GLOBAL HEALTH PROGRAM
190.0 Global Health Elective-Hadassah Medical School
Instructor: Warren Hershman, M.D., M.P.H.
Location: The Hebrew University-Hadassah Medical School, Jerusalem, Israel
Contact information: Dr. Warren Hershman, Warren.Hershman@bmc.org, and Britt Simonson, email@example.com, Evans 122, 638-7230
Number of Students: 6-8. Limited travel funds available for BUSM students
Period to be Offered: One to two months
Description of Elective:
This clinical clerkship is part of The Louis and Charlotte Kaitz BUSM/The Hebrew University-Hadassah Medical School Exchange Program. It is available to all fourth year students interested in the Israeli health system or whose professional career would be enhanced by a unique experience in Middle East medicine at a world renowned medical, educational and research institution. A conversational knowledge of Hebrew is a prerequisite for electives in general medicine and general surgery, but not for the other clinical electives.
190.00 Medical Care in Armenia
Hovaness Sarkavagyan, M.D., Chief, Thoracic Surgery, Grigor Lusavoric Medical Center
Gagig Manookyan, M.D., Chief, Intensive Care Department, GLMC
Voskan Pahlavyan, M.D., Chief, Cardiology, GLMC
Nikolai Dallakyan, Chief, Emergency Children’s Hospital and Chief, Yerevan Emergency Ambulance Service
Location: Grigor Lusavorich Medical Center and affiliated institutions in Yerevan, Republic of Armenia c/o Ara Minasyan, M.D., Chairman, Grigor Lusavoric Medical Center
10 Gurdjian Street, Yerevan, 375056
Students generally lodge at a local hotel in Yerevan or in the dormitories of the Armenian National Institute of Health, 49/4 Komitas Avenue, Yerevan, tel: 374-1-235-171
Number of Students: Up to six per rotation
Period to be offered: One four-week period throughout the year, by arrangement
Contact Armenia Partnership Program-Attn: Caroline Apovian, M.D.
Boston University School of Medicine
Description of Elective:
Boston University School of Medicine has established a medical elective for fourth-year medical students at the Grigor Lusavoric Medical Center, in Yerevan, Republic of Armenia. The elective is open to medical students from accredited medical schools. The Grigor Lusavoric Medical Center is a leading trauma center for Yerevan, the capital city, and is the base of the municipal ambulance service. The four-week elective includes short rotations in the thoracic surgery, emergency medicine, intensive care, and cardiology services of GLMC. In addition, students may elect to rotate at a maternity and pediatric hospital or pediatric and adult polyclinics. They can also have experience on ambulance service calls during evening hours, depending upon service volume.during evening hours depending upon service volume.
The intensive care and thoracic surgery departments at GLMC have residency programs. Students will be expected to shadow the house officers during their daily rounds of these services. In daily conferences, morning rounds, practical studies and discussions with the preceptor, students will gain an understanding of the practice of medicine in a non-western environment. They will see a strong demonstration of the importance of taking a patient history without benefit of extensive diagnostic testing. Medical education differences will be apparent to the student as well as international efforts to upgrade health care through the transfer of technology to Armenian hospitals.
Written evaluation of student performance will be obtained from preceptors. The elective organizers will see that all student evaluation forms are completed and mailed back to the student’s school. Written evaluations of the elective are required of students within one month of completion of the elective. Dr. Ara Minasyan will assume direct responsibility throughout the student’s stay in Armenia; individual department or section heads will be responsible for general direction and content of the elective.
“…The doctors are excellent. They will discuss their approach to patient management and contrast how it may differ in America.”
“…I felt that physicians at the Emergency Hospital were very knowledgeable in making proper diagnoses and treatments considering the lack of resources in the hospital.”
“…they respected my ideas”
“…It allows an American student to have hands-on experience with diseases that one reads about only in textbooks, such as botulism, brucellosis and echinococcal infection.”
“…We discussed the infrastructure of the health care delivery system of Armenia and its future outlook.”
“…Their approach to adapt in situations when equipment is not available is unique.”
“…We were treated like we were family.”
“…The doctors are very enthusiastic about teaching foreign students.”
