Exchange Institution: Hospitál Regional Universitario José María Cabral y Báez
Details:
- Duration: 4 weeks elective
- No. of students: 4 students per year
- Travel Funding: Not Provided
- Housing: Provided
- Board: Not Provided
- Language Requirement: Advanced Spanish
Brown Faculty Liaison: Dr. Martha Sanchez, Assistant Professor of Medicine, martha.sanchez@lifespan.org
*Students interested in DR exchange please contact Dr. Sanchez and copy david_arango@brown.edu.
Additional information:
In 2004, the Brown Department of Medicine entered into an educational exchange agreement with the Department of Internal Medicine at Cabral y Baez hospital in Santiago, Dominican Republic. In choosing Cabral y Baez as an educational exchange site, the Department considered the relevance of an experience in the Dominican Republic to our patient population in Providence, the relative ease of travel to Santiago, and the desire of many Brown internal medicine residents and medical students to gain international experience in a Spanish-speaking country. At Cabral, we found internal medicine colleagues eager to partner with us in a mutually-beneficial partnership and bilateral educational exchange program.
Hospitál Regional Universitario José María Cabral y Báez (HRUJMCB) is a public regional hospital in Santiago de los Caballeros serving as the main tertiary care center for the northern half of the Dominican Republic. It is also the main teaching hospital for the three medical schools located in Santiago.
Annually, residents from Cabral y Baez also rotate through the Brown Hospitals in Rhode Island. One of the responsibilities of medical students and residents selected to participate in the exchange is to assist Cabral residents that visit Brown in April and May.
Goals for Medical Students and Residents
- Understand the clinical presentation and management of common serious illnesses in the Dominican Republic, including dengue, leptospirosis, malaria, organophosphate poisoning, tuberculosis, and HIV infection
- Understand the structure of the Dominican healthcare system, the major causes of morbidity and mortality in the Dominican Republic and the ways in which they differ from morbidity and mortality in the United States
- Understand the structure of medical education in the Dominican Republic
- Develop skill in the cost-effective evaluation of illness in a resource-scarce environment
- Develop skill in working within the medical education system at Cabral y Baez
- Increase understanding of Dominican culture
- Develop increased competence in Spanish language
Curriculum
All students will spend at least two weeks on the Internal Medicine Wards at Cabral y Baez. Additionally, students can customize their experience per their preferences by choosing to spend time on the following services: HIV clinic, Emergency Department, night float shift, ICU, and Subspecialty departments such as Hematology/Oncology, Neurology, and Cardiology, and resident outpatient clinics.
Traditionally, students are paired with PGY2s at Cabral who are proficient in English in order to help the Brown trainees through the week long rotations. Usually, these PGY2s are also interested in participating in the exchange at RIH in April and May.
TYPICAL DAY ON THE GENERAL INTERNAL MEDICINE FLOORS AT CABRAL Y BAEZ HOSPITAL
- Sign-Out: Known as "la entrega de la guardia", the PGY1s that were on for night float ("en servicio") give sign out on all admitted patients to the day teams and overnight updates on any patients previously on the wards.
- Morning Report led by Residents/Grand Rounds given by Attendings: Sign out is followed by a lecture given by a senior resident on a particular topic or case. These lectures provide good exposure to medical Spanish in a controlled setting with PowerPoint slides. At the end of each lecture, there is a brief discussion/questions session led by the chief resident.
Weekly Grand Rounds is given by a senior attending. Most often, the attending presents 1-2 interesting cases that are currently or were recently on the wards. The attending presents the initial H+P of the patient along with a differential, diagnosis, and management, followed by an academic conversation involving senior residents and other attending physicians. - Rounds with Attending Physician or Resident Teams: Resident teams will round after lecture and formally present new patients and quickly follow up on older patients on their service.
- Afternoon Lecture: Conferences in the afternoon continue with focused lectures given by a resident or medical student.
- Completing any remaining tasks: After AM rounds, the team splits off to write progress notes, work on the sign-out sheet, and complete the necessary tasks on each patient (labs and imaging studies). If there is an interesting case on the service, you can continue to follow the patient after rounds, by reading through their chart, chatting to the patient about their situation, or by assisting the medical students with their tasks.
- Brown Rounds: On most days, Brown medical students, residents, and attendings return to the apartment by 2:30pm. Upon return, everyone gathers in the apartment living room to participate in “Brown Rounds.” “Brown Rounds” is a conference to discuss interesting cases observed during the week. Trainees follow-up on a chosen patient from the morning and present their patient as a patient would be presented on rounds at RIH. Attendings and senior residents will then facilitate the discussion of this patient. “Brown Rounds” allows for American attendings and trainees to provide their unique perspective on the case and reflect on differences and similarities in diagnosis, work-up, and treatment between RIH and at Cabral y Baez Hospital. There are three scheduled group sessions each week:
- PBL/Journal Club sessions: The discussion is led by the coordinator and attendings. PBLs and journal articles focus on clinical cases that are often seen at Cabral y Baez but rarely seen at RIH, such as dengue, malaria, leptospirosis, etc.
- Topic presentation: A medical student or resident presents a short prepared health topic pertinent to the region.
- Cultural/Emotional Debrief: Students, residents, and attendings reflect on their experiences at Cabral y Baez. This session provides an opportunity to discuss adapting to lifestyle and culture in the DR, cultural differences and similarities between care given at Cabral y Baez and RIH, and the emotional impact of the global health experience.
ADDITIONAL MEDICAL SERVICES THAT BROWN TRAINEES CAN ROTATE ON:
- Clínica de Enfermedades de Inmunología (HIV clinic), Hospitál Cabral y Baéz: The HIV clinic in Hospitál Cabral y Baéz is run by Dra. Claudia Rodriguez, one of Brown’s main contacts here in the Dominican Republic. Patients are seen by Pasantes, which are medical trainees doing a mandatory year of service before entering residency.
- Trainees will have opportunity to practice physical exam as well as history taking in Spanish.
- Observe and help with clinic visits during regular morning clinic hours.
- Choose a patient to present later during the day for “Brown Rounds”
- Emergency Room: If you want to see what happens to people in a country where there are very few enforced traffic laws, stoplights are mere suggestions, and people tear around recklessly on motorbikes without helmets, you can spend an afternoon (or night) with the internal medicine residents in the emergency room.
- Night float shift
- ICU
- Subspecialty departments such as Hematology/Oncology, Neurology, and Cardiology
- Resident outpatient clinics
