Medical School

Medical School

Checking Luggage, Privilege, and Perspective: A Reflection on Responsible Tourism and Time Spend Abroad as a Medical Student (Part One)

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Good evening everyone! I hope that you are all having a wonderful day. As you may have gathered from my recent post A Letter to Myself, as a First Year Medical Student, I had the opportunity to travel internationally during my medical school training. On a bitterly cold January morning, we were spoken to by several faculty members arranging international pre-clinical electives. The last speaker, a distinguished family physician, discussed an opportunity she had been offering in India over the last several years. In all truthfulness, I knew very little about India; however, while the speaker was talking I felt my heart beat faster and my back straighten: I just knew I was going to India.

My trip to India would mark my first official exit from North America. I was buzzing with excitement and uncertainty. As my departure date grew closer, I tried to get ahold of any and all information that would help me begin to understand India and my role as a medical student there. I had limited understanding of the importance of responsible tourism and wanted, as much as possible, to be mindful of my biases and what impact my presence would have on those around me. I asked friends who had travelled to India and other parts of the world about their experiences, hoping that hearing their narratives would help me to avoid any intolerant comments or behaviours.

A month prior to leaving, our school offered us some didactic and group cultural sensitivity training. I was thrilled and signed up immediately. The meeting involved first-year students travelling to a myriad of places: Tanzania, Uganda, Australia, Ireland, Croatia, and of course – India. During the training, we were challenged to discuss our reasons for wanting to complete clinical activities abroad. Other students eagerly discussed their hopes to better the lives of impoverished, marginalized populations. I admired their zeal but struggled to understand their intentions. How could our travels represent anything but personal gain? We had recently finished our first year of medical school and I felt that I had learned a lot of things but still really know quite little. I thought back to our recent OSCE where I put the blood pressure cuff on my patient backwards and watched in horror as it inflated like some sad inflatable swimming aid. I came to the rapid conclusion that I could not expect that I would be helping any patients. Instead, I turned my focus towards figuring out my motives for this trip. Why did I want to go to India? Could I use this experience to benefit others as a practicing physician? How might my presence impact patient care? What does responsible tourism look like in real life and how could I practice it?

I will admit, I did not have a good answer to any of these questions prior to my departure. Boarding the plane, I felt sure that this trip would allow me to get outside of my “cultural comfort zone” and to gain a general sense of what kinds of challenges and barriers newcomers to Canada might experience. I recognized that my experience could never be the same as other individuals; however, I felt that there was a huge learning opportunity for being in an area where I could not read, write, or speak the predominant language and lacked any sort of cultural knowledge. My first goal became to use these experiences to deepen my cultural humility and to use this humility when providing care to immigrants, refugees, and non-English speakers back at home.

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Some of my initial conceptions of responsible tourism began to take shape once I actually began my observership in several busy outpatient paediatric departments. I was absolutely floored by these experiences: the number of patients, the language difference, the amount of people present in the examination rooms, the heat and humidity…just to name a few. First and foremost, I felt extremely uncomfortable not being able to identify who I was and why I was present for the appointment. Understandably, I was the subject of many confused, suspicious looks from patients and family members. I felt like I was intruding in such an intimate space and desperately wished that I could ask permission to be present. I attempted to learn a few basic introductory phrases in Hindi; but after several botched attempts, I resigned myself to silence and naively hoped that my non-verbal behaviours would communicate trust and comfort.

I also struggled with how to adapt my learning process and goals to the clinical context and needs of the patients. Back in Canada, we are encouraged and expected to ask staff physicians questions about patients we have seen in clinic. In India, there were more patients waiting than I could have ever imagined. I was casually informed by a medical student that, for some patients, the journey to see a physician had been a perilous journey due to multiple road closures from heavy monsoon rains. I felt incredibly guilty asking questions knowing that taking time from my Indian preceptors to translate and answer might actually displace some needy child from having a full appointment. So I wrote my questions down and kept them with me when I had a few moments alone with a physician or resident. I had a much easier time falling asleep believing that I had not added to the already lengthy waiting times; however, I continued to think about how else my presence as a white foreigner may have distracted from the clinical process. Was this observership totally self-serving? How could I do better in the future?

