Supplemental Digital Appendix 1

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country host perceptions of short-term experiences in global health: A systematic review. Acad Med.

Supplemental Digital Appendix 1

Search Strategy for a Systematic Review of the Literature on Low- and Middle-Income Country Host Perceptions of Short-Term Experiences in Global Health, 2020

Our final search was conducted on August 1, 2020. 7 databases were searched with the following strategies:

Database: PubMed

Strategy: (host OR hosts OR hosting OR recipient OR recipients OR partner OR partnered OR partnering) AND ((medical students) OR trainee OR trainees OR physicians) AND ((global health) OR (international cooperation) OR (international health) OR (medical mission)) Database: EMBASE

Strategy: ('host'/exp OR host OR hosts OR hosting OR 'recipient'/exp OR recipient OR

recipients OR 'partner'/exp OR partner OR partnered OR partnering) AND ('medical student'/exp OR (medical AND students):ti,ab OR trainee:ti,ab OR trainees:ti,ab OR 'physician'/exp OR physician:ti,ab) AND ('global health'/exp OR (global AND health):ti,ab OR 'international cooperation'/exp OR (international AND cooperation):ti,ab OR (international AND health):ti,ab OR (medical AND mission):ti,ab)

Database: Scopus

Strategy: ( TITLE-ABS-KEY ( host OR hosts OR hosting OR recipient OR recipients OR partner OR partnered OR partnering ) ) AND ( TITLE-ABS-KEY ( “medical students” OR trainee OR trainees OR physicians ) ) AND ( ( TITLE-ABS-KEY ( ( global AND health ) ) OR TITLE-ABS-KEY ( ( international AND cooperation ) ) OR TITLE-ABS-KEY ( ( international AND health ) ) OR TITLE-ABS-KEY ( ( medical AND mission ) ) ) )

Database: Web of Science

Strategy: TS=((host OR hosts OR hosting OR recipient OR recipients OR partner OR partnered OR partnering)) AND TS=(((medical students) OR trainee OR trainees OR physician OR

physicians)) AND TS=(((global health) OR (international cooperation) OR (international health) OR (medical mission)))

Database: Education Resources Information Center (ERIC)

Strategy: ((host OR hosts OR hosting) OR (recipient OR recipients) OR (partner OR partnered OR partnering)) AND ((MAINSUBJECT.EXACT("International Cooperation") OR

MAINSUBJECT.EXACT("International Education") OR

MAINSUBJECT.EXACT("International Educational Exchange") OR international education OR International health OR (MAINSUBJECT.EXACT("Global Education") OR global education OR global health) AND (medical mission)) AND

(((MAINSUBJECT.EXACT.EXPLODE("Medical Students") OR medical student OR medical students) OR (trainee OR trainees)) OR (MAINSUBJECT.EXACT.EXPLODE("Physicians") OR physician OR physicians))

Database: Cochrane Library

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country host perceptions of short-term experiences in global health: A systematic review. Acad Med.

Strategy: (host OR hosts OR hosting OR recipient OR recipients OR partner OR partnered OR partnering) AND ((medical students) OR trainee OR trainees OR physicians) AND ((global health) OR (international cooperation) OR (international health) OR (medical mission)) Database: Global Medicus Index

Strategy: (tw:(host OR hosts OR hosting OR recipient OR recipients OR partner OR partnered OR partnering)) AND (tw:((medical students) OR trainee OR trainees OR physicians)) AND (tw:((global health) OR (international cooperation) OR (international health) OR (medical mission)))

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A systematic review. Acad Med.

Supplemental Digital Appendix 2

Thematic Synthesis Chart for a Systematic Review of the Literature on Low- and Middle-Income Country Host Perceptions of Short-Term Experiences in Global Health

Analytical theme Descriptive theme Code Number of studies that included code^reference

Number of instances code used

Sociocultural and contextual

differences

Sociocultural factors related to STEGH

Communication 1433–35,38–48 26

Cultural differences 1232,37–44,46-48 29 Emotional responses 733,36,40–42,47,48 12

Power dynamics^a 539,40,45,46,48 15

Clinical care contextualized to LMIC settings

Contextual differences 1132,35,38,40–46,48 24 Patient care 1232–34,36–38,40,42–44,46,47 24

