EMERGENCY MEDICINE INTERNATIONAL EXTERNSHIP Queen Elizabeth Hospital Barbados

EMERGENCY MEDICINE INTERNATIONAL EXTERNSHIP Queen Elizabeth Hospital, Barbados

BARBADOS Small island (21 mi x 14 mi; 167 sq. mi) located in the Lesser Antilles of the Caribbean Capital City is Bridgetown Population of 285, 000 Official language is English, locals commonly converse with regional variant called Bajan National healthcare system covers all healthcare for Barbadian citizens

QUEEN ELIZABETH HOSPITAL Main hospital on island 600 bed hospital located in Bridgetown Multiple polyclinics (ambulatory care centers) around island also provide free medical care ER is the busiest department in the hospital with over 45, 000 annual patients; managed by 20 physicians Emergency ambulance service that dispatches from 2 locations on the Island

BACKGROUND What is the purpose and value of the fourth year of medical school? …a recently published study identified five factors perceived by fourth year medical students as being the purpose and value of the fourth year of medical school. . . (Wolf et al. 2014) 1. Strengthening one’s residency application 2. Developing skills 3. Exploring diverse practice settings 4. Pursuing personal interests 5. Identifying a career

LEARNING OBJECTIVES Developing skills Develop skills in key procedures in an emergency clinical rotation Identify and develop a personal strategy for an emergency primary survey Exploring diverse practice settings Gain exposure to other/international medical practice settings Pursuing personal interests Gain appreciation for international travel with goal of future medical mission trips

DEVELOPING SKILLS Objective 1 a: Develop skills in key procedures in an emergency clinical rotation A survey of 250 faculty & residents identified procedural skills medical students are expected to gain proficiency prior to residency…not surprisingly, there is a correlation between the number of procedures performed and selfreported confidence level by the medical students (Kowlowitz et al. 1990) 21 procedures in which medical students should gain proficiency Perform UA Interpret UA CPR Perform EKG Interpret EKG Start IV infusion Perform Gram stain Interpret Gram stain Perform Pap smear Perform simple suturing Interpret CXR Perform urinary bladder catheterization Obtain basic cx (throat, skin, rectal, eye, NP, vaginal) Interpret cx (throat skin & urine) Perform arterial puncture Perform NG placement Interpret blood smear Perform venipuncture Perform Hematocrit Interpret hematocrit Perform Lumbar puncture

DEVELOPING SKILLS Elected to self-monitor exposure to 7 of 21 ranked procedures Self-monitored procedures were subjectively selected base on largest gap in actual versus desired level of competence Target number cases for each procedure based on projected student exposures in span of a month

DEVELOPING SKILLS Objective Ib: identify and develop a personal strategy for an emergency primary survey The primary survey which includes airway, breathing, circulation, disability, exposure (ABCDE) is widely accepted as the way to assess and treat all clinical emergencies. My main resource, Thim et al. 2012, presents a description of each component of the primary survey as well as the evidence to support the ABCDE approach

EXPLORING DIVERSE CLINICAL SETTINGS Objective 2: gain exposure to other/international medical practice setting Many physicians endorse gaining medical experience in diverse clinical settings, including international exposure They also acknowledged that practicing medicine in regions with limited resources allows one to master crucial skills including: History taking Physical examination techniques Utilization of superficial landmarks to direct invasive procedures

PURSING PERSONAL INTEREST Objectives 3: Gain appreciation for international travel with goal of future medical mission trips

MOST PROFOUND CLINICAL EXPERIENCE The variety & acuity of cases were in no way unique to QEH’s ED Nevertheless, since this was my first emergency department rotation, there were some cases that impacted me for personal reasons/uniqueness One case that made an impression on me was that of a postictal, epileptic patient whom I discovered to be pulseless. This case remains unique for me because despite having been certified and recertified in basic life support (BLS) over the years, in addition to witnessing multiple CPR attempts, this was my first time to actively participate Additionally, this allowed me to address one of my learning objectives for the clerkship; develop a person strategy for an emergency primary survey

MOST PROFOUND CULTURAL EXPERIENCE Barbadian (Bajan, colloquially) culture is very fascinating Some features distinctive to Barbados and the surrounding islands include: Cuisine Music Language Landscape

THE FOOD Rotis Fruits/vegetables: breadfruit, soursop, sorrel, sugarcane, guava Fresh seafood: flying fish, dolphins, kingfish, barracudas, snapper, swordfish, marlin Local brewery: Banks

THE LANDSCAPE My trip included a tour west coast, north point, and east coast Land tour revealed amazing natural beauty of the island including its landscape and beaches Large sweeping waves of the Atlantic Ocean Natural caves Animal flowers (sea anemone) Snorkel and SCUBA dive with turtles at Turtle Beach

THE PEOPLE 92. 4% black, 3. 1% mixed, 2. 7% white, 1. 3% East Indian 1/3 of population concentrated in Bridgetown Music mostly adopted from neighboring islands, primarily Jamaica (reggae) and Trinidad and Tobago (soca and calypso)

CONCLUSION Many students share similar perceptions of the purpose and value of the fourth year of medical school Early on in the fourth year many students look to identify a career and strengthen their residency applications Once residency applications/interviews are finalized, the goals of developing skills, exploring diverse practice settings, and pursuing personal interests come to the forefront If your desire is to gain exposure in a different clinical setting, travel overseas, learn about a new culture, and meet new friends, then an international rotation is for you! You have the option of enrolling in: (insert clinical rotation here) in Kansas’ subfreezing temperature, or go to the beautiful sunny Caribbean island of Barbados for said rotation in 75˚+ weather for a month…you choose!