Letters to the Editor
We agree with Dr. Are about the need to assess resident motivations for an international rotation. While some residents may exploit travel opportunities, others will develop new skills and knowledge and acquire a greater appreciation of medicine and global health. Programs usually know to select these latter applicants, but no selection process is perfect. A careful screening process, along with predeparture training, should be an essential part of every overseas program.
Second, the increase in residents’ participation in international rotations may be a combination of several factors, including more structured opportunities,1 and medical students have gradually participated in more international rotations since the late 1970s.2 The percentage of U.S. medical school graduates who delivered health services to underserved populations increased from 32% in 1993 to 68% in 2008,3 suggesting growing awareness of health disparities and growing altruistic motivations. Regardless of their motivations, we agree with Dr. Are that residents often benefit more than their patients do, and that bilateral cooperation between institutions should be emphasized. Developing longitudinal relationships between institutions and fostering bilateral exchanges of residents and faculty will help strengthen patient care for all institutions involved.4
We agree with Drs. Pherez and David that residents should receive more training on neglected tropical diseases. However, as the terminology has evolved from tropical medicine to international medicine toglobal health, global health training has evolved from a focus on communicable diseases to include additional aspects of medicine, public health, and other disciplines. Our recommendations encompass global health competencies in all six Accreditation Council for Graduate Medical Education general competencies. For the average physician, the value of understanding cross-cultural issues will be more important than being able to diagnose schistosomiasis or leprosy.
Finally, the Global Health Education Consortium and Consortium of Universities for Global Health are two organizations currently working to shape the future of academic global health training. Incorporating global health into residency training is still in its infancy, and there should be much discussion, both within and outside these organizations, as this process evolves.
Paul K. Drain, MD, MPH
Resident, Department of Medicine, Stanford University, Palo Alto, California; (firstname.lastname@example.org).
Tom Hall, MD, DrPH
Executive director, Global Health Education Consortium, San Francisco, California.
King Holmes, MD, PhD
Chair, Department of Global Health, University of Washington, Seattle, Washington.
1 Drain PK, Holmes KK, Skeff KM, et al. Global health training and international clinical rotations during residency: Current status, needs and opportunities. Acad Med. 2009;84:320–325.
2 Drain PK, Primack A, Hunt DD, et al. Global health in medical education: A call for more training and opportunities. Acad Med. 2007;82:226–230.
3 Association of American Medical Colleges. Medical School Graduation Questionnaire, All Schools Report. Washington, DC: Association of American Medical Colleges; 2008.
4 Institute of Medicine. The U.S. Commitment to Global Health: Recommendations for the Public and Private Sectors. Washington, DC: The National Academies Press; 2009.