HealthApril 06, 2020

Improving equity in global medical training

By: Bana Jobe

As COVID-19 intensifies, one of the most crucial learning resources physicians have is each other. In March, for example, Medpage Today reported that Chinese doctors shared their insights on managing complications from the novel coronavirus with American counterparts as the U.S. healthcare system braced for the virus’s impact stateside.

These international collaborations have been pivotal in local responses to the outbreak, particularly for the developing countries that are least equipped to deal with it. Now more than ever, the situation underscores the need for global medical training to continue as the planet adapts to a new normal in light of the pandemic.

Long before COVID-19 hit Wuhan, an April 2019 paper published in Academic Medicine, the journal of the Association of American Medical Colleges, made exactly that point: “Because disease knows no borders, strong health systems are needed everywhere.”

It cited Ebola, HIV, influenza and other infectious outbreaks rather than the novel coronavirus, but the argument stands: Public health is bettered by international knowledge sharing.

And yet, the authors argued, legal and regulatory barriers make international learning more difficult and less equitable for practitioners, especially when foreign medical graduates (FMGs) seek short-term, hands-on training in the United States.

The good news is that changes in policy can change that, if everyone gets on board.


To read the full paper, visit Academic Medicine.


The shortfalls of global medical training

According to the paper, some of the same opportunities afforded to American physicians who learn abroad aren’t given to FMGs who come to the U.S. for short-term training. Whereas many Americans get to practice medicine and engage in hands-on training overseas, FMGs are often limited to observational studies in the United States.

Observation-only programs shortchange what doctors can learn. For example, most prohibit taking a patient history or doing exams—a critical component for any medical workup. Even Canada and the U.K., in general, offer more latitude for FMG trainees.

Several barriers make U.S. restrictions more stringent. For example, no visa categories allow for FMGs to have patient contact. Secondarily, medical licensing boards can impose undue hardships on foreign doctors seeking U.S. training. Malpractice liabilities complicate things, too.

Consequences of unequal clinical training

Training handicaps can lead to local and global consequences. For one, a lack of hands-on experience limits the knowledge FMGs can take back to their home countries. This contributes to disparities that run counter to the U.N.’s Sustainable Development Goals.

More broadly, these inequities detract from global health experience sharing—something 75% of institutional partners believed in a 2015 report cited by the paper (which would likely be much higher in the current climate).

Policies and rules to change

As practitioners adapt their practices and perspectives in a COVID-19 world, removing barriers to global medical training will become critical once international travel is safe again.

Fortunately, the 2019 authors offered actionable policy changes to make that happen. For example:

  • Officials should create a new visa category that allows FMGs short-term clinical training in the United States.
  • State medical boards should designate a specific temporary licensure category so that FMGs can more practically engage in patient care.
  • U.S. host institutions should better support these experiences, and multiple avenues should be considered to extend malpractice coverage to FMGs, such as through host institutions or separate commercial policies.

The authors did suggest wrapping additional rules into those policy changes, for instance restricting FMGs’ ability to practice medicine in the state once the training program is over. These rules help prevent “brain drain,” where doctors leave their home countries to practice in the U.S.

But ultimately—no matter where they practice—it’s crucial that doctors learn from each other. If COVID-19 teaches us anything, let it be the value of international teaching.

Bana Jobe