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Mustafa, M., Stein, M. The utility of U.S. medical electives to the Canadian medical student. UBCMJ. 2016: 7.2 (26-27).
a MD Student 2015, Faculty of Medicine, University of British Columbia,Vancouver, BC
° Corresponding author: email@example.com
* Majd Mustafa and Michael Stein contributed equally to this article.
abstract While medical schools stress the importance of graduating well–rounded physicians, the unfortunate reality is that competitive residency programs drive some medical students to both pick a speciality early on in their training and book electives in this one speciality across the country to maximize their chances of matching.1,2 One can make the argument that flying across the country to secure strong letters of reference in a chosen discipline trumps the drive to broaden the medical school experience by booking electives outside of Canada. To date, there appears to be little incentive for the Canadian applicant to pursue medical electives in the United States, especially if they do not intend on participating in the U.S. residency match. Herein, we document the experiences of two Canadian medical students who completed electives in the United States. Neither participated in the U.S. Match, and both ultimately applied to CaRMS entry positions in Canada in Plastic Surgery and Ophthalmology.
Cardiac Transplantation, Los Angeles
For my third year elective, I travelled to Los Angeles for an elective in cardiothoracic transplantation. I worked at one of the largest cardiac transplantation programs in North America, with the opportunity to learn from world experts in the field.
During my stay, I was assigned to the transplant fellow and was expected to attend every procurement and transplant he undertook. Since an organ could become available at any moment, this essentially meant that we were always on–call. I recall the fellow’s pager going off the first night and us being escorted by hospital security to the rooftop of the hospital where a helicopter awaited. Our team consisted of a staff surgeon, a fellow, a nurse, and a transplant coordinator. I learned that an essential first step in any procurement was assessing the viability of the organs themselves. I was told that one particular donor’s heart and lungs were contused from an accident and this introduced too high a risk for the recipient. It was fascinating to see how the staff weighed the severity of the recipient’s condition with the likelihood that the donor organs would fail.
My time in Los Angeles was an invaluable learning experience. Accompanying the transplant team and appreciating the urgency and complexity of cardiac transplantation was highly memorable. As a clerk interested in pursuing a surgical specialty, I gained exposure to different techniques, built upon my knowledge of organ transplantation, and enhanced my appreciation of finances in healthcare management. I would highly recommend this elective, not only to my aspiring cardiac surgery colleagues, but to any student looking for a unique educational experience.
Oculoplastics, Los Angeles
In my fourth year of medical school, I completed an oculoplastics elective in Los Angeles, California. Oculoplastic surgery is a broad field in ophthalmology, encompassing both cosmetic and reconstructive surgery. I was eager to spend time in a research–heavy institution and a healthcare system in which I had no previous experience.
This was my first experience working in a private setting. I observed with keen interest the dynamic in which physicians advocated for their patients to insurance agencies. My initial understanding was that conditions compromising vision were covered by insurance agencies, while non–essential cosmetic procedures were paid out–of–pocket; however, a grey zone existed that turned out to be much larger than I had anticipated. For example, some patients needing Botox for blepharospasm, an abnormal and at times debilitating eyelid contracture were denied coverage, while others were approved for it. It seemed that the physicians’ input was essential in coming to these decisions.
Having only witnessed the functioning and efficiency of the Canadian healthcare system, I was also taken aback when elective surgeries were booked a day or two after the initial consultation. Similarly, elective imaging, like MRI, was available on demand. When the expertise of another specialist was required, a quick phone call was made between staff and the patient would be seen together by both teams, on the same day. The pace and time taken per consultation was astounding. Patients had time to ask questions, voice concerns, and discuss the various potential surgical outcomes.
Assisting in highly innovative and complex surgeries was truly the highlight of this rotation. The most interesting case I observed was a rare arteriovenous malformation causing the patient to have an increased risk of fatal haemorrhage. I found it striking how a team consisting of an oculoplastic surgeon, an interventional neuroradiologist, a plastic surgeon, and an anaesthesiologist—all met with the patient together rather than fragmenting the patient’s care due to their busy schedules.
The drive for learning and innovation, the patient–centered care, and the teamwork amongst the staff I worked with was infectious and made for an incredible experience.
Pediatric Intensive Care Unit, Oahu
I was greeted at the Children’s Hospital by a sea of flowered Hawaiian dress shirts. I would soon realize that this was in fact formal attire, worn by physicians underneath their white coats and essentially omnipresent among all other hospital workers. While the lure of sunshine after five months of Vancouver’s downpour will not be understated, this month–long pediatric ICU elective turned out to be much more than four weeks of beach and flowers. In fact, it turned out to be one of the most valuable educational experiences of medical school.
The importance of the social history was striking in Hawaii. In addition to the Polynesian and white–American populations that I expected to work with coming to Honolulu, I was introduced to the large Micronesian, Melanesian, Japanese, Filipino, and, of course, tourist populations—each of whom carried unique medical predispositions. I helped treat patients with rheumatic heart disease, Potts disease, Kawasaki’s disease, and hemophagocytic lymphohistiocytosis—all diseases that I had far less exposure to in Vancouver. I learned from my preceptors that, historically, streptococcal infections and TB were poorly treated in the Micronesian islands leading to a higher prevalence of rheumatic heart and Potts disease than in the general population. I also learned that Hawaii has one of the highest incidences of Kawasaki’s disease in North America.
The pediatric trauma presentations particularly resonated with me during this rotation. One young boy sustained multiple facial fractures and soft tissue injuries after being mauled by a pit bull. I was told that this was not an infrequent occurrence in Hawaii, where many residents owned pit bulls and trained them for hunting wild boars. The unfortunate reality of a market in which the most aggressive hunting dogs were preferentially bred was a high number of dog attack injuries.
As I reflect on the diversity in patient demographic and disease presentation, as well as the beautiful setting in which all this occurred, I have no doubt that this elective would be invaluable to any Canadian medical student.
The notion that medical schools graduate physicians who are well versed in all areas of medicine is essential. Rather than picking a specialty early on and narrowing their focus in the last two years of medical school, we recommend that students work to broaden their medical
education in any way they can. As previous authors have found,3 we believe that international electives expose students to diverse populations, challenge them to adapt to an unfamiliar health care environment, and work to strengthen their cultural sensitivity, all of which significantly enhance their medical education.
The authors have no conflicts of interest to disclose.
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