INTL-4015 - Medical Field Experience in International Health

INTL-4015 - Medical Field Experience in International Health

Elective Title: Medical Field Experience in International Health
Course Number: INTL-4015
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: No Limit
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Year 3 Clerkships in Pedi, IM, and Fam Med. International electives require both (1) course director approval on C-Form, AND (2) institution-level approval.
Responsible Faculty Director: Dr. Bindi Naik-Mathuria Periods Offered: 1-7 & 9-13 excluding holiday period 8 
Coordinator: Bradley Brock Other Faculty: Matthew Dacso, MD, MSc
Location to Report on First Day:
field location Students should contact Dr. Naik-Mathuria ( for more information at least 6 months in advanced of travel dates.

1.To expose future U.S. physicians to health care delivery systems in foreign countries.
2.To increase student's competence in working within and appreciating different cultural systems as they relate to the provision of medical care.
3.Raise student's awareness of global health issues, and the impact of globalization on health care in the U.S. as well as other countries.

1.Refine basic clinical skills (history taking, physical examination, medical decision-making) in a resource constrained clinical care context
2.To understand concepts of community health management and public health measures as they apply to health care in resource-limited settings
3.Learn different ways to diagnose and treat patients with a variety of medical conditions not commonly seen in the US

Description of course activities
A Clerkship in the international rotation's field must be completed before going (for example, if someone is going to do an adult tropical medicine elective, they should have done Internal Medicine before leaving; if completing an international ob/gyn rotation, the ob/gyn clerkship should be completed before travel).Planning and contact with the program manager, Dr. Matthew Dacso, should begin at least 6 months prior to the expected dates of the elective. Tasks during this time include: acquiring an understanding of priority issues in international health; selecting a foreign country for the elective experience; identifying a local(on-site) health professional willing to serve as preceptor/supervisor; making the necessary travel arrangements, including passport, visas, immunizations, etc., and planning for the financing of the elective. The student should, with the help of his/her advisor, define at least 3 personal objectives for the elective. Selection of specific locations and appropriate learning experiences will be the responsibility of the local preceptor and the Health/Medical School authorities in the host country. Each student will be expected to: (1) participate with host country staff in the delivery of patient/client care; (2) assess the effectiveness of functional components of the country's health system, and (3) delineate the impact of a variety of determinants on the health of the country's population, both nationally and regionally. On return to UTMB, each student will be required to submit an evaluation completed by the field site supervisor and complete a reflection assignment. Students will have the opportunity to debrief with a UTMB faculty member.

This course satisfies the Global Health Concentration.

Students will be expected to complete registration with the US Department of State Smart Traveler Enrollment Program.

Type of students who would benefit from the course
This elective will be especially valuable to students interested in: international health; health and medical care systems of foreign countries; cross-cultural approaches to medical practice; the exploration of possible alternatives to meeting the health care needs of populations in the U.S.; students interested in community based primary care and public health.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8 5
Tuesday 8 5
Wednesday 8 5
Thursday 8 5
Friday 8 5

 Average number of patients seen per week:
 Call Schedule: Variable Depending on Site

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    as determined by local preceptor, and at end of rotation
  B. Format - What guidelines are set for the student's written work?
    Include a description of the activity, and how the student's objectives were met (or not met).
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    varies depending on site and specific objectives- participate in clinical activities as prescribed by the local preceptor

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".
    Students will have some travel cost associated with the course.

7.  Other Modes of Evaluation
  Please explain below.
    Will complete an evaluation form specific to the elective, to be reviewed with the responsible UTMB faculty member.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.