Top 10 Habits of Highly Successful Medical Trainees

1. Top 10 Habits of Highly Successful Medical Trainees Getting the most out of medical externships Shannon Galvin, MD October 2013

2. "I arise in the morning torn between a desire to improve the world and a desire to enjoy the world. This makes it hard to plan the day.“ E B White

3. 1. Don’t die The major cause of death or serious disability for foreign travelers is • 1. HIV • 2. Malaria • 3. Motor vehicle accidents • 4. Diarrhea • 5. Depression

4. 1. Don’t die The major cause of death or serious disability for foreign travelers is • 1. HIV • 2. Malaria • 3. Motor vehicle accidents • 4. Diarrhea • 5. Depression

5. Injury and illness abroad • Approx 20-50% of persons report some illness-usually self limiting skin conditions or diarrhea • About 5% are ill enough to seek medical care • Serious injury and death • 44% from injury-MVA>>near drownings>assaults • Acute MI, angina 18% • Other medical 17% GI bleed, respiratory distress, etc • Infectious diseases 4% Galvin et al. Family Medicine 2012. Hargarten et al. A Medical J 1993.

6. 1. Don’t die • Use seat belts at all times (if possible) • Avoid night driving • Avoid motos, backs of pickup trucks • Avoid mixing alcohol with driving or water sports • Only use certified diving instructors • Use common sense when boating

7. 2. Don’t get (too) sick Important health hazards that may be encountered during travel include exposures to agents that cause… • 1. Diarrhea • 2. Acute respiratory illness • 3. Malaria • 4. Tuberculosis • 5. STDs • 6. All of the above

8. 2. Don’t get (too) sick Important health hazards that may be encountered during travel include exposures to agents that cause… • 1. Diarrhea • 2. Acute respiratory illness • 3. Malaria • 4. Tuberculosis • 5. STDs • 6. All of the above

9. Pretravel preparation Six weeks before visit travel clinic to ensure needed vaccinations-may include typhoid, hepatitis A, polio booster • Some countries require yellow fever vaccination and card Malaria prophylaxis DEET containing insect repellants Malarone, doxycyclineor other antimalarial Antibiotics for diarrhea Supply of all your own prescriptions and medical needs Hand gel, first aid kit

10. Occupational exposures • Tuberculosis • Ensure work in cross ventilated area • If you bring N-95 masks bring enough to share • Obtain follow up IGRA/PPD after 10weeks of return • Needlesticks • Make sure up to date on Hepatitis B vaccine • If source HIV status unknown or positive irrigate site well then • Truvada and Kaletra within 72 hours of exposure for 28 days • Topic covered in detail in the Infectious Disease lecture

11. 3. Be polite • You are easily identifiable as an American • You are representing your country, your profession and your school • You are assumed to be rude, rich and entitled-because you are Be polite and patient, customer service is an American concept Learn the local greeting, use it, great everyone in the room every time you enter

12. 4. Be streetwise Begging • Nothing to village kids • Street children, handicapped people-food is better or small change Touts-use good sense, be prepared when arriving at airports, train stations, bus terminals Drinking-use local customs, women take special care Dress conservatively-cover knees and shoulders Be safe, even if only out of courtesy for your hosts

13. 5. Be professional • Their way is the right way • If it seems “different” ask why things are done that way • Same rules for any clinical rotation-be prompt, follow instructions, clarify if you don’t understand what is expected • Be respectful of time of your preceptors-usually very busy clinicians • Your project/rotation is not nor should be the priority of the local staff • Try to get a copy of relevant national or WHO guidelines prior to travel

15. 6. Be responsible • You should be precepted-you are there to learn-speak up if you do not feel comfortable • Do not do any thing you have no business doing- surgeries, etc • No pictures of patients • Wait 24 hours and reread before posting anything to your Facebook, Twitter etc accounts. Then think-what if my hosts could read this?

16. 7. Be compassionate • First do no harm • Be honest with patients-do not promise things you can’t provide • Standards of patient care may not be ideal-try to identify what local standards would be • You may only be able to listen, that can be very important

17. 8. Improvise • Work around resource limitations • Renal failure-can you exam urine sediment • No echo, xray-physical examination Follow local guidelines as best as possible-then do your best

19. 9. Be an ethical researcher Every research must be approved by Northwestern and local IRB • Local IRB review can take months in some countries Consents and questionnaires need to be in local language-English->local language->back translation Be prepared for implementation obstacles Research cannot deviate from the approved protocol, but you may be able to improvise in areas where specifics were not spelled out Respect for Persons, Beneficence, Justice

20. 10. Have fun • Delight in the differences • Spend time with your hosts • It will be normal to feel stressed or sad or angry, let us know if these feelings are overwhelming or intrusive