<p>OP,
If you have never done it, how did you form your opinion?
My D. enjoys her research experience very much and will bring her enthusiasm about it to med. Schools interviews. She is having a ball in her lab along with others on her research team. Loves every aspect of it. And she was able to get couple grants for it also. Something additional to mention, since she had to write proposals to couple of places with project cost calculations. </p>
<p>Strongly advise to get into research, but it is really up to you.</p>
<p>“Simple suturing” is not the same as closing, and it sounds more like the students are discussing diagnoses, not making them. I’m not particularly concerned about adequate supervision - it’s more the idea that third world patients get to be guinea pigs for the benefit of first world students that concerns me. I think these programs are of dubious benefit to the patients and the would-be providers at best and are clearly unethical at worst.</p>
<p>Either way, it’s likely that there are better ways to get clinical experience.</p>
<p>Don’t get specific about what you get to do in third world countries unless you are asked directly if you did something or not. Pre-meds like glory and puffing themselves up because they “know how to do a physical exam” or because they got to suture. It’s fun, we all like to play doctor once in a while or we wouldn’t be so driven to become one. However, it is unethical coming from our medical establishment. A pre-med student may be standard of care in the third world, but it is not standard of care at your desired medical school. Your suturing is faulty and risky of infection. Your physical exam is faulty and prone to errors. I’m not even sure I would trust your vital signs. I can barely trust a lot of pre-meds with simple database work and data collection, I certainly don’t have faith in the pre-med masses ability to provide health care. Most of the kids that go do things like that are not going to be doctors and were never qualified to be them. Third world volunteering is great though and I do recommend it so long as you keep quiet about certain activities. The fact of the matter is a lot of doctors here in the US violate regs and allow unqualified kids to do things in surgery, etc under strict supervision. It’s part of the mentor-mentee mentality a lot of the time. I do not share shades faith in adequate supervision of these programs nor the quality of the mentors. Chances are if you are paying more than your own way it’s not worth the opportunity.</p>
<p>It’s hard to evaluate the adequacy of supervision of a program when all we know is a couple of sentences posted on a message board. Supervision is always an issue with people in training. That being said, I don’t see adequacy of supervision to be an issue than a student should be expected to address in a meaningful way. By definition, they don’t know where the boundaries are. While it looks bad to those of us who do have an idea of where the lines should be drawn, they can’t be expected to be good judges of the appropriateness of the supervision - ultimately, that’s the MD’s call.</p>
<p>What students can and should think about, though, is why they’re doing what they’re doing and what the implications are. They can and should think about the ethical issues raised by these overseas trips. They are capable here of making judgments on appropriateness.</p>
<p>Too many premeds think that being a physician is about taking blood pressures or hearing heart murmurs or doing sutures. These same premeds wonder why EMT experience isn’t valued more. Quite frankly, taking a proper history and using sound clinical reasoning is probably more akin to what a physician does. Hence, the critical reasoning that goes on in designing, troubleshooting, and analyzing a research experiment is more valuable to an admission’s officer than being able to do vitals or to suture. They’ll teach you how to do vitals properly or how to do a sterile vaginal exam in med school. Those are procedural things that a nurse can do. What separates a physician from a nurse is an understanding of pathophysiology behind a disease and the rationale behind our treatments. Critical thinking skills, not suturing skills, are what the adcom is looking for.</p>
<p>The primary focus is to help out patients in 3rd world countries that lack the support & availability of doctors and other health professionals. In the process of helping them out, as a student you will take on the very basic functions of doctoring that way you can take care of many people quickly & easily & that don’t need anything more than a simple quick fix in mass, and in essence freeing up the load of the available doctors for more serious concerns. </p>
<p>Shades is right on both: the stitching are just simple sutures and the diagnoses part is more (likely only) discussion than determinant. A student not being able to properly recognize his boundaries and limitations is a valid point.</p>
<p>In arguendo of shades’ ethical concern, I would counter with the fact that all of medicine and more specifically those that intervene physically must initially start out with “guinea pigs,” as emphasized in Atul Gawande’s Better. Every surgeon had a first for everything, many of them being things that cannot be practiced on cadavers, and therefore the first time they ever experienced it was on a living, breathing human being. First for the intravenous line placement, first for emergency situations, first for etc. It’s only through experience and practice that you can get better and the first however many of your patients that you essentially “practice” on are obviously not going to display as good of results as the patients you work on years down the road after you are skilled and more proficient. </p>
<p>I have another question. We emphasize a lot about clinical experience here. Would you guys say with merits of ethical arguments aside that this kind of experience provides one with a far better clinical experience/exposure than almost everything else we can get our hands on as undergrads?</p>
