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Elective to HCMC Medicine Resident in Costa Rica
Elective to HCMC Medicine Resident in Costa Rica
Elective to HCMC Medicine Resident in Costa Rica
Elective to HCMC Medicine Resident in Costa Rica
Elective to HCMC Medicine Resident in Costa Rica
Elective to HCMC Medicine Resident in Costa Rica
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Elective to HCMC Medicine Resident in Costa Rica


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  • 1. Elective for HCMC Medicine and Family Medicine Residents in Costa Rica through the University of Medical Sciences UCIMED. General Objectives: To provide the Resident the opportunity to experience a different medical environment of a Socialized Health System in a country that has a unique pathology due to its sub-tropical location. Specific Objectives: 1. To learn about Costa Rica’s health system in its city and /or rural hospital environment. 2. To expose the resident to a variety of diseases that could be found in a country in a sub-tropical area, for example: Dengue, Malaria, Parasitic Diseases and others. 3. Expose the resident to the management of complex pathologies with limited resources. 4. To provide the resident, if applicable, with an opportunity to do research in a different environment. 5. To develop or enhance the necessary skills in obtaining medical histories, performing physical exams, producing the differential diagnosis and treating patients in a Spanish speaking community. 6. To provide the opportunity, for those interested, of experiencing a unique Preventive Medicine program in the city or in a rural community. 7. For those interested in Tropical Infectious Diseases we offer a Parasitology Course which includes exposure and learning of a wide variety of Parasitic Diseases and is vectors at the University’s Laboratory. 8. To improve the Spanish speaking skills. 9. To experience the social and cultural characteristics of the Costa Rican community. Living with a Costa Rican family is encouraged and this experience could be arranged. If interested in other accommodations like an apartment, UCIMED, through its International Affairs Department, will also assist in this matter. Requirements: 1. Basic knowledge of the Spanish language - enough to be able to express himself or herself and communicate with others. In Costa Rica a significant proportion of the population speaks English and more so in the medical field. 2. Have the approval and authorization of the HCMC Internal Medicine Department or Family Medicine Department to perform the elective. Comply with the regulations and general rules of the hospitals and clinics in Costa Rica where the resident will be assigned. 1
  • 2. 3. Comply with the academic objectives and goals of the specific rotation that will be designed for each resident. 4. Be able to pay for the expenses incurred in the Elective which include: housing and meals, cost of any of the courses offered, plane fares, etc. Duration of the Elective: The elective will be between four and six weeks. Weekends will be free. Description of the elective: 1. The International Affairs Department thorough its Director Dr. Hernando Gonzalez will be the general supervisor for each resident in Costa Rica. 2. There will be an Attending Physician of the specialty of the resident who will be in charge of the academic aspects of the rotation. If possible, there will be another local resident rotating in the same department who could be available in case the HCMC resident has any questions or needs assistance. 3. A rotation at a local private downtown Hospital that takes care of a large population of a middle class community is available. This rotation is very well structured and recommended. Its Attending Physician is very active in teaching and includes: topic reviews in Tropical Diseases, if interested household visits for evaluation of preventive measures, evaluation of patients, etc. 4. A rural hospital experience could be available if requested under the supervision of a rural community Attending Physician. This rotation is clinical and includes the usual responsibilities of a resident in a ward: daily rounding on patients, case presentations, review and presentation of topics related to the care and management of patients, consultations for other patients around the hospital, etc. 5. A rural community clinic experience is available under the supervision of another Attending Physician. It includes walk-in patient evaluations, house visits, school visits for health education and promotion, etc. This is a very good site for a community based research projects. 6. A Tropical Dermatology rotation is available under the supervision of the Director of the Dermatology Department at San Juan de Dios Hospital. The largest downtown hospital in Costa Rica. This rotation includes a morning clinic with evaluation of a wide variety of referral cases from different sites in Costa Rica and Dermatology consultations around the Hospital. This has been a popular rotation for previous foreign residents and students, due to its diversity of Tropical Diseases and teaching. The clinic runs until noon so there is an opportunity to take a Spanish course in 2
  • 3. the afternoons or do voluntary work there or at other sites. There are some centers in San Jose that offer Conversational Spanish courses during the day or at night. If more information is requested, it could be provided. A well structured Medical Spanish interactive course is offered through the International Health Central American Institute(IHCAI) an affiliated institution to UCIMED. This Institute designed a special rotation in the afternoons for the HCMC residents and students with a reasonable price for more information see the addendum. For those interested in improving their Medical Spanish for history taking, physical examination and evaluation of Spanish speaking patients this course is highly recommended. 