Prerequisite: Russian and/or Armenian fluency
190.11 Adult Medicine/Geriatrics at Department of Medicine, University of Crete, Greece
Course Director(s): D T Boumpas, G Samonis
Coordinators: S Panagiotakis, MD
Location: Heraklion, Greece
Contact Information: Dr. Vassilis Zannis, firstname.lastname@example.org, 700 Albany Street (W509), 617-638-5085
SHORT SUMMARY OF ELECTIVE:
This is an elective designed to develop skills in history taking, physical examination and differential diagnosis appropriate for the evaluation of adult and geriatric patients. Knowledge goals include the physiology of normal adult subjects and the impact of aging on disease development and treatment. The elective takes place in the island of Greece (Department of Medicine) where adult and geriatric patients are cared for on general medical service. Daily rounds take place there with the residents and the attending physicians. There are three nursing homes in the Heraklion area, one public and two private ones. The geriatric rotation includes regular visits to them. Crete is the third largest island within the Mediterranean basin with strong family ties. Emphasis is placed on understanding adult and geriatric care within the cultural enviroment of the island. As such the rotation contributes to multicultural awareness and delivery of care to populations with different cultural backgrounds and societal values. Of interest the island has served over the years as the prototype for the Mediterranean diet and students should be able to gain first hand-experience experience in its natural setting.
DESCRIPTION OF ELECTIVE:
The elective takes care at the University of Crete teaching hospital (PAGNH), a tertiary care University consisting of 820 beds. It is located in the scenic area of Voutes, 7 km from the center of Heraklion in Crete.
Develop skills in history taking, physical examination and differential diagnosis appropriate for the evaluation of the adult and the geriatric patients.
• Discuss the physiology of normal aging
• Review the impact of aging and the pathogenesis of disease in the elderly and treatment modalities
• Participate in geriatric care adjusted to the cultural experience, needs and expectation of the elders of Crete
• Develop competence in delivery of health care in adult and aged subjects in diverse cultural environments
The Department of Medicine was one of the first established in the University Hospital. The staff consists of 4 physicians appointed by the Faculty of the Medical School (Professor and past-Chair DT Boumpas, Professor and Chair G Samonis, Professor A Gikas, Associate Professor E Ganotakis Assistant Professor DP Kofteridis), Ass Professor P Sidiropoulos Director Division of Rheumatology) and 7 physicians appointed by the National Health System (JA Papadakis, GN Fanti, G Vrentzos, E Barbounakis, S Panagiotakis and G Hamilos).
The main Faculty members have interests and/or are certified on
Rheumatology, Obesity and Metabolic Disorders, Infectious Diseases and Geriatrics Dr Panagiotakis is an internist with a masters in Gerontology and specialization in Geriatrics and serves as a the coordinator.
PRINCIPAL TEACHING METHODS
The Geriatric patients are cared for on general medical service; daily rounds take place there with the residents and the attending physicians. There are lectures on different topics of contemporary medicine, including geriatrics, during the noon conferences. There are three nursing homes in the Heraklion area, one public and two private ones. The geriatric rotation includes regular visits to them.
CORE CURRICULUM AND BASIC SKILLS
1. Dementia and delirium and other altered mental states; the ability to distinguish between all of these
2. Approach the patient with falls
3. Approach the patient with syncope
4. Approach to urinary and fecal incontinence
5. Prevention and treatment of pressure sores
7. Pharmacology in the adult and the elderly
8. The nursing home environment and problems with the nursing home patient
9. Medical ethics as it relates to the treatment of elderly patients
10. Elder abuse
PATIENT CHARACTERISTICS/CLINICAL ENCOUNTERS
While didactics are conducted in English, be aware that the majority of patient encounters are conducted in Greek. You will be paired with a Greek student who will do their best to act in part as your translator during encounters, as well as have their own responsibilities for their own rotation. The attending physicians will also help translate as needed. Adult and Geriatric patients are seen throughout the general medical inpatient and outpatient services and the emergency room admissions. There is also a dedicated Geriatric Clinic for comprehensive geriatric assessment of older people. A significant portion of the Emergency Room evaluation of patients involves the elderly, their safety and their home environment. Visits to nursing homes with faculty are available elective options. Following the morning reports, each visiting student will be assigned to follow the status and the treatment of 1 to 2 cases of patients, along with a Greek medical student. Emphasis will be placed on the geriatric patients. Both the visiting and the Greek students will be under the supervision of the attending physician. See the attached weekly calendar to understand the responsibilities and opportunities while on service. Below are descriptions of different key elements of the rotation.
