RESEARCH ARTICLE Open Access
Global health competencies and approaches in
medical education: a literature review
Robert Battat, Gillian Seidman, Nicholas Chadi, Mohammed Y Chanda, Jessica Nehme, Jennifer Hulme, Annie Li,
Nazlie Faridi, Timothy F Brewer*
Background: Physicians today are increasingly faced with healthcare challenges that require an understanding of
global health trends and practices, yet little is known about what constitutes appropriate global health training.
Methods: A literature review was undertaken to identify competencies and educational approaches for teaching
global health in medical schools.
Results: Using a pre-defined search strategy, 32 articles were identified; 11 articles describing 15 global health
competencies for undergraduate medical training were found. The most frequently mentioned competencies
included an understanding of: the global burden of disease, travel medicine, healthcare disparities between
countries, immigrant health, primary care within diverse cultural settings and skills to better interface with different
populations, cultures and healthcare systems. However, no consensus on global health competencies for medical
students was apparent. Didactics and experiential learning were the most common educational methods used,
mentioned in 12 and 13 articles respectively. Of the 11 articles discussing competencies, 8 linked competencies
directly to educational approaches.
Conclusions: This review highlights the imperative to document global health educational competencies and
approaches used in medical schools and the need to facilitate greater consensus amongst medical educators on
appropriate global health training for future physicians.
Health issues are increasingly transnational and in
recent years the concept of global health has emerged
to address these issues. Global health is the study and
practice of improving health and health equity for all
people worldwide through international and interdisci-
plinary collaboration . Factors such as increasing
international travel, the globalization of food supplies
and commerce and the occurrence of multinational
epidemics including the 2009 Influenza A pandemic
have heightened awareness of global health issues. This
awareness has influenced health practices and medical
education locally and globally. Internationally, large-
scale multinational public health programs such as the
UN Millennium Development Goals, the Global Fund
and the US President’s Emergency Plan for AIDS relief
have been created and funded with billions of dollars
. More locally, medical schools increasingly are
offering international elective opportunities; almost
one-third of recently graduated US and Canadian med-
ical students participated in a global health experience
. However, despite growing interest in and the
importance of global health, there exists little agree-
ment on what constitutes appropriate global health
training for medical students .
It has been argued that all medical students should
have some exposure to global health issues, and groups
are addressing this perceived gap in medical education
by proposing global health competencies for undergrad-
uate medical education [2,5,6]. In order to develop
initial guidance in this area, this study reviewed existing
literature to identify competencies and educational
approaches recommended for teaching global health
components in medical curricula. Using this informa-
tion, a consensus was sought in order to further solidify
this conceptual framework.
* Correspondence: email@example.com
Faculty of Medicine, McGill University, Montreal, Canada
Battat et al. BMC Medical Education 2010, 10:94
© 2010 Battat et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Data Sources and Searches
Relevant articles on global health competencies and
teaching approaches were identified by applying similar
search strategies to two databases, Ovid MEDLINE® and
Web of Science. Also, previously identified articles were
obtained from the McGill Global Health Programs files.
The Ovid MEDLINE® search terms “world health” and
“international educational exchange” were combined
using the Boolean operator “OR” for the publication
years 1996 to the 4thweek of January 2009. The initial
search used the terms “global health” and “international
health"; however, these terms mapped to the subject
heading “world health” in the Ovid MEDLINE® database.
This procedure was repeated using the search terms
“education, medical” and “education, medical, undergrad-
uate”, which was then cross-referenced with the search
term “competencies”. The resulting “education, medical"/
"curriculum” set was combined with the resulting “world
health"/"international educational exchange” set using the
Boolean operator “AND”. The results of the search were
limited to humans and English. The Web of Science
search cross-referenced the terms “medical education”,
“curriculum” and “global health” as topics for the publica-
tion years “all years” i.e. from 1900-1914 to January 2009.
A research team comprised of all authors in this study, as
well as the Liaison Librarian in the Life Sciences Library
at McGill University, agreed upon these terms with the
aim of avoiding researcher bias when selecting the arti-
cles. References from retrieved articles were reviewed to
identify additional applicable publications.
Titles and abstracts of articles obtained from database
searches were reviewed to identify those describing
competencies or educational approaches currently used
in global health components of medical school curricula.
Articles not pertaining to contemporary global health
medical educational practices or competencies were not
Data Extraction and Synthesis
Information relating to competencies and educational
approaches was extracted from the retained articles.