7. An SICU-Gastroenterology rotation is available at San Juan de Dios Hospital with an attending at a Surgical Intermediate Care Unit and Dr. Hernando Gonzalez in the Gastroenterology Department. This rotation includes rounding on patients in the Intermediate Care Unit in the morning and doing Internal Medicine Consultations at the Surgery Wards. In the afternoons a General Gastroenterology consult on Mondays and a Liver Clinic on Fridays, rounding in GI and Internal Medicine patients in the afternoons as well as GI Consultations. This rotation will expose the Resident to many patients with a variety of diseases. The Liver Clinic has many patients with NASH and Wilson´s Disease which is highly prevalent in some areas in Costa Rica. 8. A Pediatrics-ID rotation is available for the Family Medicine Residents. This rotation is done at the National Children’s Hospital, the largest referral downtown Pediatric Hospital in Costa Rica. This is a well known center in Central America for its quality and excellent care. The ID Department is well organized and structured and is a good learning environment. Other rotations for the Family Medicine Residents in Pediatrics at the National Children’s Hospital that could be arranged without a problem include: General Pediatrics in a Ward, Neonatology and Cardiology. If there is a specific interest in any of the Pediatric Subspecialties. Financial Description of the Rotation: 1. UCIMED, will not charge for any expense incurred in designing and implementing the rotation for the HCMC residents. UCIMED will charge a standard fee in order to pay the specific Doctors or other personnel involved in teaching specific elective courses. 2. UCIMED is working in an agreement with the Socialized System in Costa Rica to be able to bring foreign residents to their Hospitals . There may be a $200 to $300 fee that the Social System will charge per resident rotation once this agreement is in place. If this agreement is not finalized by the 3
  • 4. time the resident is going to start the rotation, the resident will be considered a senior student of the University(UCIMED). He/she will be included in the list of senior students that perform rotations at the Socialized System for which UCIMED pays a malpractice insurance. The status of the resident will not change due to the fact that he or she will be assigned the same duties and responsibilities of a resident practicing in Costa Rica. Housing alternatives: The living expenses will need to be covered by the resident. 1. There are local families that offer housing for approximately $400 per month that include a private room with a desk and lamp to study. Breakfast and dinner is included in this price and sometimes laundry. This option is recommended for the cultural, social and language experience. 2. Other facilities could be arranged upon request like hotels,apartment, private independent facilities attached to a local family house, etc. UCIMED offers to make the housing arrangements for the residents or provide assistance in this matter. Evaluations of the residents’ performance. 1. The HCMC evaluation forms will be used by the attending doctors in Costa Rica. 2. If the resident was involved in a research project it would be evaluated by the supervising doctor from HCMC and UCIMED. Legal Implications of the elective rotation. 1. The fact that foreign residents will be taking care of Costa Rican patients will have legal implications. The resident will be considered a senior student until the Socialized System/UCIMED agreement is in place. UCIMED provides Malpractice Coverage for their students through a Government affiliated Insurance Company. The fact that UCIMED provides an active and ongoing residency program in Dermatology which was approved by the National Educational Costa Rican Committee implies that this coverage needs to be expanded to the resident’s educational level in the near future. Courses Available (if possible at least two students per course) 1. Introductory Course to the Socialized Medical System in Costa Rica Tropical Dermatology and Parasitological Topics of Interest. Day 1: 1- Welcome of the students participating in the program. 2- Expectations and responsibilities of the attending participants. 4
  • 5. 3- General Information and brief history of UCIMED. Tour of UCIMED campus and benefits for the participants. 4- The National Health System in Costa Rica. 5- General Health Statistics and Indexes in Costa Rica. 6- The Emergency Medical System in Costa Rica. 7- Lunch (covered by the student) at UCIMED cafeteria. 8- City Tour and general orientation for the students. Day 2: 1- Emerging infections in Costa Rica: Malaria. Dengue. Leptospirosis. Colera. 1- Immigration and Health in Costa Rica. 2- Lunch per student at UCIMED cafeteria. 3- Café Britt Coffee tour Day 3: 1- Tropical Parasitology Course at Dr. Misael Chinchilla´s Laboratory. 2- Lunch per student at UCIMED cafeteria. 3- Tropical Parasitology Course at Dr. Misael Chinchilla´s Laboratory Day 4: 4- Tropical Parasitology Course at Dr. Misael Chinchilla´s Laboratory. 5- Lunch per student at UCIMED cafeteria. 6- Tropical Parasitology Course at Dr. Misael Chinchilla´s Laboratory Day 5: 7- Tropical Parasitology Course at Dr. Misael Chinchilla´s Laboratory. 8- Lunch per student at UCIMED cafeteria. 4- Tropical Parasitology Course at Dr. Misael Chinchilla´s Laboratory 2. A more comprehensive Tropical Dermatology Course is provided with classes every morning from 11:00 am until 12:00 noon. The topics covered are: 1-Epidemiology and ecology of skin in the tropics Bacterial infections of the skin Impetigo and Erysipelas Folliculitis, folliculitis cheloidailis Furuncle (boi) and Carbuncle Periporitis staphylogenes and Hydradenitis Suppurativa Tuberculosis of the skin Erythrasma 2-Superficial fungal infections Tineas Pityriasis versicolor Candidiasis Deep fungus infections Sporothrychosis Chromomycosis Lobo's disease 3-Dermatoses caused by parasites 5
  • 6. Leishmaniasis Larva migrans (creeping eruption) Dermatoses caused by arthropods Scabies Pediculosis Other common skin deseases Dermatitis cenicienta (erythema discromic perstans) Basal cell carcinoma 3. Medical Spanish Course trough the International Health Central American Institute (IHCAI). See the other document attached for a comprehensive description of the course. Estimated Costs of the Elective Estimated costs of the Elective Air fare round trip $850 Tropical Dermatology Course $350 Introductory Course to the Socialized Medical System in Costa Rica Tropical Dermatology and Parasitological Topics of Interest. $350 Medical Spanish Course through IHCAI $650 Room and board and other expenses for 4 to 6 weeks approximately $1200 6