Trips abroad offer more than CME credit

Physicians earn continuing medical education credits by traveling to foreign countries and gaining cultural experiences they can translate to their practices.

By Jay Greene, amednews staff. July 23, 2001.

The first visit to Kenya for Mary Hardy, MD, reinforced her belief in how important basic medical supplies are for underserved populations.

"I brought an herbal medicine kit, a Western medical kit and an IV to a clinic in the middle of the Serengeti Plains," said Dr. Hardy, an internist and medical director of the Mount Sinai Integrative Medical Clinic in Los Angeles.

"When the doctor saw me ... [she] told me if I had been there the day before I would have saved a baby's life. Everything we bring on these trips saves lives. It makes you feel like you are contributing."

Kathleen Squires, MD, remembers the long lines of people waiting for care at an HIV clinic in one of the poorest neighborhoods in Cape Town, South Africa.

"Patients from developing worlds have much less expectations about what can be done for them medically," said Dr. Squires, an internist and medical director at the Rand Schrader AIDS Clinic at USC Medical Center in Los Angeles. "Patients there don't think they will have the same outcome as patients here."

The weeklong trip to the Amazon that James Redmon, MD, took last November with his son, Jimmy, reminded him about the importance of good communication between patient and doctor, especially when the two speak different languages.

"The medicine I saw practiced in the jungles of the Amazon gave me a renewed appreciation for our health care system. I also saw a lot of animals in the jungle I had never seen before," said Dr. Redmon, a family physician in Louisville, Ky.

In an unusual continuing medical education activity, Drs. Redmon, Squires and Hardy traveled overseas with International Expeditions, a Birmingham, Ala.-based travel company, to experience foreign cultures and health care systems. They learned about alternative healing traditions, a variety of lifestyles and ecosystem conservation.

"We were part-time students and part-time tourists," Dr. Redmon said. "I did some piranha fishing and saw a rare jaguarundi in the wild. It was a very renewing experience because you see things you would never see and help people who wouldn't normally receive good health care."

As a bonus, Dr. Redmon said, the doctors earned CME credits. They are awarded through the University of Alabama at Birmingham School of Medicine or Cedars-Sinai Medical Center in Los Angeles. Depending on the trip, doctors can earn 12 to 20 hours of Category 1 credit towards the AMA Physician's Recognition Award.

In her first trip in 1994, Dr. Hardy, who already was interested in botanical medicine, visited the Amazon. "I had never seen a forest like this before," she said. "The combination of this incredible naturalistic environment and people using plants growing literally outside their door for medical treatments got me inspired."

After her Amazon experience, Dr. Hardy joined the Mount Sinai clinic. "The CME that is taught is integrated to the region we visit," said Dr. Hardy, who now is an IE faculty member and teaches a course on herbal medicine. " We talk about an herb and then show them the tree it comes from. I talk about what you need to know about herbal medicine to be effective in your practice."

Each year, IE takes physicians around the world on an educational adventure, said Charlotte de Frances, IE's director of health care travel.

"Many people are looking for an extra meaning to what they do," de Frances said. "They want to go someplace they have never gone before and bring something back they can use in their health care practice."

De Frances said one of IE's most popular programs is "Pharmacy from the Rainforest," a weeklong trip to the Amazon rainforests of Peru. Other destinations include Morocco, Bali, Africa, India, Belize and Galapagos where groups are led by medical experts and local naturalist guides.

"CME courses that emphasize communication strategies are very valuable to physicians," said Nancy Bennett, CME director for Harvard Medical School in Cambridge, Mass. "Immersion programs, where doctors interact with populations in countries that don't have enough health care resources, make it very real. It is quite dramatic to hear a lecture on botanicals in the middle of the Amazon jungle where you see people using herbs [rather] than listening to one on a cruise ship or in a conference room."

Cultural competency training

With 25% of the population belonging to a designated minority group, training physicians to be culturally competent is fast becoming part of CME activities, medical school curricula and residency programs, Bennett said.

AMA policy "encourages medical schools to offer electives in culturally competent health care with the goal of increasing awareness and acceptance of cultural differences between patient and provider."

By the year 2030, experts predict that minorities will account for 40% of the population while minority physicians will account for less than 25% of all physicians.

"Physicians need to understand how important it is to not only clearly communicate with patients, but to understand their culture," Dr. Hardy said. For example, botanical medicine is very important for ethnically diverse populations such as Hispanics, she said.

Understanding Hispanic culture is important because Hispanics account for 30 million people, or 11% of the population, according to the U.S. Census Bureau. In 2004, Hispanics are projected to exceed African-Americans (at 13% and 34 million) as the nation's largest minority group.

"Seventy percent of my patients are from a Hispanic background," said Dr. Squires. "It really helps me to see that population in their native environment and what health care services and traditions they have available. We have much more here, but some might not be comfortable with our system."

Dr. Hardy said her trips help put her work in perspective. "Our health care system here is awkward and a pain sometimes, but it is the best," she said. "We don't have universal coverage, but if I don't have coverage for somebody, usually I can finagle to get what I need. In developing countries, they just don't have anything."

When Dr. Hardy returns from a trip, she is in a good mood but tired. "I have been in the jungle for a week," she said. "But I feel this experience is more important than going on a cruise and seeing a floor show. You don't come back rested; you come back and say 'wow, what an incredible world we live in.' "