Table 1
Inclusion and Exclusion Criteria, From January 1 in 2018 Until October 18 in 2023.
| INCLUSION CRITERIA | EXCLUSION CRITERIA | |
|---|---|---|
| Population |
|
|
| Exposure |
|
|
| Outcome |
|
|
| Type of papers | Conference abstracts | |
| Language | English | All other languages |
[i] Abbreviations: HIC: High-Income Country. LMIC: Low- or Middle-Income Country.
Table 2
Characteristics of Included Articles.
| NR | TITLE | AFFILIATION FIRST AUTHOR | AFFILIATION LAST AUTHOR | TYPE OF PAPER | SCOPE OF PAPER | AIM OF PAPER | LMIC DESTINATIONS | POSE | GAZE |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Ten Questions to Guide Learners Seeking Equitable Global Health Experiences Abroad (2023) | Medical student at University of Michigan, USA | University of Global Health Equity, Butaro, Rwanda | Scholarly Perspective | Equitable global health experiences | To offer 10 guiding questions to support students in choosing equitable LMIC electives, for mutually beneficial partnerships | Not specified | USA/Rwanda | HIC students and HIC institutions |
| 2 | International Health Electives: defining learning outcomes for a unique experience (2023) | Department of Obstetrics and Gynaecology, University Medical Center Groningen | University Medical Center Groningen | Research | Learning outcomes for International Health Electives (IHEs) | To clarify the possible learning outcomes for International Health Electives (IHEs) in LMICs as perceived by HIC students to facilitate incorporation of IHEs in GHE and help clarify their link to professional performance. | Ghana, Malawi, Nepal, Rwanda Uganda, Sierra Leone, Suriname, and South Africa | Netherlands/Netherlands | HIC institutions |
| 3 | From the Global North to the Global South: preparing students for away rotations (2023) | Uni of Catanzaro, Italy | Uni of Catanzaro, Italy | Commentary | LMIC electives by HIC med students | To comment on students’ preparation for away rotations based on the authors’ experiences and opinions alongside a review of papers | Not specified | Italy/Italy | Unspecified |
| 4 | Ethical Considerations of Climate Justice and International Air Travel in Short-Term Electives in Global Health (2023) | Uni of Minnesota, USA | Division of Hospital Medicine, University of Minnesota, USA | Perspective | Climate change considerations in STEGH programs | To suggest several strategies that HIC GH medical education programs could implement to act on climate change health impacts and consider decolonization and decarbonization | Not specified | USA/USA | HIC institutions |
| 5 | Managing the Unpredictable: Recommendations to Improve Trainee Safety During Global Health Away Electives (2022) | Cape Western Reserve University, Ohio, USA | Yale School of Medicine, New Haven, Connecticut, USA | Original research | Student safety during GH away rotations | To provide critical safety considerations requiring additional guidance for programs and students on LMIC clinical electives | Not specified | USA/USA | HIC students and HIC institutions |
| 6 | Medical students from German-speaking countries on abroad electives in Africa: destinations, motivations, trends and ethical dilemmas (2022) | University of Freiburg, Germany | Department of emergency Medicine, Cantonal Hospital of Neuchatel, Neuchatel, Switzerland | Research | Motivations of HIC medical students on LMIC clinical electives | To provide insights into factors driving medical student to travel to Africa for clinical electives, as an opportunity for HIC med schools to restructure their international elective programs | Benin, Cameroon Ethiopia, Gambia Ghana, Ivory Coast Kenya, Malawi Morocco, Namibia Botswana, Mauritius, Senegal, Seychelles, Rwanda, South Africa, Tanzania, Togo, Tunisia, Uganda, and Zambia | Germany/Switzerland | HIC institutions |
| 7 | Low- and Middle-Income Country Host Perceptions of Short-Term Experiences in Global Health: A Systematic Review (2021) | Perelman School of Medicine, Philadelphia, USA | Yale School of Medicine, Yale University, New Haven, Connecticut, USA | Review | LMIC host perceptions of STEGH | To summarize LMIC host perceptions of STEGH, develop best practices for STEGH that provide guidance for HIC and LMIC stakeholders | Kenya, the Philippines, Namibia, Angola China, Ethiopia Ghana, Guyana India, Nepal Rwanda, South Africa, Uganda Vietnam, Argentina Peru, Malawi, Tanzania, Zambia Botswana, Eswatini Bolivia, and Benin | USA/USA | HIC and LMIC institutions |
