This discussion was created from comments split from: Non-Science Major best for Med School.
I have to get this out there–
The thinking about international volunteer trips has been evolving & changing a great deal over the past 5 or so years. They have become an ethical gray area for medical schools and professional medical organizations. There are a number of position papers that have been published over the last 5 years by august institutions such the American College of Physicians, the New England Journal of Medicine and others.
Even recognized and respected non-profit organizations are rethinking their stance on service missions abroad. And a 2018 survey AMCAS Admission Deans found that over 50% had serious reservations/concerns about the ethicality of international service trips.
There is a growing recognition that these type of programs, even when done in good conscience and with the intent to do good, are harmful.
When considering whether or not an international service program falls into a ethically gray area, the participant needs to ask themselves the following questions:
- Is the participant performing services in the host country that they would not be able to perform at home ? (This goes beyond things like students administering injections or providing medications to patients to include working on construction projects and teaching in local schools.)
If the answer is yes, then the program activity is unethical.
- Is the participant’s volunteer service impacting the local job market? IOW, is the volunteer taking a potential job away from a local community member?
Unless the volunteer is providing a unique service that not available in the host country, then the answer is yes and the program can be considered unethical or exploitative…
High school and college students who are lack significant professional-level skills are by definition not providing a unique service.
- Are the program and volunteer contributing to solving the long-term problem that the program is trying to address by training local community members to take the place of the volunteers?
If the answer is no, then program can be considered unethical and exploitative.
- Could the money it costs to send a volunteer to the site (travel expenses, infrastructure, program administration, etc) be used more efficiently and/or effectively if donated to local organization that is working to solve the problem the volunteer program is addressing?
If the answer is yes, then the program could be considered exploitative or unethical.
- Does the participant receive any benefits from donating their service? (NOTE: a benefit need not be tangible. It could be in the form of CV buffing, publicity, public recognition, an increase in reputation, etc)
If the answer is yes, then the program is exploitative.
Citations:
[More harm than good? The questionable ethics of medical volunteering and international student placements](More harm than good? The questionable ethics of medical volunteering and international student placements - PMC)
[From Medical School to Mission: The Ethics of International Medical Volunteerism](From Medical School to Mission: The Ethics of International Medical Volunteerism | Journal of Ethics | American Medical Association)
[Ethical Obligations Regarding Short-Term Global Health Clinical Experiences: An American College of Physicians Position Paper](https://annals.org/aim/fullarticle/2676739/ethical-obligations-regarding-short-term-global-health-clinical-experiences-american)
[Executive Summary of GSA Committee on Admissions Survey regarding Clinical Experiences](https://www.aamc.org/download/474346/data/clinicalexperiencesshadowingsurvey.pdf)
[The Ethics of Medical Volunteerism](http://www.globalhealthmgh.org/assets/Stone_G_Olson_KR_Ethics_of_Med_Volunteerism_Med_Clin_NAm_Vol_100_Issue_2_2016.pdf)
[Advice To Parachuting Docs: Think Before You Jump Into Poor Countries](https://www.npr.org/sections/goatsandsoda/2018/04/04/599419888/advice-to-parachuting-docs-think-before-you-jump-into-poor-countries)
[Why Surgeons Are Rethinking The Fly-In Medical Mission](Doctors Wonder If It's Time To Rethink Fly-In Medical Missions : Goats and Soda : NPR)
The questions are worth considering, but I’m obviously on the side where trips done “right” are very worthwhile on both ends.
Money spent is irrelevant. We could all stay home, never go anywhere, and just donate money to all sorts of causes. While doing so we learn absolutely nothing about our planet or world. We only “know” what we see on TV. Heck, buy a video and skip seeing the National Parks or museums while we’re at it. Learning things from all sorts of travel, but esp when one is more with “real” people instead of just “tourism” people is worth some cost IME. Learning skills for all people, those who travel and those who don’t, is also worth something.
At the school where I work, give me the student who has traveled over the one who has merely read books or watched TV (as long as the travel isn’t just to the all-inclusive in whatever country). The well-traveled youngster will know more and usually have more of an open mind about people/cultures.
There is a school of thought that finds pure tourism is valuable for the reasons you mentioned . Plus tourism (lodging, restaurants, guides, etc.) can provide much needed jobs on an area.
Short -term, unskilled visiting volunteers taking away jobs from unskilled local workers–that’s a problem.
