Curriculum: 

Institution of international rotations involving residents and faculty of BFMR began in the summer of 2004.  At present, 3 to 4 trips are planned for the next year, increasing to 4 to 6 trips within the next 2 years.  The following are curricula, which apply to residents who request international rotations as electives at BFMR.  These curricula would also apply to 4th year medical students or graduate students in rural public health programs.

Goals and Objectives:    

• Provide opportunities for additional procedural training for FM residents with faculty supervision. 
• Additional intensive experience with advanced OB and C Sections/BTL/D&C
• Advanced surgical experience for rural medicine: hernia repair, hysterectomy etc.
• Provide experience in diagnosis and treatment of tropical disease
• Provide training and experience with travel medicine recommendations
• Provide experience with cross-cultural situations to broaden residents experience
• Provide additional experience in community health and community development
• Provide opportunities for understanding role of spirituality and health

Attitudes:

The resident should recognize and an appreciation for the following:

• An internationally oriented and enriched worldview
• Appreciation of different health care delivery systems.
• Intense challenges in international health and 3rd world countries.
• Emotional and spiritual well being of patients.
• Importance of community health and development in disease prevention
• Critical importance of good cross-cultural understanding and communication

Knowledge: 

Specific areas for which the resident will do preparation and then specific study during the international health elective.  See Topics for Study for more information.

General considerations of tropical medicine and infectious diseases:

• Malaria
• Typhoid
• Dengue fever
• Yellow fever
• Amoeba and other dysentery illnesses
• Parasitic diseases
• Health promotion & prevention
• Clean water issues and diarrhea illness
• Toilets and sewage handling
• Nutrition/Food handling and parasites (liver flukes etc.)
• General parasite prevention
• Prevention of Mosquito born illness  (malaria, dengue fever, encephalitis etc)
• Education and formal school of indigenous health care providers
• Coordination of care with local health care provider
• Integration of spiritual and psychosocial issues into patient care 
• World view of medicine and religion in local culture

Thailand: 

Be able to explain Buddhist worldview in relation to health care, illness and death and dying.

Nigeria: 

Be able to explain animistic/Christian world view in relation to health care, illness and death and dying.  Medical decision making in local culture, Role of the mission facility or missionary in local setting 

Procedural Proficiency (please see supplemental document on Procedural Curriculum)

Common procedures in family medicine training (core procedures) The resident should be familiar with basic indications, procedures and techniques from a knowledge perspective in the procedures for which core competency is desired.  These procedures would include: 

• Vaginal Deliveries ( routine, forceps, breech)
• Operative Obstetrics (C-Section, D&C, Tubal ligation)
• Ultrasound (Ob and general abdominal)
• Colposcopy and LEEP procedures
• Dermatologic and advanced skin procedures
• Breast Biopsy

Advanced surgical procedures  (non FM core procedures) certain residents may have a desire for training in more advanced surgical procedures that are usually outside the scope of Family medicine in the US.  Additional preparation in study and reading will be required for these procedures which may include:

• Appendectomy
• Hernia repair (inguinal, ventral)
• GYN surgery (hysterectomy, AP repair, laproscopic exploration and BTL)
• Advanced plastic surgery and reconstructive procedures

Skills:

• Treatment of tropical disease and infectious illness in 3rd world setting
• Evaluation and plan of change for community health and development
• Integration of spiritual treatment into medical plan History and physical examination
• Focused history and examination of the musculoskeletal, neurologic, and cardiovascular systems
• Psychological assessment and counseling
• Procedural Skills Proficiency    Procedure tracking with sign off cards will be kept for the following:
• Common procedures in FM training (core procedures) These procedures would include: 
• Vaginal deliveries  ( routine, forceps, breech)
• Operative Obstetrics (C-Section, D&C, Tubal ligation)
• Colonoscopy and EGD
• Ultrasound (Ob and general abdominal)
• Colposcopy and LEEP procedures
• Dermatologic and advanced skin procedures
• Breast Biopsy
• Advanced surgical procedures  (non FM core procedures) 
• Appendectomy
• Hernia repair (inguinal, ventral)
• GYN surgery (hysterectomy, AP repair, laproscopic exploration and BTL)
• Advanced plastic surgery and reconstructive procedures