Attendance of the Geriatrics Clinic under the supervision of Dr Panagiotakis Older people with problems such as falls, unsteadiness, cognitive disorders and depression are assessed there. The assessment is comprehensive and multidisciplinary. There is a cooperation with the Psychiatry and the Neurology Clinics for referrals of more complex cases and the Social Service Department for older people with special needs in the community. Emphasis is given on the maintenance of functional autonomy of the patients and the relief of the burden of their families.
Geriatric rounds are held once a week. The rounds are either sitting and/or by the bed of the patient. Special issues of care and discharge plan on complex geriatric cases are discussed. The rounds run by a multidisciplinary team composed by Dr Panagiotakis, a senior resident on Neurology, the physiotherapist and the social worker of the ward and a nurse.
Didactic lectures/ Teaching sessions/Appraisal presentations
These are detailed in the attached weekly calendar. Of note, morning report is held daily. The new admissions and the interesting follow-ups are discussed.
When there are students rotating in Geriatrics, Journal Clubs and noon conferences are devoted to geriatric issues. Students from Boston University do also their appraisal presentations on geriatric topics in these meetings.
Nursing Home rounds/Open Care Centers for Older people visits
Kalokairinou Nursing Home is a Charity of the Philanthropistic Institutions of A & M Kalokairinou in Heraklion city with almost 120 residents. Dr Panagiotakis visit the Institution with the students for rounds. Rounds involve the social worker of the Institution and a nurse. Matters regarding the well being of the residents, drug prescriptions, and referrals to subspecialties in the university hospital are discussed. In addition, Dr Panagiotakis and the students may visit the Open Care Centers of the Municipality of Heraklion and the Alzheimer Association, depending on the timing of their rotation. In these visits the students have the opportunity to meet and discuss with ambulatory older Cretan people in the community or even visit bed ridden people in their homes and understand the type of existing services and modes of care are offered in the community.
Use of standard BU evaluation forms will be performed. Mid-clerkship evaluations and final evaluations will be provided by Drs Boumpas and Panagiotakis. Students will be required to complete a patient log describing the disease entities they encounter and learn.
NUMBER OF STUDENTS
-Up to six 3rd/4th year medical students during the months of March, April, May (a total of 12-18 students can be accommodated during the spring semester). No students will rotate during times of national or regional holidays, including Easter.
LENGTH OF ELECTIVE
ER (Emergency Room) Rotation is held either on Monday or Tuesday
Professor Rounds are held either on Wednesday or Thursday, the same day with the Firm Chief Rounds
Firm Chief Rounds are held either Wednesday or Thursday
Nursing Home Rounds are held twice a week in the afternoon (Monday or Tuesday on the day that there is no ER rotation and on Thursday)
705.0 Global Health Elective
Instructor: Suzanne Sarfaty, M.D., Director, Global Health Program, BUSM
Contact: Ana Bediako
Website: Global Health Program (provides expanded details in relation to information below)
Description of Elective:
This is a clinical clerkship or research opportunity for medical students interested in the field of Global Health (GH). BUSM has a few established affiliations with hospitals and medical schools overseas, but students may seek alternative sites for their electives. They must be conversant with the language spoken in the host country for maximal learning benefit unless there is a provision for translators as part of the elective.
Any student wishing to undertake an GH elective must complete a formal application and submit it for approval to Dr. Sarfaty or the designated faculty contact (e.g. Warren Hershman, M.D. for the Israel elective and Vassilis Zannis, M.D. for the Greece elective). A letter of acceptance from the preceptor under which the student will work is also required.
It is strongly recommended that the student initiate plans for the GH elective six months in advance, as logistics for arranging overseas electives can be difficult. Evacuation/travel insurance will be provided to medical students if deemed necessary after discussion with Dr. Sarfaty or faculty contact.
All students are eligible to apply for a stipend to support the cost of the GH elective. Applications are accepted twice a year (July 15 and October 15) and are funded through a competitive process. Awards typically range from $400 to $1500, although awards of less or more are given. Funding is by reimbursement and is intended to help cover airfare and other expenses related to the elective. A completed post-elective report and original receipts must be submitted in order for reimbursement to be granted. In addition, students should consult the website for other potential sources of funding.