Back to Front PageVOLUME 6, NUMBER 4

Medical Education Gets Extreme

By Jennifer Proctor

Participants in the 2001 MedWAR, sponsored by the Medical College of Georgia, gain knowledge, skills, and techniques necessary for proper management of wilderness medicine. Here, participants get a chance to practice on one of their own teammates.

These days it seems everything is "extreme"- extreme sports, extreme vacations, and even extreme value meals. Taking a lesson from popular culture, medical educators are increasingly realizing the potential value of "getting extreme" for doctors-in-training and, as a result, are transporting students and residents to exotic locations in distant lands or through the rugged wildernesses just beyond their backyard.

Glenn Geelhoed, M.D., Ph.D., has traveled around the world nearly six months of every year since 1966 acting as a medical missionary. A professor of international medicine at the George Washington University School of Medicine, Dr. Geelhoed counts India, Africa, Tibet, and Nepal among his more frequent destinations. He takes doctors and medical students to the most remote regions of these areas and others to provide medical care to the people on the planet least likely to receive it.

"These travels make better doctors of all the participants, not just by enhancing their medical education but by giving them an opportunity for which I have been very grateful - to learn more about the art of living and giving from the world's poor," Dr. Geelhoed says. "Every medical student should travel because of the opportunity it provides to witness medicine in its purest form."

After paying their own way - sometimes upwards of $3,000 - students are put to work as soon as they arrive at their destination. Sometimes they set up shop at an area hospital equipped with X-ray machines and lab facilities, and sometimes in a local school or other makeshift facility that may or may not have electricity. Villagers, who frequently suffer from ailments such as diarrhea, flu, malaria, measles, and malnutrition, line up to get what for many are the first medical examinations of their lives.

Under Dr. Geelhoed's watchful eye, students do what they can for their new patients, relying primarily on their hands, eyes, and ears for diagnosis rather than sophisticated equipment. Every evening, the group meets at the nearby mountain or riverside to discuss their day's experiences. Dr. Geelhoed says they examine the problems encountered and what is "fixable" considering resource and time constraints. "These students get 'extreme' by handling larger problems and more patients with fewer resources," he says.

Dr. Geelhoed's own medical mission work has not gone unnoticed. In 2000, he received the Humanitarian of the Year Award from George Magazine, and he used the platform to draw attention to the greater, often neglected world at large. "Dr. Geelhoed embodies the idea of being a 'citizen first.' He has unselfishly dedicated himself to improving health care throughout the world through contributions of time, talent, and courage," said then George Editor-in-Chief Frank Lalli.

Dr. Geelhoed boasts that he has not taken any of his students on their last medical mission trip abroad. He lights their fire, and they keep it fueled for the rest of their lives.

The Road to Medicine

On a trip to Swaziland, University of Pittsburgh School of Medicine's Dr. Markle worked with medical students at the Raleigh Fitkin Memorial Hospital in Manzini. At the hospital, medical students from the United States and Europe work side by side with African physicians.

Medical students and residents who travel in the name of medicine are changed for a lifetime. In a 1999 study published in The American Journal of Tropical Medicine and Hygiene, researchers found that international health experiences had a significant influence on the decisions and attitudes of residents. Surveyed residents who traveled for international health electives were more likely than those who had not to serve immigrants and patients on public assistance. Those who had traveled abroad for electives were also more apt to alter their career plans fromsubspecialty medicine to general practice.

Like Dr. Geelhoed, William Markle, M.D., a professor of family medicine at the University of Pittsburgh School of Medicine, has traveled around the world to practice medicine. Now through the Foreign Away Medical Experience (FAME), he helps direct fourth-year medical students interested in a rotation in a different country.

He explains that Pitt students can go to Africa, Asia, Europe, the Pacific Islands, and South America - basically anywhere that a physician is willing to supervise a student for a month or more and provide an evaluation of the student at the end of the experience. The school does expect students to do their homework before traveling, however, and requires students to begin researching the culture and customs of their chosen site a full year before they depart.

