Crossing Borders

As emergency physicians, we are privileged to be in a field that crosses more boundaries than any other medical specialty. It is a calling. Our skills are portable and transferable across cultural and geographic disparities. For these reasons, many of us are drawn to sharing our knowledge and training across the globe – towards treating patients in underserved and austere environments abroad. The rapid growth of international and global health educational initiatives across our U.S. residency training programs is a direct result of those undeniable forces. Additionally, inclusion of such rotations becomes a powerful resident recruitment tool as more and more of our trainees are looking for these opportunities during their formative years.1 However, the survey results reported by Morris et al. in the article “Emergency Medicine Residents Abroad: Current Status and Next Steps” raise some concerns about the initial orientation, mentorship, and preparation practices of our residency programs that offer international rotations.2 While we do have many shining examples of institutions that have “all the pieces in place,” these results highlight the need for increased consistency and support practices across all emergency medicine (EM) training programs in sending our residents on global health missions. Fortunately there are a number of resources available to guide programs in successfully implementing these types of opportunities. Many of our professional societies, including American College of Emergency Physicians,3 Emergency Medicine Residents Association,4 Society for Academic Emergency Medicine,5 and the American Medical Association,6 offer comprehensive webpages dedicated to the selection and development of global health rotations for students, residents and fellows. Additionally, many institutional EM residency programs across the country have been offering international rotations for a number of years and have developed extensive websites, protocols, and guidelines based on their experiences. But that is just the start. A number of key components must be present to provide consistency across all programs for the educational benefit and safety of our residents. First and foremost, there should be a faculty mentor University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California