Training Overseas Has Long-Lasting Effect On Yale Physicians-in-Training
Doctors who train for a time in underdeveloped areas are more likely, as they pursue their careers, to care for underserved patients, a Yale study shows.
Anu Gupta, a third-year resident who conducted the survey, said doctors who participated in Yale School of Medicine’s International Health Program were more prone later to care for patients on public assistance, substance abusers, patients infected with HIV and immigrant patients. They also were more likely to volunteer health related services to the community rather than financial assistance.
“It is extremely difficult to scientifically measure compassion,” said Gupta. “But we tried, with the survey, to find out whether the International Health Program (IHP) experience affirms existing values or beliefs, or whether these attitudes are developed by participating in the program.”
However, the question of whether the residents enter the school with certain values and beliefs and select Yale because of the IHP, or whether they adopt them as a result of participating in the program, remains unanswered.
“We are conducting a second, prospective study that will survey residents when they enter the program and then three years later when they complete their residency to more clearly discern the impact of this innovative training program,” Gupta said.
The study published recently in The American Journal of Tropical Medicine & Hygiene polled 352 internal medicine residents who completed their training at Yale from 1982 through 1996. Of that number, 136 participated in the IHP and 216 did not. The response rate was 61 percent.
More IHP participants than non-participants believed the physical exam is underutilized in the United States as a diagnostic tool. Both groups believe that physicians in the United States do not spend enough time taking patient histories, overuse laboratory tests and sophisticated diagnostic tests, and are too quick to prescribe antibiotics.
What was very clear, said Gupta, is that the lack of high technology medical diagnostic studies allowed residents who participated in the IHP to better develop their physical exam and history taking skills.
“They become more confident in their ability to take a history and to conduct a physical examination as part of their diagnosis because they have nothing else to rely on,” she said.
The IHP was founded at Yale in 1981 after a relocation of Southeast Asian immigrants to New Haven stimulated a volunteer residents’ clinic and created interest in overseas primary care rotations.
The goal of the program is to involve residents in primary care within diverse cultural settings, to encourage cost-consciousness using back-to-basics physical diagnosis without high technologic support, and to engender a sense of social responsibility.
The first rotation site was in Haiti and the program was later expanded to include rotations in Tanzania, Zimbabwe, Fiji, Zuni Hospital in New Mexico, and the Navajo Indian Reservation in Chinie, Arizona. The rotations are four to eight weeks in duration and are available to second or third year residents in the internal medicine training programs. Each year between 20 and 30 percent of Yale medical residents have elected to participate in the IHP.