Exploring Trends and Challenges in Global Health Medical Education: A Scoping Review

Abstract

Global health education has increasingly impacted students and professionals in the medical field in recent years. This review aims to map the literature on global health education and analyze its contribution to equity in a worldwide medical context. This was a scoping review using the Joanna Briggs Institute approach. The PCC (population, concept, and context) mnemonic guided the study's questions. The PubMed, ScienceDirect, Virtual Health Library (VHL), and Scientific Electronic Library Online (SciELO) databases were used, identifying 278 articles: 86 from PubMed; 48 from ScienceDirect; 71 from VHL; 69 from SciELO, and 4 from other sources. Articles from four continents and more than 20 countries were analyzed. As a result, global health education took place through virtual meetings, face-to-face meetings, electives, and fieldwork, such as exchanges. The development of communication skills, adaptation to limited resources, empathy, ethics, and the strengthening of multidisciplinary relationships were noted. It therefore highlighted the significant growth of global health education in international medical training. It identified the need for further research and future initiatives to evaluate its long-term effect and improve global health equity.

Keywords:
Education, medical; Global health; Health equity

Resumo

A educação em saúde global tem influenciado estudantes e profissionais na área médica de forma crescente nos últimos anos. Esta revisão tem como objetivo mapear a literatura sobre educação em saúde global e analisar sua contribuição para a equidade em um contexto médico global. Trata-se de uma revisão de escopo por meio da abordagem de Joanna Briggs Institute. Utilizou-se o mnemônico PCC (população, conceito e contexto), que direciona as questões que fundamentaram o estudo. Foram utilizadas as bases de dados PubMed, ScienceDirect, Biblioteca Virtual em Saúde (BVS) e Scientific Electronic Library Online (SciELO), identificando 278 artigos: 86 da PubMed; 48 da ScienceDirect; 71 da BVS; 69 da SciELO e 4 de outras fontes. Foram analisados artigos de quatro continentes e mais de 20 países. Como resultados, a educação em saúde global ocorreu por encontros virtuais, presenciais, eletivas e atuação em campo, como intercâmbios. Notou-se o desenvolvimento de habilidades de comunicação, adaptação a recursos limitados, empatia, ética e fortalecimento da relação multidisciplinar. Destaca-se, pois, o crescimento significativo da educação em saúde global na formação médica internacional. Identificou-se a necessidade de mais pesquisas e de futuras iniciativas para avaliar seu efeito no longo prazo e aprimorar a equidade em saúde global.

Palavras-chave:
Educação médica; Saúde global; Equidade em saúde

Introduction

The concept of global health in medical education has emerged in recent years. It is defined as the study and practice of improving health and health equity for all people worldwide through international and interdisciplinary collaborations (Patel et al., 2022). Expanding on this definition, global health encompasses international relations, health policies, and global trade, as well as the analysis of social and environmental determinants that influence vulnerabilities and epidemiological conditions in each region. In this context, global health education plays a critical role in reducing inequalities at an international level (Malgarin et al., 2024).

In an era of intense global relations, global health education in medical training has become more relevant than ever. Over the past 40 years, there has been a growing interest among medical students in studying global health, along with the expansion of this subject in medical school curricula, highlighting its influence on the academic training of medical professionals (Bentley et al., 2021).

At the beginning of this century, most medical schools were neither adapted nor prepared to offer training in global health, despite demands from students, professionals, and society itself. The lack of preparedness and adaptation in universities is mainly due to the absence of consensus among institutions regarding which knowledge and skills should be taught during medical education (Civitelli et al., 2021).

Nevertheless, global health education has expanded in medical schools worldwide, particularly when elective programs or exchange experiences are involved (Civitelli et al., 2021). Furthermore, the practice of borderless medicine for students has demonstrated concrete benefits, going beyond a symbolic act and promoting the deterritorialization of the field. Traditionally limited to a borderless approach in epidemiological and anthropological fields, borderless medicine should, by definition, integrate outcomes across different nations (Premkumar et al., 2016).

Additionally, beyond physical borders, the evolution of remote connectivity, particularly after the Covid-19 pandemic, has broadened the study of global health to include intercultural experiences that transcend national boundaries, contributing to the advancement of health equity (Patel et al., 2023). However, the challenges encountered during the pandemic, especially those related to distance, communication, and barriers to exchange programs, highlighted the need for medical training designed to address these global challenges (Umphrey et al., 2022).

