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September 24, 2008

Ethical Considerations for Short-term Experiences by Trainees in Global Health

Author Affiliations

Author Affiliations: Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, and Duke Global Health Institute, Duke University, Durham, North Carolina (Dr Crump); Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania (Dr Crump); and the Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Baltimore, Maryland (Dr Sugarman).

JAMA. 2008;300(12):1456-1458. doi:10.1001/jama.300.12.1456

Academic global health programs are burgeoning.1 According to a recent review of the Web sites of 129 accredited MD-granting US medical schools2 and their parent universities, almost half (60; 47%) have established initiatives, institutes, centers, or offices for global health. These programs announce goals that include reducing disparities in global health through a combination of research, education, and service. In part responding to student demand and enthusiasm,3 many programs provide short-term training and service experiences in resource-limited settings. Nevertheless, there are important ethical considerations inherent to sending individuals from resource-replete settings for training and service experiences in resource-limited settings. However, unlike clinical research conducted across international borders, which has attracted considerable attention in the lay and scholarly literature,4,5 much less attention has been given to ethical issues associated with education and service initiatives of global health programs.6-8 We describe some of these issues so they can be addressed explicitly by those engaged in global health education and service initiatives to facilitate the goals of providing medical students, residents, and other trainees in disciplines related to global health the opportunity for international experience while minimizing unintended adverse consequences.