Project PRIME (Psychosocial Response to International Medical Electives): Results from Medical Trainees
Background: Participation in global health (GH) training experiences is common for US medical trainees (students, residents, and fellows). However, little is known about their experience of “culture shock” (CS), which frequently occurs during these transformative cross‑cultural immersions. Objective...
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| Format: | Article |
| Language: | English |
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Ubiquity Press
2025-03-01
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| Series: | Annals of Global Health |
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| Online Access: | https://account.annalsofglobalhealth.org/index.php/up-j-agh/article/view/4627 |
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| author | Nicole E St Clair Kristina Devi Singh-Verdeflor Vanessa McFadden Elizabeth Groothuis Stephanie Lauden Megan S McHenry Stephen Merry Stephen Warrick Samantha L Wilson James H Conway |
| author_facet | Nicole E St Clair Kristina Devi Singh-Verdeflor Vanessa McFadden Elizabeth Groothuis Stephanie Lauden Megan S McHenry Stephen Merry Stephen Warrick Samantha L Wilson James H Conway |
| author_sort | Nicole E St Clair |
| collection | DOAJ |
| description | Background: Participation in global health (GH) training experiences is common for US medical trainees (students, residents, and fellows). However, little is known about their experience of “culture shock” (CS), which frequently occurs during these transformative cross‑cultural immersions. Objectives: The objectives of this study include: (1) quantitatively measure medical trainee psychosocial responses to short‑term GH electives, (2) identify factors that influence their CS experiences, and (3) determine if the stage‑based CS conceptual framework applies to medical trainees. Methods: Undergraduate and graduate medical education trainees (UME and GME) who participated in short‑term GH electives between 2016 and 2020 were recruited across nine US institutions. Using a longitudinal survey method, we gathered data predeparture (demographics, resilience, perceived stress (PS), and CS assessments), every 5 days during the elective (CS, PS assessments, and training site conditions), and 30 days postreturn (perceptions of CS experiences). Analyses included summary statistics, linear regressions, and a linear mixed effects model (LMM). Findings: 252 trainees were enrolled, with 140 (56%) included in the LMM. The primary outcome was a culture shock profile (CSP) score, with 96% reporting CS. The only trainee‑specific factor that significantly increased CSP score was trainee type (UME > GME (+22%)). Several GH elective site‑specific factors significantly influenced CSP score (e.g., support network [−10%], role clarity [−11%], and overwhelmed by medical needs [+10%]). CS experiences were variable and did not progress in predictable, stage‑based fashions, which is discordant from common CS descriptions. Conclusions: Culture shock was a near‑universal, diverse experience during GH electives. On‑site training conditions and elective site host factors influenced CS more than trainee factors in this prepandemic cohort. Further research is required to (1) determine the optimal CS “balance” (i.e., promoting transformative learning while mitigating negative professional and personal impacts), (2) offer insight into harmful CS thresholds, (3) identify host perspectives, and (4) inform best practices for GH electives and global partnerships. |
| format | Article |
| id | doaj-art-5c2668a2296d4d16a696f8feff4d7f3c |
| institution | OA Journals |
| issn | 2214-9996 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Annals of Global Health |
| spelling | doaj-art-5c2668a2296d4d16a696f8feff4d7f3c2025-08-20T02:17:29ZengUbiquity PressAnnals of Global Health2214-99962025-03-01911131310.5334/aogh.46274627Project PRIME (Psychosocial Response to International Medical Electives): Results from Medical TraineesNicole E St Clair0https://orcid.org/0000-0002-5741-8542Kristina Devi Singh-Verdeflor1https://orcid.org/0009-0003-0689-7197Vanessa McFadden2https://orcid.org/0000-0003-2925-8235Elizabeth Groothuis3https://orcid.org/0000-0002-2217-7857Stephanie Lauden4https://orcid.org/0000-0001-7932-1680Megan S McHenry5https://orcid.org/0000-0001-6753-0928Stephen Merry6https://orcid.org/0000-0002-3816-8154Stephen Warrick7https://orcid.org/0000-0002-4721-8256Samantha L Wilson8https://orcid.org/0000-0002-4983-4466James H Conway9https://orcid.org/0000-0001-6040-403XAssociate Professor of Pediatrics at the University of Wisconsin School of Medicine and Public Health and Director of their Pediatric Residency Global Child Health Training ProgramResearcher at the University of Wisconsin School of Medicine and Public HealthAssociate Professor