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Electives - Global Health

Uganda Clinical Medicine

Elective Number: 1525 (International)

Rotation Supervisors: Dr. Christopher Moore

Designated signer: Dr. Moore ccm5u@virginia.edu

Available: All Rotations - based on availability at Mbarara Regional Referral Hospital

Duration: 4 weeks (up to 8 weeks) based on Mbarara availability

Evaluation should be given to: Overseas preceptor - students should bring evals back and give to Dr. Moore

Prerequisites: Rotation must be arranged with Dr. Moore at least 4-6 months in advance to allow plenty of time to set things up in Uganda. As well, at least a month prior (but best to be 6-8 weeks prior) to beginning the rotation complete the Elective requirements on the Forms page.

Report to: Dr. Tony Wilson

Time to Report: 9:00 am

Place to Report: Medicine Ward, Mbarara Regional Referral Hospital

Attendance: Attendance at elective activities is mandatory.

  • Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Attending on Service.
  • Students are allowed to take off up to 1 day per week to interview between November 1 and February 1.

Number of students per rotation: 1-2

Learning Objectives:

  1. Learn to diagnose and treat unique medical conditions prevalent in Uganda, but unusual in the patients cared for at the University of Virginia.
  2. Learn about different healthcare delivery systems in Uganda.
  3. Develop cultural understanding that allows you to work effectively with patients of different backgrounds and cultures.
  4. Learn to practice at the level of one's capacity and not to exceed one's level of training.

Schedule/Logistics
The four-week rotation will be offered on a rotating basis throughout the year. MRRH does occasionally host students and less often students from other institutions, so availability is based on capacity of MRRH to host a UVA student. Coordination of the trip should be completed at least six-months before the rotation. MRRH is an approximately four-hour drive from Kampala. After arrival into Entebbe/Kampala airport, ground transfer to MRRH can be arranged by public bus (Swift Safari is recommended) or by private car. Arrangements with reputable drivers can be coordinated through Dr. Moore and/or the administration at MRRH.

Clinical Competencies and Objectives
This international student elective rotation is a four-week block designed to give the visiting student training in all aspects of clinical care in a resource-limited international setting. The majority of clinical exposure occurs with inpatients, but the visiting student is expected to attend at least one of several ambulatory clinics per week as well. The rotation will provide an introduction to international healthcare systems in a resource-limited setting in sub-Saharan Africa.

Patient Care
The rotation will provide visiting students with the training required to diagnose patients with acute and chronic illnesses in a resource-limited setting. The student will become familiar with common illnesses seen on the wards including, but not limited to: AIDS associated opportunistic infections, tuberculosis, cardiovascular diseases, renal failure, gastrointestinal bleeding, severe anemia, malnutrition, and organophosphate poisoning. In conjunction with housestaff and faculty, the student will help create a diagnosis and management plan for each patient on their ward round. Working in a developing country will expose the student to the difficulties in medical management encountered by clinicians and patients in resource-limited settings.

Medical Knowledge
Students will be expected to actively participate in ward rounds and contribute to the management of each patient they encounter. As such, they will hone their physical exam skills as this is the main diagnostic intervention available. Radiologic and laboratory studies are scarce so there is an increased reliance on the physical examination. Students will also be required to present teaching sessions on topics generated from patients on the ward round. They will increase their knowledge of tropical diseases not frequently encountered in the United States such as parasitic infections, nutritional deficiencies, measles, and tuberculosis, among others.

Practice-Based Learning
Students will be expected to investigate and evaluate their care of patients, appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. This international rotation will improve the student’s evaluation of necessary tests both in resource-limited and resource-privileged settings. Practicing medicine in a resource-limited setting will expose the student to diseases not frequently encountered in the US and will improve physical examination skills.

Systems-Based Learning
Students will experience the opportunities and challenges present in the Ugandan healthcare system. They will participate in the management of acute and chronic diseases managed by Ugandan physicians. They will learn how ancillary support, including patient attendants (family members or friends), augment the capacity of the Ugandan healthcare System.

Interpersonal and Communications Skills
Students will demonstrate effective communication with American physicians, Ugandan physicians and Ugandan medical students. Students will improve their cultural awareness and practice effective communication with Ugandan patients and clinical staff by participating as members of a multicultural healthcare team.

Professionalism
Students will be expected to respect and work with patients, students and physicians from a different cultural background. They will learn to adapt to a different medical system.

Disease Mix & Patient Characteristics
Students will encounter patients with a variety of diseases. Frequently encountered acute diseases include: myocardial infarction, severe sepsis, meningitis (bacterial, cryptococcal, or tuberculous), organophosphate poisoning, and diabetic ketoacidosis. Common chronic diseases include: diabetes, hypertension, kidney disease, and HIV infection.

Clinical Procedures
Procedures performed will include physical examination. Visiting students will be advised not to participate in invasive procedures such as thoracentesis or lumbar puncture.

Supervision
Dr. L. Anthony Wilson is the Chair of the Department and the onsite supervisor for visiting students. He is a senior professor of internal medicine and neurology trained in New Zealand and the United Kingdom where he had a long and distinguished academic career. The supervising Ugandan staff includes attending physicians who have completed three years of post-graduate training in internal medicine (Masters of Medicine) which is equivalent to a US based residency.

Students will participate on ward rounds on a daily basis with the housestaff and a supervising attending physician. Students will be expected to discuss management of patients with the supervising attending physicians as well as the Ugandan housestaff which generally includes an intern and a student (a Masters of Medicine candidate). Additionally, one attending physician is on call each day and rounds with the admitting team on new admissions in the morning and again in the evening every call day. Students will be expected to participate in post-call rounds each morning and at least once per week in the evening. Attending physicians also supervise housestaff in the ambulatory clinics which visiting students will be expected to attend at least once per week.

Evaluation
Rotation goals and objectives will be reviewed by Dr. Moore with students prior to commencement. Students will be given verbal feedback on their performance as well as a written evaluation using the Oasis on-line evaluation tool. Students will evaluate their attendings and the rotation itself, also using Oasis.