Educating tomorrow’s global health leaders
Neeranjali Jain, Swaranjali Jain
One of the six key priority areas identified by The United Nations Global Strategy for Women’s and Children’s Health is to develop ‘stronger health systems with sufficient skilled health workers at their core’.  Such skilled workers require an awareness of global health issues in order to meet the challenges inherent in future practice in the modern globalised world. Early exposure to global health experiences as a medical student is important in promoting future global health leadership, and can also help to optimise practice in the local community.
There has been a burgeoning interest in global health amongst medical students.  Today’s medical students are increasingly aware of global health issues and feel a strong sense of responsibility towards the global community. This can be attributed to numerous factors, including the media, which has forged a sense of an interconnected global society, and the rise of challenges that do not recognise geographic borders, such as climate change and the spread of infectious diseases. [3-5] This has emphasised that global issues are far less remote than they might have once seemed.
For medical students to make meaningful change in the global health arena, they require skills that may extend beyond those taught by traditional medical curricula. The attributes of a global health leader, according to Rowson et al., include being ‘globalised’, ‘humanised’, and ‘policy-orientated’.  Increasing globalisation demands that doctors are culturally sensitive and address determinants of health at global as well as local levels. Overseas medical experiences can encourage ‘globalised’ thinking, for example by encouraging flexibility as students witness alternative models of care guided by different cultural values.  One of the most important driving forces behind students’ commitment towards contributing to developing world health is altruism, which underlies practice as a ‘humanitarian’ doctor. Humanitarianism makes participation in global health rewarding for many, and can foster a lifelong commitment to global health action and leadership. Another less well-recognised attribute of global leaders is the understanding that doctors can have a substantial impact not only through treating individual patients, but also through policy-making at a population level. A key way Australian health professionals have helped in developing countries has been by advocating in partnership with local leaders to effect change. For example, the TraumAid International organisation established by Dr Jennifer Dawson equips local leaders to run programs in the community on how to deal with trauma experiences.  Closer to home, there have been striking examples of doctors utilising their political voices to protect vulnerable populations, such as through advocacy for the rights of asylum seekers. [5,9]
The skills learnt overseas benefit students by not only encouraging them to be global health leaders, but also to be effective doctors back home. Students have reported enhanced clinical and communication skills, lateral thinking, personal awareness and enthusiasm towards training following overseas elective experiences.  They are also more likely to seek to serve underprivileged populations, including in rural and remote Australia.  Experience in low-resource settings can also help graduates to be more aware of the impact of their clinical decisions. For example, the principles of the rational use of investigations learnt in developing countries can be transferred back to local settings to promote cost-effective practice by minimising the over-ordering of tests in favour of astute clinical assessment. 
A number of initiatives have arisen to meet the growing interest of Australian medical students in global health. Largely student- driven, these include the annual AMSA Global Health Conference and the formation of university global health interest groups which operate within the AMSA Global Health Network.  Being part of a global health group encourages students to develop an early passion in global health and network with like-minded individuals to share ideas.  Global health groups have also taken leadership in piloting education programs that raise awareness of current global health issues. Encouragingly, these programs attract not only medical students, but also students completing a variety of courses at university and even the general public, as has been our experience with the global course facilitated by the Medical Students’ Aid Project at UNSW. This underscores a key reality in global health, that solutions in the developing world often require partnership between medical professionals and those outside the medical sphere.
A popular way in which students gain practical experience in global health is through arranging electives in developing countries. The benefits of such electives are numerous. It is important to note, however, that electives can be associated with potential harm to both the student and the local community. Risks include lack of supervision which can lead to students assuming roles beyond their capabilities, which can compromise patient care.  Trainees may also experience physical harm due to unstable environments or psychological impacts which can be exacerbated by limited support networks.  The potential harm to local communities can include disruption to local practices and disincentives to governments to invest in local workforces. It is well-recognised that initiating long-term, continuous partnerships with communities are more effective in optimising health outcomes compared with short-term, “bandaid-approach” medical missions.  Further strategies to reduce risks and promote ethical practice are discussed in guidelines, such as ‘A Guide to Working Abroad for Australian Medical Students and Junior Doctors’ by AMSA and the AMA. [12,13] These resources can encourage students to be mindful of their potential impact on communities.
It is clear that an awareness of global health is vital for preparing future doctors to meet diverse future health challenges. Although numerous student-run opportunities exist for students to engage in global health, there has been a call to also integrate global health into the formal university curricula, with over 90% of students believing that global health should be a component of medical school programs. [7,11] This could complement overseas medical experiences by providing a conceptual framework of the global health environment, which can be reinforced by practical experience.
In our ever-changing environment, it is vital that students and junior health professionals are offered all of the opportunities they require to lead meaningful change in tomorrow’s world.
Conflict of interest
N Jain: firstname.lastname@example.org
S Jain: email@example.com
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