In this regard, it is essential to understand how global health medical education can help mitigate the aforementioned issues and how it is currently being implemented. Understanding this landscape is crucial for the continuous improvement of medical school curricula and their international impact.

This review aimed to map the literature on global health medical education, identifying the social and structural processes that shape global health and its key pillars, as well as its influence on medical education and its equity contribution. To this end, the relationship between the curriculum and medical practice at all levels of undergraduate education was considered

Methodology

This study is a scoping review, a method aimed at mapping the literature within a specific field of interest. This methodology is used to assess the scope of research on a particular topic and identify knowledge gaps. The review is thus structured based on the breadth of studies conducted (Coelho et al., 2021; Guedes & Valente, 2023). The approach followed the Joanna Briggs Institute (JBI) methodology (Aromataris et al., 2024).¹

Research Question Identification

By addressing the proposed objective, this study contributes to understanding the evolution of medical education and the dynamics of research within health institutions regarding global health. Two key questions guided the analysis in this review:

• a) What is the scope of the literature published between 2019 and 2024 focusing on global health medical education?

• b) How has the study of global health contributed to professional training in the medical field?

The research question was structured based on the PCC mnemonic (Population - Concept - Context), following the methodology that guided the search and refinement of the inclusion and exclusion criteria used in this review. These criteria are presented in Table 1 below:

Table 1
Mnemonic Used to Identify the Research Question According to JBI, 2024

Factors	Description
Population (P)	Professionals, teachers, and students in the field of Medicine;
Concept (C)	Structure and approach to global health teaching in medical training curricula;
Context (C)	Higher education institutions.

• Source: Danelle et al. (2024).

Search Strategy

The search was conducted in the following databases: PubMed, ScienceDirect, Virtual Health Library (BVS), and Scientific Electronic Library Online (SciELO). The descriptors used, according to the MeSH/DeCS platform, were global health education and medical education, and the boolean operator AND. The search was conducted between February and June 2024, with a time filter for the last five years, specifically from 2019 to 2024, considering gray literature and articles published in Portuguese, English, and Spanish in a global context, with maximum literature coverage. The temporal scope applied to this scoping review is justified by the large number of studies identified in the databases. A total of 278 studies were found across the databases, with: 86 from PubMed; 71 from BVS; 69 from SciELO; 48 from ScienceDirect; and 4 from other sources.

Article and Thesis Selection

To select the articles and theses, inclusion and exclusion criteria were used to better direct the focus of the topic under discussion, which are outlined in Table 2 below:

Table 2
Inclusion and exclusion criteria for the review

Criteria	Description
Inclusion	Articles and gray literature focused on the approach of global health education in medical education; Articles published between 2019 and 2024; Articles in English, Portuguese, and Spanish.
Exclusion	Duplicated articles and gray literature; Articles and gray literature that are outside the scope of the research.

• Source: Danelle et al. (2024).

The search resulted in 278 studies, and using the Rayyan platform (Qatar Computing Research Institute), 68 duplicates were excluded. Using the Mendeley platform (Elsevier Ltd), 12 articles were excluded as ineligible by automated tools. From the remaining 198 articles, 93 were excluded based on title evaluation and 19 based on abstract evaluation, resulting in 86 articles. Of these, two were excluded due to the inability to extract data, and 54 were excluded for not being directly related to the scope of the research. All steps were conducted by consensus among blinded reviewers, who independently made the selection decisions, resulting in 30 included articles.

In April 2024, the research was registered and approved as an Open-Ended Registration on the Open Science Framework (OSF) platform, with the following access code: “https://doi.org/10.17605/OSF.IO/HD698.”

Additionally, this study applied the PRISMA checklist for scoping reviews (PRISMA ScR). This extension, published in 2018, includes 20 essential reporting items and two optional items to be included when completing a scoping review (Tricco et al., 2018).

Below is the flowchart of the method used, organized according to the PRISMA statement (Moher, 2009):

Summary of the Article Selection Process

Figure 1
Flowchart of the identification, selection, and inclusion of articles for this scoping review, according to PRISMA (2020).

