On-the-Job Training
Another eye opener for those who go abroad is the chance to observe differences in practice and learn about physician training. “In many countries there is very little structured training after graduation from medical school,” notes Dr. Jovin. “Young doctors learn by following more senior doctors around; it is more an apprenticeship-type training. In many rural areas, fresh medical school graduates may be practicing alone with very limited diagnostic and treatment tools.”
Tanyaporn Wansom, MSIV, a fourth-year medical student at the University of Michigan Medical School in Ann Arbor, is the 2007-2008 chair of the Global Health Action Committee for the American Medical Student Association. During her 2006-2007 stay in Thailand (as an NIH/Fogarty Global Health and Clinical Research Fellow at the Research Institute for the Health Sciences, Chiang Mai University), she was especially impressed with the broad range of diagnostic skills possessed by her supervisor, an infectious diseases (ID) fellow. “For example, I know how to do a lumbar puncture if I am worried about the possibility of meningitis,” she says. “I know how to put the [cerebrospinal] fluid in a tube and send it to the lab. But there, my ID fellow knew how to do all the stains herself, and was able to make immediate diagnoses. There are strengths to the specialization of the American healthcare system, but it is amazing to go abroad and see what other doctors can do.”
This impression is echoed in evaluation forms from the UCSF Global Health Scholars Program, says Dr. Dandu. “One of the common comments is, ‘I’m incredibly impressed by my colleagues abroad because of their amazing physical exam skills,’ ” she says. She believes the exigencies of medical practice in the United States (reliance on testing, adherence to reporting, and regulatory requirements) often mean residents and physicians do not have “the space to focus on the physical exam or the patient’s history. And sometimes, with the way we practice medicine here, it can take longer to see the fruits of what we do and see. In their one-month immersions, people have the ability to see and effect change in a more direct way.”
Dr. Bui
Tanyaporn Wansom, MSIV (bottom center) from the University of Michigan Medical School in Ann Arbor, found great benefit from her 2006-2007 service in Thailand.
Rare Encounters
Wansom, who is Thai-American, was motivated to work abroad by her curiosity about her ancestral roots and her commitment to working with people living with HIV/AIDS. She found the physician-patient relationship quite different in Thailand. “Patients look up to you, almost as they would a deity,” she says. “Sometimes it is hard to get their real input on what they are feeling. You may think, because they are nodding, that they are agreeing with everything you say and are totally compliant. In fact, the opposite may be true.”
It is this kind of sensitizing experience that can improve clinicians’ skills when they return to the States, says Dr. Bui. At tertiary care centers such as UPMC, a large transplant center, hospitalists are likely to encounter people from all over the world. “If they have interacted with people from a different culture, they can deal with our [mix of] inpatients better,” she says.
Another significant benefit of traveling to developing countries is that residents get a chance to treat diseases rarely seen in the United States, says Dr. Bui. For instance, she says: “A resident who had treated patients with dengue fever during his clinical elective in India would be quick to include this differential in a returning traveler from Central America admitted to our hospital with fever, headache, myalgia, and a rash. Having seen some of those diseases during their international elective, residents are more comfortable with managing those kinds of diseases, such as when treating travelers who come back with malaria.”