Global health in the Medical Curriculum
Anna Shore presents the benefits of a more global attitude to health education
Ease of travel, the impact of the internet, large multinational corporations, population migration - all good examples that we live in an increasingly globalised society. The need for health is common to the whole of the world’s population, and it is unsurprising that medicine too is starting to become more global in its outlook.
Many areas of medicine bear evidence of this change, including undergraduate education. (1) Medical schools in the UK and overseas are starting to respond (2), and it is possible to spend a year studying for an intercalated degree in International Health at selected universities.
Over five years ago, a group of enthusiastic students at Leeds University approached Doctor Nick Emmel, a lecturer in health policy and development attached to the Institute of Health Sciences and Public Health Research at Leeds, with a request that he help set up an International Health BSc - at the time, only the second of its kind to be established in the country. (3) I met up with Dr Emmel to explore his views on the increasing importance of global health in the undergraduate medical curriculum.
Popularity of global health issues
Dr Emmel feels strongly that much of the interest in global health ‘comes from students themselves’. Medical students’ interests are, he said, “as much focused on the global as on the local; they travel more, which creates the enthusiasm to become more informed about the key issues in global health”. Other factors, such as the growing number of newer, less traditional medical curricula and even the increase in female medical undergraduates - “women bring to bear different, more social concerns” - alters the focus of medical teaching and were felt by Dr Emmel to carry weight in the changing perspective of undergraduate teaching. He also made the point that “entry to medicine is no longer solely scientific”. People are selected for more than their aptitude in chemistry, maths and physics, and medical teaching has responded to this wider range of interests.
Importance of global health education
Global health is growing in popularity and importance; the primary motivation for this being the way medicine is developing. Whereas previously, the emphasis was on turning out junior doctors who had memorised numerous facts, people are waking up to the fact that international health education and related concepts deserve a more prominent place on the undergraduate course. Awareness of social sciences and determinants of health was included as a new point in the 2003 Tomorrow’s Doctors publication by the GMC (General Medical Council) (4), something which reflects this changing attitude.
Clearly the traditional components and skills required for a thorough medical education are no less essential, and whilst the cynic could argue that the average patient is more concerned that junior doctors are able to mange their medical complaint effectively than understand another country’s health system, doctors with insight into global health systems and cultures have broader skills and are better able to relate to patients from different parts of the world. There are clinical conditions which have become ‘global’ conditions - whilst once localised to particular countries or continents, they are now seen in a wider variety of areas. Knowledge of international health is invaluable in these and many other situations.
Representation of international health on the medical curriculum
Currently, different medical schools have different methods of introducing students to this subject. Some offer International Health ‘taster days’ as part of the public health course, others have student selected components with an international flavour, or even the chance to work abroad. Many students gain their first taste of medicine overseas during their elective. The medical schools which offer BScs in International Health (5) give students the chance to take a year out of normal medical study to pursue a chosen area in greater depth.
Useful in the future?
So how does a BSc in international health contributed to a medical student’s future career? Dr Emmel’s response was that as well as providing the “chance to refine generic skills such as critical analysis, writing and wider reading”, it also offered the opportunity to interrogate social policy, health care systems and development in a setting which encourages learning and challenges thought processes. An International Health BSc is not essential for future work in lower income countries, but the point of global health education is to deepen understanding of healthcare systems, and the nature and definition of health. This is as useful for doctors working in their own country - part of a globalised system - as abroad, and provides the basis to build upon knowledge later in a medical career or to put towards study on one of the growing numbers of International Health Masters Degrees or Tropical Medicine diplomas that are offered worldwide.
Use the Network
Groups such as Medsin (6), the IFMSA (7) and Alma Mata (8) have been “enormously useful” in raising the profile of global health education, says Dr Emmel. The networks and mobilisation of like-minded students that these groups help to facilitate, together with the chance to “debate issues of topical importance in international health” with the energy and enthusiasm often found at national and international conferences, received high praise.
Over to you!
Lastly, I asked Dr Emmel what advice he would give to students keen to set up an intercalated BSc in International Health at their own university. He suggested two important points to reflect upon. Setting up a BSc is a large undertaking and it is important firstly to demonstrate to your institution that the interest exists, and that the project would be feasible. Finding a supportive member of staff linked to the medical school by teaching or research is invaluable. Secondly, drawing upon the research expertise available at your medical school is recommended. Each International Health BSc offered in the UK has its own flavour, something which mainly results from the interests and facilities which were already in existence at these institutions. This is a positive factor and will allow the development of more - and different - courses.
In conclusion, the energy and enthusiasm for global health education in undergraduate medical training is on the up, and can be furthered by medical students across the globe showing they are passionate about the issues and keen to campaign for greater depth and quality of teaching in this area. Many relevant issues - development studies, consideration of inequalities, and knowledge of health care systems and policy - would expand and diversify medical student training. Adding to the amount of international health on the medical curriculum has the potential to improve the capacity of doctors to tackle challenges that arise as medicine becomes an increasingly global system and can only bring positive results.
Anna Shore
FY1 House Officer
Leeds
UK
annashore@gmail.com
(1) Edwards R, Rowson M, Piachaud J. Teaching International Health Issues to Medical Students. Med Educ. 2001; 35; 807-808
(2) Bateman C et al. Bringing Global Health Issues to Medical Training. Lancet 2001; 358; 1539-1542
(3) Broome JL et al. International Health in Medical Education: Students’ Experiences and Views. JHOM 2007; 21 575-579
(4) General Medical Council. Tomorrow’s Doctors. 2003; GMC Publishing
(5) http://www.medsin.org/bscs
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