Background: Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. Method: This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. Results: Existing guidelines are almost entirely written by and addressed to educators and practitioners in the Global North. There is broad consensus on key principles for responsible, effective, and ethical programs-need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. Conclusions: Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles.

Canadian undergraduate nursing programs have incorporated global health concepts and experiences in their curricula as these are elements of Registered Nurses’ entry-level practice competencies. With their knowledge of global health concepts, nursing students are aware of local, national, and international populations’ health needs. While there are multiple ways of promoting such knowledge, many nursing programs include optional clinical experiences abroad. This dissertation explored nursing students’ reentry process following immersive global health clinical experiences in resource-limited international settings. Charmaz’s Constructivist Grounded Theory approach was used and led to the development of a substantive theory named Reentry Process Theory. Data was gathered through face-to-face in-depth interviews with 20 participants recruited for the study, including Level 4 nursing students, nursing alumni, and faculty from a School of Nursing in Ontario. Data analysis identified 4 conceptual categories that explain processes embedded in participants’ reentry experiences: adjusting to being back, seeking understanding, making meaningful connections, and discovering a new self. Findings revealed the importance of understanding experiences and factors that impact the lives of nursing students who have lived and studied in resource-limited international settings not only in their role as students but also as individuals and soon to become professional nurses. Recommendations are made for education, research, policy and for future undergraduate students pursuing a global health clinical experience. / Dissertation / Doctor of Philosophy (PhD) / Many Canadian undergraduate nursing programs include optional clinical experiences abroad as a way of fostering nursing students’ knowledge of global health concepts as well as local, national, and international populations’ health needs. This dissertation investigated factors that impact nursing students’ reentry process following immersive clinical experiences in resource-limited international settings. The study adopted Kathy Charmaz’s constructivist approach to Grounded Theory and constructed a Reentry Process Theory that addresses nursing students’ personal and professional development. Data was gathered through face-to-face in-depth interviews with 20 participants, including Level 4 nursing students, nursing alumni, and faculty from a School of Nursing in Ontario. Data analysis identified 4 conceptual categories that underpin participants’ reentry experiences: adjusting to being back, seeking understanding, making meaningful connections, and discovering a new self. Recommendations are made for education, research, policy and for future undergraduate nursing students involved in immersive clinical experiences abroad.

From Dar es Salaam to Dartmouth: A Case Study of the Experiences of Fogarty AIDS International Training and Research Program Fellows at Dartmouth Lisa Purvis, EdD Candidate, MPH, MBA Background The United States (US) is a major host nation to international college students and scholars who study a variety of disciplines (Farrugia & Bhandari, 2014). Beginning in the last decade, the demand for global health training has risen (Kanter, 2008; Kerry, Ndung'u, Walensky, Lees, Kayanjas, & Bangsberg, 2011). Since 2000, Geisel School of Medicine at Dartmouth has been one of 26 US universities participating in a global health training program, funded by the National Institutes of Health, Fogarty International Center's AIDS International Training and Research Program (AITRP). The Fogarty AITRP annually trains scholars (Fogarty Fellows) and focuses on building HIV/AIDS research and medical capacity in low- and middle-income countries through advanced training. Along with the economic, social, and cultural assets that international students bring, are key challenges in students' transition, assimilation, and acculturation. It has been observed that many of the Dartmouth Fogarty Fellows have experienced issues in matriculating at Dartmouth. Purpose of Research Little data exists on the experiences of international students studying global health in the US. Using a case study of the Fogarty Fellows at Dartmouth, this qualitative research project sought to examine their unique transition and assimilation experiences as international graduate students. A secondary purpose of the case study was to identify ways to improve students' experiences. Berry's theory of acculturation provided the theoretical framework for the project (Berry, 1997). Research Approach A qualitative approach was used, guided by Action Research methodology. Action Research focuses on problem-solving and it is typically defined as a reflective process of progressive problem-solving led by an individual(s), who is part of the community of practice, to address issues and solve problems (Bargal, 2008). Research Methods To gain a fuller understanding of the issues and to identify solutions to problems of acculturation that may already exist, in-depth interviews took place with 22 participants: 1) 10 alumni of the Fogarty Program at Dartmouth College; 2) 5 MPH faculty at Dartmouth; 3) 2 MPH administrators; 4) 4 Dartmouth Fogarty Program administrators; and 5) the Fogarty International Fellows Program Officer at NIH. Field research also took place in Tanzania, the home country of the Fogarty Fellows at Dartmouth, to understand the Tanzanian context. Findings Recommendations for program improvement included formalizing the program at several milestones; providing comprehensive pre-matriculation information; using technology to orient Fellows to their new environment; formal mentoring and networking; cross-cultural training with students; and orienting the faculty to the program and the needs of international students. Colleges and universities need to understand the unique experiences and the student support needs of the international student. Future research at the 25 Fogarty AITRP US-based sites is recommended before implementing any of the Dartmouth-based recommendations.