We live in a globalised world. This is true for all of us, from the suburbs of London to the slums of Nairobi, whatever our profession, and whether or not we travel overseas or stay in one location. Educational institutions have a particular responsibility for training the next generation of professionals who are prepared for the challenges and opportunities that this globalised world brings. The UK Department for International Development (DFID) recognised that responsibility a few years ago by awarding funding to a project that I’ve spent the last three years supporting – ‘Students as Global Citizens’.
A research partnership was formed between the Development Education Research Centre (Institute of Education, University of London), the Institute for Global Health (University College London), the Royal Veterinary College (RVC), the School of Pharmacy (University College London), and the London International Development Centre (LIDC). The project aimed to engage with students and staff to assess existing understanding of global and development issues, and to create and evaluate new opportunities for teaching and learning related to global health.
But why did we start the project in the first place?
Health professionals, such as doctors, veterinarians and pharmacists can have an enormous impact on international development, whether they work overseas or in the UK. However, curricula for medical, veterinary and pharmacy courses tend to be focused on the development of clinical knowledge that, while indispensable, leaves little room for learning about the wider global issues that affect health or for the development of key global skills such as the ability to communicate with people from a range of diverse backgrounds, to work in interdisciplinary teams, or to solve complex multidimensional problems.
What do global issues have to do with me if I want to practice as a GP in London? you may ask. Any medical professional, whether working in the UK or overseas can be confronted with a tropical disease and should be able to diagnose it correctly. Patients travel and bring back with them pathogens that are not usually found in the UK. Diseases move with migration flows too – for example, TB, once nearly eradicated in the UK, is now on the increase again in some parts of the country. Understanding cultural differences can also help doctors understand diverse perspectives on health which have an impact on a patient’s behaviour, for instance leading to reluctance to undergo a medical examination or to follow medication regimes as prescribed.
OK, but surely if I want to be a vet working in a typical UK veterinary practice, then I don’t need to bother with global issues? In fact, with the increasing globalisation of meat production vets need to understand animal diseases and production systems, welfare and food chains in all parts of the world. Vets have an important role to play in addressing sustainable food production, conflicts between conservation and livelihoods, and the increasing impacts of climate change on both animal and human health. In some parts of the world people and livestock live side by side, and diseases can easily pass between species. Recent outbreaks of diseases such as SARs and Avian Influenza illustrate the potential for diseases in an animal reservoir to spill over into the human population and cause a pandemic. Cultural practices with respect to the treatment of animals also vary widely and every vet needs to be sensitive to these. As people move countries, they bring their practices and beliefs with them, leading to a diversity of perspectives that health professionals are likely to encounter in their practice.
It is no different for pharmacists, who need to understand why patients of particular cultural or social backgrounds may be unwilling or unable to comply with certain medication regimes. In the UK, pharmacists are often the first port of call for patients, so they need to be able to diagnose a tropical infection and talk to patients of all backgrounds in a way that encourages them to describe symptoms and behaviours and to seek effective treatment. Pharmacists also play a key role in the international pharmaceutical industry and supply chains. They encounter problems such as resistance to existing drugs or recreational drugs becoming drugs of abuse, medicines supplied through unregistered online pharmacies, online advertising of prescription drugs, and the distribution of substandard and counterfeit medicines.
In the Students as Global Citizens project, we looked at these and other questions to come up with a set of key global issues and skills that we think every future medic, vet or pharmacist needs in order to be global professionals. We also looked at links between the three professions, in the spirit of One Health, a principle that takes a holistic approach to health, integrating the well-being of humans and animals, as well as the condition of the environment. We then explored how these issues might be embedded within the already demanding curricula for each training programme, and proposed changes to both the content of programmes and the kinds of teaching and learning approaches that can best support young professionals to develop their knowledge, skills and expertise.
What did we accomplish? While it is not easy to change university curricula, the project has achieved a lot in a very short time. Royal Veterinary College, UCL School of Pharmacy and UCL Medical School are implementing a number of changes in their teaching curricula for all undergraduates and we hope other schools in the country will follow suit. At the RVC, for instance, first year students now get a chance to attend a series of ‘Global Vet’ lectures and workshops and to write essays on One Health, and in years two and three they take part in directed learning sessions about a range of global veterinary issues. The RVC has also developed a website which shares resources – including a guide for students who want to do part of their clinical training overseas – as well as the broader experiences of the project.
One of the great strengths of the project was the opportunity for professionals from the three disciplines to collaborate on both the overall research and also new interdisciplinary teaching initiatives. For instance, we organised two interdisciplinary workshops on Avian Influenza to give students in all three professions a chance to meet and learn together. Student feedback after the sessions was overwhelmingly positive, with participants recognising the importance of working across health professions and also seeing the value in a multi-levelled approach to complex global health concerns.
The biggest success is perhaps not in the formal arrangements, however, but in the increasing awareness of global health issues amongst both staff and students at the three partner institutions. Students, in particular, are demanding more engagement with global issues, fully aware of the globalised world that awaits them outside the walls of their alma maters. They know that in addition to clinical skills and textbook knowledge, they need a range of global knowledge and skills to be successful professionals in a globalising world. The students know full well that global learning is not just for those who plan to work overseas, but is a key part of the training of every health professional.
Contributed by Dr. Nicole Blum, Lecturer in Development Education, Institute of Education