First, Do No Harm: Unintended Consequences of Skill-Based Training in Global Health

Abstract Background: Many medical trainees participate in international clinical rotations in resource-limited settings and they frequently describe pressure to perform outside their scope of clinical practice. Educators must provide trainees with tools to manage dilemmas prior to departure and should also review relevant procedural skills that may be useful. The Northwestern University McGaw Global Health Clinical Scholars program (GHCS), created to provide global health skills across medical disciplines and promote clinical self-awareness, incorporates a skills and ethics simulation curriculum for participating trainees and this study aims to evaluate the impact on trainee self-perceptions.Methods: Training sessions were held between 2015 and 2017 for trainees participating in the GHCS program. The sessions were: ethics, obstetrics/gynecology/pediatrics, and surgery/anesthesia. Pre- and post- surveys assessed comfort and resources to navigate ethical dilemmas including participant beliefs about benefits versus harms of performing skills potentially outside of their scope and their willingness to perform these skills, if they were the only provider present.Results: There were 56 responses from 68 trainee session experiences. After the ethics session, participants reported more confidence dealing with issues around scope of practice, professionalism, and harm (p<0.05). After the skills sessions, the majority of participants stated the benefits outweighed harms of performing skills and were more likely to perform all skills if they were the sole provider.Discussion/Conclusions: Despite having a dedicated ethical simulation reviewing basic ethical frameworks, including scope of practice, skill-based trainings resulted in increased stated willingness of trainees to perform skills outside of their scope of training.