Results

The results showed that participation in global health experiences provided participants with the development of essential skills for medical practice. The data from the articles highlighted the importance of building intercultural relationships, learning about the differences in knowledge and scientific development between countries, as well as the need for medical education with a globalized perspective.

Another important point observed in the results was the growing demand and interest from students and professionals in participating in programs, courses, and exchanges focused on global health. Despite this, some studies identified barriers that hinder participation in these activities. These results are detailed in Table 3 below:

Table 3
Descriptive Summary of the Analyzed Studies

Authors and Year	Country	Methodology	Participants	Description
Al-Shakarchi et al., 2019	England; Scotland; Wales and Northern Ireland	Literature review and quantitative research	Not applicable	The article presented a scoping review of global health competencies in physicians and an analysis of postgraduate medical curricula. The review and curriculum analysis revealed that most curricula lack education focused on global health, particularly in the areas of diversity, human rights, and medical ethics
Bandyopadhyay et al., 2020	England; Scotland; Wales and Northern Ireland	Quantitative research	Not applicable	The study analyzed the curricula of medical schools from the years 2018 and 2019. It was identified that 38 schools (97%) covered all global health topics, and among them, 17 (44%) explored this subject in greater depth
Biswas et al., 2020	Israel	Experience report	Medical students	Research conducted with pre-clinical students on the topic: Global Health and Medical Anthropology Course. The study presented the curriculum offered and the skills developed during the course, which took place through lectures and dissertations
Blum et al., 2019	England	Qualitative research	Medical students	The authors interviewed 5th-year students before and after the global health module. Many students stated that it was a light topic with little importance. Additionally, the classes for this module had fewer students attending compared to the others
Brouwer et al., 2019	Hungary; Malaysia and Netherlands	Qualitative research	Medical faculty	The authors interviewed 26 curriculum developers for international medical programs. Additionally, an analysis of these curricula was conducted. They identified two profiles of physicians: the "global physician," with specific competencies for international practice, and the "universal physician," with a level of competence suitable for practice anywhere in the world
Civitelli et al., 2021	Italy	Quantitative research	Medical students and professionals from other health fields	The study addressed the participants' responses regarding global health courses offered in Italy at universities that are part of the INGHE. The results showed that, although there was significant learning from the courses, few students had international experience
Doobay-Persaud et al., 2019	United States of America	Quantitative research	Professionals, faculty, and medical students	The study developed an analysis of questionnaires regarding medical practice outside the scope of training in the context of global health experiences. The research recorded both quantitative and qualitative reports from professionals working in circumstances different from their training in their home country and the challenges they faced
Fant et al., 2022	Kenya and United States of America	Experience report	Faculty and medical students	The research presented the collaboration of the described universities for online meetings that lasted 12 months. The topic studied was surgical pediatrics and took place through the simulation of clinical cases and discussions between the facilitators and students afterward, generating significant learning
Hou et al., 2021	China	Quantitative research	Not applicable	A questionnaire about the approach to global health in medical curricula was sent to 161 medical schools in China. Only 33 medical schools (36%) reported having global health as part of their curriculum
Jimenez-Gomez et al., 2019	United States of America	Quantitative research	Medical professionals and students	The article presented an evaluation of 80 pediatric neurology and neurology programs in the United States, highlighting that over 75% allow rotations in global health. It was emphasized that a more efficient partnership between institutions would enhance this development
Kim et al., 2024	South Korea	Quantitative research	Medical students	The authors conducted an online survey with 678 medical students from medical schools across the country, addressing issues related to experiences and perceptions of global health. Among the participants, 411 (60.6%) stated the need for global health education in a new curriculum, while 82 (12.1%) agreed that the current curriculum already addressed the approach adequately
Kreitlow et al., 2021	Germany	Literature review and qualitative research	Medical students	A scoping review on global health in medical education was conducted in Germany, followed by a questionnaire applied to medical students on the same topic. The results highlighted the importance of strengthening the voice of students as future professionals through adequate funding for medical education in global health, as well as the influence of COVID-19 on global health and its impact on medical education.
Lawrence et al., 2020	United States of America; Ghana	Experience report	Medical students and professionals	The article presented a retrospective study of over a decade of collaboration between the University of Michigan and universities in Ghana. Medical interns and residents participated in elective rotational studies with varying durations of exchange, both in research and clinical or surgical practice
Lee et al., 2020	South Korea	Qualitative and quantitative research	Medical students	With the COVID-19 pandemic, some adaptations in teaching were necessary. The study compared online and in-person teaching of the same course (on global health education) for second-year students. The results showed a preference for online teaching among the students, as well as better performance on the final exam for those who took the course in this teaching model
