Author + information
- Abhinav Sharma, MD∗ (, )
- James S. Khan, MD, MSc,
- John W. Stanifer, MD, MSc and
- Puneet Seth, MD
- ↵∗Duke Clinical Research Institute, Duke University, 2440 Pratt Street, Durham, North Carolina 27705
We read with great interest the review by Abdalla et al. (1) on the American College of Cardiology (ACC) International Cardiovascular Exchange Database. Global health experiences can positively affect the development of early-career cardiologists. Yet these experiences can often be heterogeneous and, as indicated by the investigators, the time and financial investment required to participate in such endeavors can be considerable. Early-career physicians may have to forfeit time needed to develop a clinical practice and research portfolio at their home institution. Unless explicitly negotiated before joining a practice, it can be difficult to acquire such opportunities once a physician has already started to work.
However, we agree with Abdalla et al. (1) that the benefits of global health experiences outweigh the disadvantages. Such exchanges can start earlier, such as during fellowship training (2) or even medical school. Personal experience in low- and middle-income countries (LMIC) such as India (A.S.), Kenya (P.S.), and Tanzania (J.W.S.) during our medical training has given us a greater perspective on the medical, social, and economic challenges faced by many of our patients. We encourage fellowship program directors to foster programs that enable fellows to gain such experiences during training. We would also encourage the ACC to promote global health experiences among fellows by creating international travel awards and grants.
Nonetheless, clinical decisions made by physicians and practitioners rotating in host countries may have unforeseen consequences. For example, in LMICs, rationing of medical care is frequent, which means that physicians directly and indirectly play a crucial role in the distribution of technologies and treatments. This scenario highlights that within a complex, foreign community, the early-career cardiologist or trainee’s goals need to be clearly defined and coupled with local support. Furthermore, such experiences raise other issues. To use the example provided by Abdalla et al. (1), as cardiologists, should we be involved in the care of critical patients during a natural disaster if we are not trained to do so?
As a starting point, Abdalla et al. (1) have shown that global health experiences can be fruitful and beneficial. We encourage universities, fellowship programs, and the ACC to establish global health exchanges that focus on bidirectional education, research, and infrastructure development to ensure that the host countries benefit. Furthermore, guidance from the ACC and host countries with regard to the roles, responsibilities, and limits of early-career physicians in LMICs on such exchanges would be of great value.
Please note: Dr. Sharma is sponsored by a Alberta Innovates Health Solution Clinician Fellowship. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Deepak L. Bhatt, MD, MPH, served as Guest Editor for this paper.
- American College of Cardiology Foundation
- Abdalla M.,
- Kovach N.,
- Liu C.,
- et al.
- Bloomfield G.S.,
- Huffman M.D.