Table 2 Thematic Analysis of International Elective Experiences

Theme

Representative quotation

 Building cross-cultural relationships

I enjoyed the time spent with the residents and attending physicians there. They had a lot of very interesting and enlightening insights about medicine globally, the role of countries like the US, and the day to day practice of working as a physician in Ghana.

 Exposure to different healthcare environments

Although I knew Ghana would be more under-resourced than the US, it was still very eye-opening to see how physicians dealt with these problems first hand. There are also cultural aspects that can only be experienced and learned with immersion into another country. Through this rotation, I feel that I have gained more of an understanding about how to bridge the gap between cultural differences and scientific knowledge.

 Hands-on clinical and surgical experience

In the operating room, I had the opportunity to first assist in procedures including c-sections and tubal ligations, which allowed me to build basic surgical skills.

 Working with new patient populations/ exposure to different medical conditions

I was exposed to a wide variety of medical cases that are rare in the United States, including sickle cell disease in pregnancy, malaria, and obstetric fistulas. I also had the opportunity to participate in the care of patients who presented with severe complications and at late stages of diseases that are not commonly encountered in developed countries. Working with patients who presented with malignant reproductive cancers and life-threatening obstetric complications was transformative in my understanding of the importance of cancer screening and prenatal care.

 Motivation for future international work

“With an interest in Gastroenterology, I became acutely aware of the lack of trained endoscopists in the nation, the limited knowledge in interventional endoscopy, as well as the numbers of patients suffering from chronic hepatitis B now complicated by cirrhosis and end stage liver disease and hepatocellular carcinoma. While the knowledge was disheartening, it provided an opportunity and area which I can now work towards and hopefully one day tangibly impact the lives of these patients. Had it not been for this rotation, I would have still been naive to these issues. I am excited about the potential to be an active participant in the healthcare of this nation and I am now more so than ever, resolved to making sure that I do not become complacent and actually meet these goals.”

 Exposure to limited resources vs overutilization in USA

“Patients pay for everything out of pocket in Ghana, which means that the physicians there think a lot more about the medications and tests they are ordering, and whether they are really necessary. I hope that, having had this experience, I will remember these two things throughout my residency and not take the technology and resources we have in the US for granted.”

 Professional development

“This experience has definitely impacted the way I think of myself as a physician. It taught me that being a physician is more than diagnosing and treating diseases. It’s also about being an advocate for your patients and a good steward of resources.”

 Development of physical exam skills

“Learning how to do a very careful and thorough physical exam was an experience I valued deeply and was a wonderful addition to my American medical school training.”