International
emergency medicine (IEM) is one of the most popular subspecialties in emergency medicine. Among other medical specialties, international medicine is just as popular.
As a senior resident, I have seen many a medical student or junior resident light up when I discuss IEM.
But even though IEM is a great buzzword, it can mean different things to
different people. Does it refer to a clinical rotation to see how EM is
practiced in other parts of the world? How about developing emergency systems,
or providing humanitarian relief? Where does research or teaching fit in? In my
first president's column, I want to share my passion for IEM with you by providing
some guidance and advice that I wish I had gotten when I was first drawn into
IEM.
Everyone’s
path in IEM is different, and I share my background with you so that you can
see my circuitous path in this journey. Students and residents often ask about
getting involved with IEM and what things they should consider in building an
IEM career. Here are some thoughts:
1)
The only way to know whether or not you will like something is to try it. If
you are new to international work, find an opportunity and jump on it. Don't be
picky about location or type of experience. Many schools and residencies will
have an international rotation. Most likely it is a one-month clinical
experience, but occasionally it is a research project (e.g., studying malnutrition) or an educational
opportunity (e.g., teaching point-of-care ultrasound). There may be a relief
mission that needs your help. Some of my residency classmates went to assist
with the disasters in Haiti and Japan. These were not things that they planned,
but they jumped on opportunities that came up. Explore multiple options. Your
own program is the most natural place to start, but also look elsewhere in your
university. The American Medical Student Association has medical student
elective listings. AAEM/RSA is also establishing an international rotation
database. Keep your eyes and ears
open and ask other residents and attendings to be on the lookout for you.
2)
There has been a lot written in recent years about "medical tourism".9,10
While this phrase conjures up unpleasant connotations, and sustainability in
international programs is very important to think about, don't discount
experiences because of your own (unnecessary) guilt. International
rotations are important for your exposure, and whether you end up doing
international work or not in your career, your experience will be instructive
for you and good for your future patients. Find your own way to meaningfully
learn and to contribute.
3) Once
you’ve had experience with IEM, decide whether it is something that you feel
passion for versus something that you would like to do only occasionally. There
is no right or wrong answer--don't feel guilty if your experience showed you
that you don't want to live in war-torn countries forever. Be honest about what
you like doing and how you think international work will fit into your career.
What attracts you most about the work? Does clinical work excite you while
research bores you? Are you happiest doing impact evaluations from the comfort
of your own home? Would you want to do these things occasionally, or do you
love them so much that you need to build it into your career?
4)
Consider the other interests that you have to balance. International fieldwork is
hard to find time for in residency, but it might be even more challenging with
a young family. Know how your significant other feels about your work. This is
a continuing conversation for me and my husband, a South African native who I
met in the U.K. Initially, we thought that we would spend two months every year
abroad, but this is difficult to manage in both of our careers right now. It
took me a while to realize that not everything I want has to be done at this
very moment. Perhaps this is the time to focus on your family and your
clinical work. IEM opportunities will be there when your life settles
down. Perhaps later on, you and your family might consider a year or two
abroad, or you may be able to take a job with greater travel flexibility. Think
about how you want to balance your IEM interest at this point in time and be
flexible to change.
5)
Don't discount related work in the U.S. I have come full circle in this regard
by starting in domestic health policy, falling in love with IEM, then
coming back to U.S. policy. There are huge problems with access to care and
health inequities in the U.S., and what you learn through your international
experiences will inform your work here - whether it's in policy, advocacy,
community activism, or your clinical work. Many international interests can be
built into your domestic work and vice versa. If you have an interest in EMS,
you can develop your expertise in the U.S. first and then do projects abroad.
If you have experience with teaching mid-level providers internationally, you
can design similar programs in the U.S. The options are limitless!
6)
Build and nourish your network. Identify mentors as early as possible. Seek out
those you admire and follow their career paths. Read their work. Ask for advice
from those who have IEM careers and those who don't--their perspectives
will be just as important for you. Women, it may help to find identify
female mentors as women face a unique set of challenges. The Academy of Womenin Academic Emergency Medicine is a great resource, and this year it
is offering free membership to residents.11 Along the
same lines, build your peer group. IEM is a small world, and your peers
will encourage and inspire you throughout your professional lifetime.8,12
As
my mentors have taught me, a successful IEM career necessitates thinking
outside the box—and keeping an open mind and open eyes and ears. Speaking of
being open, now is the perfect time to get involved! Don't discount any opportunities. Now is the time to make a difference, in the U.S. and internationally, with our profession and most importantly with our patients.
References:
1. The New York Times. Two For the Road Blog. Available at http://twofortheroad.nytimes.com.
Accessed 1 June 2012.
2. Wen LS, Oshiomogho JI,
Eluwa GI et al. Characteristics and capabilities of emergency departments in
Abuja, Nigeria. Emerg Med J. 2011; Nov 2. [Epub ahead of print]
3.
Wen LS, Anderson PD, Stagelund S et al. National survey of emergency departments in Denmark. European Journal
of Emergency Medicine. 2012; in press.
4. Wen LS, Char DM. Existing
infrastructure for the delivery of emergency care in post-conflict Rwanda: an
initial descriptive study. Af J Emerg Med. 2011; 18(8): 868-71.
5. Wen
LS, Geduld HI, Nagurney JT et al. Perceptions of Graduates from Africa’s First
Emergency Medicine Training Program. CJEM. 2012; 14(2): 97-105.
6. Wen LS, Nagurney JT,
Geduld HI et al. Procedure competence versus number performed: a survey of
graduate emergency specialists in a developing country. Emerg Med J.
2011; Oct 21. [Epub ahead of print]
7. Wen LS, Geduld HI,
Nagurney JT et al. Africa’s first emergency medicine training program at the
University of Cape Town/Stellenbosch University: history, progress, and lessons
learned. Acad Emerg Med. 2011; 18(8):868-71.
8. Wen LS, Greysen SR,
Keszthelyi D et al. Social accountability in health professional education. Lancet.
2011; 378(9807): e12-13.
9. Jesus JE. Ethical
challenges and considerations of short-term international medical initiatives:
an excursion to Ghana as a case study. Ann Emerg Med. 2010;55: 17-22.
10. Van Hoving DJ, Wallis LA,
Docrat F et al. Haiti disaster tourism—a medical shame. Prehosp Disaster
Med. 2010;25: 201-2.
11. Society of Academic Emergency Medicine. Academy of Women in Academic
Emergency Medicine. Available at: http://www.saem.org/academy-women-academic-emergency-medicine.
Accessed 1 June 2012.
12. Morton MJ, Vu A. International emergency medicine and global health:
training and career paths for emergency medicine residents. Ann Emerg Med.
2011;57: 520-5.
Portions of the article will appear as part of the American Academy of Emergency Medicine's Common Sense magazine. I serve as the President of AAEM/RSA. These opinions represent my own and not of AAEM or AAEM/RSA.
12 comments:
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My daughter wants to pursue the field of medicine. Yesterday, she came up to me and asked for my advice. I have no idea about medicine because I have been a professional white paper writer all my life so I needed time to research, and I told her that. After searching the internet for hours, I feel like international emergency medicine is a good option. I will suggest it to her - let's see how she feels about it.
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