A preclinical global health immersion model for Amazonian villages: Cultivating cultural humility and family medicine competencies

Background: Medical education faces interconnected crises: systematic empathy decline during training (particularly Year 3), eroding patient trust, and persistent workforce gaps serving underserved populations. This empathy decline has measurable consequences: lower empathy among physicians is linked to poorer patient outcomes, lower patient satisfaction, and higher malpractice risk. Despite evidence linking global health experiences to sustained physician commitment to underserved populations, preclinical interventions remain critically understudied. The preclinical years offer an ideal but overlooked intervention window before the documented empathy decline. Objective: Evaluate outcomes from a preclinical global health immersion pilot and synthesize findings with existing literature to develop an evidence-based, scalable implementation model grounded in transformative learning theory, cultural humility principles, and ethical partnership frameworks aligned with family medicine competencies. Methods: Mixed-methods retrospective analysis of a two-week Amazon mobile clinic pilot serving ten remote villages. Participants included one OMS-II student, one PA student, and four premedical students who completed an estimated 270 supervised clinical encounters (triage, physical examinations, OB/GYN assists, dental cleanings). Data sources comprised prospectively logged activities, during-immersion interviews, and post-immersion surveys. Reflexive thematic analysis using Mezirow’s framework was conducted to identify transformative learning patterns. Activities were mapped to ACGME Family Medicine Milestones across six competency domains. Pilot findings informed development of a comprehensive three-phase preclinical global health education model and implementation toolkit. Results: Thematic analysis revealed enhanced whole-person assessment integrating biopsychosocial factors, deepened patient-centered listening and cultural humility, increased clinical resourcefulness in resource-limited settings, and strengthened commitment to serving underserved populations. Zero scope-of-practice violations and 100% completion demonstrated safety and feasibility. Students demonstrated Level 1-3 ACGME milestone achievement across all six domains, representing accelerated competency development. Integration of pilot findings with systematic literature review informed development of a comprehensive three-phase preclinical global health model, demonstrating preliminary effectiveness and indicating need for rigorous prospective evaluation with larger sample size and propensity-matched controls. Conclusion: Preclinical immersion during professional identity formation leverages transformative learning mechanisms before Year 3 empathy decline. Global health immersion cultivates family medicine competencies and offers a pathway to developing culturally humble, equity-focused physicians. This study significantly advances preclinical literature by contributing pilot evidence, a comprehensive three-phase implementation model, and an actionable implementation toolkit for curriculum integration that address critical gaps in the field.