organizational costs.
There is no system that accredits ethically sound partnerships or training opportunities. Similarly, hosts have no way to ensure that a visiting trainee is mindful of cultural and ethical challenges inherent in short-term global health rotations. Residents should review ethics guidelines in consultation with a faculty mentor before seeking a training opportunity.
- Know what to expect and what is expected of you.
What are the logistics? What resources are available to review before you go? Who makes up the medical team? Prior to travel, connect with a mentor/guide at the site and with someone who previously rotated there.
- Know what you don’t know.
Programs increasingly are preparing all pediatric residents in essential topics in global child health, but many residents are surprised at how little they know about management of commonly encountered diseases (e.g., severe acute malnutrition, malaria). Learn about the most common conditions seen at your site and review World Health Organization guidelineshttp://bit.ly/1QhM9RD.
- Don’t practice outside of your scope.
Residents might be turned to as the expert when at the partner site. Resist this relationship. Instead, seek ways to work as a team member. Don’t be afraid to say when you are seeing something for the first time. You may be asked to practice outside of your scope (e.g., perform a liver biopsy when you’ve never even seen one done). Advocate for the patient by reminding your host colleagues of your desire to learn from them.
- Look into licensing requirements.
Many countries require visiting doctors to have a license to practice there. Your local faculty mentor should help to check with the host country’s Ministry of Health to determine if licensing is required.
- Register with the Department of State.
Prior to traveling outside the country, register with the Department of State Smart Traveler Enrollment Program (https://step.state.gov/step/) for travel alerts and warnings. Enrolling also ensures the U.S. government knows you are abroad in the event of a crisis.
- Obtain traveler’s and evacuation insurance.
Check whether your institution provides insurance. Both types are essential to ensure adequate medical coverage and evacuation. Your destination may not have a robust emergency medical system infrastructure. Traveler’s insurance will help only if you can get to a care facility safely.
- Expect culture shock, and understand cultural humility.
Even well-seasoned travelers experience culture shock, the sense of disequilibrium when immersed in a new culture. Avoid a judgmental attitude when comparing the medical care at your home institution to an institution with limited resources. Prior to travel, review the stages of culture shock and understand steps to practicing cultural humility during the adjustment process. (See Resources.)
- Remember: A tweet is mightier than the sword.
Be a good ambassador of your program. Adhere to the same ethical and privacy standards as at your home institution. Never post pictures on social media of a hospitalized patient or describe the challenges of working at a host institution. Ask yourself if you would be comfortable with a host faculty reading what you post. Keep a personal journal instead.
- Debrief with someone on return.
You may encounter challenging experiences and emotional stressors when rotating abroad. It is important to discuss these, as well practical improvements, with program faculty upon your return home.
Residents often describe their global health rotations as some of the most meaningful time spent during their training. Taking proactive steps can ensure a mutually beneficial experience that optimizes health and safety abroad while embracing cultural humility in a setting with very different resources, hospital and educational culture, and societal cultural norms.
Drs. Pitt and St. Clair are members of the AAP Section on International Child Health. Dr. O’Callahan is past chair of the section's executive committee.
- Pediatrics article “Global Health Education in U.S. Pediatric Residency Programs”
- Global health training database: Consortium of Universities for Global Health
- Global Health Learning Opportunities
- Free module for residents from the Global Child Health Educational Modules Project:
Preparation for a Global Health Elective