Luckett et al., 2019	Botswana	Qualitative and quantitative research	Physicians	Questionnaires were analyzed based on the participation of residents at a hospital in Botswana in the area of obstetrics. The results highlighted the residents' learning in clinical and surgical hospital practices, as reported in their responses to the questionnaire
MacNairn, 2019	United States of America	Documentary research	Medical professionals and faculty members	The research presented HVO, a non-governmental organization that sent medical professionals to provide specific clinical and surgical training in low-income countries. The training period varied, and volunteers administered validation questionnaires after the program
Matthews et al., 2020	England; Scotland; Wales and Northern Ireland	Qualitative and quantitative research	Medical faculty and students	A questionnaire on medical education in global health was sent to medical schools. It was answered by the faculty member deemed most appropriate by the university and by a final-year undergraduate representative. Significant gaps in global health education were identified, highlighting the need to formalize global health as a mandatory part of the medical school curriculum
Morgan et al., 2020	United States of America	Experience report	Medical professionals	The program presented in the article was an experience designed for medical residents and fellows from any specialty. The course lasted two years and offered theoretical training and fieldwork in low- to middle-income countries (LMICs)
Ogbenna et al., 2022	Nigeria	Qualitative and quantitative research	Medical professionals and students from various health fields	The study described the proposed curriculum for a training course for healthcare professionals. The lectures were conducted online and involved knowledge exchange in the field of palliative care between Nigeria and the United States
Park et al., 2023	South Korea	Quantitative research	Medical students	Of the 2,450 participants, 781 (31.9%) expressed interest in global health. Interest decreased as students progressed in their studies. Additionally, exposure to this topic during undergraduate education increased the likelihood of future interest in the field
Peck et al., 2021	Colombia and United States of America	Experience report	Medical students	The article presented a retrospective evaluation of student exchanges between the United States and Colombia. The goal was to conduct research in the surgical field through the funding of scholarship programs for university students
Potter et al., 2021	South Africa	Qualitative research	Medical students	The study involved 245 medical students who received a questionnaire addressing their interest in global health, as well as their knowledge of the competencies and concepts required. Among them, 27% reported having experience in global health during their undergraduate studies, and 87% expressed interest in pursuing a career focused on global health
Scott et al., 2019	United States of America	Quantitative research	Medical students	According to the questionnaires conducted, just over half of the university students expressed interest in international surgery programs. However, barriers mentioned for the execution of these programs highlighted the need for more opportunities and resources
Shalan et al., 2021	Tanzania and United States of America	Experience report	Medical students	The case study reported the preparation process of seven students for the experience in Tanzania. As result, the students, who conducted research and wrote a dissertation on public health, reported having developed more social, clinical, and problem-solving skills
Slifko et al., 2021	United States of America	Quantitative research	Physicians	The study was conducted with 161 medical graduates from the institution between 2011 and 2015. They answered an online questionnaire about potential elective courses in global health during their undergraduate studies, as well as details of their experience. Among the responses, 70% highlighted an improvement in cultural competencies and understanding of public health, and 20% stated that their medical skills were enhanced through the elective courses
Umphrey et al., 2022	United States of America	Literature review	Not applicable	A systematic literature review was conducted with 40 articles that described medical education activities in global health. Most of the activities (55%) were carried out in high-income countries. The main drivers of the activities were the course content, organization, online flexibility, and peer interactions. The results showed the benefits of these activities, with improved relationships and identification of gaps related to global health
Volaric et al., 2019	Guatemala; United States of America	Experience report	Medical professionals	Four clinical rotations were conducted, and pathology residents from the University of Virginia were able to participate in team-based clinical and surgical case discussions with residents from Guatemala. The study promoted engagement through contact between the residents and pathologists via teleconferencing
Wang et al., 2020	China	Literature review	Health researchers	The review related global health research to the most impactful journals, countries, and universities with the highest volume of publications. The most researched subtopics included infectious diseases, oncology, and obesity, with an increase in research across all areas in recent years
Weine et al., 2021	United States of America	Experience report	Medical students	The study presented a literature review associated with COVID-19 and suggestions for promoting global health among students, including online meetings, discussions about the impact of the pandemic, research in African countries, and active listening to healthcare workers
Wu et al., 2020	United States of America	Qualitative and quantitative research	Medical students	Online meetings were held for biannual discussions with students from high-income countries across four continents. The second phase involved exchanges between the countries. The students responded to questionnaires in which they reported significant knowledge exchange across various fields of Medicine and Global Health

