Managing the Unpredictable: Recommendations to Improve Trainee Safety During Global Health Away Electives

– Avoid hazardous methods of transportation (e.g., motorcycles).

– Understand crime patterns; avoid traveling alone in high crime areas, especially at night.

– Establish procedures for accidental exposures, chemical prophylaxis, and PPE requirements.

– Link trainees and institutions for choosing health and evacuation insurance that meets individual health and site-specific needs.

– Provide training on away institution sexual harassment reporting and counseling policies as part of pre-departure orientation.

– Establish a method of communication and identify a contact person.

– Plan administrative/institutional response to handling cases of sexual harassment.

– Assign a liaison at the student/administration interface to modify rotation requirements and protect student privacy.

– Review insurance to ensure mental health concerns are a valid reason for evacuation.

– Screen for trainee mental health concerns during regular check-ins (weekly/biweekly).

– Review insurance for coverage of trauma-focused counseling, especially if the away institution does not have similar resources available for trainees.

– Enroll in government-based program (e.g., STEP).

– Establish regular communication between the trainee and institutions (weekly or biweekly)

– Ensure access to health, disability, and evacuation insurance while abroad.

– Create a contingency fund and advocate for additional resources.

– Ensure access to trauma and sexual harassment-focused counseling from home and/or away institutions; if these resources are insufficient, activate evacuation response.

– Establish clear procedures for reporting cases of sexual harassment or assault within the away institution administration.

– Reach out to emergency contacts.

– Follow daily communication plan between trainee, home institution, away institution, and necessary external resources; the away institution should provide hyperlocal safety information for all other parties.

– Create clear thresholds to activate various levels of emergency response between administrations (i.e., when to suspend rotations, when to evacuate trainees).