Going Global { featured story

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Increasingly, medical schools are offering clinical rotations overseas as an elective.

1Drain et al (Global health in medical education: A call for more training and opportunities. Acad Med. 2007; 82:226-230)

2Thompson et al (Educational effects of international health electives on U.S. and Canadian medical students and residents: A literature review. Acad Med. 2003; 78:332-347)

3Drain et al (Global Health Training and International Clinical Rotations during Residency: Current Status, Needs, and Opportunities. Acad Med. 2009; 84:320-325) F or more than a decade, universities have been studying the myriad ways in which global health training shapes a physician’s career path and philosophies of care. In one study, researchers documented that American students who completed an international rotation were more likely to choose a primary care career2, an area of particularly high need nationwide.

Two years after publication of the 2007 survey results, Academic Medicine published a follow-up report by the same authors. They reported that medical students and residents who took advantage of international clinical opportunities were also more likely to pursue work with underserved populations upon their return3. In addition; the article noted that the globally exposed students were more confident performing physical examinations and other clinical procedures. The authors speculated that the inability to rely on expensive diagnostic tests forced students and residents to hone their clinical judgment.4

In recognition of how “small” the world has become and to respond to the increasing demand for international rotations, WVSOM formally established the Center for International Medicine and Cultural Concerns (CIMCC) in 2009. Prior to 2009, students who wished to do an international rotation had to make their arrangements independently then present their proposal to the assistant dean in their Statewide Campus region. There were no guidelines or restrictions, other than minimum academic requirements, and there was no assistance in how to proceed.

During this period, the AOA’s Bureau on International Osteopathic Medical Education and Affairs (BIOMEA) circulated a white paper Guidelines for International Electives and Cultural Competencies for Osteopathic Physicians-in-Training, which recognized the “significant impact of culturally diverse perspectives, values, beliefs, traditions and customs upon health care choices, health policy and actual delivery of care.” The AOA recommended that osteopathic medical schools establish a core “cultural competency” curriculum that would “meet the challenges of cross-cultural issues and osteopathic care for culturallydiverse groups in the United States” and offer standardization of expectations for international clinical and/or research electives.

To advance the successful implementation of international clinical curricula, the BIOMEA drafted an outline of recommendations for COM students and OPTI residents seeking a more global education. The guidelines emphasized a commitment to ethical principles and sensitivity to every patient’s age, gender, religion, culture, disabilities and impairments, along with the need to be open-minded to medical practices and delivery systems which differed from anything the student travelers had previously experienced.

Adrienne B. Biesemeyer, a licensed professional counselor (LPC) and one of WVSOM’s learning specialists, oversees the CIMCC.

“The CIMCC’s mission is to assist WVSOM students to train globally in medically underserved communities,” Biesemeyer said. “Everything we do is designed to develop physicians who are culturally aware, sensitive and knowledgeable. We believe their overseas experiences can make them uniquely qualified to practice in underserved communities here in West Virginia and throughout the U.S.”

The CIMCC assists students to find worthwhile clinical training in areas around the globe which have a high need and, often, limited resources such as India, the Dominican Republic, the townships of South Africa and recently added Malawi, just to name a few. WVSOM students can rotate anywhere in the world, if the CIMCC determines it is safe, based in part on travel information provided by the U.S. State Department.

“The international experiences WVSOM students gain are unlike any other,” Biesemeyer continued. “Students learn how to deliver babies without the help of 21st century technology, to perform surgery with gas-generated lights and so much more they will never experience in a modern clinical setting.”

From the CIMCC’s launch in 2009 through July 2013, 45 WVSOM students have traveled on international clinical rotations. More remarkable is that 45 students have completed the pre-application process for international rotations taking place in 2014-2015 — equaling in one year the sum of the previous three. An additional 80 students have identified their international interest or plans to apply, but have yet to submit the necessary paperwork. Biesemeyer is actively engaged in developing the international opportunities for WVSOM students and recently returned from an overseas trip, which strengthened relationships with medical institutions in developing countries. WVSOM students on international rotations report back to Biesemeyer with their experiences, good or not so good, to ensure she remains informed and up-to-date on the quality of training and medical exposure being experienced.

For osteopathic medical students traveling abroad, these experiences not only provide an opportunity for hands-on training in resource-scarce environments or exposure to indigenous and tropical medicine, but they serve to educate the global health community about the philosophy and practice of osteopathic medicine in this country.

In the student diaries that follow, readers may discover for themselves how international health experiences can broaden a student’s perspective and provide a greater understanding of the effect of health and illness on individuals and their local cultures.

“We seek out experiences for our students which will be meaningful, but also safe,” Biesemeyer said. “We cannot promise them personal transformation, but many do come back transformed — more capable, more confident; more humane.”