BACKGROUND Globalization has made it possible for global health professionals and trainees to participate in short-term training and professional experiences in a variety of clinical- and non-clinical activities across borders. Consequently, greater numbers of healthcare professionals and trainees from high-income countries (HICs) are working or volunteering abroad and participating in short-term experiences in low- and middle-income countries (LMICs). How effective these activities are in advancing global health and in addressing the crisis of human resources for health remains controversial. What is known, however, is that during these short-term experiences in global health (STEGH), health professionals and those in training often face substantive ethical challenges. A common dilemma described is that of acting outside of one's scope of training. However, the frequency, nature, circumstances, and consequences of performing outside scope of training (POST) have not been well-explored or quantified. METHODS The authors conducted an online survey of HIC health professionals and trainees working or volunteering in LMICs about their experiences with POST, within the last 5 years. RESULTS A total of 223 survey responses were included in the final analysis. Half (49%) of respondents reported having been asked to perform outside their scope of training; of these, 61% reported POST. Trainees were nearly twice as likely as licensed professionals to report POST. Common reasons cited for POST were a mismatch of skills with host expectations, suboptimal supervision at host sites, inadequate preparation to decline POST, a perceived lack of alternative options and emergency situations. Many of the respondents who reported POST expressed moral distress that persisted over time. CONCLUSIONS Given that POST is ethically problematic and legally impermissible, the high rates of being asked, and deciding to do so, were notable. Based on these findings, the authors suggest that additional efforts are needed to reduce the incidence of POST during STEGH, including pre-departure training to navigate dilemmas concerning POST, clear communication regarding expectations, and greater attention to the moral distress experienced by those contending with POST.

中文翻译：

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在全球卫生领域进行范围之外的培训的程度、性质和后果。


背景全球化使得全球卫生专业人员和学员有可能跨境参加各种临床和非临床活动的短期培训和专业经验。因此，越来越多来自高收入国家 (HIC) 的医疗保健专业人员和学员在国外工作或志愿服务，并在低收入和中等收入国家 (LMIC) 参加短期体验。这些活动在促进全球健康和解决卫生人力资源危机方面的效果如何仍然存在争议。然而，众所周知的是，在这些全球健康短期经历 (STEGH) 中，卫生专业人员和接受培训的人员经常面临实质性的道德挑战。所描述的一个常见困境是超出培训范围的行为。然而，执行范围外培训 (POST) 的频率、性质、情况和后果尚未得到充分探讨或量化。方法 作者对过去 5 年内在中低收入国家工作或志愿服务的高收入国家卫生专业人员和受训人员进行了在线调查，了解他们在 POST 方面的经历。结果 共有 223 份调查回复纳入最终分析。一半 (49%) 的受访者表示曾被要求进行超出其培训范围的工作；其中，61% 报告了 POST。受训人员报告 POST 的可能性几乎是有执照的专业人员的两倍。 POST 的常见原因包括技能与东道主期望不匹配、东道点监管不力、拒绝 POST 的准备不足、缺乏替代选择以及紧急情况。许多报告 POST 的受访者表示，随着时间的推移，他们的道德困扰持续存在。 结论 鉴于 POST 在道德上存在问题并且在法律上是不允许的，因此被询问和决定这样做的比率很高，这一点值得注意。基于这些发现，作者建议，需要做出更多努力来减少 STEGH 期间 POST 的发生率，包括出发前培训以解决有关 POST 的困境、关于期望的清晰沟通，以及更多地关注那些与 POST 抗争的人所经历的道德困扰。邮政。