In Reply to Ventres and Page and to Asgary: Drs. Ventres and Page express concern that global health education diverts attention from domestic health issues. While we fully agree that significant global health issues exist among underserved domestic populations, we feel that teaching global health education complements, rather than competes with, domestic health training. As stated in 1969 in the Journal of the American Medical Association,1
If, as a routine, young American doctors were encouraged to spend some months working in a developing country … the result could only be better medicine at home and abroad.
Global health education allows trainees to identify health disparities, and international experiences provide practical exposure that cultivates interest in addressing these issues and an opportunity to understand innovative low-resource approaches to medical care and health promotion. Many trainees who engage in international rotations return passionately invigorated about domestic health inequalities and want to serve their communities. Furthermore, exposure to international medical care can lay the foundation for reverse innovation—the importation of approaches, technologies, and systems from the “developing” to the “developed” world.2 As health equity, cost-effectiveness, and public health promotion take priority in the United States, reverse innovation for health may become an increasingly relevant output of global health exposure.
We agree with Dr. Asgary’s suggestion for comprehensive domestic global health training for medical trainees, but we favor different approaches for medical students and residents. Medical students can participate in classroom time and community-based practical experiences, while residents are suited for specialty-specific training and advanced preparation for advocacy, partnership, and interdisciplinary collaboration. We have previously suggested structured global health education during undergraduate and graduate medical education,3 and we are publishing a guidebook for developing global health programming.4
Others have called for the development of global health education standards and core competencies,5 and we agree that developing formal guidelines for global health education would be beneficial. Implementing core competencies, as Dr. Asgary suggests, would give educators more direction for curricula, ensuring that all medical trainees receive a minimal exposure to global health issues. Ultimately, this exposure will lead to better medicine, public health, and advocacy—both abroad and at home.
Paul K. Drain, MD, MPH
Instructor in medicine, Harvard Medical School, and assistant in medicine, Divisions of Infectious Diseases, Massachusetts General Hospital and Brigham and Women’s Hospital, Boston, Massachusetts; firstname.lastname@example.org.
Jessica Evert, MD
Executive director, Child and Family Health International, San Francisco, California, and clinical faculty member, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California.
Pierce Gardner, MD
Professor of medicine and public health and associate dean for academic affairs, emeritus, Stonybrook University School of Medicine, Stonybrook, New York.
1. . Overseas medical aid. JAMA. 1969;209:1521–1522
2. Syed SB, Dadwal V, Rutter P, et al. Developed–developing country partnerships: Benefits to developed countries? Global Health. 2012;8:17
3. Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P. Global health in medical education: A call for more training and opportunities. Acad Med. 2007;82:226–230
4. Evert J, Drain PK, Hall T Developing Global Health Programming in Medical and Other Professional Schools. 20132nd ed San Francisco, Calif Global Health Collaborations Press
5. Brewer TF, Saba N, Clair V. From boutique to basic: A call for standardised medical education in global health. Med Educ. 2009;43:930–933