Information discussing the theoretical knowledge or
practical skills authors believed medical students needed
to obtain was categorized as a competency. Descriptions
of specific programs or teaching methods were categor-
ized as educational approaches.
The results of the search strategy on global health com-
petencies and educational approaches are summarized
in Figure 1. The Ovid database search strategy yielded
forty-five articles. The Web of Science search yielded
two additional articles not found in the Ovid database
[7,8]. Twelve more articles were found through review-
ing references from retrieved articles[6,9-19]. Four other
articles were obtained from the McGill Global Health
Programs files[20-23]. Combining all of the search
efforts and removing duplications, 63 articles were avail-
able for consideration. After reviewing titles and
abstracts, 47 were retained for further consideration.
Following a full review of the remaining articles, 32 arti-
cles were felt to contain relevant information and were
included in the review.
The percentage of articles recommending a particular
competency topic, the type of competency and the sug-
gested method of implementation are summarized in
Table 1. Fifteen unique global health competencies for
training medical students from 11 articles (34.4%) were
identified in the literature [7,10,17-19,24-29]. Most com-
petencies were concerned with increasing medical stu-
dents’ knowledge, though some addressed physician
behaviour, physical examination abilities and other clini-
cal skills. Competencies mentioned in more than one
article included: an understanding of the global burden
of disease; travel medicine; healthcare disparities
between countries; immigrant health; primary care
within diverse cultural settings; and skills to better inter-
face with different populations, cultures and healthcare
systems. All other competencies were mentioned only
by a single article.
Global health educational approaches were described
in 18 of 32 (56.3%) identified articles [6,7,9,10,
13,15-17,19,22,24,26,28-33]. The percentage of articles
recommending a particular educational approach, and
the suggested methods for implementing that approach,
are summarized in Table 2.
The most common recommended educational
approaches for teaching global health topics were didac-
tics and experiential learning. However, there was sub-
stantial variability across described programs in the
educational approach to global health as well as the
methods used to implement these approaches. No com-
monly applied didactic method for teaching global
health to medical students was apparent from this litera-
ture review. Moreover, descriptions of educational
approaches often did not provide a tangible picture of
what occurred in these programs.
Competencies and educational approaches were linked
in 8 (25.0%) articles [7,10,17,19,24,26,28,29]. Eleven arti-
cles (34.4%) mentioned global health educational
approaches or competencies for medical students, but
did not provide sufficient detail to be used further
[5,8,11,12,14,20,21,23,34-36]. Although these articles met
Battat et al. BMC Medical Education 2010, 10:94
Page 2 of 7
search criteria, they tended to discuss international part-
nerships and suggestions for future endeavors rather
than specifics regarding contemporary program compe-
tencies or educational approaches.
Interest in global health has grown dramatically among
medical students in the past decade, and medical
schools are grappling to define the skill sets and knowl-
edge needed to ensure that graduates are appropriately
prepared to work in this emerging field. Successful glo-
bal health educational programs exist, and we explored
the medical literature to identify competencies and edu-
cational approaches that might serve as potential
resources for medical schools developing their own
training programs. This literature review found no clear
consensus on which global health competencies are rele-
vant for most or all medical graduates to be able to
draw on as future physicians. There also was little gui-
dance regarding educational approaches for teaching
global health competencies beyond the traditional meth-
ods of didactics and experiential learning.
Fifteen competencies were mentioned in the literature.
The most commonly discussed ones included an under-
standing of the global burden of disease; travel medicine;
healthcare disparities between countries; immigrant
health; primary care within diverse cultural settings; and
skills to better interface with different populations, cul-
tures and healthcare systems. Although these competen-
cies were mentioned in more than one article, no single
topic area was covered in more than 16% of identified
articles, suggesting a lack of consensus on the importance
assigned to any particular subject. It is not possible from
this review to determine why a lack of consensus exists;
one possibility may be that medical schools developed
their global health curricula independent of each other.
Such an approach may foster innovation, but also means
that the quality of resulting programs is likely to vary
widely as was found in a review of global health pro-
grams . Developing consensus on global health compe-
tencies would help ensure that all medical students were
exposed to similar basic levels of training.
An alternative explanation for the lack of consensus in
the retrieved articles is that published literature does
not reflect common practice. Despite the tremendous
growth in global health programs, only 11 articles were
identified that addressed competencies. Furthermore,
competencies were rarely the main focus of retrieved
articles, giving little information on which to draw con-
clusions. A general consensus may exist among global
health experts not reflected by the published literature.
