More U.S. medical students are studying abroad

New doctor shares vision for global physicians, discusses research paper on cross-cultural rotations.

By Myrle Croasdale, amednews staff. Oct. 6, 2003.

Nearly 39% of U.S. medical students studied in other countries in 2002, according to the American Assn. of Medical Colleges, up significantly from the 20% who did so in 2000 and the 6% in 1982.

And while those who study in foreign settings say they turn out to be more culturally competent than their colleagues, little research has been done on the impact of an experience abroad.

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Ian Mutchnick, MD, a recent medical school graduate, aims to change that. He has done a literature review on the impact of international rotations on health professions students. "Expanding the Boundaries of Medical Education: Evidence of the Benefits of Cross-Cultural Exchange" will be presented at the AAMC's annual meeting in November. Dr. Mutchnick says the paper will be published in the October Academic Medicine.

Question Does cross-cultural medical training have a lasting impact on students as they move into practice?

Answer That depends on the person. Some studies try to measure this.

[One study of Yale internal medicine residents found that those with cross-cultural experiences were more likely to have more public assistance, immigrant and HIV patients.]

I remember sitting down to play the drums at a fair in Tanzania. I was the only white guy in sea of African people, and I could see it on their faces: "Who's this white guy?"

Maybe I don't understand the reality of this drug-seeking woman with back pain who comes in every four months asking for Vicodin and morphine, but my experiences allow for a little more compassion.

You become less arrogant. If you go somewhere like France or Italy, you still have to deal with other languages. You get frustrated or you develop compassion for your own limits.

Q Why do you think more medical students are doing this?

A The process of globalization has created an information environment among the educated elite that is simply more global in perspective. We realize how interconnected we are. Bangladesh is not a place we can't locate on a map anymore. We know it's a place of poverty and a breeding ground of militant Islamics.

[In that vein] Harvard doesn't just train doctors for the greater Boston area but with a national orientation. Over the next 20 years schools will transcend creating physicians just for the United States, creating them for many parts of the world.

Q That sounds idealistic. Do you think this is really going to happen?

A I hope so. There's no room for arrogance and lack of perspective in the decisions we make on how we are going to live our lives. I live in a place where I can get enough food to eat. I don't have to worry about my own personal safety. I don't have the privilege of becoming jaded. There are things to be done about the situation in the world at large, a situation that is incomprehensibly crappy for so many.

Q All these studies talk about how great cross-cultural medical experiences are. Do they ever go badly?

A That's definitely a bias in this literature review. We think it's important to do more methodical studies.

Q How have cross-cultural experiences affected you?

A I was an insipid undergraduate when I went into the Peace Corps in Tanzania, found there was a larger world out there and I wasn't the center of it. The truly important outcome was I found I could make a difference.

I knew I wanted to return to the Third World, and that helped me decide to be a physician. Medicine is really a transcultural profession.

Q What kind of medicine are you studying?

A I'm in my first year of neurosurgery [in Louisville, Kentucky]. If physicians are needed in the Third World generally, specialists are needed desperately. While I was at the University of Michigan, we had faculty who would spend two weeks in Guatemala each year and put shunts in for kids with hydrocephalus. I saw a neurosurgery model that worked, and I loved that clinical practice.

There's enough demand [from the middle class] for subspecialty care and that can be used to help fund primary care [for the poor].