Producing the global health doctor: discourses on international medical electives

The field of global health has grown rapidly over the past two decades. In response, academic institutions have established new educational practices and training opportunities for students. One flourishing area of global health training is in international medical electives (IMEs) in which medical students experience medicine in a different political, cultural, and epidemiological context for a short period of time. Scholarly literature on IMEs has been published and disseminated widely, and various discourses establish the way that IMEs are understood and experienced. However, rather than offering neutral descriptions, discourses actively shape the world in favor of certain viewpoints. When accepted uncritically, dominant discourses can reproduce inequalities by legitimizing certain practices. In the field of global health, dominant discourses have been largely unexamined and unquestioned. Informed by social constructionist and post-structuralist views of language, this study critically examines IME discourses in 60 journal articles published between 2000 and 2011. A method for analyzing discourse influenced by the French philosopher Michel Foucault was used to emphasize the intricate relationship between discourse, knowledge, and power. The findings reveal that two dominant discourses cohere to produce commonly accepted and appropriate knowledge about IMEs. The discourse of “disease and brokenness” depicts IMEs as situated in faraway lands plagued by “exotic” diseases, and the discourse of “romanticizing poverty” portrays developing countries as trapped in time. These discourses emphasize and privilege certain meanings, while discrediting and silencing others. Moreover, IME discourses constitute uneven power relations and are characterized by a language that relies on dichotomies. In both of the identified discourses, medical students are privileged subjects while inhabitants are marginalized. As a result, inequalities between developed and developing countries are reproduced and the possibilities for forming mutually beneficial relationships during IMEs are constrained. Recognizing that reality is constituted through language, the findings indicate that prevailing representations are constructed rather than inevitable “truths”. Furthermore, this study suggests that dominant meanings can be resisted, articulates how current “truths” can be destabilized, and proposes a new way of conceptualizing IMEs. By critically reflecting on their work, students, researchers, and practitioners in the field of global health can engage in more socially just practices