Resources 1232–36,39–45 24

Standards of practice 635,37,40-42,45 10 Institutional and

programmatic components

Formal and equitable partnerships

between LMIC and HIC institutions

Collaborative planning 632,36,40,42,44,48 13

Partnerships 732,33,35,36,40,46,48 12

Long-term relationships 635,39,40,42,45,48 9 Mutual expectations 732,33,40,43,44,46,48 10 Reciprocity^b 1132,33,35,38–42,44,46,48 30

Research^c 734,35,37–39,43,48 9

Preparation and logistics related to STEGH

Debriefing 2^42,44 2

Evaluation 633,37,40,42,43,48 11

Funding^d 833,36,38–40,42,44,45 17

Preparation 1132,33,36,37,40-44,47,48 31

Role of visitors 536,38,40,46,48 13

Scheduling 733,36,37,40,42,44,48 9

Selection of visitors 632,36,40,42,46,48 14

Supervision 636,37,42,44,46,48 15

Visit duration 835–37,40,42,44,45,48 17

STEGH as educational

Bidirectional learning 932,33,35,36,40,41,44,45,48 12

Capacity building 2^38,40 7

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Impact on host institutions and individuals

experiences for hosts and visitors

Learning environment 536,40,42,44,47 11

Medical education 1232–38,40,44-46,48 35

Mentorship 2^38,40 2

Impact of STEGH on various

stakeholders

Career development 636-39,41,45 9

Competing agendas^e 935–40,42,45,48 10

Effects on host institutions 733,37,39,41,44,46,48 21 Effects on host supervisors 937,39,41–46,48 20 Funding^d

Global citizenship 636,39,41,42,44,48 10 Professional development 733,38–40,45,46,48 11

Short-term relationships^f 6^38–42,48 13

Visitor

characteristics and conduct

Host perceptions of visitors’ personality traits

Character 1032,36–39,42–44,47,48 29

Host preferences of visitors 435,40,44,46 5

Professionalism^g 736,37,39,43-45,48 17

Host concerns regarding visitors’

conduct during STEGH

Competing agendas^e

Ethics 934,36,39–42,45,46,48 17

Photography 3^39,46,47 3

Power dynamics^a Professionalism^g Reciprocity^b Research^c

Safety 2^42,44 3

Short-term relationships^f

Vacation 636,37,39,40,45,48 8

Abbreviations: STEGH, short-term experiences in global health; LMIC, low- or middle-income country; HIC, high-income country.

a-gCodes classified under more than one descriptive theme.

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Supplemental Digital Appendix 3

List of Representative Quotes for Each Code in a Systematic Review of the Literature on Low- and Middle-Income Country Host Perceptions of Short-Term Experiences in Global Health

Analytic theme

Descriptive

theme Code Total number of studies that

included code^reference Representative quote(s) Sociocultural

and contextual differences

Sociocultural factors related to STEGH

Communication 1433–35,38–48 Most participants felt students needed to understand the importance of relationship in African culture. They felt it was useful for students to know how to interact with local staff particularly nursing staff: “You had to greet (nurses) and ask how they are, have a little nice chat that is actually human decency which we have lost in the West. So

basically, it’s human relationships come first before what has to happen.”⁴²

...some patients become “scared” that they have a “serious disease” or will receive a “serious intervention” when expatriate doctors examine them, owing to

miscommunication. He recalled a time when a patient left an encounter with an expatriate physician in the middle of the physical examination because the patient thought that being examined by an expatriate meant that she was going to receive an invasive procedure: “Because of her fear, she did not come back.” The student felt that this

misunderstanding prohibited patient care.³⁸ Cultural

differences

1232,37–44,46-48 "Maybe in the African culture… People tend to be

cautious. They tend to not be so confrontational… They might speak in parables or make suggestions that this might not be the best way to do things, whereas someone from another culture would say, “That’s the wrong way to do things”. So those kinds of cultural differences in the way people communicate might sometimes create issues."⁴⁰

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Many respondents viewed positively the fact that STEGH female students do not reproduce this gender inequality.

Surprisingly, they benefited at times from their status as foreigners in health care interactions with male patients.

