Commentary: critical reflections on subspecialty fellowships in low-income countries

Interest in international health is growing, and international electives have become increasingly popular among medical students and residents. Subspecialty fellowships have so far been excluded from this growing popularity, but as health care indicators improve in low-income countries (LIC), a role in global health initiatives for subspecialty fellows is imminent. Improvements in patient care made in one subspecialty can carry over to other areas of health care or can represent models for the development of the health care system. In this commentary, the authors argue that global health training during subspecialty fellowships, including international electives, both represents a moral imperative and matches the goals defined by the Royal College of Physicians and Surgeons of Canada. Although international electives pose complex ethical, personal, financial, organizational, and cultural issues, to mention a few, subspecialty fellows can significantly contribute to clinical activity, provide education to colleagues and other allied health care professionals, conduct research, and help establish collaborations in LIC settings. At the same time, they gain a diverse clinical experience as well as a better understanding of cultural diversity, which will be applicable in their local practice and community. Global health training in subspecialty fellowships represents a valuable learning opportunity for both sides of international partnerships.