Training programmes in global healthBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6860 (Published 03 December 2010) Cite this as: BMJ 2010;341:c6860
All rapid responses
As a group working to enhance the availability of educational
opportunities in global health we wholeheartedly welcome the Working Group
on Ethics Guidelines for Global Health Training (WEIGHT) guidance(1). Too
often international placements are undertaken without due consideration to
the burden placed on the host institution or to the necessary preparation
of the individual. This editorial is particularly timely as several
recent events and publications have raised the issue of the competence of
health professionals to engage in global health activities. For example,
there was the Lancet Commission(2) on the education of health
professionals for the 21st Century and Lord Crisp, author of the Crisp
Report(3), raised the matter in the House of Lords(4). In addition there
was a recent editorial in the British Journal of General Practice about
the role of primary care in global health(5). This surge of activity
demonstrates the need for competence in global health issues and a
consensus that health professionals of all specialities are currently
unprepared for appropriate engagement in global health activities. There
is therefore clearly a need to further global health education within
United Kingdom postgraduate health professional training to address this.
As Lord Crisp highlighted, though there is a lot of interest and agreement
on this issue, "what we need now is some action" (4).
We believe that to rectify this situation, postgraduate health
professional curricula need to be reviewed to enhance their global
relevance. Moreover, training programmes need not just to recognise the
benefits to trainees, the National Health Service and host countries of
appropriately planned and approved overseas experience, as listed in
Vermund et al's editorial (1), but to actively facilitate it. Some work
is already underway: Medsin has produced a global health curriculum for
medical students; Alma Mata has developed a proposal for postgraduate
training in global health (6); and our nascent group linking like-minded
junior doctors across Royal College speciality committees is tackling the
issue of the curricula. However, these efforts will need high level
support in order to effect change in an educational system that has not
kept pace with the challenges of the 21st Century.
Dr Jennifer Hall, MFPH, Public Health ST4, Intercollegiate Global
Health Junior Doctors Working Group Chair and Faculty of Public Health's
International Health Trainees' Group Chair
Dr Colin Brown, MRCP, NIHR Academic Clinical Fellow in Infectious
Diseases on behalf of Alma Mata Global Health Graduates' Network Working
Dr Luisa Pettigrew, MRCGP, First 5 GP
1. Vermund S, Audet C, Martine M, Heimburger D. Training programmes
in global health. BMJ. 2010; 341: p. 1231-1232.
2. Frenk J, Chen L, Bhutta Z, Cohen J, Crisp N, Evans T, et al.
Health Professionals for a new century: transforming education to
strengthen health systems in an interdependent world. Lancet. 2010
November; 376: p. 1923-58.
3. Crisp N. Global health partnerships: the UK contribution to health
in developing countries. London:, Department of Health; 2007.
4. Houses of Parliment. [Online]. Available from:
5. de Maeseneer J, Twagirumukiza M. The contribution of primary
health care to global health. British Journal of General Practice. 2010;
60(581): p. 875-876.
6. Brown C, Martineau F, Spry E, Yudkin J. Postgraduate Training in
Global Health - Ensuring UK doctors can contribute to health in resource-
poor countries. Clinical Medicine. 2011.
Competing interests: We are all junior doctors with an interest in global health issues who are advocating for their greater inclusion into all post graduate medical curricula.
Global health scenario has been a matter of concern in the recent
years. The diseases have acquired somewhat international character as the
occurrence or outbreak of a disease in a particular country affects the
people across the globe. It is a welcome step that Working Group on
Ethics Guidelines for Global Health Training (WEIGHT) has formulated
guidelines for institutions, trainees and sponsors in field-based global
health training on ethics and best practices . The framing of such
guidelines can be a trendsetter for training-providers - particularly
those offering avenues for structured overseas trainings or fellowships.
Whenever the host and home institutions are located in different
countries, several cautions are needed to be exercised by nations,
institutions and individuals. Host institutions located in developing
countries may find few takers for training than the ones in the better
developed countries. Candidates for training must be deputed only in the
geographical areas where they can utilize their native language or English
skills so that precious training time is not wasted on learning the
language of the host country. It must be strictly followed for trainees
undergoing to acquire their first professional degrees. The trainees at
higher levels can be expected to devote sometime to host country language
learning. Such training will definitely be an advantage in case the
trainees need to work in the cross-cultural scenarios during the post-
It is better if Global Health Training excludes the persons who are yet to
complete first degrees in their respective professions. It is a common
observation that the graduate trainees have better sense of responsibility
and professional judgment. It means that quality of patient care will not
Once the candidates have been accepted into the host institutions and have
joined their respective places of postings, it must be ensured that the
trainees are given hands-on experience in primary care settings under the
active and direct supervision of expert physicians. It will be in the
larger interest of the patients as well as trainees. The trend of
research or training on diseases such as AIDS, SARS etc. must not be
emphasised and first priority should be given to training in the diseases
(such as malaria, filariasis, tuberculosis, leishmeniasis) which are
prevalent in developing countries. Clinical expertise in diagnosis and
treatment / management modalities must be the first and foremost training
area. Above all, it has to be ensured that the training-abroad programs do
not become grounds for talent hunting from less-developed or developing
economies where the governments spend a lot to train manpower for local
health requirements. Any failure to comply with this ethical duty of
trainer country will lead to brain drain from not-so-rich countries where
training and /or working in the developed countries is largely perceived
as a status symbol.
1. Vermund SH, Audet CM, Martin MH, Heimburger DH. Training programmes in
global health. BMJ 2010; 341:c6860.
Competing interests: Pharmacy Teaching at Undergraduate and Graduate level.