of Pediatrics at the Medical College of Wisconsin and Associate Section Chief for Hospital MedicineAssistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine and Assistant Program Director of McGaw Medical Center’s Global Health Clinical Scholars ProgramChief Medical Officer, Lower Lights Health, Columbus, OHAssociate Professor of Pediatrics within the Ryan White Center for Pediatric Infectious Disease and Global Health at Indiana University School of MedicineAssociate Professor of Family Medicine at the Mayo Clinic Alix School of Medicine and Chair of the Mayo International Health ProgramVolunteer Assistant Professor of Clinical Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati College of MedicineProfessor of Pediatrics within the Division of Pediatric Psychology and Developmental Medicine, Medical College of Wisconsinon behalf of the Project PRIME Investigators, Professor of Pediatrics at the University of Wisconsin School of Medicine and Public Health, the Pediatric Infectious Diseases Fellowship Program Director, and the Director of the Office of Global HealthBackground: Participation in global health (GH) training experiences is common for US medical trainees (students, residents, and fellows). However, little is known about their experience of “culture shock” (CS), which frequently occurs during these transformative cross‑cultural immersions. Objectives: The objectives of this study include: (1) quantitatively measure medical trainee psychosocial responses to short‑term GH electives, (2) identify factors that influence their CS experiences, and (3) determine if the stage‑based CS conceptual framework applies to medical trainees. Methods: Undergraduate and graduate medical education trainees (UME and GME) who participated in short‑term GH electives between 2016 and 2020 were recruited across nine US institutions. Using a longitudinal survey method, we gathered data predeparture (demographics, resilience, perceived stress (PS), and CS assessments), every 5 days during the elective (CS, PS assessments, and training site conditions), and 30 days postreturn (perceptions of CS experiences). Analyses included summary statistics, linear regressions, and a linear mixed effects model (LMM). Findings: 252 trainees were enrolled, with 140 (56%) included in the LMM. The primary outcome was a culture shock profile (CSP) score, with 96% reporting CS. The only trainee‑specific factor that significantly increased CSP score was trainee type (UME > GME (+22%)). Several GH elective site‑specific factors significantly influenced CSP score (e.g., support network [−10%], role clarity [−11%], and overwhelmed by medical needs [+10%]). CS experiences were variable and did not progress in predictable, stage‑based fashions, which is discordant from common CS descriptions. Conclusions: Culture shock was a near‑universal, diverse experience during GH electives. On‑site training conditions and elective site host factors influenced CS more than trainee factors in this prepandemic cohort. Further research is required to (1) determine the optimal CS “balance” (i.e., promoting transformative learning while mitigating negative professional and personal impacts), (2) offer insight into harmful CS thresholds, (3) identify host perspectives, and (4) inform best practices for GH electives and global partnerships.https://account.annalsofglobalhealth.org/index.php/up-j-agh/article/view/4627global healthglobal health electivesmedical studentsmedical traineesculture shock |
| spellingShingle | Nicole E St Clair Kristina Devi Singh-Verdeflor Vanessa McFadden Elizabeth Groothuis Stephanie Lauden Megan S McHenry Stephen Merry Stephen Warrick Samantha L Wilson James H Conway Project PRIME (Psychosocial Response to International Medical Electives): Results from Medical Trainees Annals of Global Health global health global health electives medical students medical trainees culture shock |
| title | Project PRIME (Psychosocial Response to International Medical Electives): Results from Medical Trainees |
| title_full | Project PRIME (Psychosocial Response to International Medical Electives): Results from Medical Trainees |
| title_fullStr | Project PRIME (Psychosocial Response to International Medical Electives): Results from Medical Trainees |
| title_full_unstemmed | Project PRIME (Psychosocial Response to International Medical Electives): Results from Medical Trainees |
| title_short | Project PRIME (Psychosocial Response to International Medical Electives): Results from Medical Trainees |
| title_sort | project prime psychosocial response to international medical electives results from medical trainees |
| topic | global health global health electives medical students medical trainees culture shock |
| url | https://account.annalsofglobalhealth.org/index.php/up-j-agh/article/view/4627 |
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