Advocating for Ethical Best Practices of PreHealth Students

Advocating for Ethical Best Practices of Pre-Health Students Internationally Ben Pederson MD Sam Donovan MD Jessica Evert MD

“I am trying to establish a long-term and impactful relationship between the [my school’s] student body and the villages and small towns of South Africa. [My school’s] students, who have a reputation for being extremely medically-driven, would be very interested in serving the communities medically, whether it is through patient advocacy, disease/illness awareness, or being able to directly participate in minor surgeries and procedures. ” -Undergraduate student, April 2, 2013

Source: http: //www. goabroad. com/volunteerabroad/search/medicine/volunteer-abroad-1

PRE-PROFESSIONAL PROGRAMS Source: https: //preprofessional. osu. edu/prehealth/competitive-candidate

Murky Ethics in Student Encounters “We saw that many people come like those who want to be tourists. Eh? And tourism doesn’t happen on the body of a human. Tourism is done with animals and other things which are not living things. Now we see when they come many want to go into theatre, want to go in the labour ward, these are cases which we can’t permit… We don’t see the reason a person who is premedical wants to go to the labor ward to see a woman give birth. ” Head Hospital Administrator, Tanzania Sullivan, N. Service through Learning: Ethics, Partnerships, and Best Practices. Exploring Differing Motivations and Expectations and Host Communities: A Case Study from Clinics in Tanzania. NAFSA Faculty Conversation, 8 April 2015.

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+ Power imbalances in healthcare and hurdles for patients to advocate for themselves/choose caregivers and “ask questions” + + Easily “ignored” healthcare ‘system’ that looks very different than where students’ frame of reference. Rise of chronic disease and health treatments that require longitudinal care and continuity. Highly motivated, driven students wanting to ‘help’ immediately and see themselves as the solution for complex global health challenges. + High risk environment for medical errors & patient harm

Guidelines and Standards for Health-Related Programs http: //www. ajtmh. or g/content/83/6/1178. long

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• 18 disciplines • 20+ Institutions • Multiple Global Health Education/Service Organizations • Formed in November 2014 • www. gaspworkinggroup. org

Working Group on Global Activities by Students at Pre-health levels (GASP) Tricia Todd MPH, University of Minnesota Health Careers Center, Global Ambassadors for Patient Safety Program Shailey Prasad MD MPH, University of Minnesota Family and Community Medicine Jessica Evert MD, Child Family Health International, UCSF Family and Community Medicine, CUGH Global Health Advisory Service/TAC/EPS Matthew De. Camp MD Ph. D, Johns Hopkins Berman Institute of Bioethics, Johns Hopkins Division of Internal Medicine Aditi Joshi MD, Former President IFMSA-USA, Emergency Physician Brittany Seymour DDS MPH, Harvard Dental School, Harvard Global Health Institute Rebekah Getman, Harvard Global Health Institute Lawrence Loh MD MPH, The 53 rd Week, University of Toronto Liz Wiley MD JD MPH, Immediate Past President AMSA, Supervising Council, IFMSA, TAC Member, CUGH, University of Maryland Family Medicine Kathy Pedersen PA-C, Global Partners, University of Utah Family and Preventive Medicine Cat Myser Ph. D, Anthropologist/Bioethicist, Cross Cultural and Global Health Ethics Network, Associate Editor, Global Bioethics Will Bynum MD, Family Medicine Fort Belvoir, Chair, AAMC Organization of Residents Sydney Callahan DO, Former, IFMSA-USA officer, OB/GYN Carmen Rexach Ph. D, Mt. San Antonio College, Board of Directors, NAAHP (National Association of Advisors to Health Professionals) Tess Times, Medical Student, Boston University School of Medicine Judith Lasker Ph. D, Lehigh University, Department of Sociology Wendy Gordon, LM, CPM, MPH, Assistant Professor, Dept of Midwifery, Bastyr University Karen Hays, DNP, CNM, ARNP, Adjunct Faculty, Bastyr University Department of Midwifery Avril Whate NP, CFHI Medical Director and Country Coordinator, Capetown, South Africa Martha Johnson, Assistant Dean, Learning Abroad, University of Minnesota Mei Elensary MPhil, MD, Pediatric Resident, Boston Children's, Co. Creator, AMSA Pre-Departure Ethics Workshop Alyson Holland MPhil, MD, Pediatric Emergency Medicine Resident, Dalhouse University, Director, First Do No Harm (documentary) Peter Lucklow, Co-Founder, Globe. Med, Co-Founder, Last Mile Health, Dartmouth Medical School Katie Toste Ph. D, Atlantis Project, Ethics, Emory University David Mc. Ray MD, Director, Maternal and Child Health, John Peter Smith, Health Network Noelle Sullivan Ph. D, Global Health Studies and Department of Anthropology, Northwestern University Susana Alvear MD, Catholic University, Quito, Ecuador, CFHI Medical Director, Ecuador Eric Hartman Ph. D, School of Leadership Studies, Kansas State University, Co-Founder, Fair Trade Service-Learning and Globalsl. org Jody Olsen Ph. D MSW, University of Maryland, Former Peace. Corps Director, Former Board Member NAFSA Peggy Zitek Ph. D, Pre-Health Advisor, Member, Academic Standards Board, University of Michigan James Conway, MD, University of Wisconsin-Madison, School of Medicine and Public Health, Professor of Pediatrics, Admissions Committee Member

Goals of GASP (initially targeting 4 disciplines: medicine, public health, dentistry, and midwifery): 1. Raise awareness among admissions committees and leadership of admissions processes aware of Department of Justice endorsed guidelines for health-related activities of undergraduate students abroad. 2. Raise awareness that vague language on admissions’ websites and outreach materials regarding international ‘activities, ’ service and patient care. 3. Increase visibility of established global health competencies and admissions committees who are considering the details of global experiences when vetting applicants.

“We recently did not offer a student admission who had great test scores, grades, extracurricular activities, and was someone we would have other accepted because she couldn’t see the ethical issues with what she had done when she was on an international volunteer trip as a pre-med and she had done stuff that the admission committee had major concerns about. ” -Medical School Admissions Dean www. gaspworkinggroup. org

Small Group Breakout Session • Introductions – Personal and professional experiences with this issue – Root causes (i. e. oversight, admissions incentives, etc. ) – Where we are now & where we should be going • Strategy to organize and promote best practices – Pre-health level – Health professional school admission policy action – What WE can do! Next steps. Regroup & report small group discussions