As has been reflected in some of our previous blog posts, global health is tricky to define. It encompasses all manner of areas, from refugee health, to climate change, reproductive rights and prevention of non-communicable diseases – our AMSA project groups cover but a small portion of the vast terrain that global health traverses. Importantly, global health encompasses more than inequities between nations, but those within nations, with the goal of improving health for all. With so much ground to cover, where does global health fit in to the standard medical school curriculum?
If you’re anything like me, you’ve once (or maybe a few times…. maybe several hundred), bemoaned the sheer volume of content we’re expected to learn day in and day out. From B-cell maturation to the causes of pulmonary hypertension, the life cycle of the hookworm to appropriate doses of IV and oral opioids. There is a fear that any gaps in our knowledge may render us incapable practitioners, and this in part stems concerns that adding content could replace or compromise essential curriculum outcomes. We have so much packed into our medical degrees, and a life time of learning ahead, that it’s difficult to conceive of how global health fits into our formal education.
At its core, global health underpins much of what we learn in medicine, and most of what we hope to achieve – to reduce the global burden of disease, to encourage multi-disciplinary and multinational collaboration, and ultimately to advance the practice of medicine and the health of our patients. As the people of the world are more mobile than ever before, as we face changes in climate, lifestyle, and political influences, a working knowledge and skill set in global health will be essential for maximising our effectiveness in meeting and anticipating the needs of the communities we serve.
In recent years, medical schools internationally have started to acknowledge the importance of global health within the curriculum. Several organisations have worked towards codifying global health core competencies, including the Global Health Education Consortium and the Institute for International Medical Education. The Australian Medical Council graduate standards are framed around four domains, with Domain 3, ‘Health and Society: the medical graduate as a health advocate’, addressing global health education. And while global health competencies are acknowledged in many health education systems, there is a lack of consensus on the best pedagogical approaches for achieving these graduate outcomes (Battat et al., 2010; Bills & Ahn, 2016).
Research by Eaton, Redmond, & Bax (2011) describes different approaches to global health education as ‘additive’, ‘integrative’, or ‘transformative’. The ‘additive’ approach describes including global health teaching as supplementary to the core curriculum without impacting the basic program structure. This approach is believed to reflect the most common current practice in medical education due to the ease of implementation. In the ‘integrative’ approach more global health content is embedded within the core curriculum, contributing to broader learning outcomes and assessment. In the ‘transformative’ approach, a whole institution engages in developing an adaptable and wholly integrated core global health curriculum with objectives determined through interactive teacher and student dialogue. Evidence suggests that transformative approaches have the most traction on enhancing student learning in global health education, especially when they allow students to progress beyond reflection to ownership of their learning outcomes and desire to act upon them, or ‘praxis’ (Finnegan, Morse, Nadas & Westerhaus, 2017).
As put by Eaton, Redmond, and Bax (2011, p.564), “if we accept that medical education and training needs to adapt to meet the challenge posed by a world where national and discipline-based boundaries are becoming increasingly porous, then programmes will need to ensure that its graduates are educated appropriately.” In an overcrowded medical curriculum, adding more content seems crazy, but if we accept the importance of global health as core to our medical education, then we surely need to focus on how we can best integrate the knowledge and skills in a way that is dynamic and meaningful.
This year, the AMSA Global Health team is starting research on the status of global health education within the Australian medical curriculum. If your medical school has some great global health teaching, or if you have any ideas and would like to be involved, please send me an email. I’d love to hear from you.
AMSA Global Health Education Officer
Australian Medical Council (AMC). (2012). Standards for Assessment and Accreditation of Primary Medical Programs, www.amc.org.au/joomla-files/images/Accreditation/FINAL-Standards-and-Graduate-Outcome-Statements-20-December-2012.pdf
Battat, R., Seidman, G., Chadi, N., Chanda, M., Nehme, J., & Hulme, J. et al. (2010). Global health competencies and approaches in medical education: a literature review. BMC Medical Education,10(1).
Bills, C., & Ahn, J. (2016). Global Health and Graduate Medical Education: A Systematic Review of the Literature. Journal Of Graduate Medical Education, 8(5), 685-691.
Eaton, D., Redmond, A. and Bax, N. (2011). Training healthcare professionals for the future: Internationalism and effective inclusion of global health training. Medical Teacher, 33(7), pp.562-569.
Finnegan, A., Morse, M., Nadas, M., & Westerhaus, M. (2017). Where We Fall Down: Tensions in Teaching Social Medicine and Global Health. Annals Of Global Health, 83(2), 347-355.
AMSA Global Health and the Medical Curriculum policy: https://amsa.org.au/sites/amsa.org.au/files/Global%20Health%20and%20the%20Medical%20Curriculum%20%282017%29.pdf