Garrett Masey MD, Sindhu Dwarapumdi BS, Ayesiga Herman MBBS, Lily Gutnik MD MPH
The demand for global surgery has been on the rise in medical schools across the United States. International electives during medical school and residency training encourage personal growth, deepen medical knowledge, and develop cultural competence of our future medical care providers. Although bidirectional exchanges occur, more frequently, opportunities are afforded to students in HIC to visit hospitals and institutions in LMIC.
We want to share three unique perspectives on these experiences: a fourth-year medical student who participated in an international rotation, the US academic surgeon with a globally focused career, and the Tanzanian surgeon who hosts students from all over the world.
Garrett Massey is a recent graduate of UAB Heersink School of Medicine and currently a general surgery resident at Vanderbilt with a strong interest in global surgery. She spent one month in Tanzania at Kilimanjaro Christian Medical Centre (KCMC) rotating with the acute care surgery service. Her goals for this experience aligned with objectives of her previous rotations in the United States: further medical education and contribute to the surgical team. However, she also developed professionally as a result of self-assessment of her role on the team and flexibility in goal fulfillment. She was guided by observations and feedback from KCMC residents and faculty rather than adhering to preconceived ideas and expectations of medical student contribution. Garrett recommends that other medical students pursuing international rotations similarly “find a way to align their contributions with the needs articulated by the local institution instead of coming in with a rigid view.” By engaging deeply and letting your actions be informed by the priorities of the local partners, you are more likely to experience a deeper sense of personal fulfillment. Garrett’s international rotation has shaped her outlook and approach to care as a health care provider, and she encourages all medical students to participate in international rotations if feasible.
Dr. Lily Gutnik is an assistant professor and Associate Vice Chair of Global Surgery at UAB whose research focus is breast cancer screening and detection in low resource settings such as KCMC. Her primary expectation of medical students is to learn both within and outside the operating room. Dr. Gutnik realizes the transformative nature of these experiences firsthand as she has studied, researched, and cared for patients across the globe. She encourages medical students pursuing an international rotation to take in the challenges unique to global healthcare settings and immerse themselves in a completely different culture and perspective of healthcare. “Medical students should embrace these as a valuable opportunity to broaden their horizons, carefully observe medicine in a low-resource setting, and remain sensitive to the context in which healthcare is delivered by listening to those who navigate the system every day.” Dr. Gutnik places less emphasis on medical student contributions to the team and regards those actions as exceeding general expectations. While she recognizes how tasks like note writing and patient transport, common medical student responsibilities, can be the foundation to understanding the health care system, she emphasizes making learning a priority during international rotations to become a compassionate and competent healthcare provider.
Dr. Ayesiga Herman is a colorectal surgeon and director of surgical services at KCMC. His approach to hosting medical students varies from student to student and begins with expressing expectations. He acknowledges one component of medical student engagement centered on problem recognition and working on a team to find solutions. He extends this concept beyond patient care to include the health care system. For example, Garrett is a part of the research team focused on analyzing reasons for prolonged hospital stay in the surgical wards. Including medical students in these types of projects develops a framework for identifying bottlenecks in health systems. By mentoring students as they work to identify and address systemic challenges, Dr. Herman nurtures their sense of inquiry and innovation. He notes that it is important for medical students on international rotations to develop their problem-solving skills, stating “Those that come in with an open mind to their rotations are better able to acknowledge local problems and use their unique perspectives and knowledge to successfully challenge even embedded structural issues, improving healthcare delivery for all individuals.”
In conclusion, expectations of international rotations differ with each individual, although both Dr. Gutnik and Dr. Herman similarly hold a broader perspective of medical student goals. Dr. Gutnik’s focus is on education while Dr. Herman emphasizes the role of the health care system. Garrett’s perspective evolved throughout her rotation: initially focusing on tangible tasks and ultimately broadening her mindset. Overall, Dr. Gutnik, Dr. Herman, and Garrett highlight the importance of adaptability in one’s responsibilities while appreciating the perspectives of the local institution as a medical student participating in an international rotation.
Lily Gutnik