The point is there are many areas in the US that need help. You don’t need to travel overseas to find a foreign culture that is in need. The poverty and lack of access to health care on the Native American reservations of the west (AZ, NM, SD, WY, AK) rivals anything a student will see overseas.
I will point out I have no objection to trained medical personnel doing service work overseas so long as they don’t arrive as the “great American savior”, but are respectful of local culture and customs, and involve the local stakeholders in the decision making process. (What a foreigner perceives as a problem, may not be perceived in the same manner by a native.)
Long term service through the Peace Corp or international medical mission programs like MSF (Doctors Without Borders) serve as useful purpose. But both those groups are careful to involve the local stakeholders in the decision-making process and hire as many local people as possible.
And I don’t know about you, but I have never had any problems meeting “real” people while traveling.
This presumes the volunteers are taking away jobs. On the trips my lads have taken that hasn’t been the case at all. No one was paid and that would have stayed the same had they not gone. Sending money is worthless without someone who knows what to do - how to lead. That’s similar to sending folks books and assuming they will be able to teach themselves out of them. Some might. Most can’t, or can’t do it as effectively or well.
The US has needs and people try to provide. The world has needs - some places far greater than in the US - and people try to provide. It’s by all of us being led to different causes that we can try to help the most folks all over. We’re all citizens of the same planet.
When it comes to charity, it even helps that some are led to donate to schools, museums, research, and the multitude of options out there. There is never one “right” answer of what should be done.
All that said, there are volunteer tourism organizations (so I’ve heard) that are merely in it for the money and really do no good whatsoever. Avoid those at all costs in the same way one should avoid any charitable organization where the bulk of the money sent goes to the fundraising group itself - not the cause.
As with anything, investigate.
I guess what WOWM is referring to College level medical volunteering, especially for those have medical schools in mind. If the medical volunteering is performed by an MD, it should not matter. I am sure my cousin, a full fledged Dermatologist who runs 3 clinics with over 50 doctors and nurses working for her, spends two weeks of her own time to volunteer in Centrol America does not count into what WOWM’s description.
I’m pretty sure I’m on the same line of thinking with my lad who went as an undergrad in college the first time and a summer break 1st/2nd year med school student the second. Both times it was real medical folks doing the main medical things. When my guy was merely an undergrad he was taking BP and basic info (name, age, etc) or helping to sort meds in a group setting using everyone. When he was a med school student they asked him what experience he already had from school and used him the same way there - interviewing, taking vitals, getting an idea of what it could be, and running it past the medical professional who double checked anything she wanted to and made all final decisions - then they discussed the issues later if there was anything to discuss.
If there’s anything unethical about that, I don’t see it. My mind wonders about how unethical it is to leave people with no medical access at all - which is what these situations were otherwise. And if what he did was unethical there, why is it not unethical when he does the same in the US?
@Crrekland–
It would be unethical if:
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your son exceeded his [scope of practice](Scope of practice - Wikipedia) while working at the mission site.
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the program duplicates or, even worse, competes with medical services already offered in the area whether it’s services offer by a local practitioner, a governmental agency or another international mission clinic.
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the mission does not involve the local stakeholders in determining what services are of greatest need within the community.
@WayOutWestMom and it was none of the above. It’s why I don’t agree with broadbrush painting of these trips with such a negative vibe. Many people will lose out if the general take away is, “don’t go on these trips.” It should be “investigate to find something worthy” IMO.
My lad was also a regular (weekly) volunteer doing the same things at a Free Clinic in the same city his med school is in. Perhaps that’s unethical? There are doctors in that city - plenty of doctors - and I guess they’re losing out financially by having a free clinic there. There were NO doctors near where the medical missions trips went. I even googled MSF. They work in the countries giving limited support for certain things like maternal health, but nowhere near the same areas. Their website even talks about a great need medically in these countries.
Granted, short trips don’t fix everything, but they can fix some things and are better than nothing. In a couple of situations more dire cases were referred to a doctor in a more major city with people trying to figure out how to get transportation, etc. I’m not sure how those ended, but the chances of getting there without someone with “clout” asking were likely very slim.
Regarding scope of practice, in our country we need to remember “we” have different standards for here that aren’t the same elsewhere. In many (most?) other countries students go straight from high school into med school. This puts them younger. In some (generally poor) countries med schools might exist, but many learn medical care via apprenticeship - again - starting at a young age. This is especially true for things like delivering babies where often doctors aren’t even involved - midwives are - and these can be ladies who merely learned from other ladies doing the job.
