We agree with Drs. Loh and Lin regarding reframing current global health experiences and programs to balance the interests of the sending institutions, learners, and the receiving communities. Drs. Loh and Lin reflect upon a pilot program utilizing a “crowdsourcing” model to help coordinate multiple short-term volunteer and educational activities into more cohesive longitudinal efforts. Crowdsourcing may offer a number of potential benefits, including (1) eliminating redundancies and improving efficiency, (2) developing consistent program goals, (3) bridging discontinuity in the provision of local care, and (4) improving innovation with diverse sets of eyes and perspectives. In fact, crowdsourcing has been used effectively across medical fields, especially with the advent of online-based collaboration platforms.1
However, a few pragmatic issues must be considered with this model. Despite common project goals, multiple handoffs between short-term cohorts may fragment attempts at establishing continuity. Even with online-based support, full-time staff from an intermediary organization may still be required to optimize care transitions. Another hurdle is that program evaluation becomes more challenging with increasing numbers of participants and groups. Attempts to create uniform programs may restrict individual sending institutions’ preferences and tailored learning and clinical focus.
Ideally, the integration of historically fragmented efforts by outsiders would not only be coordinated amongst the external actors but also coordinated with the existing health system, even if the system is or appears to be limited in nature. This approach has further benefits by aligning the goals of visitors with local systems’ priorities, workforce realities, and capacities. Likewise, integrating previously disjointed activities into the existing local health system may facilitate local capacity building, helping to ensure that impacts of global health activities endure beyond the duration of short-term outsider presence.2 Regardless of potential limitations, as we attempt to develop contemporary impact-driven global health education and engagement, novel collaborative approaches provide important avenues to harnessing the collective strengths of medical professionals, institutions, and trainees.
Muthiah Vaduganathan, MD, MPH
Second-year resident, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Jasmine Rassiwala
Fourth-year medical student, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Jessica Evert, MD
Executive director, Child Family Health International and Clinical Faculty, University of California in San Francisco, Department of Family and Community Medicine, San Francisco, California; jevert@fcm.ucsf.edu.
Footnotes
Disclosures: Dr. Jessica Evert is executive director of Child Family Health International (CFHI). As such, she is not independent of one of the organizations discussed in the original article that is subject of these letters. CFHI and other third-party organizations were not directly involved in the reflection sessions detailed in the cited program evaluation.
References
- 1.Ranard BL, Ha YP, Meisel ZF, et al. Crowdsourcing—harnessing the masses to advance health and medicine, a systematic review. J Gen Intern Med. 2014;29:187–203. doi: 10.1007/s11606-013-2536-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
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