• Source: Danelle et al. (2024).

The research identified 24 universities and more than 269 partner medical schools that developed studies on the theme of "medical education in global health".

Among the listed institutions, eight conducted international field experiences, such as exchanges in partner countries and practices in hospitals. Six of these were described by universities in the United States, including Northwestern University, University of Michigan, University of Virginia, Columbia University, University of New York, and Rutgers University. The remaining two institutions are the University of Lagos in Nigeria and the Regional Hospital De Occidente in Guatemala. The other universities and institutions relied on different forms of research, such as questionnaire analyses, online courses, elective courses, and literature reviews.

The continents included were America [South (n=01) (3.33%), Central (n=01) (3.33%), and North (n=14) (46.62%)]; Europe (n=09) (29.97%); Africa (n=06) (19.98%); and Asia (n=06) (19.98%). The countries included in the research were: United States, present in 46.62% (n=14), followed by the United Kingdom, including England, Wales, Scotland, and Northern Ireland, with 13.32% (n=04), 9.99% from South Korea (n=03), China (6.66%) (n=02), Italy (6.66%) (n=02), and the remaining countries: Germany, Nigeria, Botswana, Israel, Guatemala, South Africa, Hungary, Malaysia, Netherlands, Ghana, Kenya, Colombia, and Tanzania (3.33%) with n=1 each, totaling 21 countries. The "n" values used in parentheses earlier refer to the corresponding number of articles in which each country is present, being greater than the final number of articles, since some articles involved multiple countries in the study composition. Therefore, the percentages added up to more than 100%, as the percentage values of the participating countries are relative to the number of 30 articles, with overlapping percentages, making this value relevant to indicate the participation percentage of countries about the total number of articles.

Among the methodologies analyzed, 33.34% (n=10) used quantitative research to evaluate the results, 26.64% used experience reports (n=08), followed by quali-quantitative research (16.65%) (n=05), literature review (13.32%) (n=04), qualitative research (13.32%) (n=04), and one documentary research (3.33%), noting that in two articles, more than one methodology was use.

Of the 30 articles, 40% (n=12) utilized questionnaires in their studies. The methodology of the articles that employed this tool varied, including quantitative and quali-quantitative research. The most prevalent theme in the questionnaires was related to the interest and participation of medical students and professionals in global health programs, as well as the challenges and barriers faced in this context. The institutions that conducted the questionnaire application were: Northwestern University; Botswana Harvard AIDS Institute Partnership; Rutgers Robert Wood Johnson Medical School AMSA; Columbia University; Italian Network for Global Health Education (INGHE); Peking University; University of North Carolina; Gachon University; Hanover Medical School; University of Cape Town; among other institutions associated with the study.

Discussion

Based on the comprehensive analysis of the results, the majority of participants in the selected articles evaluated global health learning positively, whether through elective courses, programs, online classes, or exchanges.

Participants, whether students, faculty, or physicians, reported the development of various skills during their involvement in field research. These included building intercultural relationships, learning about the differences in scientific knowledge between countries, improving basic surgical skills, motivation for international work, using limited resources more efficiently, exchanging experiences between less experienced and more experienced medical professionals, strengthening multidisciplinary teamwork, consensus on the need for global health education, understanding the importance of empathy and ethics in practice, and dealing with emergencies that challenge the theoretical rigor of studies (Doobay-Persaud et al., 2019; Lawrence et al., 2020; MacNairn, 2019; Morgan et al., 2020; Peck et al., 2021).