| 8 | Embedding international medical student electives within a 30-year partnership: the Ghana-Michigan collaboration (2020) | University of Michigan, USA | University of Michigan, USA. | Research article | The Ghana-Michigan collaboration | To explore the University of Michigan med student elective in Ghana within the context of the Ghana-Michigan collaborative | Ghana | USA/USA | Unspecified |
| 9 | Developing Ethical and Sustainable Global Health Educational Exchanges for Clinical Trainees: Implementation and Lessons Learned from the 30-Year Academic Model Providing Access to Healthcare (AMPATH) Partnership (2020) | Indiana University School of medicine, Indiana, USA AND Moi University Medical School Eldoret, Kenya | College of Health Sciences, Moi University, Eldoret, Kenya | Perspective | Lessons learned from the AMPATH partnership for educational exchanges for clinical trainees | To describe the bilateral exchange of trainees in the AMPATH partnership of 12 universities in North America and 1 in Kenya, and hereby provide a model for developing institutional HIC-LMIC partnership | Kenya | USA/Kenya | HIC and LMIC institutions |
| 10 | Perspectives and Solutions from Clinical Trainees and Mentors Regarding Ethical Challenges During Global Health Experiences (2020) | Harvard Med school, USA | Harvard Medical School, USA | Original research | Staff and students’ perspectives on ethically responsible STEGH | To describe perspectives and potential solutions in STEGH as identified by HIC students and staff, to help prevent, mitigate or resolve ethical challenges. | Not specified | USA/USA | HIC students and HIC institutions |
| 11 | Rethinking Goals: Transforming Short-Term Global Health Experiences Into Engagements (2020) | University of Arkansas for Medical Sciences, Arkansas, USA | University of Texas Medical Branch, Texas, USA | Perspective | Transformative learning goals for STEGH, reconceptualizing STEGH as engagements | To present and encourage the use of 5 key learning goals for STEGH participants for transformative learning | Not specified | USA/USA | HIC institutions |
| 12 | Structured medical electives: a concept whose time has come? 2019 | Kings College London, UK | Medical School for International Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel | Review | Roles for HIC medical schools organizing international clinical electives | To provide insights into the role of HIC med schools in organizing international clinical electives | Ghana, Ethiopia India, Nepal Sri Lanka, Peru, Malawi, and Zambia | UK/Israel | HIC institutions (UK medical schools primarily, and also HIC medical schools in general) |
| 13 | Extent, nature and consequences of performing outside scope of training in global health. 2019 | Northwestern University, Chicago, USA | Massachusetts General Hospital, USA AND Harvard Medical School, Boston, USA. | Research | Students performing outside scope of training | To explore the frequency, nature, circumstances and consequences of performing outside scope of training (POST) | Not specified | USA/USA | Unspecified |
| 14 | Are you ready? A systematic review of pre-departure resources for global health electives (2019) | John Hopkins Center for GH, Baltimore, USA AND John Hopkins Bloomberg School of Public Health, Baltimore, USA | Johns Hopkins Center for Global Health, Baltimore, USA AND Johns Hopkins School of Medicine, Baltimore, USA | Review | PDT for LMIC clinical electives | To quantify the plethora of PDT for LMIC electives | Not specified | USA/USA | HIC institutions in collaboration with LMIC sites |
| 15 | Development of a Novel Global Surgery Course for Medical Schools (2019) | Massachussets Hospital and Havrard Med School, USA | Lund University, Sweden | Review | A multinational exchange course in global surgery | to share evaluation results from a multinational exchange course in global surgery, involving students from Sweden, USA and Zimbabwe (with clinical elective for the Swedish and American in Harare, and clinical elective in Sweden for the Zimbabwian) | Zimbabwe | USA/Sweden | HIC institutions |
| 16 | Global health electives: Ethical engagement in building global health capacity (2020) | University of Calgary, Alberta, Canada | University of Calgary, Alberta, Canada | Research | The impact of Canada clinical electives on host institutions in Tanzania and Uganda | To provide host perspectives to help better design ethically responsible LMIC electives | Tanzania and Uganda | Canada/Canada | HIC institutions |
