5 Questions to Ask When Considering Pre-Med Clinical Experiences Abroad
1. First of all, why go abroad for clinical experience?
Healthcare is becoming increasingly global, as are almost all aspects of public and private life. We are traveling more than ever, able to take out our phones and connect with someone on the other side of the planet, and are in constant discussion about the future of American healthcare in comparison with the healthcare systems of other countries.
As interest in global health increases, international medical internship programs for pre-medical students are becoming more and more popular as well. Not only is it generally less likely that a pre-med student will be able to take an entire semester to study abroad, even though 10% of their peers will do so, but the need to understand foreign healthcare systems sooner is increasing. It is not uncommon that medical school interview questions involve questions about the current U.S. healthcare debate.
Should we keep our healthcare system the way it is? Should we model ours after European countries? Sure, you can ask your professors what they think, or you could do some research online. But would anything really compare to experiencing the realities of a foreign hospital for yourself?
At this point, we have all heard that Millennials, especially, would prefer to invest in the experience itself, rather than things.
However, it is important to understand that while these global experiences enhance students’ self-awareness, intercultural understanding, and tolerance for ambiguity, they can also do more harm than good if not chosen carefully.
Before choosing one of these programs, it is important to ask yourself important questions about the program you’re considering.
2. Is the program you are considering ethical?
In the context of the increasingly diverse U.S. healthcare environment, intercultural understanding is vital, as health, illness and the social determinants that influence them are inextricably bound up in cultural beliefs and practices.
Experiencing healthcare in a different country and operating within the bounds of a different healthcare system provides students with a global perspective that cannot be obtained in the United States. Yet, despite the many benefits, an international experience can hurt your reputation as a future medical student if you fail to ensure the ethicality of the program.
Pre-health students who travel abroad on medical trips are placed in unique situations because they usually work closely with vulnerable people and populations. It is wonderful to write about international experiences on medical school applications, but if a pre-med student mentions unqualified assistance in the performance of medical procedures, this could raise major ethical concerns in admissions committees.
Students should not engage in any medical procedures that they are not licensed to perform in the United States. This could jeopardize both patient and student safety and cause setbacks in the field of global health. Patients deserve the highest quality care, whether they are entrusting their health to local professionals or strangers from a different country.
Pre-med students should always remember that ethical conduct and standard of care transcends borders. This being said, it is simply important to be aware of your limitations. Research any programs before you participate. Knowledge of the organization’s guidelines and your own boundaries will help you to extricate yourself from any task or situation in which it is unethical for you to participate.
3. But, doesn’t ‘hands-on’ look better for medical school applications?
No. In fact, as a pre-med student, there is very little in the medical environment that you are allowed to participate in directly. Unless you have been trained formally, which many pre-med students have not, it could actually do more harm than good to be getting your hands on patients, no matter where you are in the world.
Some will argue that any help is appreciated in some underserved areas of the world, but in reality the risk created by attempting a task without proper training is high; to do so is unethical, dangerous for both the student and the patient, and ill-advised by admissions committees.
So, while you may think it shows initiative to be sewing sutures in the rainforest, the medical school admissions officers will think the opposite. Failing to recognize the severity of acting outside of regulations will display characteristics of thoughtlessness, recklessness, and even selfishness.
As a student, remember that your primary role is to observe, ask questions, and learn by watching the example of a trained professional. If you are given small tasks to do that do not involve a patient, or that you have been trained for, that is generally fine.
“So, while you may think it shows initiative to be sewing sutures in the rainforest, the medical school admissions officers will think the opposite. Failing to recognize the severity of acting outside of regulations will display characteristics of thoughtlessness, recklessness, and even selfishness.”
4. Is the program sustainable?
A second question to ask is this: Does the program you are considering provide sustainable assistance? To clarify this concept, let us turn to the documentary Poverty, Inc., which provides an excellent example of unsustainable aid. Following the genocide in Rwanda, an organization in the United States sent dozens and dozens of eggs to a Rwandan community.
As an unintended consequence, the glut of eggs put the local chicken farmer out of business. The following year, this same organization decided to focus its impact in a different area of need. However, because the local chicken farmer went out of business and sold all of his chickens, the Rwandan community was then forced to import eggs from a different source.