Regarding the questionnaires, which involved the perceptions and interests of students, the surveys included various questions, such as the opportunity to conduct field research in the surgical field, studying global health in the area where the faculty or professional lives, whether the student would be prepared or interested in joining a global experience program, and the barriers to participating in a global program. Questions on these topics were the most prevalent and aimed to assess the level of interest, participation, and availability of students and professionals to engage in global health activities, as well as identify the challenges they might face when participating in these programs (Bandyopadhyay et al., 2020; Blum et al., 2019; Fant et al., 2022; Jimenez-Gomez et al., 2019; Scott et al., 2019).

The surveys showed that interest in global health education has increased in recent years,and that more and more opportunities for global study and exchange exist, especially for students at institutions that establish partnerships with institutions in the United States or with low-income countries.

Additionally, an analysis of the countries involved in the studies revealed that, although many of the exchanges took place in low- and middle-income countries, the majority of them have English as their official language. Out of the 21 countries that make up the study, 11 (England, Scotland, Wales, Northern Ireland, the United States, Kenya, Ghana, Botswana, Nigeria, South Africa, and Tanzania) have English as the primary language. It was also noted that there was only one country from Central America (Guatemala) and one country from South America (Colombia). This landscape suggested a significant predominance of English-speaking countries in the exchanges, possibly indicating a preference for destinations where English facilitates communication and integration between countries.

The studies showed an uneven distribution in low-and middle-income countries, predominantly in the Global South. Research has primarily focused on African countries. However, South and Central American countries were almost not involved, and studies from Oceania and South Asia were absent.

Ultimately, regarding the courses offered, both in-person and online, students described satisfaction with the possibility of collaborations between educational institutions and the programs offering the course. Among the learnings, the opportunity for partnerships, the development of clinical situation simulations, enhancement of communication and confidence to exercise their medical skills, knowledge of ethical divergences, cultural differences, and disparities between healthcare systems in each country were reported (Civitelli et al., 2021; Fant et al., 2022; Lee et al., 2020; Ogbenna et al., 2022; Wu et al., 2020).

Conclusion

Global health medical education is of paramount importance today. The integration of this topic into medical curricula worldwide demonstrates a growing commitment to training professionals who are not only technically skilled but also culturally competent, to meet the demands of our interconnected and diverse world.

The teaching methods used in global health education varied across the countries in the analyzed articles. These methods, ranging from virtual meetings and in-person classes to fieldwork and exchanges, proved to be effective in consolidating concepts in global education. The development of skills such as communication, empathy, ethics, and professional adaptation to limited resources is essential in preparing medical students to overcome the challenges of medical practice in global and challenging contexts.

Furthermore, an important milestone that highlighted the relevance of international collaboration was the Covid-19 pandemic. Some of the articles examined addressed the challenges faced during this period and emphasized the importance of medical training focused on a global approach to health, serving as a crucial tool to equip healthcare professionals to face these challenges ethically and collaboratively.

It is important to recognize that, despite the efforts made, some gaps and challenges were identified. One of the limitations observed, considering the most spoken languages in the world, was the absence of Portuguese-speaking, Hindi, French, Arabic, Bengali, Russian, and Japanese countries in the reviewed studies. This suggested a gap in linguistic and cultural representation, potentially influencing the diversity of perspectives and approaches considered in the analysis of global health medical education. Furthermore, the lack of institutional support, adequate funding, and language barriers emerged as significant obstacles to the effective implementation of global health programs in various countries.

The limitations identified in this study do not undermine the relevance of the global health medical education approach and highlight areas that need more attention and improvement. There is a need for more research to evaluate its long-term effects and improve equity in global health. Future studies can deepen these initiatives, contributing to more inclusive and effective medical education in a global context.

Acknowledgments

This work was conducted with the support of the Araucária Foundation / SETI / Paraná, through a Scientific Initiation scholarship

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• 1
  All research data are available in this text.

• Editor:
  Fernanda Mattioni

Data availability

All research data are available in this text.

Publication Dates

• Publication in this collection
  15 Sept 2025
• Date of issue
  2025

History

• Received
  07 Aug 2024
• Reviewed
  20 Aug 2024
• Accepted
  03 Oct 2024