"Everyone who goes gets something different out of the experience," Dr. Markle says. He adds that students' reasons for traveling to extreme locations are varied. Some are interested in the service side, while others want to broaden their educational experience by working within a different health care system and seeing diseases firsthand that they may only be able to read about in the United States.

Given the growing diversity in the United States, Dr. Markle says doctors- in-training may find they are better prepared to practice here after spending time abroad. "When students are abroad, they have to use interpreters and respect different health beliefs and customs," Dr. Markle says. These skills are in increasingly high demand in the United States as well, he stresses. "Many people who come to our country don't speak English but do need quality health care. Future doctors should be ready to face those kinds of challenges."

He adds that the lack of technology in some of the more remote areas of the world requires students to hone their diagnostic and examination skills, often fostering a respect for and interest in primary care.

Dr. Markle's interest in international medicine is not limited to his students. As a medical student, he spent three months in India working with a native surgeon. Later, he and his wife lived in Indonesia for eight years. He says these experiences brought to light the inequity of medical care around the world and helped build an ongoing commitment to serving the world's poor.

National organizations, such as the International Health Medical Education Consortium (IHMEC) and the American Medical Student Association's (AMSA) International Health Action Group, also help facilitate trips for medical students who wish to gain medical experience abroad. According to AMSA's Web site: "Issues [such as illnesses related to lack of education and poverty] that have been the traditional cries of developing nations are present right here in our own. International health promotes active involvement in communities around the world in order to share ideas and information that might counter these difficult issues."

Extreme Adventure Next Door

Dr. Markle examines one of his own young patients in Swaziland.

Medical students don't have to travel abroad for extreme adventure. At the Medical College of Georgia, students, residents, and faculty members have the option to explore wilderness medicine right down the street from campus. In April 2001, the inaugural Medical Wilderness Adventure Race (MedWAR), held in Columbia County, Ga., tested participants' hiking, running, and canoeing abilities in addition to their wilderness medicine knowledge.

"We wanted to see if people can continue to work together as a team and keep their heads about them when they are cold, tired, wet, and hungry," says David Ledrick, M.D., research program director for the Medical College of Georgia's Department of Emergency Medicine and a member of MedWAR's faculty steering committee.

MedWAR organizers developed a mission statement and a curriculum, which includes hypothermia and hyperthermia treatment, wound repair, and spinal immobilization. About 20 teams of three or four people each took part in the games. Prior to the event, organizers posted on the Web a list of possible challenges, which incorporated the curriculum. Participants were encouraged to study the challenges beforehand, prepare their medical packs accordingly, and plan how to proceed.

"Participants found themselves challenged in ways they had never been challenged before," says Dr. Ledrick, whose own extreme sports adventures inspired the event. He says that medical students not only benefit from the additional wilderness medicine knowledge but also from the bonds and friendships they form during MedWAR. "Many of the folks had never done anything in the wilderness. We put them in a high-intensity situation and gave them as close to a true-life experience as we could."

Dr. Ledrick adds that MedWAR also encouraged teamwork, forcing participants to deal with the personalities of others and function as a group. He says the teams that kept their cool and worked together as a unit were the ones that did well.

The first MedWAR sparked interest nationwide, and Dr. Ledrick promises that it will become an annual occurrence. He envisions a series of MedWAR-type events that test participants in various environments, climates, and altitudes. Dr. Ledrick is leaving the Medical College of Georgia for a new position in Ohio, where he intends to start a similar medical adventure race.

He emphasizes that MedWAR and comparable events help prepare physicians to meet the needs of the public, which is increasingly seeking extreme adventure. The back pages of adventure magazines are filled with travel opportunities, and many of these excursions hire doctors to make the journey as well. "People are participating in more extreme activities, and doctors must be ready to meet these challenges," Dr. Ledrick says.

And Pitt's Dr. Markle stresses that health experiences in which students care for patients under extreme circumstances can foster a lifelong commitment to service. "In serving these areas, the enormous needs of the people become clear. However, the opportunity to spread knowledge and resources is also clear," he says. "You can see with your own eyes how you change people's lives."

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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08 August 2001