“Because they are patients who refuse! African patients who refuse to be treated by Beninese women… I noticed they didn’t refuse when it was [female] foreign

trainees.”⁴⁶ Emotional

responses

733,36,40–42,47,48 Host supervisors expressed the challenge of witnessing

international medical students’ distress when they were confronted with health inequities and ethically challenging situations and were sometimes unsure of how to best navigate this with the student. One supervisor described a difficult situation for both himself and the student: "There was this instance a patient died and … I should have done more, but because of the politics of the system, I couldn’t do that much. So, [the student] took it a little badly, so I had a hard time trying to explain to her that, I mean it goes beyond the doctor, the facility, the serious situation. And it was kind of difficult for me … I had a difficult time trying to explain the situation to her."⁴¹

Power dynamics^a

539,40,45,46,48 “You know there is limitations that persists in Africa

where the white man is almost like God. When a white comes to treat someone the patient says to himself: ‘I have the best care.’ There is still this myth that exists. As a result, it easily facilitates access to patients for foreign students when they come to Benin… You know where was the colonization, there was the fact that the European countries are more developed than the African

countries.”⁴⁶

Participants observed that patients often perceived [visitors] more positively than local health care staff, although participants did not view this as a problem. This recurring theme was called ‘the muzungu effect’ by one

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physician: “…the patients get excited especially if ah the muzungu effect… here ‘eh the muzungu has touched me’

and they get excited… some cannot distinguish between a muzungu who is qualified and a muzungu who is a

visiting student…”⁴⁸ Clinical care

contextualized to LMIC settings

Contextual differences

1132,35,38,40–46,48 Participants also perceived visiting health care

professionals as attempting to impose their visions of health and health care onto the local environment. Local health care professionals felt that visitors were often trying to apply Western concepts of medicine and standards of care in a setting where resource limitations often make such concepts impossible to implement. The local health care professionals acknowledged that although the ideas brought by visitors were good, they were rarely relevant in the environmental context.³²

“…you know, I’m a third-year [Ugandan] resident [laughter] I should be giving you a lecture on how we do this repair here, not you giving me a lecture how we do the repair here.”⁴⁸

Patient care 1232–34,36–38,40,42–44,46,47 Host supervisors identified potential harms to patient care that might arise in the presence of visiting medical

students, including harms associated with differing standards of care, longer wait times, lack of cultural competency, and language barriers between students, patients and staff.³³

Resources 1232–36,39–45 ...limitations in service provision owing to limited resources, which could provoke frustration on the part of supervisors: When they come, they want to know, evidence based medicine, “why are you doing [this, or that]” … with our decisions, but sometimes we are constrained; we can’t provide the best. … One faculty [kept] saying that he felt as if he was being interrogated by a student. I think the student was … picking out many

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gaps that were … in the system, [rather] than being helpful.⁴¹

Standards of practice

635,37,40-42,45 ...benchmarking of “best practices,” facilitated through

conversations with traveling medical students, served to highlight differences in standard of care as determined by geography, politics, and resource availability (personnel and supplies).⁴¹

Institutional and

programmatic components

Formal and equitable partnerships between LMIC and HIC

institutions

Collaborative planning

632,36,40,42,44,48 "They acknowledged that lack of communication with a

sending institution often led them to question the objective and relevance of the elective: "The other side of the coin is that maybe these students are doing things completely outside their curriculum. All I know is they apply saying they would like to come and we accept them. Maybe that as far as the faculty in their school is concerned, they don’t really expect to hear from us – I don’t know... But I have enough to do to run this place and I’m not going to be chasing medical schools to be telling them what their students are doing – if they are not interested [enough] to contact us, then why should we contact them?"³⁶

Partnerships 732,33,35,36,40,46,48 "I would say that we prefer the formal partnerships because we can apply some control on how things work and when we have some structure in terms of objectives, then it is possible to evaluate and say this has worked well and this hasn’t."⁴⁰

Long-term relationships

635,39,40,42,45,48 "Forty-two percent of the participants mentioned that a successful international educational exchange occurred when a long-term relationship was formed, which could be with an individual, institution, or both. When asked why this was positive, participants responded that it could lead to other rotators in the future, project creation and collaboration, and research."³⁵

Mutual expectations

732,33,40,43,44,46,48 “There should be somebody that we can talk to when we

have feedback. We should be able to notify them of issues so that learners do not repeat the same mistakes. This way learners will know what is expected of them based on previous experiences.”⁴³

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“We all need to understand what their objectives are.

