Think Locally, Act Globally

 As a product of several work/study abroad programs dating to my undergraduate years and continuing through medical school and residency, I can attest to the importance that these programs have had on my educational and medical experiences, as well as on decisions I have made as a physician. As an undergraduate at the University of North Carolina, I was involved in a work abroad program in West Africa. I lived and worked among Africans as I labored on a farm and in a brick factory and helped construct a school. Some of the more notable experiences during this time led me to commit my life to becoming a physician, a decision confirmed during several subsequent programs in other parts of the world. Later, prior to medical school, the time I spent volunteering in a mission hospital in Central Africa cemented my decision to pursue a master's degree in public health.

 After I graduated from medical and public health schools, my early experiences abroad led to my decision to deploy with Doctors Without Borders as a tuberculosis/human immunodeficiency virus field physician in East Africa and to join other physicians in Haiti following the devastating earthquake there. All of these experiences would have been unlikely had I not been encouraged to participate in that first program in Ghana during my college years. I thank my parents for this foresight. My experiences with international healthcare influenced my career choice, reaffirmed my humanism, and improved my cross-cultural understanding. Although most medical students seek international rotations to help and improve the communities they work with, it is my experience that the students receive much more from their experiences than they give.

Richard Allen Vinroot, Jr., MD, MPH

The world is getting smaller and more accessible, with concurrent improvements in hygiene, increases in water availability, and more options for transport. More students desire experiences abroad and are cognizant that these experiences will lead them to become more globally responsible and to act locally by giving back to their communities. In 2004, 22.3% of graduating American medical students reported participating in a clinical education experience abroad compared to 5.9% in 1978.¹ International rotations have demonstrated educational and personal benefits for students, including working with limited resources, enhancing sensitivity to cost, developing clinical skills, relying less on technology, developing a greater appreciation of cross-cultural communication, and experiencing new peoples and cultures.^2,3 Interestingly, students who have international experience are more likely to enter a primary care specialty, obtain a public health degree, practice among the poor and ethnic minorities, and engage in local community service.^4,5 Altruism, empathy, and prosocial behavior should be inherent in doctors, and yet medical students lose their empathy during medical school and have a high rate of burnout that contributes to the loss of these behaviors.^6,7 Training in developing countries with people of different cultures and social structures may help restore these essential characteristics of a good physician. As Dr Vinroot reminds us by sharing his life experiences with international medicine, these global rotations have not only made him a better physician but also a better person.

The opportunity to participate in improving the health of the global community will lead to experiences that enhance the lives of our medical students, residents, and staff physicians. Currently, these opportunities are often limited to international clinical electives arranged by the students. For students to receive the full benefit from their rotations and for programs to facilitate safety and protect students from practicing beyond their medical competence, these rotations should be part of a formal medical school curriculum with a focus on global health topics and personal growth. We believe that we should encourage programs abroad and that they should be a priority for the academic and medical community.

Leonardo Seoane, MD, FACP

• Academic Division of Ochsner Clinic Foundation