ORIGINAL ARTICLE
Surgical Mission Trips as an Educational Opportunity for Medical Students Kriya Gishen, BS and Seth R. Thaller, MD, DMD Abstract: Although much debate remains regarding the ethical obligations of surgeons who conduct mission trips in foreign countries, it seems certain from our experience that medical students who participate on such trips have invaluable educational opportunities. From patient care to resource allocation, medical students gain first-hand experience in relatively short periods. They develop skills of patient management along with an enhanced cultural sensitivity and sense of fiscal responsibility. With appropriate guidance and teaching, medical students gain experience that can positively influence their careers and shape their development into competent physicians. Key Words: Education, medical student, mission trips (J Craniofac Surg 2015;26: 1095–1096)
M
any medical students begin their careers with the altruistic goal of serving their communities and improving lives. Some are afforded the opportunity to travel on surgical mission trips to countries where care would otherwise be unavailable. The trend of increasing interest in global health and surgical missions1 is trickling down to the level of the medical student. Conversely, at such an early career stage is there any benefit to participating on such trips? A longstanding ethical debate regarding mission trips remains unsettled: Are we accomplishing anything by traveling to underdeveloped countries, operating on patients, and then leaving? Is changing the life course of 1 patient or 2 or even 20 enough? Or, are we overstepping our bounds to interfere in unique cultural and economic environments? Are we leaving our patients with inadequate resources to fend for themselves when we return home? Opinions vary. Residents agree that participation on such mission trips provides valuable training in cultural competency, social responsibility, and altruism.2 In our experience, the medical students who participate also undoubtedly are provided a unique educational opportunity. Medical students are still training. Their responsibility is first and foremost to the patient. They must strive to define their roles as physicians, shape their personalities as surgeons, and find a balance between their own morals and what is deemed acceptable behavior by society. Students of surgery are engendered to master a set of skills to operate and to acquire a basic fund of knowledge to safely manage patients. Students, too, should develop a compassion for From the Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL. Received November 24, 2014. Accepted for publication January 30, 2015. Address correspondence and reprint requests to Kriya Gishen, BS, University of Miami Miller School of Medicine, Division of Plastic Surgery, Miami, FL; E-mail: [email protected] The authors report no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001695
The Journal of Craniofacial Surgery
fellow human being under their care. Certainly, all of these components of education can be mastered at a home institution. Yet, when medical students are removed from their home institution, their limited knowledge of medicine is applied and adapted to new environments and diverse cultures. Medical students on a surgical mission trip have the opportunity to study advanced disease states while simultaneously interacting with team members on an individual basis. Based on these experiences, medical students can establish their role in patient care. Students in this setting participate in preoperative screenings, operations, and postoperative care and follow-up. The learning curve is sharp; the momentum of work, swift. Quickly, students must interact with a foreign group of health care workers, while being mindful to respect a foreign medical culture. Quickly, students must recognize the necessity to function with limited supplies. Students must appreciate the economics of the operating room. The cost of supplies and consideration of waste come to the forefront of care. Similarly, students become acutely aware of what is permissible abroad. The role of students on a surgical mission trip theoretically is not confined by the same rules that apply in the United States. Therefore, it becomes the students’ and their attending physician’s responsibility to provide the same level of care and supervision that would be provided at the home institution. Students must maintain their role as students, not as active physicians, so as never to take advantage of patients. The students’ responsibility is to recognize their limits and apply the expectations of home to a new set of circumstances in a foreign country. The most profound lessons of a surgical trip abroad, although, come less from within the walls of the operating room and more from the patients themselves. In the face of every patient, medical students find their own compassion. They come to appreciate entirely different mechanisms of life from their own. Patients have diverse values, cultures, family dynamics, religions, practices, and beliefs. To establish valuable trustworthy relationships with patients, medical students must always be sensitive to these differences. They must understand that although a lack of money, transport, and resources may have impeded previous medical care, these entities do not completely define the patient. Medical students must consider how proceeding with surgery will change the patient’s life