There are those that are coming with objectives and it’s not just I’m going to Malawi for a month to save Malawi.”⁴⁴

Reciprocity^b 1132,33,35,38–42,44,46,48 "Most participants expressed a desire for greater

reciprocity between sending institutions and host hospitals as they felt the relationship was generally one-sided. They expressed a desire to look at partnerships where students or registrars from both host and sending institutions could be part of an exchange programme to experience medicine in a different culture: “The one area that I would like to explore is students can come and learn from us, but could we send our fellows training in sub-specialties to them because they would be more developed.”⁴²

“It would have been nice for us to be able to travel, too, to see how things are done on the other side, because

whenever one of ours goes there and come back, we sense that his behaviour is different, we sense that he sees things differently because he has certainly seen other realities.

But increasingly today, we realize those doors are more often closed. It’s very difficult to travel, to go to the West to see how things are done, but meanwhile we’re happy to welcome you.”⁴⁶

Research^c 734,35,37–39,43,48 "Some host community members expressed resentment towards HIC trainees for whom they had helped set up research projects; the majority of these students did not remain in touch or provide collaborators with research results."³⁹

Preparation and logistics related to STEGH

Debriefing 2^42,44 "Some participants felt early debriefing during the first week of the elective and regular tutorials would enhance learning for students unfamiliar with the scope of

pathology and the severity of the disease. Participants felt a formal “exit” interview at the end of the elective period would provide valuable learning for themselves as they

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would get feedback from the student about the elective experience and what improvements could be made."⁴² Evaluation 633,37,40,42,43,48 "Host clinical preceptors also requested the creation of a

formal mechanism for two-way feedback: "Sitting down with learners to fill out evaluations may be difficult because we may also ‘swallow it’. And it should be both ways, we can evaluate them and give formal feedback and they can also give formal feedback about us.”⁴³

Funding^d 833,36,38–40,42,44,45 "...locally trained clinicians were coded as expressing the desire for incoming students, their sending institutions and even their government(s) to be more proactive in

providing financial and technical support to hosting sites.

One clinician revealed why some local staff were not willing to support the elective programme at their site:

"...we know that when they [students] come here they pay a small fee which is [a] contribution to the running cost of the hospital. In return we have to teach them more about common tropical diseases. But most of the clinicians here are not willing to conduct such theoretical teaching because there are no incentives... I think there is the element of “why should I bother!"³⁶

Preparation 1132,33,36,37,40-44,47,48 Respondents identified several knowledge gaps among STLs [short-term learners] and indicated that it would be beneficial for STLs to have predeparture training to address medical knowledge in specific domains, ethical challenges, procedural skills, and cultural and language skills.³⁷

Role of visitors 536,38,40,46,48 Generally, participants emphasised that despite being presented with opportunities to do more, elective students were primarily coming to learn and not to work. The key component was that students coming on electives were not expected to make a more significant clinical contribution than local medical students: "...I think we have to be realistic about what a student can contribute to frontline patient care. To be frank it’s a limited amount that we can expect from them..."³⁶

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Scheduling 733,36,37,40,42,44,48 ...elective programmes may interfere with ongoing teaching... Although some sites reported that they tried to draw up an elective schedule that did not interfere with local teaching, problems still emerged when clinical staff assigned to supervise visiting students were also expected to teach local students. In circumstances in which this happened, priority was given to local students.³⁶ Selection of

visitors

632,36,40,42,46,48 ...a potential drawback of this arrangement [partnership

model] referred to the possible loss of the host’s control over the selection of candidates. Three respondents (from different sites) felt that choices of incoming students were imposed on them and that in some circumstances those selected did not have the resilience to learn in challenging environments.³⁶

Supervision 636,37,42,44,46,48 During times when clinical staff are struggling to keep pace with the number of patients, the designated supervisor may not find time to teach, which leaves elective students feeling they are being neglected.³⁶ Visit duration 835–37,40,42,44,45,48 Participants felt longer electives would be mutually

beneficial as they thought it took students at least two weeks to become culturally adapted and adjusted to host organisation structure before they could contribute clinically: “It’s most disappointing when students are all of a sudden oriented and comfortable and productive in their new environment and then that’s usually around about the one month mark and then they go.”⁴²

Impact on host

institutions and

individuals

STEGH as educational experiences for hosts and visitors

Bidirectional learning

932,33,35,36,40,41,44,45,48 "...interviewees said education was bidirectional, flowing from rotator to host and host to rotator."³⁵

