Columbus gets the credit, but in 240 BC, Eratosthenes of Cyrene discovered that the earth was round. In 1990, the Hubbell telescope proved that the universe is expanding. In the 21st century we know that the world is round but with the Internet and smart phones, it feels small and flat. With ease of travel and technology, all aspects of modern life have changed, including medical science, practice, and education.
The term global health usually refers to research and activity to improving health worldwide, integrating the perspectives of medical science, sociology, economics, and politics. It focuses on eliminating social and economic disparities that lead to problems around the world such as high rates of child and maternal mortality, along with so-called “diseases of poverty” like malnutrition, malaria, cholera, and epidemic tuberculosis.
There are several global approaches to medical science and practice, replacing old models of expertise guiding patient care in local settings:
- Evidence-based medicine (EBM). Formal methodology is used to review and assess research in populations and to guide clinical decision-making for individual patients. Systematic review and grading of all available research is carried out, regardless of where the research is conducted.
- Clinical practice guidelines. These recommendations arise from the synthesis of the highest-quality evidence to inform practice. Where medical problems are similar in populations in different countries, the guidelines follow that medical practice should be similar, influenced by local resources and culture. Clinicians are obligated to keep up with guidelines related to their practice regardless of where they practice.
- Globalized training. Physicians cross borders to train, including “international medical graduates” who come to the US for school and then often return to their home country to practice.
- Academic and clinical outreach. Leading institutions like Harvard University and Cleveland Clinic collaborate in global educational and health system development.
- “Medical tourism.” Affluent patients from poor countries have always traveled to the United States and Europe for medical expertise and advanced technology. Patient travel to less-developed areas for expert care by Western-trained physicians in modern facilities (at lower costs) is also increasingly popular.
- Telemedicine. Patient monitoring and clinical expertise are available everywhere but are still limited by high costs.
Technology is transforming medical education with ongoing overhaul of content and delivery, framed by today’s approach to adult learning principles. In local and global contexts, paper textbooks and journals are being rendered obsolete because they are expensive to produce and distribute, usually outdated before they are published. Additionally, they are not immediately accessible in daily patient care and have no interactive features. With the disappearance of paper, the physical library is replaced with a virtual one that we carry in our pockets, which offers decision support and allows interaction with peers. Likewise, the physical classroom is being replaced with online learning—accessible at any time and anywhere, and simulation technology is replacing the “see one, do one, teach one” approach to all aspects of practice.
While Columbus was searching for a new trade route, today’s explorers are searching for solutions for real patients with real needs. And they are finding them with technology from colleagues from different cultures. They are learning new techniques that work with their patients. It’s a virtual sea that helps real people.
ACCP faculty and staff with colleagues from the International Medical Center in Jeddah, Saudi Arabia.
Mark J. Rosen serves as Director of Global Education and Strategic Development for the American College of Chest Physicians and is integral in the planning of the ACCP 2014 CHEST World Congress in Madrid, Spain.