Implementation:

The implementation of this curriculum was initiated in 2004 at Brazos Family Medicine residency with trips made twice a year to Nigeria.  Faculty member, Dr. Stuart Quartemont and 2 residents have made trips to Nigeria for 3-week intervals out of 4-week blocks.  Residents are able to have continuity in clinic at BFMR for 1 week of the 4-week block.  During the week before the trip, the faculty preceptor also supervises research and preparation for the trip.   Attention to attitudes and knowledge should be evaluated by the faculty preceptor during this preparatory time as well.  During the rotation, residents will be directly supervised by the faculty preceptor to ensure adequate learning and quality of care for all patients.  Records of all procedures will be maintained by each resident and signed of by the faculty preceptor to document competency.  These records will become part of the resident’s permanent file to aid the resident and program director in evaluation and recommendations for procedural competency and for hospital privileges for the graduate resident. 

Program Evaluation:

Residents who participate in the program have both an entrance and an exit interview and are required to write a paper pertaining to their experience in the overseas rotation.  The reports of past participants indicate very rewarding experiences, that these participants have a new understanding of the world and an appreciation of the people with whom they worked overseas.  The papers provide evidence that the objectives of the international health rotation are being met.  Residents will also be evaluated with our standard online evaluation tool, MYEVALUATIONS.COM.  The residents will be evaluated in the six ACGME competency areas:  1. Patient Care; 2. Medical Knowledge; 3. Practice-Based Learning and Improvement; 4. Interpersonal and Communication Skills; 5. Professionalism; 6. Systems-Based Practice.

The schedule for international health rotations will be published and updated on the website of the Brazos Family Medicine Residency, and contact information will be furnished for residents or students from other institutions. 

For further information on these trips you may contact Stuart R. Quartemont, MD for information concerning trips to Nigeria, John O. Gibson, III, MD for information concerning trips to Thailand,  Lani K. Ackerman, MD for information concerning trips to Nepal, Kelly M. Maedo, MD for information concerning trips to Central America, or David A. McClellan, MD or information concerning trips to Mexico.

Topics for Study:

Tropical Disease: Short overview of Tropical-Medicine topics

Mosquito Born Illness:

       Dengue Fever:   MedlinePlus Medical Encyclopedia: Dengue fever

       Malaria :  MedlinePlus Medical Encyclopedia: Malaria

          CDC info on Malaria Worldwide

                   Yellow Fever: CDC Yellow Fever Home Page

SARS:  SARS information

Parasitic Disease:  MedlinePlus Parasitic disease

Typhoid Fever: DBMD - Typhoid Fever - General Information

Community Health  and Disease Prevention:  Resource List

Language and Culture Acquisition:  IHMEC  then go to resources, Foreign Language Study

Thailand Rotation Information:  Baptist Clinic and Hilltribes Ministry Northern Thailand

Other Web Resources

UTMB resource page for international Health:  UTMB - International Health Resources

Travel Medicine: Travelers' Health

AAFP International Health Opportunities:  International Health Care Opportunities -- American Academy of Family Physicians

IHMEC Guidebook : http://www.ihmec.org/  then go to resources, then IHMEC Guidebook

Scholarship, Funding and other Program Info:

Scholarships - Christian Medical & Dental Associations

Baptist Medical Dental Fellowship-Scholarships

INMED - Institute for International Medicine

Program of Oklahoma Students/Residents  (older site but lots of good info and advice

Creative Funding from AMSA

Duke Univ. : International Electives & Student Medical Missions

International Medical Education - UMass Medical School

• Introduction
• Residency Director Comments
• Rural Fellowship 

• Stipends, Vacation & Benefits
• Instructions for Applicants
• Program Contacts