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Knock Down Barriers in Global Physician Training

March 28, 2019
by Julie Parry

In the position paper, “Reconfiguring a One-Way Street: A Position Paper on Why and How to Improve Equity in Global Physician Training,” published in Academic Medicine, the authors advocate for changes to the “observership” model, which is the primary type of short-term clinical training that is permissible under federal and state laws.

“We know that there is an issue with a lack of bidirectionality in global health education programs,” says co-author Tracy Rabin, MD, SM, assistant professor of medicine (general internal medicine) and associate director, Office of Global Health at Yale School of Medicine. “It’s a matter of ensuring that both parties in an academic partnership derive benefit from the relationship. In exchange for allowing our trainees to go to limited resource settings to learn from local colleagues, U.S. academic institutions with global health programs need to engage in reciprocal capacity building efforts. One clear mechanism is to provide clinical training opportunities for colleagues from those partner institutions, as Yale does, building capacity to improve health and stability in their home countries. This training is invaluable in the support of international goals for health as well as global health security.”

According to the observership model, participating physicians are not permitted to talk to patients or perform a patient exam. These and other limitations do not allow for the degree of supervised, hands-on clinical experience that is ‘critical for learning’.

The team cited the significant barriers in U.S. laws around visas and state licensure and believe that to “promote equity in medical training opportunities and support meaningful health care capacity development worldwide, specific legal and regulatory changes must be made at the federal and state levels to allow U.S. universities and affiliated hospitals to create effective short-term clinical training programs for non-U.S. learners.”

Lead author, James C. Hudspeth, MD, from the Boston University School of Medicine noted, “The changes we propose will allow better training in the U.S. for physicians from low-resource settings, leveraging the educational capacity of U.S. academic medical centers to improve the health of all people."

The authors “look forward to a national dialogue that moves us [the U.S.] toward equity. It is time for U.S. institutions to reevaluate the current global health education and partnership model, and to provide more equitable educational opportunities for [foreign medical graduates] FMGs determined to improve the health of their home countries.”

“Reconfiguring a One-Way Street: A Position Paper on Why and How to Improve Equity in Global Physician Training” was written by Hudspeth, Rabin, Bradley A. Dreifuss, MD; Mylo Schaaf, MD, MPH, DTHM; Michael S. Lipnick, MD; Christiana M. Russ, MD; Amy Autry, MD; Michael B. Pitt, MD; and Virginia Rowthorn, JD, LLM.

Submitted by Julie Parry on March 28, 2019