Teaching global health ethics using simulation: interprofessional training

Abstract

Background: Many ethical dilemmas in global health fieldwork stem from cultural differences and limited resources, and trainees frequently report feeling ill-equipped to deal with such issues. A literature review shows a need for predeparture training that would enable participants to develop a strategy for recognising and resolving such problems. Methods: After reviewing global health ethics education and predeparture training resources, we organised multidisciplinary focus groups with global-health experts at our institution. These sessions identified key ethical issues that our training should address: scope of practice, informed consent, privacy or confidentiality, professional ethics, harm and benefit, and corruption. We then developed four scenarios focusing on these ethical issues. Each scenario was followed by a debriefing session led by a faculty facilitator. We piloted the simulation training with a multidisciplinary cohort (n=27) of postgraduate trainees. All participants completed prestimulation and postsimulation evaluations that assessed their exposure to the scenarios' ethical issues and ability to deal with these ethical dilemmas and identify resources for help. Findings: The results showed a significant knowledge gain in the above domains. Paired t-tests were used to compare participants' agreement scores with the statement “I have a strategy to deal with this ethical issue,” which significantly increased (p<0·05) postsimulation for the following ethical issues: scope of practice, privacy, harm, and corruption. Interpretation: Our preliminary results show that the simulation sessions accomplish our training's objectives. Further, our institution's ethics faculty expressed a keen interest in integrating these exercises into the mainstream ethics curriculum. Funding: The Haile T Debas Academy of Medical Educators Innovations Funding Grant.