Global Health Research Ethics, Part 1: Gaining Experience

Students considering what to do during their summer break in medical school or public health school often face a dilemma in choosing what to do. The commonly held belief is that in order to build your resume, you must undertake a research project. Volunteering for a global health program, either focused on provision of medical care or public health oriented, is perceived as the weaker choice, one that won’’t look as good to your future employers.
There are several underlying reasons for this perception, for example, many employers come from a more traditional perspective and were trained prior to the proliferation of global health opportunities. They and their peers may not have had similar experiences and may not identify with how formative or educational they can be, or be familiar with the types of skills that can be gained through participation. Another reason for trepidation is that the quality of global health opportunities is so widely variable, and many loosely organized and informal programs exist. Nearly anyone can get in to a global health volunteer program of some sort, as long as they are willing to pay, since such programs serve as income generation mechanisms for many nonprofit organizations or may be run by students on an ad hoc basis, with little selectivity.
However, a student need not feel torn between the desire to pursue an interest in global health and the motivation to become a more attractive candidate for graduate employment opportunities. Research may have a stodgier image, but it is important to remember that there is a wide world of research beyond bench science conducted in a laboratory, hunched over a bubbling beaker. It is possible, though more challenging, to find an opportunity to conduct research while at the same time working in the global health field.
As when choosing a clinical experience or public health volunteer experience, it is crucially important to consider the ethical repercussions of the type of experience you will undertake. A poorly conducted research project may not result in any useful knowledge, will fail to give those involved the opportunity to disseminate what they learned more widely through presentations at conferences or publications in journals, and will not provide nearly as useful a stepping stone on your path to a global health career. More importantly, though, such projects do not serve the populations being studied, and in the worst cases, they may in fact do harm to the dignity or the health of the participants.
When seeking a research opportunity in global health, it is important to consider several aspects of research projects that can greatly affect planning and choice of programs for application. The most important one is the length of time to commit to the project. Any student who is truly interested in global health as a career should give strong consideration to taking a minimum of one year to devote to a research experience. Quite frankly, this is the strongest determinant of whether the research experience will be fruitful, will add substantively to knowledge in the field on the subject being researched, and will give the student the skills to go on to more advanced opportunities in global health research in the future. A shorter project, which might be conducted over a period of weeks to months, can help to get a taste of what research is like in order to guide future career choices, but is unlikely to provide a solid skill set or to contribute to global health science in a meaningful way. This is particularly true if the student is planning to conduct the research project without the support of an institution or program, or as an ‘independent study’ with little guidance.
A quick primer and review of research methods and how they might be utilized in the global health field might be helpful in determining what types of projects you should be looking for. First, there are two major categories of research, qualitative, and quantitative. Students with a bent towards clinical research and who are planning careers in the biological sciences should more strongly consider a quantitative research project, which involve measurements and statistics to determine the answers to questions beginning with “when”, “where”, “how many”, or “which”. Examples of quantitative projects include comparison trials of interventions, epidemiologic or demographic studies, and surveys. Qualitative projects may involve some degree of statistical analysis, but their focus is on answering “why” or “how” questions in a more narrative format. Examples of qualitative research projects include key informant interviews and focus groups. Students in the public health field could consider either type of project.
There is a more recent trend towards combining aspects of both quantitative and qualitative research, this is known as mixed methods research. Mixed methods research can be particularly useful in global health because qualitative research can be used to explain cultural, social, or political factors that may illuminate the reasons behind trends found in quantitative studies. Since research teams in global health may not be studying an area with a local culture with which they are intimately familiar, the inclusion of qualitative research components to quantitative projects can greatly inform the discussion of the study results. The use of qualitative research strategies to inform quantitative studies can help to ensure that the community being studied has had input on the issue or intervention in question and its value or appropriateness in the local context.
Although funded opportunities for global health research are limited and highly competitive, students who want to get the best experience should strongly consider applying to such programs, ideally with assistance from faculty members at their institution to guide them through the application process. Formal opportunities for international research experience that are renowned for rigor and quality include the Fogarty Global Health Fellows program, which is run by a consortium of American universities to provide 11 months of mentored research experience in developing countries. This experience is supported by a modest stipend and includes travel costs and health insurance. Note: the former Fogarty International Clinical Research Scholars program no longer exists. The Doris Duke International Clinical Research Fellowship is administered through American universities including Duke, UNC, and Harvard, and provides support for a yearlong research experience. Each university has several specific affiliate sites in locations such as Africa and Asia. Applicants do not need to be students at these affiliate universities to apply. The Fulbright-Fogarty Fellowships in Public Health is a program for global health research, available to graduate students in the United States. It provides a grant for a 9 month research project in specific country sites in Africa, Asia, and Latin America.
Another factor which can significantly impact the value of the research experience, both to the student and to the target community, is a good mentor. Having skilled mentorship is an invaluable asset to any student, both in terms of helping to provide guidance on career questions and also to be able to assist in the appropriate planning, design, and execution of the research project, and to ensure adherence to ethical principles. The previously referenced programs include mentorship as a key component of the experience. Any student contemplating the execution of a research project without an experienced mentor would be well advised to reconsider their choice.
In the next article in this series, I will elaborate further upon ethical pitfalls to avoid in global health research projects. Stay tuned!
Alison Schroth Hayward, MD, MPH is a board certified emergency medicine physician at Yale New Haven Hospital. In 2003, she co-founded a nonprofit called Uganda Village Project, and currently serves as the chair of the board. Any expertise she has in global health ethics has mainly resulted from making the mistakes already herself, and trying to learn from them.
Hunt, M. and Godard, B. Beyond procedural ethics: foregrounding questions of justice in global health research ethics training for students. Global Public Health. 8(6), 2013, pp713-724.
Provenzano A, et al. Short Term Global Health Research Projects by US Medical Students: Ethical Challenges for Partnerships. Am J Trop Med Hyg. 83(2), 2010, pp.211-214.