International Medical Rotation Curriculum

Goals:

1. Exposure to clinical medical education in a foreign country.
2. Exposure to disease processes not commonly encountered in the United States.
3. Opportunities to teach from the perspective of an American-trained medical professional.
4. To develop and nurture trainee’s sense of altruism.
5. Develop and practice medical Spanish language skills.
6. To gain understanding of how the social, economic, and environmental issues affect health care in the Dominican Republic.

Curriculum:

The rotation has three main learning opportunities at Hospitál Cabral y Báez. There are many other opportunities to take advantage of if you are interested, these are listed at the end.

1.    Outpatient Internal Medicine Consults, Hospitál Cabral y Báez

On Monday-Thursday, four fourth-year residents see patients in an outpatient clinic.  There is an attending overseeing the clinic and is sometimes there to help with complicated patients.  Clinic begins at 9 to 9:30 and usually lasts until noon.  On average, residents see about 10 – 12 patients per day.

a.    Attend morning report with Dominican residents and students.

b.    Attending will help oversee patient visits facilitated by Dominican resident.

c.    Trainees will have opportunity to practice physical exam as well as history taking in Spanish.

d.    While Dominican resident provides Dominican perspective, American attendings and trainees can provide their own unique perspective.

e.    Attend afternoon conference.

f.      Choose patient to present at “Brown rounds” in the afternoon.

g.    Participate in afternoon PBLs and journal club discussions.

2.    General medical floors, Hospitál Cabral y Báez.

Hospitál Regional Universitario José María Cabral y Báez (HRUJMCB) is a public regional hospital in Santiago serving as the main tertiary care center for the northern half of the Dominican Republic.  It is also the main teaching hospital for the three medical schools located in Santiago.  During their time on the medical floors students/residents will:

a.    Be paired with a resident from the Dominican Republic.

b.    Spend one evening or night in the Emergency Department – try to do this early in the week as it is a great way to pick up a patient to follow the rest of the week

c.    Attend morning report with Dominican residents and students.

d.    Round with the team of the resident with whom they are paired.

e.    Choose a patient during rounds to follow up on later in the day.

f.      Attend afternoon conference.

g.    Follow up on the patient chosen in the morning, read the chart, and present the patient at “Brown Rounds” (see below).

h.    Participate in afternoon PBLs and journal club discussions.

3.    Clínica de Enfermedades de Inmunología (HIV clinic), Hospitál Cabral y Baéz.

The HIV clinic in Hospitál Cabral y Baéz is run by Dra. Claudia Rodriguez, one of Brown’s main contacts here in the Dominican Republic.  Patients are seen by Pasantes, which are medical trainees doing a mandatory year of service before entering residency.

a.    Attend morning report with students on medical floors.

b.    Observe and help with clinic visits during regular morning clinic hours.

c.    Choose a patient to present later during the day for “Brown Rounds” (See below).

d.    Attend afternoon conference with students on medical floors.

e.    Participate in afternoon PBLs and journal club.

Lectures - Brown/BU students, residents and faculty can contribute to the education of the Dominican Republic medical system by giving lectures or case conferences.  One day per week, there will be an hour blocked in the Dominican and residents’ schedule for a lecture in English.  This can be of any topic of interest, and may expose the residents to illnesses or treatments not encountered often in the Dominican Republic. Residents, students and faculty should have two case conferences prepared upon arriving.

Brown Rounds – This is a conference solely for American students/residents/faculty.  Trainees will have followed up on their chosen patient from the morning, and will present their patient as a patient would be presented on rounds in the United States.  A faculty member or senior resident will then facilitate the discussion of this patient.

PBLs classes will take place one afternoon per week in lieu of Brown Rounds.

Journal club will take place one afternoon per week in lieu of Brown Rounds.

Other opportunities:

1.    Resident lectures at Hospitál Cabral y Báez

1. Monday – 11:00 – EKG lectures for first-year residents.  American medical students and residents are welcome to attend; medical students will probably get more out of the lecture.
2. Wednesday – 8:30 – “Grand Rounds.”  Dominican residents present patients at the attending’s discretion and are questioned about the management of the patient.  Not the most educational lecture, but will give you an interesting look at the Dominican medical education system.
3. Friday – 8:30 – Lecture given by a physician in the large auditorium on the second floor.  This is given to all residents in the hospital, and can have a wide range of topics.  Given with power point, and is usually quite interesting.

2.    Food Distribution - Olga is a Dominican woman who lived in Cincinnati for some time working as a social worker with HIV positive individuals.  She now runs a food distribution service for HIV positive patients out of Hospitál Cabral y Baéz.  She has about 20 clients, and distributes the food every-other Friday.  This is a great opportunity to see the social side of HIV care, especially for someone who’s Spanish isn’t as strong (she speaks English!).  She is in consult room #42.

3.    Emergency Room – If you want to see what happens to people in a country where there are very few enforced traffic laws, stoplights are mere suggestions, and people tear around recklessly on motorbikes without helmets, you can spend an afternoon (or night) with the internal medicine residents in the emergency room.

4.    HIV Vertical Transmission – Enerio is an upbeat, cheerful nurse who does most of the ground-work for pregnant and recently parous women with HIV.  His activities are heavily funded by the Clinton Foundation, and he gives excellent comprehensive care to the women.  Above this, he is energetic, caring, and loves to teach.  As of 2009, he can be found on the main floor consult area, consult room #42 (same as Olga).

5.    Dermatology consults – Dra. Taverez is a dermatologist who sees patients at Cabral y Báez in the morning.  She currently sees patients in the consult #43?, right across the hall from vertical transmission and Olga’s food distribution.  She loves to have American students/residents.

Trainees will also be encouraged to spend time exploring the sunny tropical island, taking part in the delicious culinary offerings, and passing a few days on one of the wonderful local Caribbean beaches (with plenty of SPF 90, of course!).

NOTE – read before coming

If you are inclined, and have the financial resources and luggage space to do so, Johnson & Johnson offers a “Medical Mission Pack” that can be purchased from the following website for $50.  It includes a variety of medications and medical supplies, and the folks at Pequeños Pasitos will be ever thankful if you show up with box.  International flights offer two free checked bags, so if you’re only checking one bag, please consider it!  Warning:  The goods should be re-packed in another bag, as the box with a large red cross gives the customs agent plenty of reason to search, pilfer, plunder, and confiscate.

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