both in terms of personal health and his/her interaction with community at large. Medical students, away from the technologically advanced constructs of the American health care system, see the human being in totality. Patients often bring their lives with them. This typically includes their possessions, their families, and their unfaltering faith. Students have a unique chance to delve deep to establish the raw emotional connections with these patients, who in turn unquestioningly entrust their lives to strangers in white-coats. While working in an environment that is free from the rules and regulations that define the system of domestic health care, the medical student has increased responsibility for the patient. It becomes the team’s duty to advocate continuously for their patient. Although in theory this is always the goal of a surgeon, it is only when an individual is stripped bare of the institution that usually enshrouds him/her that intentions and the fight for the patient become most exposed. When medical students witness such
Volume 26, Number 4, June 2015
1095
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Gishen and Thaller
The Journal of Craniofacial Surgery
well-intentioned treatment that uses limited resources and pure medical knowledge to achieve maximum outcomes, they can fully appreciate the bare bones of medicine and surgery. For medical students, surgical mission trips provide an opportunity to see surgery and patient care in its most unadulterated form. Their experience becomes deeply embedded in their future career goals. Going to a foreign country to step outside of one’s own reality, serves to heighten the senses. It fosters an increased awareness of the challenges faced in surgery and earnestly demonstrates the need to be steadfast yet to adapt and to evolve. Medical students learn to be bold yet cautious, to be generous with heart yet frugal with supplies and valuable resources. In the microcosm of an underequipped foreign operating room, the whole of surgery snaps
1096
Volume 26, Number 4, June 2015
into focus for medical students. Lessons that at home may take a career to learn are instantly at their fingertips. These lessons are the medical students’ metaphorical scalpels. Theirs is the privilege and the responsibility to apply what they learn aboard throughout their careers.
REFERENCES 1. Powell AC, Mueller C, Kingham P, et al. International experience, electives, and volunteerism in surgical training: a survey of resident interest. J Am Coll Surg 2007;205:162–168 2. Vu MT, Johnson TR, Francois R, et al. Sustained impact of short-term international medical mission trips: resident perspectives. Med Teach 2014;36:1057–1063
#
2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Surgical Mission Trips as an Educational Opportunity for Medical Students Kriya Gishen, BS and Seth R. Thaller, MD, DMD Abstract: Although much debate remains regarding the ethical obligations of surgeons who conduct mission trips in foreign countries, it seems certain from our experience that medical students who participate on such trips have invaluable educational opportunities. From patient care to resource allocation, medical students gain first-hand experience in relatively short periods. They develop skills of patient management along with an enhanced cultural sensitivity and sense of fiscal responsibility. With appropriate guidance and teaching, medical students gain experience that can positively influence their careers and shape their development into competent physicians. Key Words: Education, medical student, mission trips (J Craniofac Surg 2015;26: 1095–1096)
M
any medical students begin their careers with the altruistic goal of serving their communities and improving lives. Some are afforded the opportunity to travel on surgical mission trips to countries where care would otherwise be unavailable. The trend of increasing interest in global health and surgical missions1 is trickling down to the level of the medical student. Conversely, at such an early career stage is there any benefit to participating on such trips? A longstanding ethical debate regarding mission trips remains unsettled: Are we accomplishing anything by traveling to underdeveloped countries, operating on patients, and then leaving? Is changing the life course of 1 patient or 2 or even 20 enough? Or, are we overstepping our bounds to interfere in unique cultural and economic environments? Are we leaving our patients with inadequate resources to fend for themselves when we return home? Opinions vary. Residents agree that participation on such mission trips provides valuable training in cultural competency, social responsibility, and altruism.2 In our experience, the medical students who participate also undoubtedly are provided a unique educational opportunity. Medical students are still training. Their responsibility is first and foremost to the patient. They must strive to define their roles as physicians, shape their personalities as surgeons, and find a balance between their own morals and what is deemed acceptable behavior by society. Students of surgery are engendered to master a set of skills to operate and to acquire a basic fund of knowledge to safely manage patients. Students, too, should develop a compassion for From the Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL. Received November 24, 2014. Accepted for publication January 30, 2015. Address correspondence and reprint requests to Kriya Gishen, BS, University of Miami Miller School of Medicine, Division of Plastic Surgery, Miami, FL; E-mail: [email protected] The authors report no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001695