Capacity building

2^38,40 “It should be done in such a way that the expatriates train

local people to eventually run the show—not just fill the gap for a year and go, because then we will be

permanently dependent on others. They should train the trainers.”³⁸

Learning environment

536,40,42,44,47 "...hosts in rural hospitals engaged closely with students to

help them meet their learning objectives. By contrast, respondents from urban teaching hospitals reported that

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because of the large number of elective students visiting the site at any given time, it was impractical to discuss each student’s learning objectives. The opportunities and support offered to students were, therefore, significantly less personalised."³⁶

Medical education

1232–38,40,44-46,48 "The staff were always quite excited ‘cause they get someone visiting from overseas and, you know, view them as an expert who’s going to be terribly helpful, but very often… what they are teaching will be very much at odds either with what our guidelines were, which were not perfect, or what we physically would be capable of

doing."³²

Another patient mentioned that visiting students may interfere with Nepali student learning by “taking away opportunities from Nepalis.” Two physicians also commented that the visiting students may take away Nepali students’ opportunities in the hospital. One

surgeon stated: “I want them [visiting students] to help do the operations, and scrub-in with me, but some Nepali students may be upset that their opportunity has been taken by the international student.”⁴⁵

Mentorship 2^38,40 “Expatriates are role models and mentors, and they help Malawian students to network. Being their mentor means actively connecting students to people who fit their

interests, providing educational materials and experiences, and being available to discuss personal issues,

psychological issues, and lifestyle issues.”³⁸ Impact of

STEGH on various stakeholders

Career development

636-39,41,45 Respondents noted that some STLs [short-term learners]

seemed to have no intention of returning to work in resource-limited settings and contrasted their performance to those who intended to continue global health work in the future: "It is clear that some are here for the

experience but have little interest in returning to the developing world. Others are more engaged and interested in doing work abroad as part of their career."³⁷

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Competing agendas^e

935–40,42,45,48 This carefree behaviour contributed to the perception that

trainees’ intent to undertake the programme abroad was based mainly on the wish to build their resume and gain enjoyment.³⁹

“I have had situations where students are in obstetrics and then they come and say ‘oh, there is also pediatrics I also want to spend some two weeks in pediatrics’… so it tends to end up being a medical tour… and I think it’s a

problem to have tourists…”⁴⁸ Effects on host

institutions

733,37,39,41,44,46,48 Nearly all physicians in both India and Bolivia (83%, n =

10/12) claimed that working with a US-based organisation and hosting HIC trainees increased the prestige of their medical centre in the eyes of the community. Physicians reported that their patients were impressed that HIC trainees had travelled from far away to learn from the patient’s local personal physician. An Indian physician stated: "Most of our patients are appreciative, and some think, “My doctor has visitors from other countries. Okay, the doctor is so learned because he is teaching the foreign student.”³⁹

Effects on host supervisors

937,39,41–46,48 Host clinical preceptors stated that when STGHE [short-

term global health elective] learners act unprofessionally, they affect the perception of all STGHE learners. In some cases, unprofessional interactions may make host clinical preceptors hesitant to precept STGHE learners in the future.⁴³

“The speed that I see patients is totally different when I have a learner. I can be slow because I am explaining, translating, or interpreting back and forth. I am slower than I am when seeing patients alone.”⁴⁴

Funding^d

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Global citizenship

636,39,41,42,44,48 They [hosts] felt that by hosting students, they could hand

the baton on to a future generation of doctors and pay back something to the profession. Some felt paternalistic towards the students and had a mentoring role. Others felt it was their duty to introduce students to a different cultural experience which could stimulate an interest in global and rural health and promote a culture of global citizenship.⁴²

Professional development

733,38–40,45,46,48 Supervisors also reported supervising IMEs [international

medical electives] in order to motivate themselves to continue lifelong learning and to enhance their teaching experiences: "I'm positively challenged to discuss differentials, to participate in the enthusiasm of the students in learning..."³³

6^38–42,48 Faculty commented that expatriates help make Malawians

feel less isolated. “Expatriates break up this feeling of being isolated in a poor country without any contacts to the outside world. They give the opportunity to feel connected to the greater medical community.”³⁸

...IMEs from the same country seemed to stick together as a group and although that provided companionship and a shared experience in a foreign country, large groups meant that students were less integrated and, in some instances, less accountable: “They might all duck off at lunchtime, particularly if a big group of five all come at once.”⁴² Visitor

characteristics and conduct

Host

perceptions of visitors’

personality traits

Character 1032,36–39,42–44,47,48 Many physicians (67%, n = 8) noted that some HIC trainees were not proactive and did not ask questions. An Indian physician said: “Quite a lot of them have been, you know, not interested much... But something has to come from them. I cannot just go blabbering on and on and on.

