UC Davis Medical Students Go Globally and Think Locally
In theory, medical education begins by learning concrete information and slowly (under supervision)
expanding on general principles of medical diagnosis and treatment to gain proficiency. It is only after
years of hard work and careful dedication that the mature, evidentiary clinical mind is born. Just two
weeks shy of completing our first year in medical school, I think back to some of the challenges that
we overcame individually and as a class, and forward to those that lie ahead in the future. What obstacles
are most significant for our future as physicians? How might we address these potential areas in the present,
while we still have the time and flexibility in our schedules?
UC Davis School of Medicine has implemented courses specifically pertaining to doctor-patient communication.
These courses seek to establish early familiarity with the interview and physical examination process
in order to stimulate future development of these skills. Furthermore, the numerous student-run clinics
associated with the School of Medicine provide invaluable opportunities for supervised, hands-on practice
in patient care every weekend. All of these factors combine to form a strong basis for developing skills
that will be transferable when we begin our clinical training in the third year. However, will our ability
to function as physicians be compromised if we encountered patients from a different culture, that spoke
a different language, and who believed in a system of illness that may or may not be compatible with our
own medical opinions? In other words, if the crux of the doctor-patient relationship lies on the ability
to communicate with our patients, how can we acquire the skills necessary to contend with differences
in language and culture?
To address this issue, a group of tenacious and enterprising medical students at UC Davis has started
what we hope will become a formalized international program for medical students. Through this program,
current and future medical students can be exposed to language, culture, and health care in Nicaragua.
The MEDICOS (MEDical Intercultural Opportunities for Students) project began in the fall of 2003, as the
vision of medical student Andrew Mihalek, and has grown to encompass an enthusiastic and dedicated core
of students from various years. Owing in large part to assistance from the Davis chapter of Rotary International,
MEDICOS has allied with the Universidad Nacional Autonoma de Nicaragua (UNAN) in León to afford UC
Davis medical students an opportunity to travel to Nicaragua gain firsthand, immersive exposure to foreign
culture, language, and medical practice. Students will participate in patient diagnosis and care in the
Centro de Salud in Subtiava as well as in primary care health posts in the outskirts of León, which
help service the underserved community in the region. Supervision will be provided through both Nicaraguan
clinical physicians as well as UC Davis physician preceptors traveling to Nicaragua. In addition to extensive
exposure to the primary care clinic in Subtiava, students will also have opportunities to shadow physicians
in the secondary and tertiary care centers in León and gain an understanding of the state of healthcare
in Nicaragua. Lastly, all students will include Spanish language schooling particularly geared
towards medical terms and patient interview to complement the extensive patient exposure throughout
the four-week program.
As it became increasingly evident that the MEDICOS project would become a reality, institutional support
from Michael Wilkes, vice dean of medical education, and Mark Schenker, professor and chair of the Department
of Epidemiology and Preventive Medicine, has been forthcoming. Additionally, three UC Davis faculty members
will be traveling to Nicaragua this summer to serve as clinic preceptors: Douglas Gross, from the Department
of Pediatrics and Human Anatomy, Ron Sprinkle, from the Department of Family Practice, and Stephen McCurdy,
from the Department of Epidemiology and Preventative Medicine. We are very grateful that these excellent
clinical preceptors were available on such short notice to provide a crucial component to our medical
Many of the medical students involved in MEDICOS have contributed significant amounts of time, money,
and thought to help make this idea into a reality. At each step along the way, our group has called upon
individuals to step up to meet a challenge, and each time our group has responded with remarkable ingenuity.
However, there remain numerous areas in which our concerted efforts could be greatly augmented by assistance
from the medical community at large. Resources remain an area of continuous need, and include:
In regards to medical supplies, we welcome both equipment as well as pharmaceutical donations (which
are tax deductible). A lack of basic resources at the clinic in Subtiava presents unique challenges to
adequate patient care. Most medications will likely be used during the trip, so pharmaceuticals nearing
expiration are perfectly acceptable, as is old equipment. Finally, trip costs for students primarily
due to airfare will approach $1000 per person. While we have been resourceful in procuring modest
travel funding through external and internal sources, each student will pay the bulk of the expenses from
their own pockets. We graciously accept any of the above donation types, and encourage you to inquire
about these or other ways in which you can contribute to the MEDICOS project.
The first clinical cohort traveled to León June 28 through July 22 (an update to the project will be
published shortly). The group anticipates returning to León in the summer of 2005, with the possibly
of an earlier visit in the winter of 2004, pending preceptor and student time and interest.
Our goal is to develop this program into a reliable and ongoing opportunity for UC Davis medical students
to gain international health experience. It is directed towards providing care in a location of great
need, and where students can make a tremendous and immediate difference. But beyond these immediate goals,
we believe that improving awareness and communication between doctor and patient will ultimately increase
quality of healthcare we can provide in the future in ways that are not readily taught through the medical
We welcome any questions, comments, or recommendations on how to improve our program. For more information
on precepting, donations, or about MEDICOS in general, please contact us by e-mail at firstname.lastname@example.org
or call Antonio Germann at (530) 757-7852.