Internal Medicine Residency

International Health Elective - Uganda

Collage photo of Residents in Uganda

Mission Statement

The mission of the McMaster University Department of Medicine International Health Program is to provide genuinely interested internal medicine residents and opportunity to participate in an overseas elective in Uganda to enhance their cross-cultural medical experience. Moreover, to develop a sense of humanitarianism and ongoing collaboration with institutions in less developed areas of the world in areas of research, teaching, clinical work.

Program Faculty and Personnel

Specific Objectives for Residents

  • Gain clinical experience in the delivery of health care in a developing country
  • Increase awareness of the complicated barriers to health care in a resource poor environment
  • Enhance cultural sensitivity and a global health perspective
  • Refine history and physical exam skills in a technologically poor environment
  • Develop an ability to deal with complex medical problems with limited resources
  • Explore international health as a potential career interest
  • Develop mentoring relationships with McMaster University faculty interested in international health
  • Acquire proficiency in basic global health issues
  • Participate in research that addresses the health or the health services of a developing country
  • Develop a sense of social responsibility
  • Motivate the resident to continue this type of overseas work post-residency

Specific Goals for the Collaborating Universities

  • Establish academic relationships between McMaster University and Makerere University
  • Increase interest and competitiveness in the internal medicine residency programs
  • Create sustainable research programs that benefit both institutions by fostering long term, longitudinal research projects relating to utilization, quality of care, and the diseases of poverty
  • Demonstrate leadership in social justice and global health
  • Share clinical and teaching resources through visiting professor and resident exchange programs
  • Elevate the status of our institution on an international level
  • Encourage residents from less developed nations to participate in our internal medicine program, CTU’s, subspecialty clinics, and teaching program

Background

The McMaster University Internal Medicine Program is home to top residents in the country. Not only the extraordinary breadth of research and clinical faculty attracts applicants, but also the diversity of clinical pathology and teachers. While being a leader in both clinical and basic science research, McMaster is also a model of community service and provision of care to under-serviced communities as noted by its long-standing ties with the Aga Khan University in Pakistan. Not surprisingly, many residents coming to the program have an interest in global health. In fact, many of our residents have gone on to do work overseas with various organizations. These include Medicine Without Borders, Health Volunteers Overseas, and several mission groups to name a few. However, no formal program in international health existed till this year. As it is the mission of the residency program to improve curriculum and training tracks to fit resident’s interests, maximize exposure to clinical and research mentors, and guide residents to become leaders in the medical community, we are establishing an international health program (IHP).

The IHP will provide residents with clinical and research opportunities overseas, increase their awareness of global health issues, and enhance McMaster’s reputation as a leader in caring for vulnerable populations. Other top rated programs already offer international health experience at the residency level in Canada and US schools have successfully implemented international health programs. These programs have had broad effects for residents in areas of training, medical practice, and career choices. Participants have cited marked improvements in physical exam skills and development of more cost conscious medical care upon return to their home institution (1). Graduates of international health electives are more likely to pursue careers in academic general medicine and public health, have enhanced proficiency in cross-cultural health care, and possess increased commitment to caring for under-served populations (2,3).

The availability of an international rotation has also been shown to influence student’s selection of residency programs (3). Creating an international health program will significantly enhance this program’s attractiveness and its ability to recruit top candidates in an increasingly competitive environment.

McMaster is in a unique position to offer a meaningful global health experience to interested residents. A significant portion of the McMaster faculty is involved in the provision and/or study of tropical diseases, diseases of poverty, cross-cultural medicine and global health in several countries throughout the world.

Surveys have been conducted of many Deans and Department Heads of various universities in developing countries to determine what they would hope to get from this type of program. The responses are consistent across countries and continents: access to up to date information for clinical care, opportunity to train in a technologically advanced institution, potential for on-going research collaborations and access to training in clinical research. As it is our mission to establish a mutually beneficial collaboration we have created this program with these goals in mind.

The Elective

The core component of the IHP will be the four-week international rotation. Selected third year Medical residents (PGY3’s) at McMaster will use their GIM Community month in the developing country. Rotations will primarily be clinical experiences. Some residents may choose to engage in an ongoing research project in the developing country. However, research will not be a requirement for this rotation. For the academic year starting 2005, will see 2 residents participating in this program as a pilot experience.

Site: Makerere University, Kampala, Uganda

Sites have been selected based on funding availability, clinical exposure, faculty oversight, McMaster connection and language/translation availability.

Educational experience

Makerere University is the home to the larger of two medical schools in Uganda. The University has medical students, internal medicine, and surgical residents. They also have training programs in a few subspecialties. There are two main hospitals affiliated with the University. Mulago Hospital is the public hospital. There are 6 inpatient teams consisting of a consultant (attending physician), 1-2 senior house officers, two interns, and several third or fifth-year medical students. Teams are on call every 6 nights and on average admit 30 or more patients in a call cycle. McMaster residents will be assigned to one of these teams for the month. Mulago Hospital also has a very active outpatient department. The clinic schedule below highlights a number of clinic that have been selected based on clinical and teaching value that the resident may chose to attend. (Clinic/dates may change)

Monday Tuesday Wednesday Thursday Friday
General Med General Med General Med General Med (4B2) HIV (4B2)
HIV Chest/TB HIV Heme (4A1) Rheum (4B2)
HTN (4A1) Renal (4C2) Diabetes (4B1) Cardiac (4A1) Endoscopy
Thyroid (4B1)   Neurology Bronchoscopy Psychiatry
Rheumatology        

Mulago Hospital has a weekly conference schedule, including grand rounds, physical diagnosis rounds, subspecialty rounds, and journal club. In addition the training program has weekly resident teaching sessions. Visiting McMaster residents will be expected to deliver 1-2 formal teaching sessions to their colleagues during this time.

Residents may chose to participate in the Reach Out HIV/AIDS Initiative Clinic. This clinic is located in Mybuya neighbourhood. Here HIV patients are treated for opportunistic infections, and medications for OIs and for prophylaxis are provided for free on site. In addition, residents may participate in home visits, through either Reach Out or Hospice Uganda.

Language

English is the spoken language at Makerere University and affiliated hospitals. Most patients will speak English. When necessary, translation services are typically provided by family members.

Housing: Mulago Guest House

Located within Mulago Hospital grounds. Within 5 minute walk to the hospital. Option of single or shared room with or without attached bathroom. All beds with mosquito netting. All 7 guests in the house share living room and dining room. Breakfast served at house. Other meals can be obtained at the guesthouse for a cost of 3,500 shilling or at a variety of sites in the hospital.

Food: typical of Uganda can be obtained at hospital cafeteria for a very nominal cost.

References

  • Barry M. International health and general medicine. J Gen Intern Med. 1990:5:454-455.
  • Gupta AR, Wells CK, Horowitz RI, et al. The international health program: The fifteen-year experience with Yale University’s internal medicine residency program. Am. J. Trop. Med. Hyg. 1999; 61:1019-1023.
  • Miller WC, Corey GR, Lallinger GJ, et al. International health and Internal medicine residency training: The Duke University experience. Am J Med. 1995; 99:291-297.

Additional Information