Global Health Education: a cross-sectional study among German medical students to identify needs, deficits and potential benefits (Part 1 of 2: Mobility patterns & educational needs and demands)

Abstract

Background: In recent years, education and training in global health has been the subject of recurring debate in many countries. However, in Germany, there has been no analysis of the educational needs or demands of medical students, or the educational deficits or potential benefits involved in global health education. Our purpose is to analyse international health elective patterns of medical students enrolled at German universities and assess whether or how they prepare for their electives abroad. We examine the exposure of medical students enrolled at German universities to training courses in tropical medicine or global health and assess students' perceived needs and demands for education in global health.

Methods: Cross-sectional study among medical students in Germany including all 36 medical schools during the second half of the year 2007. All registered medical students were eligible to participate in the study. Recruitment occurred via electronic mailing-lists of students' unions. We developed a web-based, semi-structured questionnaire to capture students' international mobility patterns, preparation before electives, destination countries, exposure to and demand for global health learning opportunities.

Results: 1126 online-replies were received and analysed from all registered medical students in Germany (N = 78.067). 33.0% of all respondents (370/1126) declared at least one international health elective and of these, 36.0% (133/370) completed their electives in developing countries. 36.0% (131/363) did not prepare specifically at all, 59.0% (214/363) prepared either by self-study or declared a participation in specific preparation programmes. 87.8% of 5th and 6th year students had never participated in a global health course and 72.6% (209/288) had not completed a course in tropical medicine. 94.0% (861/916) endorsed the idea of introducing global health into medical education.

Conclusion: Students in our sample are highly mobile during their studies. International health electives are common, also in developing countries. Formal preparation beyond self-study is virtually non-existent amongst our sample and the participation rate in courses of tropical medicine or global health is appallingly low. We have identified unmet perceived needs and the demand for more learning opportunities in global health in our sample, urging for reforms to adjust curricula to a globalising world.

Figure 1

Students' mobility by level of study.

Figure 2

Past and future mobility. *IHE = international health elective.

Figure 3

Destination of international health electives by continent and region.

Figure 4

Purposes of study-related transborder movements. * Percentages refer to the proportion of categories among n = 604 answers. ** NGO = non-governmental organization.

Figure 5

Course participation and mobility. *p-value of Fischer's exact test Percentages on the y-axis refer to the proportion of "IHE no", "IHE-North" and "IHE-South" among the subgroups „Global Health course yes/no" and "Tropical medicine course yes/no" (column total: 100%). Figures within each bar are absolute frequencies. Missing figures to N = 1126 are due to the exclusion of n = 7 respondents, who did not specify their IHE destinations. IHE = international health elective; IHE-South = electives predominantly completed in developing countries; IHE-North = electives predominantly completed in industrialised countries; IHE-no = no electives abroad.

Figure 6

Prevalence of global health education by level of study.

Figure 7

Form of education in global health. Percentages refer to N = 251 answers of 184 students (Total > 100% due to the possibility of multi-option answers).

Figure 8

Prevalence of global health education by medical school. * Only universities with more than 50 respondents are illustrated.

Figure 9

Satisfaction with the supply of global health course opportunities. N = 1126 students (100%).

Figure 10

Satisfaction with the supply of global health course opportunities by subgroups. *p-value of Fischer's exact test. IHE = international health elective; IHE-South = electives predominantely completed in developing countries; IHE-North = electives predominantely completed in industrialised countries; IHE-no = no electives abroad.

Figure 11

Satisfaction with the supply of global health course opportunities by level of study.

Figure 12

Demand for global health learning opportunities. N = 916 students (100%); n = 210 provided no answer.

Figure 13

Demand for global health learning opportunities by level of study. N = 916 students (100%); n = 210 provided no answer.