The Journal of Craniofacial Surgery
fellow human being under their care. Certainly, all of these components of education can be mastered at a home institution. Yet, when medical students are removed from their home institution, their limited knowledge of medicine is applied and adapted to new environments and diverse cultures. Medical students on a surgical mission trip have the opportunity to study advanced disease states while simultaneously interacting with team members on an individual basis. Based on these experiences, medical students can establish their role in patient care. Students in this setting participate in preoperative screenings, operations, and postoperative care and follow-up. The learning curve is sharp; the momentum of work, swift. Quickly, students must interact with a foreign group of health care workers, while being mindful to respect a foreign medical culture. Quickly, students must recognize the necessity to function with limited supplies. Students must appreciate the economics of the operating room. The cost of supplies and consideration of waste come to the forefront of care. Similarly, students become acutely aware of what is permissible abroad. The role of students on a surgical mission trip theoretically is not confined by the same rules that apply in the United States. Therefore, it becomes the students’ and their attending physician’s responsibility to provide the same level of care and supervision that would be provided at the home institution. Students must maintain their role as students, not as active physicians, so as never to take advantage of patients. The students’ responsibility is to recognize their limits and apply the expectations of home to a new set of circumstances in a foreign country. The most profound lessons of a surgical trip abroad, although, come less from within the walls of the operating room and more from the patients themselves. In the face of every patient, medical students find their own compassion. They come to appreciate entirely different mechanisms of life from their own. Patients have diverse values, cultures, family dynamics, religions, practices, and beliefs. To establish valuable trustworthy relationships with patients, medical students must always be sensitive to these differences. They must understand that although a lack of money, transport, and resources may have impeded previous medical care, these entities do not completely define the patient. Medical students must consider how proceeding with surgery will change the patient’s life both in terms of personal health and his/her interaction with community at large. Medical students, away from the technologically advanced constructs of the American health care system, see the human being in totality. Patients often bring their lives with them. This typically includes their possessions, their families, and their unfaltering faith. Students have a unique chance to delve deep to establish the raw emotional connections with these patients, who in turn unquestioningly entrust their lives to strangers in white-coats. While working in an environment that is free from the rules and regulations that define the system of domestic health care, the medical student has increased responsibility for the patient. It becomes the team’s duty to advocate continuously for their patient. Although in theory this is always the goal of a surgeon, it is only when an individual is stripped bare of the institution that usually enshrouds him/her that intentions and the fight for the patient become most exposed. When medical students witness such
Volume 26, Number 4, June 2015
1095
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Gishen and Thaller
The Journal of Craniofacial Surgery
well-intentioned treatment that uses limited resources and pure medical knowledge to achieve maximum outcomes, they can fully appreciate the bare bones of medicine and surgery. For medical students, surgical mission trips provide an opportunity to see surgery and patient care in its most unadulterated form. Their experience becomes deeply embedded in their future career goals. Going to a foreign country to step outside of one’s own reality, serves to heighten the senses. It fosters an increased awareness of the challenges faced in surgery and earnestly demonstrates the need to be steadfast yet to adapt and to evolve. Medical students learn to be bold yet cautious, to be generous with heart yet frugal with supplies and valuable resources. In the microcosm of an underequipped foreign operating room, the whole of surgery snaps
1096
Volume 26, Number 4, June 2015
into focus for medical students. Lessons that at home may take a career to learn are instantly at their fingertips. These lessons are the medical students’ metaphorical scalpels. Theirs is the privilege and the responsibility to apply what they learn aboard throughout their careers.
REFERENCES 1. Powell AC, Mueller C, Kingham P, et al. International experience, electives, and volunteerism in surgical training: a survey of resident interest. J Am Coll Surg 2007;205:162–168 2. Vu MT, Johnson TR, Francois R, et al. Sustained impact of short-term international medical mission trips: resident perspectives. Med Teach 2014;36:1057–1063
#
2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