When Americans go there they need to be aware that most natives are going to assume they can do more than they may have been taught because that’s the way it is with most people there - local or coming from other countries. It’s up to the American to tell them otherwise, esp if they don’t feel comfortable doing something due to lack of training. Most people can give shots TBH. That hardly takes a lot of training for basic vaccinations. When there are thousands waiting to be seen, a doctor’s time (and nurse’s time) is better spent elsewhere.
There are medical schools in every country in the world. Nowhere is medicine learned by apprenticeship. (Traditional or folk midwifery, otoh, is learned by apprenticeship even in the US, but we’re not talking about midwives here. Nor are we talking about other types of traditional or folk healers. ) The 6 year medical education that is the model in much of the world does place physicians-in-training into clinical settings at slightly younger age than in the US, but what does have to do with scope of practice? The 6 year model eliminates the undergrad degree requirement and collapses undergrad down to 2 years of essential core science coursework. (Accelerated BS/MD programs in the US do much the same thing.) The rest of the medical education is very similar to how US medical students are educated. I don’t understand what point you’re trying to make about age.
Scope of practice is scope of practice. If isn’t not Ok/legal to perform a certain procedure on someone in the US, what makes it OK to perform the same procedures on someone just because they live in another culture or country or are poor and desperate? That violates the Declaration of Helsinki and is considered illegal and unethical everywhere in the world. Not to mention it’s racist and/or elitist.
{quote] most natives are going to assume they [US volunteers] can do more than they {local healthcare providers] may have been taught
[/quote]
This is a particularly racist/elitist statement.
The US has a very ugly history of using the poor people, both domestically and internationally, as uninformed test subjects in medical experimentation
And just because the scope of practice may be different for local doctors trained/certified in the host country, that does not make it right for US trained individuals to exceed their own scope of practice.
RE: your son’s domestic clinic experience. Many medical schools maintain outreach clinics for provide medical service to the medically underserved, often funded through a state or federal grants. (What did you think that med school ran them out the goodness of their hearts?) These clinics are not trying to displace local physicians nor are they setting up a parallel medical system (which is often what happens with international service missions). Our local med school runs several homeless and low income clinics where med students volunteer because it’s exactly these patients who will come into the ER at the public/county hospital {which the med school is part of] because public ERs cannot by law turn patients away for any reason. The clinic is part of the continuity of car and attempt to reduce unnecessary ER visits. I will also note that med students are {u]always supervised by practicing physicians and are never asked to exceed their scope of practice.
The MSF does more than provide limited support. They provide long term medical & other humanitarian services to areas of crises. They provide services to victim of mass genocide and those in forced resettlement camps. (Think South Sudan, Eritrea, Bosnia, Dafur.)
You are totally missing my point. I can understand yours in areas where there are medical care opportunities. Anyone coming in to be the “Savior” is misguided at best. I’m not really a fan of most of the Peace Corps things from what I’ve heard of them, but some might be ok. I’d investigate rather than broadbrush.
There have not been other options in the places where my lad has gone. Cote D’Ivoire is one spot. The Civil War in that country drove off most of the doctors. MSF has a maternal care clinic (90 beds) in one area - not the area my lad went to. I did not see other areas in that country on a quick glance at their website. Perhaps you know of others that I couldn’t find. I believe the local people when they said they had no access and (some) traveled for miles/days to attend the clinic offered.
Where he was there was only one nurse staffing a very small clinic with few supplies and this served several villages. You may claim it doesn’t happen, but yes, she taught her “help” solely via apprenticeship because no one else was available. This happened in the other place my lad went too. There were local medical nurses who trained their own staff from a relatively young age. One trainee there was hoping to go to med school in the future, but hadn’t as of yet and was still doing what she could to help out and this included some of the basics with treatment.
When US students go to these projects (there were more than just my lad) it is often assumed they know more than they do by the local people. That is neither racist nor elitist nor any other word you like to think it means. It’s fact. My lad was assumed to be equivalent of a doctor merely because he had finished one year of med school (and was male). He had to repeat to many, over and over, that he wasn’t there yet - not even close. The other folks along on the trip understood (from US and Aus), but not the local people running the event nor the patients coming for help.