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<p>Most of the kids that go do things like that are not going to be doctors and were never qualified to be them.</p>
<p>Is this the general view towards students who take part in these trips? Particularly medical school adcoms. - Just out of curiosity.</p>
<p>Chances are if you are paying more than your own way it’s not worth the opportunity.</p>
<p>I definitely agree with this, the cost-benefit is quite low. However, what if your trip were completely or almost completely funded for?</p>
<p>In my view, as long as such a trip (1) has students doing only very basic tasks, (2) doesn’t replace any other components of the application, and (3) is written about thoughtfully, it can be an excellent addition to an application.</p>
<p>But it has to be an addition. You don’t get to use it to replace conventional volunteering.</p>
<p>I don’t understand this recent trend on CC about whining about how menial hospital volunteering is. Seriously, what do you think being a doctor is?</p>
<p>No. The difference b/w a medical student or resident practicing on a patient vs. an undergrad is that a) the medical student or resident will likely actually use these skills in the future while the undergrad has a 80% chance of never getting into med school at all (hence you are subjecting the patient to an unnecessary risk) and b) the undergrad likely has no clinical skills whatsoever. A bio major is not any more adept at practicing clinical medicine than an English major or any guy off the street since undergrad bio has almost no clinical slant to it. A premed has about as much a chance of getting a blood pressure right as the random guy sitting next to me.</p>
<p>As I said above, exposure to clinical decision making is more valuable than exposure to actual procedural things. Hence, if you find a really good mentor here, a really good doctor to shadow, you should get a great clinical experience. More than half of what we learn as med students on rotations is why certain things are done a certain way or why we use this drug instead of another drug. Yes, you learn to perform procedures but that’s not what medicine is really about. Going to a foreign country and learning how to do bp’s on a buncha patients is not valuable than having a doctor here explain why we monitor bp’s in pregnant women so closely.</p>
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<p>Most of them lack initiative. Most of them end up stapling papers for 200 hours. This same kind of attitude is what’ll get you a marginal pass on your rotations. If you simply showed up and sat at the nurses station for 3 hours, then you are not going to get a good experience. If you showed up on your rotations and simply did the bare minimum, you aren’t going to learn much. Go talk to the nurses about patient care. They actually know quite a lot. Schmooze the attendings or residents. Next time they see a patient, they’ll take you along. Read some of the H&P’s in the patient’s chart that you are stapling. Look at how a history and physical is performed, what kind of questions we ask for common diseases. Go introduce yourself to the patients and ask about their illness and experience of being sick. You want to be like a med student? This is what we do every day. Don’t just fold beds for 5 hours and then complain about what a crappy clinical experience that is. Do something about it. In the hospital, whether you are an undergrad or a med student, no one is going to hand you anything. No one is going to come to you and ask you to come along or explain things to you. If you want to see a patient with someone, ask the attending. If you want to know about a disease, ask the healthcare provider taking care of a patient.</p>
<p>I went to Africa to do volunteer HIV education, and was able to do some shadowing in a hospital on the side. There was little liability/confidentiality to worry about, so I was able to see essentially anything I wanted, including births and surgery. Mainly I just followed a doctor doing rounds each day in pediatrics, and the most involved I ever got was feeding babies in the NICU. Ethically, I’m not into doing anything you aren’t qualified or trained for, and doing things like taking blood pressure isn’t exciting or substantial. I really got more out of doing education, which seemed to really be needed, and taught me a lot.</p>
<p>If you want to volunteer abroad, and have the money (or funding) to do so, have at it. It was a blast, I learned a lot, and it was a once-in-a-lifetime adventure, I’d do it again in a heart beat… but not for application reasons. You aren’t going to learn to be a doctor, you aren’t really going to gain skills that will be relevant to a medical education, and you aren’t saving the world any more than you would be if you volunteered in the US.</p>
<p>And is it the attitude of the the participant as much as the task being performed that produces the whining? </p>
<p>I know that my D’s high school and UG experiences have served her well in her (med school orientation) hospital immersion and first couple of weeks of med school. Emptying bedpans is certainly not something she’d like to do everyday but …to a certain extent hospital volunteering is a familiarization/de-sensitization process that allowed her to be the student who (when called upon as a group) reached over and removed a catheter from a bed-ridden patient without hesitation, didn’t fall out during observations of icky stuff, well…a whole bunch of things already where she felt her experiences were worthwhile. </p>
<p>Maybe just maybe the attitude needs to be adjusted. Maybe students need to look beyond the menial nature of patient transport (whatever) to a time they are the doc in the chute and it’s their bull to ride. </p>