The most common educational approaches for teach-
ing global health were didactics and experiential learn-
ing. However, the implementation of these approaches
varied considerably in the literature. Our review was
hampered by the limited descriptions of educational
approaches present in identified articles that may not
have provided a complete picture of these programs.
More detailed documentation of global health educa-
tional approaches is needed if the literature is to serve
as a resource for medical schools developing new
Figure 1 Search strategy for retrieving literature on global health competencies and educational approaches.
Battat et al. BMC Medical Education 2010, 10:94
Page 3 of 7
Of the 11 articles addressing competencies, 8 (72.7%)
linked them to an educational approach. Conversely,
educational approaches were mentioned in a majority of
articles, but less than half of these linked these
approaches to a competency. Competency-based
descriptions of training give a more complete picture of
global health education in medical curricula; schools
looking to build global health educational activities
should begin by defining the desired competencies, fol-
lowed by enumerating the educational approaches to be
used to teach them.
Over one-third of retrieved articles did not provide
specific details regarding global health educational
approaches or competencies despite the search strategy
used. These articles often focused on the creation of
international institutional partnerships to improve the
quality and pace of global health curriculum develop-
ment. However, establishing learning objectives and
corresponding educational approaches should be prere-
quisites for undertaking activities such as international
global health partnerships. This review highlights
another potential weakness in existing global health
Table 1 Global Health Competencies
Methods of Implementationb
Skills to better interface with different
populations, cultures and healthcare systems
15.6• Achieve meaningful community activities: experience working
with at least 1 refugee family at a shelter for newly arriving refugee.
• Lunch time seminars from faculty member or guest speakers with
experience in medicine abroad
• International health elective in fourth year
• Workshop in cross-cultural communication: sensitize students to
cultural differences that influence communication, teach how to
use translators by interviewing standardized patients portraying
An understanding of immigrant health[7,25,29] Knowledge/
9.4• Internet-based training module focusing on refugees’
• Self-assessment quiz focused on global and refugee health
• Cultural sensitivity workshop provided by medical faculty with
expertise in refugee health.
Primary care within diverse cultural settings
9.4• 4-8 weeks resident rotations
• Second or third year internal medicine residents; 3 clinical
rotations in the affiliated medical center of the host country
• Community activities: working with refugee families at a
Understand healthcare disparities between
Knowledge6.3• Work with patients and healthcare professionals in international
An understanding of the burden of global
Knowledge6.3• Teaching about world health reports and Disability-Adjusted
Life Years (DALYs)
An understanding of travel medicine[7,25] Knowledge6.3 Not described
Develop a sense of social responsibility Knowledge/
3.1• 4-8 weeks resident rotations
• Second or third year residents in the internal medicine training
• Emphasis: clinical rotations in the affiliated medical center of
the host country.
Appreciate contrasts in healthcare delivery
systems and expectations
Knowledge3.1• Work with patients and healthcare professionals in international
3.1 Not described
Scientific and societal consequences of global
Knowledge3.1 Not described
Evolving global governance issues Knowledge3.1 Not described
Cost of global environmental change Knowledge3.1 Not described
Taking adequate patient histories and physical
examinations in resource poor settings
Cost-consciousness; using physical diagnosis
without high technologic support
Clinical skills3.1 Not described
aThe percent of articles mentioning competencies was calculated by dividing the total number of articles discussing a certain competency by the total number
of retrieved articles.
bArticles discussing competencies without examples of how these competencies were implemented were listed as not described under the category of Methods
Battat et al. BMC Medical Education 2010, 10:94
Page 4 of 7
training; medical schools may be pursuing secondary
activities before establishing basic program components
such as competencies and educational approaches.
Without well thought-out competencies and educational
approaches, medical students may lack the foundation
necessary to participate in international global health
Steps are underway to build consensus among global
health experts regarding basic global health training for
medical students. For example, the Global Health Educa-
tion Consortium (GHEC) and the Association of Faculties
of Medicine of Canada (AFMC) Resource Group on Glo-
bal Health have created a joint committee to propose
consensus global health core competencies for medical
students . Recently, a number of leading university-
based global health programs came together to form the
Consortium of Universities for Global Health (CUGH).
CUGH is another potential forum for sharing global
health program development information across schools.
Locally, we have used the results of this review to add
global burden of disease and travel-associated health
topic areas to our curriculum. We suggest that medical
schools use a competency based approach when develop-
ing global health programs. Educational approaches can
then be linked to the learning objectives they are
designed to teach. Documenting this information in the
literature will facilitate the ability of medical schools to
compare competencies and educational approaches being
used across programs, and may stimulate consensus on
appropriate global health training for medical students.