The American organization had desired to meet a broad need in the Rwandan community, but had not taken sufficient care to anticipate the long-term impact of its actions. A sustainable approach, on the other hand, is working in collaboration with communities to help cultivate long-term, continuous change rather than a short-term fix.
Sometimes short-term programs place more focus on the needs of the visiting students rather than those of the local community. When investigating international medical trips, especially to underdeveloped countries, take the time to look into the sustainability and effectiveness of the programs.
Some questions to ask yourself and program directors include: Does the program promote sustainable practices? Does it have a good established relationship with the community and the community members? Is it working on short-term fixes or addressing root causes?
5. What is your purpose for going on the trip?
The final question you should ask before pursuing an international medical internship is this: What is the purpose of the trip? Are you participating simply to add another bullet point to your resume? Or do you have an interest in learning about another culture and growing in your understanding of global health systems?
If approached correctly, a global health experience will be a valuable learning opportunity. As future health professionals, you must approach these experiences in an open-minded, respectful, and curious way. Asking questions, making observations and analyzing differences allows you to become more knowledgeable about healthcare systems and delivery. What you learn will certainly help you as you work to tackle healthcare problems.
Although the brunt of the learning will take place when you are immersed in the culture of the country you visit, it is important to learn something ahead of time too. Having a basic understanding of the country’s cultural norms before arriving can smooth the transition, helping to preclude confusion and inappropriate interactions with community members. Learning some common words in the language can be helpful and respectful as well.
How Atlantis checks off all of the boxes
The Atlantis Fellowship is one example of an international program committed to upholding ethics and developing cultural competence. Atlantis follows the AAMC’s ethical guidelines for shadowing to ensure that students follow the norms practiced in the United States, and provide global awareness training pre-departure.
Because Atlantis Fellowships are focused strictly on observation-only hospital shadowing and cultural immersion and are located in developed countries, there are no sustainability concerns.
The opportunity to spend such long hours in a highly developed foreign hospital allows students to see first-hand the pros and cons of a different healthcare system, which provides students with a meaningful global health experience that prepares them to participate effectively in the debate surrounding the role of healthcare in the United States, and around the world.
Through experiencing these differences between U.S. and European healthcare, you will be able to distinguish the areas of overlap, highlighting the universality of medicine and the physician’s role, despite what might seem like fundamental differences in culture. While participating in an Atlantis Fellowship, students have a safe and ethical opportunity to gain a global perspective on healthcare systems and explore their medical interests.
“The opportunity to spend such long hours in a highly developed foreign hospital allows students to see first-hand the pros and cons of a different healthcare system, which provides students with a meaningful global health experience that prepares them to participate effectively in the debate surrounding the role of healthcare in the United States, and around the world.”
Making Your Decision
Whether you choose Atlantis or another program, it is important to understand what you should and should not do when you are volunteering or learning abroad. Any international experience has the power to transform the way you view medicine and the world, and is something you should be able to discuss thoughtfully in your medical school personal statements or interviews.
There are a lot of gray areas when it comes to medical missions trips, so it is best to know for sure what you can and cannot do according to American laws, while in other parts of the world. At the end of the day, awareness of these rules will take away some of the stress or hesitation, so that you are able to have a more meaningful and appropriate experience.
Always remember that global health is about learning, collaborating and knowledge-sharing, not about saving other countries. Communication, cooperation, and teamwork are essential to strengthening healthcare systems and finding sustainable solutions to problems, both domestically and internationally. Proper exposure to healthcare systems abroad will always aid you on the path to becoming a well-informed, broad-minded physician.
Brooke Lapke is a native of LaMotte, Iowa. She is a rising senior at the University of Kansas, where she is majoring in microbiology with a minor in Spanish and a certificate in global awareness. Brooke has been involved with Atlantis in a multiple of capacities during college: she went to Alcázar de San Juan, Spain during summer 2017, and is doing research in Padua, Italy on her second Fellowship as a Global Scholar. Additionally, Brooke has been an Alumni Ambassador and attended the ambassador summit in Washington, D.C. with Atlantis. Brooke's long-term goals are to go to medical school and get a masters in public health or global health. Brooke is passionate about increasing access to healthcare and improving healthcare delivery worldwide.