<p>And anyway, she’s a goofball. She actually enjoyed it and most times had something interesting to share about what she saw or did.</p>
<p>Emily, You gained perspective, cultural and situational awareness, maybe a little confidence in yourself and your decision to be a doc, and you didn’t do it (solely) for app enhancement…and you could afford it. </p>
<p>“I-Banking: Simulate exciting work by having people yell at you all the time. We know that you just shuttle data from Excel into Powerpoint, but our work environment will keep your pulse pounding and your adrenaline pumping. When we yell at you, it’ll seem like you’re a firefighter entering a burning building–except without, you know, fires or any legitimate emergencies.”</p>
<p>Now contrast Emily and her experience to the pre-med who pays $6K to go on a medical tour of (insert 3rd World Country here) thinking it will be the tip they need for med school admission and that it replaces/trumps long-term clinical experience here at home. That one would be a loss. ;)</p>
<p>"I don’t understand this recent trend on CC about whining about how menial hospital volunteering is. "</p>
<p>-It does not have to be that way at all. Some places adjust to UG college students vs. HS kids (just for example) giving UG’s more challenging positions, that they will enjoy. And they do. For example, participating in musical therapy at mental illness facility could actually be fun.</p>
<p>I went on a medical trip to Costa Rica a few years ago. It wasn’t very expensive, most of the cost of our trip went to paying the healthcare professionals who came with us, and “all” we did was set up primary care clinics. </p>
<p>Agree wholeheartedly that the procedural part wasn’t important–there were 2 business majors on our trip (who just wanted to volunteer abroad) and they kept pace with the premeds just fine. I’m not so naive to think that my ability to say “respire profundo” and use a stethoscope on lungs means I can even know what I’m listening for (besides perhaps the wheezing a patient had already mentioned), or that being able to weigh and measure a child will clue me into something about his nutritional needs. So from a practical standpoint, I’d be hardpressed to say that anything I learned there will give me any kind of “edge” in medicine/applying to med school.</p>
<p>But the absolutely crucial part, in my opinion, was the huge perspective I gained about access to patient care and healthcare in a foreign country. It was amazing to me to see how grateful our “patients” would be for us to just sit there and listen to them, present their case to our attending, and chat while they were waiting for a diagnosis. Before that trip, I had no idea that simply taking the time to listen to someone could have such an impact on their confidence in healthcare situations (measured by how timid they were at the beginning, to how chatty they were at the end), and noticing how valued they felt because this big group of Americans left their comfy American lifestyles to travel to the middle of nowhere in order to talk to THEM about their healthcare.</p>
<p>So in essence, my trip really opened my eyes to medical service, public health, global medicine, and to how valuable meaningful interactions can be for patients. When I came back, I used that experience as inspiration to take service learning courses (and tack on a public service minor), volunteer with pregnant teens/teen parents/women in crisis pregnancies, start a nonprofit in my community to help patients with low health literacy, and take the time to talk with patients I encountered while shadowing.</p>
<p>There’s not a doubt in my mind that many of the things I’m most proud of about my med school application came as a result of my trip to Costa Rica. I have absolutely no idea if my experience is common (I hope it is–it’s been awesome), but I’d like to think that I came to all these conclusions without endangering, experiementing on, or exploiting people in a foreign country. In the end, they helped me learn about myself–what more could I ask for?</p>
<p>EH: Shades hit most of what I was going to say. A resident has been selected out of a pool of candidates which was in turn made up of a much larger pool of candidates. He or she has the training to benefit from performing new procedures and the intelligence to make such a “first” worth the risks. Volunteering in third world countries as an undergrad does NOT truly take the burden off of doctors. Off a hospital with no resources for techs, maybe. Unless you are a C-section tech, a nurse, a midwife, etc you really aren’t taking the heat off of docs because you don’t possess the knowledge or skills to do so. At the very best you are taking the heat off one of the above so that they can take the heat of the doctor. I will be generous and postulate that these programs give you 2 full weeks of medical training. What can a bunch of pre-meds (many of which who aren’t even near making the cut) really learn in two weeks to replace years of medical education? Medical education is not just a big blob of knowledge, it is built in layers. Taking the top layer and feeding it to pre-meds for two weeks does not in any way prepare them for even the simplest of cases. Not even a cold. Not even a perfectly well person.</p>
<p>As far as your two questions, no the adcom doesn’t automatically assume you are a moron and unqualified for going on these trips. If you can show that you got something valuable from it they will take it at face value. They may roll their eyes if you dropped $10k for a pre-med trap that they are familiar with though.</p>
<p>If the trip is funded then, in my mind, that is a much more legit service opportunity. Even if you are just paying for your travel, room, and board that is legit. However, most of these programs have you give them the money so that they can “set up everything for you.” I’m sure some straight up take a fee. These I suspect.</p>