Have you ever travelled abroad to complete any type of clinical work? What have your experiences been like? Where did you go and what did you learn? Do you have any advice for medical learners planning international electives?

Stay tuned for Part Two where I discuss my experience in Lucknow, a northern Indian city, where I facilitated a professional competencies workshop for first year medical students.

Medical School, Personal Development

A Letter to Myself, as a First Year Medical Student


A letter…to me,

It’s me, or I suppose, a tired-er, slightly older version of you  It is August 2017 and another eventful summer is winding down. Over the last two weeks, most of the medical schools in Canada have been gearing up to welcome their incoming classes and it got me thinking about you and your first day. You were so excited and with good reason – the next few years of your life are going to be some of the very best, but also some of the most challenging. So while we have some time, let me go over a few tips I wish I had known on my first day.

You are going to meet and make some of the greatest friends. During orientation week, you’ll connect with a few people and wonder how these relationships will evolve over time.  You will also be hopelessly day dreaming about your old city and social network. Take the visits and time that you need to grieve the ending of that chapter, but know, that you struck “friendship gold” with the group you met during your first week. This group will be your comedy show when you are feeling down, your ride when you are lost, your teacher when you are confused, your pseudo-therapist when you are angry, and your DJ when you feel like dancing. Soak up every minute, friends like these don’t come around often.

Take risks (within reason). There are an unbelievable amount of opportunities waiting for you. Medical school will be one of the most supportive and engaging learning environments you will have ever been in. So get outside of your comfort zone and try something new. You’ve never been outside of North America before – maybe now is the time. Ever considered India? Also, keep an open mind when setbacks happen or plans fall through, because they can and they will. These changes will land you in some pretty surprising and interesting opportunities which you may not have had otherwise.

Learn to set boundaries and say no. This is something we still continue to struggle with (Sorry!). I know how badly you want to make everyone happy but, sometimes, it comes at the expense of your own happiness. You do not have to do every extra-curricular activity you hear about (If you know that you are not into general surgery, why agree to do a massive chart review?!?). You do not have to attend every social function to maintain your friend group (Would you really want to be friends with someone who held missing trivia over your head?). Finally, and this is a biggie, you do not have to go on a date with anybody who doesn’t treat you well. Period. Draw those lines and stand behind them. I got your back.

There’s no easy way to say this one – you will struggle with your mental health, like, really struggle. At times, it will feel like there’s no hope of getting better. You will want to push everyone away and sleep for inhuman amounts of time. You will pass up meals and wonder if you will ever truly feel happy again. Don’t worry – you will. At the time, you will feel downright empty, scared, and alone; but you’ll come to realize just how many people you have in your corner. You are so loved. Go to yoga, take that nap you’re itching for, ask for help, hug the people who stood by you, and breathe. Take ownership of this illness and recognize it for what it is: an illness. It will help you become a better physician, and more importantly, a better person.

You are already concerned about what specialty you will do and where you will go for residency. Pause, take a deep breath, and know that everything will work out. I am not going to give you any spoilers as to how it ends (where’s the fun in that?). It will be a challenging process, you will cry on more than one occasion, and you will write an obscene amount of CaRMS letters. But you are so much better for it and so much more confident that the choice you made was right for you. Make sure you have lots of Reese’s Piece’s on hand.

Oh, and one more thing, when you get Tinder – and stop rolling your eyes, you do inevitably get Tinder – don’t chicken out on swiping on that handsome Occupational Therapy student – that story ends pretty cool.

Give Tucker pets and kisses as often as you can and I will see you in a little bit,

You (circa 2017)