Comparative studies also should be undertaken to mea-
sure how global health training affects clinical practice.
Table 2 Educational Approaches
Educational Approach Method of Implementation%a
• Domestic [10,19,28,29]• Mandatory clerkship in community medicine
• The first year of medical education includes a clinical and International Health and Medicine Day 
• Community prevention outreach program at a shelter for government-assisted refugees 
• Weekly patient contact is offered to all first-year students
• 2-week pre-clinical placement in developing countries[30,31]
• Pre-departure training[10,30,31]
• Two month elective at an international site[10,16,33]
• Pre-departure orientations
• Elective terms for medical students in preclinical and clinical years[7,26]
• Summer immersion experience 
• International clinical electives, international rotations and opportunities for residents
• International Health Fellowship Program (IHFP) (two weeks of full-time preparatory courses followed by 6 to 8
weeks of international fieldwork)
• Student discussions 
• Group projects
• Intensive courses (several weeks courses) [30,31]
• Core courses
• Elective courses[10,30]
• Global health “tracks” 
• Student involvement in conferences 
• Collaboration with departments of health
• Courses taught by activist faculty members
• Mandatory courses in biostatistics, epidemiology, preventative medicine and health services
• Introductory course [16,19,28,33]
• Residency “tracks”
• Preclinical courses
• Website resources
Peer Education[7,16,29]• Regular global health meetings involving student leaders and senior faculty members
• Student-run workshops for cross-cultural communication
• Student leadership with family physician mentorship
Residency Training[9,15,24]• Global Health tracks within residency programs
• Preparation for oversees electives 
• Additional year of training outside core residency programs
• 4-8 weeks resident rotations
• Block, longitudinal didactic international health training exposure to residents
Research and Scholarly
• Research opportunities abroad
• Research opportunities for residents abroad
aThe percent of articles mentioning education approaches was calculated by dividing the total number of articles discussing a certain educational approach by
the total number of retrieved articles.
Battat et al. BMC Medical Education 2010, 10:94
Page 5 of 7
Helping medical schools build appropriate global health
components into their curricula should make physicians
more informed and better equipped to care for patients
in this increasingly globalized world.
This review highlights the imperative to document glo-
bal health educational competencies and approaches
used in medical schools and the need to facilitate
greater consensus amongst medical educators on appro-
priate global health training for future physicians.
The authors acknowledge the work of the AFMC Resource Group on Global
Health/GHEC joint committee in developing the proposed competency
guidelines. Committee members include: Kelly Anderson, Timothy Brewer
(Chair), Thuy Bui, Veronic Clair, Thomas Hall, Laura Janneck, Renee King, Ann
McCarthy, Neal Nathanson, Sujal Parikh, Calvin Wilson and Karen Yeates. Also
we would like to thank Jill Boruff for assistance with the search strategy.
This research was partially funded by a grant from the Donner Canadian
Foundation. The funder did not play any role in the design and conduct of
the study, the collection, management, analysis, and interpretation of the
data, or the preparation, review, or approval of the manuscript.
RB designed the study, coordinated the research team, designed the search
strategy, conducted the literature search, organized and analyzed data, and
was the primary author of the manuscript. RB read and approved the final
manuscript. GS conducted the literature search, organized and analyzed
data, and was the secondary author of the manuscript. GS read and
approved the final manuscript. NC conducted the literature search, analyzed
data, and edited the manuscript. NC read and approved the final
manuscript. MYC conducted the literature search and analyzed data. MYC
read and approved the final manuscript. JN contributed to the design of the
search strategy, conducted the literature search and analyzed data. JN read
and approved the final manuscript. JH conducted the literature search,
analyzed data, and edited the manuscript. JH read and approved the final
manuscript. AL conducted the literature search and analyzed data. AL read
and approved the final manuscript. NF conducted the literature search and
analyzed data. NF read and approved the final manuscript. TB conceived
and designed the study, oversaw data analysis, secured funding, and edited
the final manuscript. TB read and approved the final manuscript.
There are no conflicts of interest for any of the authors of the paper,
including specific financial interests and relationships and affiliations relevant
to the subject of the manuscript.
Received: 30 August 2010 Accepted: 22 December 2010
Published: 22 December 2010
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Cite this article as: Battat et al.: Global health competencies and
approaches in medical education: a literature review. BMC Medical
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