| 17 | Reciprocity? International Preceptors’ Perceptions of Global Health Elective Learners at African Sites (2019) | University of Utah, USA | Baylor College of Medicine, USA | Original research | Benefits and burdens of LMIC clinical electives from host perspectives | To provide insights in LMIC host preceptors’ perceptions regarding benefits and burdens of hosting STLs | Malawi and Lesotho | USA/USA | Unspecified (other than a ‘need for institutions to identify mutuality’) |
| 18 | Longitudinal Service Learning in Medical Education: An Ethical Analysis of the Five-Year Alternative Curriculum at Stritch School of Medicine (2018) | University of Illinois, Chicago, USA | none | Perspective | The GH Fieldwork Fellowships in Bolivia and its benefits for students | To describe the one-year GH Fieldwork Fellowship (GHFF) in Bolivia as a curricular model to foster professionalism and social values | Bolivia | USA | Unspecified |
| 19 | The ethical experiences of trainees on short-term international trips: a systematic qualitative synthesis (2018) | John Hophins Hospital, Baltimore, USA | John Hopkins University, Baltimore, USA | Review | STINTTs ethical experiences | To identify ethical issues medical trainees encounter during STINTTs | Not specified | USA/USA | HIC institutions |
| 20 | Pre-departure Training for Healthcare Students Going Abroad: Impact on Preparedness (2018) | John Hopkins School of Med, Baltimore, USA | Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA | Original research | The efficacy of PDT in preparing students for LMIC clinical electives | To identify characteristics of PDT associated with participants’ reporting levels of preparedness. | Not specified | USA/USA | HIC institutions |
| 21 | International medical electives in selected African countries: a phenomenological study on host experience (2018) | University of Notre Dame, Australia | University of Notre Dame, Australia | Research | Host perspectives on IMEs | To explore the host experience on international medical electives as a selection of hospitals in LMICs in Africa, to inform toe preparation of GH curricula. | Uganda, South Africa, and Eswatini | Australia/Australia | HIC institutions |
| 22 | Ethical reflection for medical electives (2018) | University of Birmingham Medical School, UK | University of Birmingham Medical School, UK | Original research | Ethical considerations for LMIC medical electives | To identify ethical considerations for elective students, based on interviews with UK students in the Solomon Islands | Solomon Islands | UK/UK | HIC institutions, and specifically primarily UK institutions |
| 23 | A Comparison of the Expectations and Experiences of Medical Students From High-, Middle-, and Low-Income Countries Participating in Global Health Clinical Electives (2018) | Boston USA | Yale University USA | Research | LMIC and HIC student perspectives on GH clinical electives | Identifying differences and similarities in the experiences of HIC students on LMIC clinical electives and LMIC students on HIC clinical electives, | “six in Latin America, three in Africa, three, in Asia, and two in the Caribbean” | USA/USA | Unspecified |
| 24 | Ethical dilemmas during international clinical rotations in global health settings: Findings from a training and debriefing program (2018) | San Francisco Med center, USA | yale University, USA | Research article | An ethics workshop to prepare US students for an international clinical elective | To describe the impact of an ethics workshop in the context of international clinical rotations to inform future interventions | China, South Africa, Uganda, Argentina, Indonesia, Thailand, Peru, Jamaica, and Dominican Republic | USA/USA | HIC institutions |
Figure 1
Flowchart of the Literature Study Search and Inclusion Process.
Table 3
Pose Based on First and Last Author’s Affiliation for Articles Included.
| HICs | HIC AND LMIC | LMICs | |
|---|---|---|---|
| AUTHORS FROM 1 HIC (n = 19) | AUTHORS FROM 2 HICs (n = 3) | AUTHORS FROM 1 HIC & 1 LMIC | AUTHORS FROM 2 LMICs |
| USA (14) | Germany-Switzerland (1) | USA-Rwanda (1) | None |
| Italy (1) | United Kingdom-Israel (1) | USA-Kenya (1) | |
| The Netherlands (1) | USA-Sweden (1) | ||
| Canada (1) | |||
| Australia (1) | |||
| United Kingdom (1) | |||
| HICs: n = 22 (92%) | HIC and LMICs: n = 2 (8%) | LMICs: 0% | |
[i] Abbreviations: HIC: High-Income Country. LMIC: Low- or Middle-Income Country. USA: United States of America.
Figure 2
Interrelated Ethical Themes in LMIC Clinical Electives and Their Meaning Based on the Synthesis Results.