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 education.

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 curriculum.

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 ucdmedicos@yahoo.com or call Antonio Germann at (530) 757-7852.