The same principle that makes it ok to do things perhaps a little above scope there works in our country too. There is no one “better” available in the area and doing nothing is worse. It’s how we have Good Samaritan laws here post vehicle accidents or anything else that comes up. When a community is lucky to see a doctor once every couple of years, the doctor needs to be kept busy fixing the real needs - not giving vaccinations. If something changes and a doctor (from any country) can be there full time, then yes, there’s more time for other things.
To me, it’s super elitist and racist to assume we only need to take care of those in our own country. Let everyone else fend for themselves - or die. I’m a citizen of the world, the USA is merely my birthplace and passport holder. I raised my kids the same way. Someone’s birthplace or race or religion is 100% irrelevant in how we respond to them.
FWIW, even in the states my lad is considered a “doctor” by many of the patients he sees both in the hospital and free clinic. He has to correct them too - often more than once. It doesn’t really matter what his badge says or that he introduced himself correctly. Many people assume based upon profile. That’s pure fact.
This thread is a spur off one for a particular kid who doesnt understand.
With respect, this isn’t about what worked for one kid or even a handful. It’s about the length and depth of healthcare delivery experience that’s enough for most med schools. And the broad ethical issues related to dart in/dart out, pay to play volunteering.
Obviously, not all intl service is unethical. But there are legit concerns.
And it may have been the free clinic work, not the short trips that was more valued.
All of his Free Clinic work has been since he started med school, so there’s no way that added to his med school app. He had other hours of various sorts too, of course, including shadowing and Hospice volunteering, etc.
I don’t really think overseas volunteering in general (not necessarily medical missions) is a bad thing if investigated correctly using the guidelines. URoc wouldn’t have this paragraph in their Med School Class Profile if it were a negative there:
https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/education/md/documents/2022-profile.pdf
Again, I do believe there are plenty that ARE bad (international and domestic), so my opinion is not a broadbrush “pick a group and go” endorsement. It’s investigate and pick something worthy if interested.
@WayOutWestMom @Creekland how you characterize the gesi.northwestern.edu program for African country, Uganda?
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GESI participation earn students credit for their experience so it’s not a volunteer experience and should not be listed as such.
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based on the website, GESI appears to be more of a short-term cultural enrichment/cultural exposure activity than a meaningful service activity.
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as to whether it exploitative–it depends on what types of activities the student engages in and if the students’ presence impacts the local job market. It doesn’t appear that students are bringing any kind of particular expertise to any of the organizations they are working with. But they are working within the local infrastructure of charities/organizations so at least they aren’t competing with them.
If your child chooses to participate in the program–that’s fine; however, it’s not an activity that’s going to impress adcomms and shouldn’t be a highlighted activity on their med school application.
@PPofEngrDr I have never looked into that program, so really can’t comment authoritatively.
I likely disagree with @WayOutWestMom on whether something like this should be an activity listed on an application though - esp in light of what U Rochester states in their Class Profile and what I’ve seen of multiple successful med school applicants who have gone on overseas trips.
A trip in no way overshadows the important things of GPA/MCAT/shadowing, etc, but something of the sort (domestic or international) does seem rather “expected” at some schools. It may not matter a hoot at others, so I suppose it depends upon where one wants to apply.
Trips overall still really expose students to more of the world rather than their own domestic bubble (or tourism realm of the world). As long as they aren’t the WTH type imposing on countries and people going there to somehow “save the world”, but rather work with reputable local people/organizations to assist where there are gaps/needs I see them as doing more good than bad. I’ve seen many changed students return. What they think is reality elsewhere is often different than reality elsewhere. They find that humans are humans wherever they go (good and bad) and material things don’t = happiness among other things.
Isolationism is bad IMO. That easily leads to “them vs us” and “naturally we’re better.”
If your child likes to do and if you can fund, go for it since it provides an experience. Not for MD app per se.
@GoldenRock that helps. Its too late, infact he is returning next week. It seems his trip is very similar to your D (2 units credit = ~6 semester credits) for a Global Development class. He has stayed with host family for last 2 months. Well good to know her AMCAS input so I guess its same for him after 2 years.
Hi @WayOutWestMom ! I’m a former lead advisor with the Canadian Medical Association and current director of physician services. I’m also a chair on the Association for physician recruitment in conjunction with the PTMA and health authorities. Long title, but I am heading to NZ Jan. 18 to 1st of February and wanted to connect on potential knowledge sharing and discussion on indigenous healthcare. Please let me know how I can reach you?