So if the student is not showing an initiative... then maybe we don’t feel like teaching those students. Then the rapport is not good.”³⁹

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Host

preferences of visitors

435,40,44,46 [Twenty-five percent] of hosts preferred when residents

came in the later stages of training or to have an attending accompany residents. This relieved the host from having to teach basic skills to residents and facilitated increased knowledge transfer from rotator to host.³⁵

Professionalism^g 736,37,39,43-45,48 "...some students do come with an attitude that because they are Western medical students they will know much more than what our clinical officers know. They will find that they are not right and they have to learn to respect the Malawian clinical officers, respect their decision

making."³⁶

Others noted a general lack of professionalism:

"Some...made it clear through their actions that they were here for a glorified holiday and prioritized travel over clinical care. It is difficult to see [STLs] arrive late, leave early, and show little interest in clinical care and still pass a very judgmental attitude toward care being delivered here." ³⁷

Host concerns regarding visitors’

conduct during STEGH

Competing agendas^e

Ethics 934,36,39–42,45,46,48 "I think some of them [elective students] are frustrated because we will not allow them to do things that they are not qualified to do. This is not a bush hospital; this is a hospital that has been there for 105 years... We are never enough, but I would never put a scalpel in the hand of a student, never, it has never happened."³⁶

Photography 3^39,46,47 "They get a shock because maybe three patients are sharing a bed and sometimes they would like to take a photograph."⁴⁷

Power dynamics^a

Professionalism^g

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Reciprocity^b Research^c

Safety 2^42,44 Participants highlighted that student safety was one of the main concerns for them when hosting students on

electives: “I think one of the things that living and working in Africa I would often be concerned about is their personal safety because they weren’t aware of the dangers.”⁴²

Vacation 636,37,39,40,45,48 ...respondents commonly discouraged electives in which students simply observed practice or, worse, used the placement as a holiday. Hosts expected elective students to participate in most basic procedures, as local medical students were expected to do: "What we have no tolerance for, whatsoever, are the students who are sort of coming for a medical tourism. Those who want to see lots of fancy things and then go to the lake for a weekend and disappear for an extra day or two. Those who don’t show any

commitment to longer-term health needs in poor parts of the world..."³⁶

Three physicians in particular perceived the visiting students as coming to Nepal for vacation and working minimal hours at the hospital. Students engaged in tourist activities such as Himalayan treks without notice, making it difficult for departments to accommodate them. One physician lamented that “Sometimes it seems like their main motive is just to roam around the countryside, and at that time we feel really bad.”⁴⁵

Abbreviations: STEGH, short-term experiences in global health; HIC, high-income country; STL, short-term learners; STGHE, short-term global health elective; IME, international medical elective.

a-g Codes classified under more than one descriptive theme.

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Supplemental Digital Appendix 4

Examples of Online Global Health Predeparture Training Resources

Resource Description Link

Guidelines

Ethics and best practice guidelines for training experiences in global health. American Journal of Tropical Medicine and Hygiene, 2010.

Best practices for institutions, trainees, and sponsors of STEGH. Developed by the Working Group on Ethics Guidelines for Global Health Training (WEIGHT).

https://pubmed.ncbi.nlm.nih.gov/21118918/

Ethical obligations regarding short-term global health clinical experiences: An American College of Physicians position paper. Annals of Internal Medicine, 2018.

Paper that describes core positions required to inform ethical decision making surrounding participation in STEGH. Developed by the ACP Ethics, Professionalism, and Human Rights Committee.

https://pubmed.ncbi.nlm.nih.gov/29582076/

Articles

Are you ready? A systematic review of pre- departure resources for global health electives.

BMC Medical Education, 2019.

Systematic review that outlined specific pre-departure content areas frequently described in the literature as well as logistical factors related to pre-departure training delivery and evaluation.

https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-019-1586-y

Visiting trainees in global settings: Host and partner perspectives on desirable competencies. Annals of Global Health, 2017.

