Special Considerations in the Preparation of Family Medicine Residents and Medical Students Interested in International Experiences

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International activities in family medicine are valued at both an individual and organizational level by the American Academy of Family Physicians. As an organization, this value is incorporated into the overall strategic plan of the American Academy of Family Physicians. Some benefits of international involvement for the individual student or resident are listed below.

Medical students and residents have ever-increasing opportunities for educational experiences in international settings. In 2005, 67% of family medicine residencies in the United States indicated the existence of an educational opportunity outside of the U.S. These programs reflect a broad range of experience and involvement with international health opportunities. Many of these institutions also provide assistance to residents or students from other programs who wish to participate in an international rotation, independent of their institution.

With an increase in opportunities, there is more demand for general guidelines to inform and support international experiences. This special considerations paper is set forth as a resource for faculty who lead groups of students or residents abroad or supervise students or residents who arrange an independent international rotation. However, this resource is also useful for the residents and students themselves as they prepare for an international experience.

Issues of cultural sensitivity and competence in working with individuals and families from diverse cultural backgrounds are recommended components of medical school and residency curriculum. These competencies are directly addressed through international experiences.

Many students and residents have an interest in working with underserved populations. People and agencies in international developing-world settings can benefit from student and resident rotations, if part of an ongoing and sustained program. In this way, the learners’ educational experiences complement the services they provide to patients. Residents and students gain a sense of making a difference in the lives of individuals and families in these settings. It can be a true service-learning opportunity.

In addition to the opportunity to see unique diseases such as tropical infections, common diseases may be encountered in more advanced stages than are typically seen in the United States.

Learning goals and objectives for the experience need to be established and clearly articulated for the student or resident and participating faculty.

Potential learning goals for the resident or the student:

Objectives
Objectives will need to focus on what the learners can do after the experience to demonstrate what they have learned. For example, based on the goals above:

Methods of evaluation
When the goals and objectives are determined, methods of evaluation should be clarified. This may consist of written papers, group and/or poster presentations, testing on specific content, and evaluation of level of participation or other methods.

Supervision
With proper preparation, the actual on-site experience can be an academic and personal highlight desired by both faculty and learner. On-site supervision is of importance just as with traditional educational experiences. Sponsoring institutions need to take the responsibility to assure this is arranged. There should be regular contact between faculty and learner to ensure that the goals and objectives are being achieved.

It is important to prepare in advance for an optimal experience in an international setting. Preparation for an international experience can occur in a number of ways.

Courses or self-study

For some, this will be the first international travel experience. Other issues that need to be explained to the student or resident prior to leaving for an international rotation or clerkship include personal health, safety preparation, and basic legal and logistical issues.

Issues to be clarified and reviewed with the student or resident:

In many cases, the student or resident will have had life-changing experiences and needs to have a facilitated session to deal with the feelings and reactions to the international rotation. This can be accomplished in many different ways ranging from a slide show allowing for discussion about the experience to more formal presentations to students, residents and/or faculty. Faculty can help with framing these experiences to provide perspective and maximal growth in the resident or student.

In order to prepare in advance for a maximally rewarding experience, it is suggested that you make every attempt to become familiar and knowledgeable regarding the cultural and medical environment in which you will learn and work. To the best of your ability, familiarize yourself with the expectations of the foreign facility by researching cultural, social, and medical aspects of the work environment. If possible, contact directors, supervisors, and teachers of the host facility before arrival in order to establish a dialogue regarding environment and expectations. This initial exchange and independent research ought to facilitate your level of preparedness and comfort in learning about and participating in supervised unfamiliar medical practices not done at your home institution. Such exposure can be invaluable and provide unparalleled learning, expanding your breadth of experience outside the scope of the domestic medical practices to which you have become accustomed at your institution.

View a list of selected online resources from the AAFP International Activities Office.