Wednesday, February 11, 2015

Medical Elective learning points from our recent student visitors February 2015

Bhavik Shah is a final year MBBS student from BJMC, Ahmedabad and Chase Yarbrough is a PGY2 resident in Harvard Medical School receiving dual training in Medicine and Pediatrics as part of a 5 year program. We had the pleasure to learn with them last week during their visit to our institute for the BMJ Cases Medical Elective and following are some of our learning insights around the differences between the US medical education system and Indian Medical education system shared so that we can discuss how to optimize the upsides and downsides of both.
1) According to Chase Yarbrough, the US medical graduate UMG finishes all their theory lecture classes by the end of second year and is expected to spend the rest of their 2 years in the wards and take 'ownership' of their patients, presenting and discussing their cases in the wards and altogether getting involved with the treating team. The Indian medical graduate IMG on the other hand is expected to attend lecture classes throughout the 4 years and taking 'ownership' of their patients is never encouraged for most part of their clinical attendance. The concept of 'Patient Ownership' (or perhaps a better label is 'developing a continuous and positive relationship with patients' ) is something that the Indian Medical graduate learns much later in his/her life as a clinician and many who are not fortunate enough to be part of a 'patient centered learning ecosystem' never feel the need to learn it?
2) The Indian Medical graduate IMG is encouraged to be a walking and talking encyclopedia of facts while the US medical graduate is taught to just 'look-up' what they may not know.
3) In their lecture-presentations the Indian Medical graduate, Bhavik highlighted terms such as radio-radial-femoral delay that are often supposed to be important exam questions here, but Chase felt that it may not be important to hammer every detail into the minds of students but rather encourage them to look-up things and keep learning.
4) Our senior resident Dr Nadiya who also joined us this week, (she has recently completed her MD residency from PGIMER, Chandigarh and MBBS from JIPMER) commented that a US medical graduate UMG is more mature to handle things in the above manner and the IMG may not be expected to know these. Medicine requires the ability to juggle both humanities and science and most of our IMGs are already specialized in science before they apply for medical school whereas the UMG doesn't specialize at a high school level. Chase had finished a degree in Computer science and was a high level coder before he became a medical student and one can argue that it need not have made him better able to handle medicine (other than the informatics component of medicine)? Also how do we explain why Bhavik appeared to be handling so well all the complex patient issues that we generally do not expect from an MBBS student in India?
5) Words that we take for granted here in India such as ragging, mugging, whatsapp etc were being heard by Chase for the first time. :-)

In spite of all these differences we were pleasantly surprised to find that both the IMG and UMG teamed up to deliver a splendid performance over their 1 week stay with us.

Other than their their involved participation with our patients from 9:00 AM to 4 PM, and the evening-lecture-classes they took for our students in LNMC (, they also made a great clinical presentation on one of our patients of severe mitral stenosis and aortic regurgitation (, Their demonstration (as a result of their internet searching) of other viable low cost options to tackle the social issues around the patient's problem went a long way toward helping the patient. I can't imagine any PG student in a premier institute in India going 'beyond' the discussion of 'disease related issues' and 'standard approaches to further management,' in their presentations. Chase and Bhavik's involvement with all their cases and their presentation went far beyond my expectations. :-)
So how do we create an ideal global physician with the best attributes from different learning cultures? Bhavik and Chase may have found their own way toward an answer. Bhavik hopes to do a residency in internal medicine in India and then travel the globe with the orgranization 'Doctors without borders' ( aka MSF) and Chase hopes to, after finishing his 5 year residency in internal Medicine and Pediatrics from Harvard, serve in rural India and become a rural doctor for the rest of his life.
Personally i have gained more from their visit than what they may have gained from us.

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