Global health: guidance for family physicians

Global health work often involves teaching, program development and system building. Organizational skills are essential for supporting continuing medical education programs, developing curricula and helping establish or strengthen local or national family medicine organizations. These skills help ensure efforts are sustainable beyond a single clinical placement.

Faculty development skills are critical in settings where family medicine training programs are emerging or expanding. This includes mentoring new teachers, supporting curriculum development and helping local faculty build confidence and leadership capacity. The goal is to strengthen local training programs rather than provide short-term instruction.

Effective global health work requires the ability to adapt to local norms, expectations and decision-making structures. This often means embracing community-oriented approaches rather than individualistic models and adjusting to different workflows and resource constraints. Developing this competency helps physicians work respectfully and effectively within host cultures.

You should have a Master of Public Health degree or equivalent community experience. Although this may be considered optional, public health training can open doors that are closed to someone who only offers clinical skills in countries that lack public health resources. A population-based preventive health approach will often yield much better health outcomes than simply offering clinical services.

Sustained involvement in global health often requires flexibility in lifestyle and career planning. Physicians may need to make difficult decisions related to family responsibilities, debt, income expectations and professional commitments. Long-term or repeated engagement may not be feasible without intentional planning and support.

In many low-resource settings, family physicians are expected to perform and teach a broader range of procedures than is typical in North America. Requirements vary by country, health system and workforce capacity, but physicians working outside the United States should be prepared to perform and teach the following skills:

You may anticipate working primarily in a clinical setting. However, you should also be prepared to teach local physicians, nurses, clinical officers, physician assistants, allied health personnel and medical students. In many countries outside the United States, a critical role for family physicians is to train local health care professionals and support the development of family medicine programs. In addition to strong teaching skills that allow you to share knowledge and experience effectively, you may also need the ability to do the following:

Review these areas before departure and check for updates during your trip.

Plan for health needs based on destination risks, available services and length of stay.

Developed by the AAFP Subcommittee on Global Family Medicine, this resource outlines suggested training topics for medical schools and residency programs planning global-health-service-learning experiences.

Many countries and regions have laws, regulations and professional standards governing the recording, copying, storage, disclosure, display and distribution of materials such as photos, videos and medical information. These rules may prohibit, restrict or otherwise control how a particular image or item of information can be used.

For example, copyright and privacy laws may prohibit publishing certain photographs without consent. Child protection laws may prohibit posting photos or videos of children online, even when consent has been obtained. Health information protection laws may restrict sharing certain types of medical information.

The considerations discussed here are not intended to provide or substitute for legal advice. They do not cover all laws, regulations or professional standards that may apply in a particular country, region or situation. Because application of these rules depends on the countries involved, the content of the image or information and the intended use, you should seek legal counsel for guidance in specific circumstances.

Confidentiality and privacy protections extend to a wide range of materials that reveal information about an individual, including photographs, videos, voice recordings, patient records, personal history and location data. These considerations apply not only to patients but also to other people who may be shown or described, such as family members or community members.

These protections apply in any setting where clinical activities occur, even in public places. Sharing information beyond those directly involved in a patient’s diagnosis and treatment—whether through presentations, publications or other communications—raises confidentiality and privacy concerns.

Public dissemination, such as posting material on the internet, may increase risk. However, lectures, journal articles and other professional communications with limited audiences may also require careful attention to confidentiality and privacy.

A patient’s agreement to have a photo or other image taken may imply consent for clinical diagnosis and treatment. It does not imply consent to share that image publicly, such as in a publication or on the internet, or to distribute it beyond those directly involved in the patient’s care.

Best practice is to obtain express informed consent before including a photo, video or other recording of an individual in any communication beyond those directly involved in the patient’s care, such as a lecture, presentation, publication, online article or blog post.

Informed consent requires clearly explaining how the material will be used and shared, including whether it will appear online and what steps will be taken to de-identify it (see “De-identify images and recordings”). If the individual is a child, consent must be obtained from a legal guardian.

Standards for obtaining consent to take or use images may vary across cultural, geographic and political settings. In some situations, meaningful consent may not be feasible.

Even when consent has been obtained, physicians should prioritize the subject’s dignity, cultural context and personal safety. Images should portray individuals and communities respectfully and maintain professional standards. Extra care is required when the subject is vulnerable, including children, people with disabilities and individuals who may not be living freely, such as refugees, prisoners or victims of conflict.

The safety and protection of individuals and their personal information must take priority. Do not use images that could place someone at risk.

A variety of power differentials may exist between those capturing images or other recordings and the subjects of those images or recordings (e.g., differences in provider role, education, political status or socioeconomic position). These power differentials can interfere with the ability to obtain truly free consent, especially in global health settings that involve cultural differences, geographic boundaries and complex power dynamics.

In addition, images of certain physical manifestations of illness may cause embarrassment or ridicule, or risk linking a patient’s identity with medical information. When obtaining consent, be aware that a subject may not fully understand these risks or their potential consequences. Also, keep in mind that once an image or recording is posted on the internet or otherwise distributed outside the physician’s direct control, it may be used in ways that differ from the original intent of the consent.

For these reasons, even when informed consent is obtained, it is best practice to de-identify images and other recordings so individuals cannot be recognized, particularly when the material will be distributed beyond the physician’s immediate control. For example, a physician may choose to use identifiable images in a live, in-person presentation to a group of physicians. However, if that presentation is recorded, posted online or distributed in printed form, the images in those versions should be de-identified.

The appropriate steps to de-identify an image or recording depend on its content and purpose. In all cases, direct identifiers such as patient name, medical record number and date of birth must be removed or redacted. For non-facial conditions, it is advisable to obscure the face and any distinguishing physical features. For facial conditions, images should be cropped so the entire face is not visible, and identifying features such as the eyes and nose should be obscured to the extent reasonably possible. Similarly, voice recordings should be modified to prevent identification by voice.

To preserve confidentiality and protect patient privacy, descriptions of a patient and their circumstances should be de-identified in any presentation or communication beyond those directly involved in the patient’s diagnosis and treatment.

Ways to de-identify this information include:

Establish standards within your organization for maintaining accurate records of informed consent obtained for the use of images, recordings and related materials, including the nature and scope of that consent. Educate personnel on the importance of obtaining informed consent and de-identifying images, recordings and other patient information.

Limit access to these materials to authorized personnel and monitor their use to prevent deliberate or inadvertent misuse. If improper use of images or information is identified, take prompt and reasonable steps to stop further use or dissemination.