Developing consensus for postgraduate global health electives: definitions, pre-departure training and post-return debriefing

BACKGROUND: Global health (GH) electives are on the rise, but with little consensus on the need or content of pre-departure training (PDT) or post-return debriefing (PRD) for electives in postgraduate medical education. METHODS: Using a 2-iteration Delphi process to encourage discussion and consensus, participants from 14 medical schools across Canada provided input to promote more uniform policy towards defining GH electives, when PDT and PRD should be mandatory and what curriculum should be included. RESULTS: There is consensus that PDT and PRD should be mandatory for international electives. Respondents felt that PDT should include a broad range of topics including objectives, travel safety, personal health, logistics, ethics of GH, scope of practice/supervision, and cultural awareness. PRD should include elective evaluation, lessons learned, knowledge translation, review of health and safety, and issues of reintegration. The format of PDT and PRD needs to be individualized to each institution to fit within the limitations of faculty who can serve as facilitators. Global health educators agreed on the importance of mandatory PDT and PRD for remote Canadian aboriginal electives, but did not feel that they could make recommendations without additional input of aboriginal scholars. CONCLUSIONS: All residency programs that send residents on international electives should work towards instituting quality, mandatory PDT and PRD. PDT and PRD should be recognized by universities as having academic merit and by program directors as core resident learning activities. Curriculum and objectives could be arranged around CanMEDS competencies, a physician competency framework that emphasizes qualities beyond medical expert such as professionalism, health advocate, and collaborator.