Mandatory Global Training Experiences

Grasp of global health issues and engagement in global health efforts should be ingrained in physician education in a structured, integral way, not offered as an optional add-on.

Much of this need not require boarding a plane. Online case-based learning sessions can be conducted remotely across borders, pairing trainees in different health systems around the same clinical problem. Joint projects in research and design can bring students together internationally at no cost beyond coordination. Shared journal clubs, cross-national morbidity and mortality conferences, and collaborative quality-improvement projects all work at distance. And immersion by site visit remains valuable where it is bidirectional and not extractive.

Nor need such programming be relegated to individual medical schools operating alone. Joint programs can be developed among the medical schools of a given country, together reaching out to other countries and regions, which distributes cost, widens the pool of partner institutions, and gives smaller schools access they could not build unilaterally.

One objection has been accumulating since Chapter VII. The curriculum is already full, every identity chapter has closed by adding a formative requirement, and a mandatory global experience is one more claim on the same finite years. The objection would be decisive if these were content to be added. Chapter XI argues instead that the inherited curriculum is organized around content a machine now holds better than any graduate will, and that what replaces it is a different organizing principle rather than a longer list. The global requirement is feasible only inside that reorganization. Part III proposes what should occupy the room that already exists.

The concept of glocal belongs in the curriculum: raising awareness of global issues through local engagement. The determinants that produce ill health in a refugee settlement operate, in different proportion, in the catchment of most teaching hospitals. A trainee who has worked with a local immigrant community, a rural health shortage area, or an urban housing crisis has encountered the same structural logic that global health describes at scale.

The failure mode of global health education is the well-intentioned trip that changes nobody's practice, which is why formation of the global physician identity should be stated as competencies. The graduate should be able to read a population as fluently as a patient, asking what the denominator is, who is missing from it, and what determines the difference. The graduate should also be able to evaluate whether a tool validated elsewhere applies here, and to say so when it does not; to work as a guest, not an expert, in a system not their own; and to recognize, in their own catchment, the structural logic that global health describes at scale. These capacities transfer; they are not destination-specific. The glocal framing therefore becomes a practical center of the curriculum.

Health is managed at the level of populations, not only individuals. Risk stratification, prevention, and attention to social and environmental determinants make the physician a guardian of the public's health, and of communities and the planet. Beyond the individual encounter, the physician shapes the systems, incentives, and conditions that produce health, accepting a renewed social contract for fairness, stewardship, and the public good.

Four identities have now been described, and Part III asks how they are actually produced.

Part Iii

The Transition