International, International EM

A Resident’s Current Guide to Navigating Global Health: What Now?

I was optimistic at the start of residency that I could pursue projects in global health, but reality played out differently.

Global health has seemed elusive over the past two years for a variety of reasons: the coronavirus pandemic, a shift from in-person to remote work, and the changing landscape of job security within emergency medicine. These challenges were in addition to pre-existing barriers: demanding clinical rotation schedules, restrictive elective time (usually one month for the entirety of residency), and limited funding and resources.

So what now? Recent events have limited us to domestic work, but many global health projects still require attention. If anything, the past two years have demonstrated that global health events have a profound effect on local health as well. Though global health may conventionally seem less accessible, your involvement may actually be more feasible during residency through a more creative approach.

Where do I begin?
Identify the area of global health in which you are most interested. General categories include medical education, residency development, systems and capacity building, and research. Which specific topics within these larger categories appeal to you? An alternative is to identify a location of interest and develop an idea or attach to an existing project. Ask friends and colleagues for any contacts within global emergency medicine.

How do I find a project?
There are two ways to approach this: find a mentor you enjoy working with and assist with an existing project, or identify a project or location of interest and subsequently find a mentor who has experience in those areas. Do not be afraid to “cold email” faculty at institutions with robust global health departments, especially if your home residency does not offer formal global health training or electives. Pursuing an opportunity outside your program demonstrates your dedication to your interests. Communicating with another institution regarding global health is in no way binding, but you should close the loop with mentors you contact regarding your final decision. Good places to find programs and contacts are the EMRA Fellowship Guide chapter on International Emergency Medicine, the Global Emergency Medicine Fellowship Consortium website, and the EMRA Match database for fellowships. Many faculty members at these programs are involved in a multitude of projects and would welcome resident interest.

What ethical questions should I consider?
It is important to consider what impact your involvement will have on projects. It is almost always better to consider a community’s needs and join projects that have an established relationship with a site. If you have to withdraw from a project, what impact will that have on the outcome and on your team? Does this project serve an existing need in the community, and is the community amenable to your involvement? What political or social dynamics regarding hospital leadership, site administration, or project history need to be taken into account?

In what capacity can I be involved?
In the current travel climate, remote involvement in projects is the most feasible. Despite the drawbacks of remote work in such situations, consider this: Remote involvement allows for a longitudinal relationship with a site, scheduled check-ins, and team meetings. Site visits can be time consuming, expensive, and risky. As residents, we are certainly short on time. We often are not granted additional funding, and financing travel is not always feasible. Consider remote involvement as a new avenue to global health involvement, with the ability to establish online resources for community health workers, a digitized trauma registry, or virtual lectures for conferences. As our digital infrastructure grows, so will our capacity to provide healthcare remotely.

How will this impact my clinical care at my home institution?
Involvement in global health has educational and clinical benefits, including improving your clinical care for underserved populations during residency, becoming cost and resource conscious, and understanding cultural impacts on health care. There are many similarities between working in global health and working with underserved populations at our own home institutions.

What are other tips for success?
Clarifying time allotment, specifying deliverables, and discussing outcomes with your mentor are good ways to lay the foundation for successful teamwork.

Key Points

  • Identify a mentor and project in your location of interest.
  • Leverage remote involvement as a longitudinal project that can be scheduled around shifts.
  • Consider ethical questions regarding your involvement.
  • Set a timeline, anticipate delays, and develop contingency plans.

EMRA Resources
For those interested in pursuing opportunities in global health, EMRA offers a few valuable resources.

One place residents can turn to is our book, “The Nuts & Bolts of Global Emergency Medicine.” Readers will learn about terminology within the realm of global EM, ethics and cultural awareness, and travel-related safety considerations, among other topics. Plus, there’s a whole section dedicated to educational opportunities, which includes chapters on mentorship, research, and funding. The book is accessible online and available for free download.

Additionally, the Global Emergency Medicine Student Leadership Program (GEMS LP), formerly known as the International Ambassador Mentorship Program (AMP), was established in 2018 as a joint effort of EMRA and the ACEP International Ambassador Program. It provides guidance to the growing number of EM-bound medical students seeking GEM mentorship.

Goals of the mentor-mentee initiative are:

  • To connect EMRA medical student members interested in global emergency medicine with ACEP International Ambassador Mentors.
  • To familiarize students with the current state of emergency medicine as a specialty in different countries around the world.
  • To educate students about professionalism, leadership, and teamwork through participation in ACEP International Ambassador projects.
  • To provide an overview of global emergency medicine work including research, education, development, humanitarian work, and ethical implications.
  • To provide mentees with a network of contacts in global emergency medicine that they can utilize to further their professional interests.

This program aims to expose medical students to the field of GEM through participation in global health projects, engagement in a thought-provoking journal club, mentorship from ACEP Ambassadors participating in EM programs worldwide, and networking with like-minded peers. In addition to fostering interest in GEM, the program seeks to expose students to some of the complex issues in global health and the importance of having an ethical, equitable, and sustainable approach to global health involvement.

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