Why no AAVMC guidelines for pre-vet students providing patient care abroad?


In the US, one of the most common — if not the most common reason — for pre-vet students to volunteer internationally is because they want to perform surgery. VIDA is the only company that wink/nod/unofficially sells that opportunity to inexperienced high school and undergraduate students. In the pre-med world, there is a bigger voluntourism industry catering to students’ desires to gain clinical experience and make themselves competitive applicants to professional schools. (Although I’ve never heard of a pre-med student performing surgery.) The bulletin boards of every building at my undergrad university were plastered with “volunteer abroad” ads, including for pre-med programs.

Because international volunteering is popular with pre-medical and pre-dental students, both the American Association of Medical Colleges and the American Dental Education Association have written guidelines on volunteering in countries with loosely-enforced rules around medical care. These publications are distributed to colleges, and were publicized by my undergrad university’s pre-health advising department. It’s good to see medical and dental schools send the message that ethics are important when working in developing countries. (Which should go without saying.) See the full .pdf documents here: Guidelines for Premedical and Medical Students Providing Patient Care During Clinical Experiences Abroad, and Guidelines for Predental Students Providing Patient Care During Clinical Experiences Abroad.  Some key bits from the AAMC’s guidelines:

Many students are now taking advantage of opportunities to gain clinical experiences abroad, where regulations governing the procedures that students can perform on patients are often less stringent and well defined than in the United States and Canada. Additionally, existing local regulations may not be uniformly or fully enforced. While many students have had beneficial experiences through involvement in patient care activities abroad, and services have been provided to people in need, the potential for harm and abuse in these situations cannot be ignored…

There are companies that will, for a fee, help place you in a foreign clinic. Be aware that some of these companies are in the business of making money first, and they may not be ethically sound. Check out these companies very carefully before signing any contracts. If any agency is over-promising and suggests that you will actually practice medicine while abroad, rather than simply observe or shadow, you should have serious reservations about working with this agency…

Always keep the welfare of the patient foremost in your mind, not the perceived opportunity for proving yourself. Ask yourself how you would feel if you were in the place of a patient and a person with limited skills and preparation was about to perform a procedure on you. If this thought makes you feel uncomfortable, it is probably not an appropriate task for you to be doing. Recognizing patient autonomy is one of the core values of medical ethics; it is particularly important to honor in communities with limited resources, where all patients must be given the choice whether or not to have trainees involved in their care.

Why doesn’t the American Association of Veterinary Medical Colleges have similar guidelines for pre-vet and vet students? They already have a template of what those suggestions could look like from the AAMC’s document. I emailed the AAVMC about this in 2014, but no one has yet replied to me. Perhaps if they hear from multiple people politely asking them to create a guideline page for students volunteering abroad, they might produce one. Their contact form is here. Such guidelines would be non-binding and unenforceable, but it still demonstrates an acknowledgement that animals in developing countries, just like humans in developing countries, aren’t expendable and invisible educational models for the privileged to practice on. Volunteering abroad is a great thing, but it must be done so thoughtfully.

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