Study that evaluated LMIC host supervisor desired competencies and learning objectives for visitors participating in STEGH.

https://www.annalsofglobalhealth.org/articles/abstract/10.1016/j.aogh.2017.04.007/

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Pre-departure training for healthcare students going abroad: Impact on

preparedness. Annals of Global Health, 2018.

Study that identified specific pre-departure training content areas that medical and nursing students perceived as bolstering their level of preparedness for STEGH.

https://www.annalsofglobalhealth.org/articles/10.29024/aogh.2378/

Toolkits

International Federation for Medical Students Association (IFMSA) ethics pre-departure training toolkit. IFMSA.

Toolkit with preparatory content for STEGH pertaining to

medical ethics, research ethics, and culture shock.

https://ifmsa.org/pre-departure-training/#1526311261636-f297e91b-d797

Global health in pediatric education: An

implementation guide for program directors.

American Board of Pediatrics.

Resource designed for educators interested in incorporating global health education within pediatric training programs.

https://www.abp.org/ghpdguidehome

Global Ambassadors for Patient Safety (GAPS) toolkit. University of Minnesota.

Toolkit with preparatory content related to appropriate selection of STEGH programs as well as culture and ethics training.

https://www.healthcareers.umn.edu/courses-and-events/online-workshops/global- ambassadors-patient-safety

Global Service Learning (GlobalSL) tools and syllabi. Campus Compact.

Collection of pre-departure training resources broadly applicable for all students interested in STEGH.

https://compact.org/global-sl/toolsandsyllabi/

Training Modules Various training modules.

Consortium of

Universities for Global Health

a) Case studies:

Reasoning

without resources

a) Clinical case studies designed for medical students and residents interested in practicing medicine in low-resource settings.

a) https://www.cugh.org/resources/case-studies-reasoning-without-resources b) https://www.cugh.org/educational-module-topic/working-visiting-low-

resource-countries

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b) Global health training modules

b) Series of presentations and training modules to support students on various topics related to visiting and working in LMIC settings.

SugarPrep: Curricular resources for global health educators.

Midwest Consortium of Global Child Health Educators.

Curriculum to help prepare medical providers to work within LMIC settings. Includes 3 training programs: (1) SUGAR (Simulation Use for Global Away Rotations), (2) PEARLS (Procedural Education for Adaptation to Resource-Limited Settings), and (3) S-PACK (SUGAR’s Pre-departure Activities Curricular Kit).

https://sugarprep.org/

Ethical challenges in short-term global health training. Johns Hopkins Berman Institute of Bioethics and Stanford University Center for Innovation in Global Health.

Series of clinical and research cases focused on commonly encountered ethical challenges that may arise during STEGH.

http://ethicsandglobalhealth.org/

Culture matters. Peace Corps.

Workbook that provides cross- cultural training content.

Developed by the Peace Corps to help new volunteers successfully and respectively engage with new cultures.

https://files.peacecorps.gov/wws/interactive/culturematters/index.html

Global health clinical ethics. AAMC

MedEdPORTAL, 2015.

Small group workshop built around clinical vignettes that highlight common ethical challenges visitors may encounter during STEGH.

https://www.mededportal.org/doi/10.15766/mep_2374-8265.10232

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Ethics simulation in global health training (ESIGHT). AAMC MedEdPORTAL, 2017.

Simulation based workshop built around clinical vignettes that highlight common ethical challenges visitors may encounter during STEGH.

https://www.mededportal.org/doi/10.15766/mep_2374-8265.10590

Online Courses

The practitioner’s guide to global health. EdX.

Boston University.

Two-week course through EdX that prepares students to safely and effectively participate in STEGH.

https://www.edx.org/course/the-practitioners-guide-to-global-health#!

An introduction to global health. Coursera.

University of Copenhagen.

Four-week course through Coursera that provides an overview on common global health challenges.

https://www.coursera.org/learn/global-health-introduction

Global Health eLearning Center. United States Agency for International Development (USAID).

Variety of courses through the Global Health eLearning Center/USAID that provides education on diverse global health topics.

https://www.globalhealthlearning.org/courses

Note: this is not an exhaustive nor comprehensive list of available resources.

Abbreviations: STEGH, short-term experiences in global health; ACP, American College of Physicians; CUGH, Consortium of Universities for Global Health; LMIC, Low- or Middle-Income Country; AAMC, Association of American Medical Colleges.